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Sample records for cardiac catheter ablation

  1. Novel energy modalities for catheter ablation of cardiac arrhythmias : Pitfalls and possibilities of potent power sources

    OpenAIRE

    Neven, K.G.E.J.

    2014-01-01

    The acceptance of catheter ablation as treatment for cardiac arrhythmias is amongst others dependent on its success rate, a high initial success rate will increase physician and patient acceptance. One of the reasons why recurrence of arrhythmia after ablation is substantial is non-transmurality of ablation lesions. Transmurality is essential for conduction block and is depending on many factors, such as tissue ablation duration, thickness of the cardiac wall, ablation technique used, cathete...

  2. Cardiac tissue ablation with catheter-based microwave heating.

    Science.gov (United States)

    Rappaport, C

    2004-11-01

    The common condition of atrial fibrillation is often treated by cutting diseased cardiac tissue to disrupt abnormal electrical conduction pathways. Heating abnormal tissue with electromagnetic power provides a minimally invasive surgical alternative to treat these cardiac arrhythmias. Radio frequency ablation has become the method of choice of many physicians. Recently, microwave power has also been shown to have great therapeutic benefit in medical treatment requiring precise heating of biological tissue. Since microwave power tends to be deposited throughout the volume of biological media, microwave heating offers advantages over other heating modalities that tend to heat primarily the contacting surface. It is also possible to heat a deeper volume of tissue with more precise control using microwaves than with purely thermal conduction or RF electrode heating. Microwave Cardiac Ablation (MCA) is used to treat heart tissue that allows abnormal electrical conduction by heating it to the point of inactivation. Microwave antennas that fit within catheter systems can be positioned close to diseased tissue. Specialized antenna designs that unfurl from the catheter within the heart can then radiate specifically shaped fields, which overcome problems such as excessive surface heating at the contact point. The state of the art in MCA is reviewed in this paper and a novel catheter-based unfurling wide aperture antenna is described. This antenna consists of the centre conductor of a coaxial line, shaped into a spiral and insulated from blood and tissue by a non-conductive fluid filled balloon. Initially stretched straight inside a catheter for transluminal guiding, once in place at the cardiac target, the coiled spiral antenna is advanced into the inflated balloon. Power is applied in the range of 50-150 W at the reserved industrial, scientific and medical (ISM) frequency of 915 MHz for 30-90 s to create an irreversible lesion. The antenna is then retracted back into the

  3. Robotic catheter cardiac ablation combining ultrasound guidance and force control

    OpenAIRE

    Kesner, Samuel Benjamin; Howe, Robert D.

    2014-01-01

    Cardiac catheters allow physicians to access the inside of the heart and perform therapeutic interventions without stopping the heart or opening the chest. However, conventional manual and actuated cardiac catheters are currently unable to precisely track and manipulate the intracardiac tissue structures because of the fast tissue motion and potential for applying damaging forces. This paper addresses these challenges by proposing and implementing a robotic catheter system that uses 3D ultras...

  4. Novel energy modalities for catheter ablation of cardiac arrhythmias : Pitfalls and possibilities of potent power sources

    NARCIS (Netherlands)

    Neven, K.G.E.J.

    2014-01-01

    The acceptance of catheter ablation as treatment for cardiac arrhythmias is amongst others dependent on its success rate, a high initial success rate will increase physician and patient acceptance. One of the reasons why recurrence of arrhythmia after ablation is substantial is non-transmurality of

  5. Combined Therapeutic and Monitoring Ultrasonic Catheter for Cardiac Ablation Therapies.

    Science.gov (United States)

    Carias, Mathew; Hynynen, Kullervo

    2016-01-01

    This study evaluated the feasibility of a combined therapeutic and diagnostic ultrasonic catheter for cardiac ablation therapies. Ultrasound can be used to determine when diseased cardiac tissues have become fully coagulated through a method known as local harmonic motion imaging (LHMI). LHMI is an imaging modality for treatment monitoring that uses acoustic radiation force, displacement tracking and the different mechanical properties of viable and ablated tissues. In this study, we developed catheters that are capable of LHMI measurements. Experiments were conducted in phantoms, ex vivo cardiac samples and the in vivo beating hearts of healthy porcine subjects. In vivo experiments revealed that four of four epicardial sonications revealed a decrease in measured displacements from LHMI experiments and that when lower power was used, no lesions formed and there was no corresponding decrease in measured displacement amplitudes. In addition, two of three endocardial lesions were confirmed and corresponded to a decrease in the measured displacement amplitude. PMID:26431798

  6. Periprocedural anticoagulation of patients undergoing pericardiocentesis for cardiac tamponade complicating catheter ablation of atrial fibrillation.

    Science.gov (United States)

    Lin, Tao; Bai, Rong; Chen, Ying-wei; Yu, Rong-hui; Tang, Ri-bo; Sang, Cai-hua; Li, Song-nan; Ma, Chang-sheng; Dong, Jian-zeng

    2015-01-01

    Anticoagulation of patients with cardiac tamponade (CT) complicating catheter ablation of atrial fibrillation (AF) is an ongoing problem. The aim of this study was to survey the clinical practice of periprocedural anticoagulation in such patients. This study analyzed the periprocedural anticoagulation of 17 patients with CT complicating AF ablation. Emergent pericardiocentesis was performed once CT was confirmed. The mean drained volume was 410.0 ± 194.1 mL. Protamine sulfate was administered to neutralize heparin (1 mg neutralizes 100 units heparin) in 11 patients with persistent pericardial bleeding and vitamin K1 (10 mg) was given to reverse warfarin in 3 patients with supratherapeutic INR (INR > 2.1). Drainage catheters were removed 12 hours after echocardiography confirmed absence of intrapericardial bleeding and anticoagulation therapy was restored 12 hours after removing the catheter. Fifteen patients took oral warfarin and 10 of them were given subcutaneous injection of LMWH (1 mg/kg, twice daily) as a bridge to resumption of systemic anticoagulation with warfarin. Two patients with a small amount of persistent pericardial effusion were given LMWH on days 5 and 13, and warfarin on days 6 and 24. The dosage of warfarin was adjusted to keep the INR within 2-3 in all patients. After 12 months of follow-up, all patients had no neurological events and no occurrence of delayed CT. The results showed that it was effective and safe to resume anticoagulation therapy 12 hours after removal of the drainage catheter. This may help to prevent thromboembolic events following catheter ablation of AF. PMID:25503659

  7. Periprocedural anticoagulation of patients undergoing pericardiocentesis for cardiac tamponade complicating catheter ablation of atrial fibrillation.

    Science.gov (United States)

    Lin, Tao; Bai, Rong; Chen, Ying-wei; Yu, Rong-hui; Tang, Ri-bo; Sang, Cai-hua; Li, Song-nan; Ma, Chang-sheng; Dong, Jian-zeng

    2015-01-01

    Anticoagulation of patients with cardiac tamponade (CT) complicating catheter ablation of atrial fibrillation (AF) is an ongoing problem. The aim of this study was to survey the clinical practice of periprocedural anticoagulation in such patients. This study analyzed the periprocedural anticoagulation of 17 patients with CT complicating AF ablation. Emergent pericardiocentesis was performed once CT was confirmed. The mean drained volume was 410.0 ± 194.1 mL. Protamine sulfate was administered to neutralize heparin (1 mg neutralizes 100 units heparin) in 11 patients with persistent pericardial bleeding and vitamin K1 (10 mg) was given to reverse warfarin in 3 patients with supratherapeutic INR (INR > 2.1). Drainage catheters were removed 12 hours after echocardiography confirmed absence of intrapericardial bleeding and anticoagulation therapy was restored 12 hours after removing the catheter. Fifteen patients took oral warfarin and 10 of them were given subcutaneous injection of LMWH (1 mg/kg, twice daily) as a bridge to resumption of systemic anticoagulation with warfarin. Two patients with a small amount of persistent pericardial effusion were given LMWH on days 5 and 13, and warfarin on days 6 and 24. The dosage of warfarin was adjusted to keep the INR within 2-3 in all patients. After 12 months of follow-up, all patients had no neurological events and no occurrence of delayed CT. The results showed that it was effective and safe to resume anticoagulation therapy 12 hours after removal of the drainage catheter. This may help to prevent thromboembolic events following catheter ablation of AF.

  8. Bilateral occipital lobe infarction with altitudinal field loss following radiofrequency cardiac catheter ablation

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    Chen Celia S

    2010-03-01

    Full Text Available Abstract Background Bilateral stroke following radiofrequency catheter ablation is an unusual complication and may result in bilateral altitudinal visual field defects. Bilateral altitudinal visual field defects usually result from prechiasmal pathology causing damage to both retinas or optic nerves and rarely from bilateral symmetric damage to the post chiasmal visual pathways. Case presentation A 48-year-old man complained of visual disturbance on wakening following radiofrequency catheter ablation. The patient had a CHADS score of 1 pre-operatively and no complications were noted intra-operatively. Examination revealed a bilateral superior altitudinal defect and MRI of the brain showed multifocal areas of infarction predominantly involving the occipital lobes which correlated to with the visual deficits. Conclusion While the risk of thromboembolism and perioperative stroke during radiofrequency catheter ablation is small, it is not insignificant.

  9. Bilateral occipital lobe infarction with altitudinal field loss following radiofrequency cardiac catheter ablation

    OpenAIRE

    Chen Celia S; Lee Andrew W; Luu Susie T

    2010-01-01

    Abstract Background Bilateral stroke following radiofrequency catheter ablation is an unusual complication and may result in bilateral altitudinal visual field defects. Bilateral altitudinal visual field defects usually result from prechiasmal pathology causing damage to both retinas or optic nerves and rarely from bilateral symmetric damage to the post chiasmal visual pathways. Case presentation A 48-year-old man complained of visual disturbance on wakening following radiofrequency catheter ...

  10. Early recurrence of atrial fibrillation after catheter ablation with left atrial fibrosis identified at cardiac magnetic resonance by late gadolinium enhancement.

    Science.gov (United States)

    Totaro, Antonio; Casavecchia, Graziapia; Gravina, Matteo; Ieva, Riccardo; Santoro, Francesco; Grimaldi, Massimo; Pellegrino, Pier Luigi; Macarini, Luca; Di Biase, Matteo; Brunetti, Natale Daniele

    2016-08-01

    In patients with atrial fibrillation (AF), extensive atrial tissue fibrosis identified by delayed enhancement magnetic resonance imaging has been associated with early recurrence of AF after catheter ablation. We present a case of a patient with extensive atrial fibrosis and AF recurrence.The study of late gadolinium enhancement with cardiac magnetic resonance imaging in patients with AF could be a valuable noninvasive tool for the selection of patients suitable for successful catheter ablation. PMID:26826170

  11. Role of Cardiac Imaging (CT/MR Before and After RF Catheter Ablation in Patients with Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Aravindan Kolandaivelu, MD

    2012-08-01

    Full Text Available Pre-procedure X-ray computed tomography (CT and magnetic resonance imaging (MRI angiography are commonly used to delineate the complex and variable relationship of the left atrium, pulmonary veins, and surrounding structures. 3D CT and MR angiography are routinely incorporated into electroanatomic mapping systems to guide ablation lesion placement in the context of patient specific anatomy. Post-procedure CT and MRI have also proven useful for evaluating complications such as pulmonary vein stenosis. In the future, these imaging modalities may be used to visualize more detailed tissue characteristics such as atrial fibrosis and ablation lesions. This could improve selection of patients for different treatment strategies and perhaps guide more effective ablation. This review will discuss current and emerging applications of CT and MRI before and after radiofrequency catheter ablation of atrial fibrillation.

  12. Effects of radiofrequency catheter ablation of atrial fibrillation on soluble P-selectin, von Willebrand factor and IL-6 in the peripheral and cardiac circulation.

    Directory of Open Access Journals (Sweden)

    Jelena Kornej

    Full Text Available BACKGROUND: Catheter ablation (CA of atrial fibrillation (AF is associated with inflammatory response, endothelial damage and with increased risk of thrombosis. However, whether these processes differ in peripheral and cardiac circulation is unknown. METHODS: Plasma markers (von Willebrand factor (vWf, soluble P-selectin (sPsel and interleukin-6 (IL-6 were measured by ELISA at three time points in 80 patients (62±10 years, 63% males, 41% paroxysmal AF undergoing CA. These were at baseline--from femoral vein (FV and left atrium (LA before ablation; directly after ablation--from the pulmonary vein (PV, LA and FV; and 24 hours after procedure--from a cubital vein (CV. RESULTS: The levels of vWF and IL6--but not sP-sel--increased significantly 24 h after procedure (p<0.001. Baseline vWF was significantly associated with persistent AF (Beta = .303, p = 0.006 and Beta = .300, p = 0.006 for peripheral and cardiac levels, respectively, while persistent AF (Beta = .250, p = 0.031 and LAA flow pattern (Beta = .386, p<0.001 remained associated with vWF in cardiac blood after ablation. Advanced age was significantly associated with IL6 levels at baseline and after ablation in peripheral and cardiac blood. There were no clinical, procedural or anti-coagulation characteristics associated with sP-sel levels in cardiac blood, while peripheral sP-sel levels were associated with hypertension before (Beta = -.307, p = 0.007 and with persistent AF after ablation (Beta = -.262, p = 0.020. CONCLUSIONS: vWF levels are higher in persistent AF and are associated with LAA rheological pattern after AF ablation. Increase of peripheral vWF and IL6 levels after procedure supports current AF ablation management with careful control of post-procedural anticoagulation to avoid ablation-related thromboembolism.

  13. Catheter ablation of parahisian premature ventricular complex.

    Science.gov (United States)

    Kim, Jun; Kim, Jeong Su; Park, Yong Hyun; Kim, June Hong; Chun, Kook Jin

    2011-12-01

    Catheter ablation is performed in selected patients with a symptomatic premature ventricular complex (PVC) or PVC-induced cardiomyopathy. Ablation of PVC from the His region has a high risk of inducing a complete atrioventricular block. Here we report successful catheter ablation of a parahisian PVC in a 63-year-old man.

  14. Soft thrombus formation in radiofrequency catheter ablation

    NARCIS (Netherlands)

    Demolin, JM; Eick, OJ; Munch, K; Koullick, E; Nakagawa, H; Wittkampf, FHM

    2002-01-01

    During RF catheter ablation, local temperature elevation can result in coagulum formation on the ablation electrode, resulting in impedance rise. A recent study has also demonstrated the formation of a so-called soft thrombus during experimental ablations. This deposit poorly adhered to the catheter

  15. Collateral damage from Catheter Ablation of Atrial Fibrillation

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    Wanwarang Wongcharoen, MD

    2013-04-01

    Full Text Available Atrial fibrillation (AF is the most common sustained arrhythmia, contributing to a significant morbidity and mortality. Catheter ablation of the pulmonary veins (PVs and left atrium (LA has been shown to be an effective strategy for the treatment of symptomatic AF. Regardless of technological advances and technique improvement, catheter ablation for AF remains a highly complex procedure and the risk of procedural complications is not negligible. The major complications have been reported to occur in up to 5.2% of procedures. A systematic investigation among 32,569 patients undergoing catheter ablation for AF has demonstrated that mortality is around 0.1%. Nevertheless, the true prevalence of complications is possibly underestimated in retrospective surveys because of recollection bias and other factors. This article will focus on the management of serious complications of catheter AF ablation including PV stenosis, atrioesophageal fistula, cardiac tamponade, stroke and thromboembolic complication

  16. Black-box modeling to estimate tissue temperature during radiofrequency catheter cardiac ablation: feasibility study on an agar phantom model

    International Nuclear Information System (INIS)

    The aim of this work was to study linear deterministic models to predict tissue temperature during radiofrequency cardiac ablation (RFCA) by measuring magnitudes such as electrode temperature, power and impedance between active and dispersive electrodes. The concept involves autoregressive models with exogenous input (ARX), which is a particular case of the autoregressive moving average model with exogenous input (ARMAX). The values of the mode parameters were determined from a least-squares fit of experimental data. The data were obtained from radiofrequency ablations conducted on agar models with different contact pressure conditions between electrode and agar (0 and 20 g) and different flow rates around the electrode (1, 1.5 and 2 L min−1). Half of all the ablations were chosen randomly to be used for identification (i.e. determination of model parameters) and the other half were used for model validation. The results suggest that (1) a linear model can be developed to predict tissue temperature at a depth of 4.5 mm during RF cardiac ablation by using the variables applied power, impedance and electrode temperature; (2) the best model provides a reasonably accurate estimate of tissue temperature with a 60% probability of achieving average errors better than 5 °C; (3) substantial errors (larger than 15 °C) were found only in 6.6% of cases and were associated with abnormal experiments (e.g. those involving the displacement of the ablation electrode) and (4) the impact of measuring impedance on the overall estimate is negligible (around 1 °C)

  17. CT imaging of complications of catheter ablation for atrial fibrillation

    International Nuclear Information System (INIS)

    The complication rate following radiofrequency catheter ablation for atrial fibrillation is low (<5%). Complications include pericardial effusion, cardiac tamponade, pulmonary vein stenosis, oesophageal ulceration or perforation, atrio-oesophageal fistula formation, stroke/transient ischaemic attack, phrenic nerve injury, haematoma at the puncture site, and femoral arteriovenous fistula. Among available imaging tools, computed tomography (CT) can be very useful in diagnosing complications of the procedure, particularly in the subacute and delayed stages after ablation. This review illustrates CT imaging of several of the common and uncommon complications of radiofrequency catheter ablation

  18. Attitudes Towards Catheter Ablation for Atrial Fibrillation

    DEFF Research Database (Denmark)

    Vadmann, Henrik; Pedersen, Susanne S; Nielsen, Jens Cosedis;

    2015-01-01

    BACKGROUND: Catheter ablation for atrial fibrillation (AF) is an important but expensive procedure that is the subject of some debate. Physicians´ attitudes towards catheter ablation may influence promotion and patient acceptance. This is the first study to examine the attitudes of Danish...

  19. Cryoballoon Catheter Ablation in Atrial Fibrillation

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    Cevher Ozcan

    2011-01-01

    Full Text Available Pulmonary vein isolation with catheter ablation is an effective treatment in patients with symptomatic atrial fibrillation refractory or intolerant to antiarrhythmic medications. The cryoballoon catheter was recently approved for this procedure. In this paper, the basics of cryothermal energy ablation are reviewed including its ability of creating homogenous lesion formation, minimal destruction to surrounding vasculature, preserved tissue integrity, and lower risk of thrombus formation. Also summarized here are the publications describing the clinical experience with the cryoballoon catheter ablation in both paroxysmal and persistent atrial fibrillation, its safety and efficacy, and discussions on the technical aspect of the cryoballoon ablation procedure.

  20. Cardiac ablation by transesophageal high intensity focused ultrasound

    Institute of Scientific and Technical Information of China (English)

    JIANG Chen-xi; YU Rong-hui; MA Chang-sheng

    2010-01-01

    @@ Cardiac ablation is an important modality of invasive therapy in modern cardiology, especially in the treatment of arrhythmias, as well as other diseases such as hypertrophic obstructive cardiomyopathy (HOCM). Since Huang et al1 used radiofrequency (RF) to ablate canine atrial ventricular junction, RF has developed into the leading energy source in catheter ablation of arrhythmias.

  1. Contact force assessment in catheter ablation of atrial fibrillatio

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    Josef Kautzner; Petr Peichl

    2014-04-01

    Full Text Available The efficacy of catheter ablation of atrial fibrillation (AF remains limited. Increase of success would require more durable lesions without increased risk of steam pop and cardiac perforation. Recently, novel technologies have been developed to estimate real-time catheter-tissue contact force (CF. This paper reviews three available tools for assessment of CF and data on experimental or clinical experience. Experimental data with open-irrigated catheter showed that lesion size was greater with applications of lower power (like 30 W and greater CF (e.g. 30 to 40 g than vice versa. Impedance drop in the first 5 seconds was significantly correlated to catheter CF. Perforation was achieved more rapidly with the ablation catheter in a sheath despite the same CF because the sheath prevents catheter buckling. Clinical experience confirmed poor relationship between CF and either unipolar amplitude, bipolar amplitude, or impedance. Within the left atrium, the most common high CF site was found at the anterior/rightward LA roof, directly beneath the ascending aorta (confirmed by merging the CT image and map. Importantly, several studies showed that the use of CF leads to shorter procedure with less fluoroscopy time and less RF applications. CF assessment was also found to be associated with higher proportion of durable lesions. Finally, pilot studies showed that CF measurement could be associated with better clinical efficacy AF ablation.

  2. An Update on the Energy Sources and Catheter Technology for the Ablation of Atrial Fibrillation

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    Pawan K. Arora

    2010-03-01

    Full Text Available The ablation of atrial fibrillation (AF is an area of intense research in cardiac electrophysiology. In this review, we discuss the development of catheter-based interventions for AF ablation. We outline the pathophysiologic and anatomic bases for ablative lesion sets and the evolution of various catheter designs for the delivery of radiofrequency (RF, cryothermal, and other ablative energy sources. The strengths and weaknesses of various specialized RF catheters and alternative energy systems are delineated, with respect to efficacy and patient safety.

  3. Value of multislice computed tomography angiography of the thorax in preparation for catheter ablation for the treatment of atrial fibrillation: The impact of unexpected cardiac and extracardiac findings on patient care

    Energy Technology Data Exchange (ETDEWEB)

    Wissner, Erik; Wellnitz, Clinton V.; Srivathsan, Komandoor; Scott, Luis R. [Mayo Clinic Arizona - Mayo Clinic Hospital, Cardiovascular Diseases, 5777 East Mayo Boulevard, Phoenix, AZ 85054 (United States); Altemose, Gregory T. [Mayo Clinic Arizona - Mayo Clinic Hospital, Cardiovascular Diseases, 5777 East Mayo Boulevard, Phoenix, AZ 85054 (United States)], E-mail: altemose.gregory@mayo.edu

    2009-11-15

    Objective: In patients referred for catheter ablation for the treatment of atrial fibrillation, multislice computed tomography angiography of the thorax is routinely performed to assess pulmonary vein anatomy. We sought to investigate the incidence of unexpected cardiac and extracardiac findings in this select patient population and to establish how these findings influence subsequent patient care. Methods: Ninety-five patients (mean age 62 {+-} 10 years, 35% female) referred to our institution for ablation therapy for atrial fibrillation between July 2003 and October 2007 underwent multislice computed tomography angiography of the thorax. Radiologists interpreted all images. Need for additional testing, consultation and eventual diagnosis were assessed by electronic record review. Results: A total of 83 (5 cardiac, 78 extracardiac) unexpected findings were observed in 50/95 (53%) of patients. The findings prompted 23 additional tests (5 cardiac, 18 noncardiac) in 15/95 (16%) of patients and 8 subsequent referrals in 7/95 (7%) patients. In 6 patients the findings significantly altered future patient care and resulted in postponement of ablation therapy in 4 patients. In 2 patients, extracardiac findings (pulmonary emboli and adenocarcinoma of the lung) were of potentially life-saving consequence. Conclusions: In patients undergoing multislice computed tomography angiography of the thorax in anticipation of planned catheter ablation therapy for the treatment of atrial fibrillation, unexpected findings are common and of potentially significant value. In comparison, there is a higher prevalence of unexpected extracardiac, rather than cardiac findings. Further investigation of these findings may lead to postponement of ablation therapy, but may also be of potentially lifesaving consequence.

  4. Value of multislice computed tomography angiography of the thorax in preparation for catheter ablation for the treatment of atrial fibrillation: The impact of unexpected cardiac and extracardiac findings on patient care

    International Nuclear Information System (INIS)

    Objective: In patients referred for catheter ablation for the treatment of atrial fibrillation, multislice computed tomography angiography of the thorax is routinely performed to assess pulmonary vein anatomy. We sought to investigate the incidence of unexpected cardiac and extracardiac findings in this select patient population and to establish how these findings influence subsequent patient care. Methods: Ninety-five patients (mean age 62 ± 10 years, 35% female) referred to our institution for ablation therapy for atrial fibrillation between July 2003 and October 2007 underwent multislice computed tomography angiography of the thorax. Radiologists interpreted all images. Need for additional testing, consultation and eventual diagnosis were assessed by electronic record review. Results: A total of 83 (5 cardiac, 78 extracardiac) unexpected findings were observed in 50/95 (53%) of patients. The findings prompted 23 additional tests (5 cardiac, 18 noncardiac) in 15/95 (16%) of patients and 8 subsequent referrals in 7/95 (7%) patients. In 6 patients the findings significantly altered future patient care and resulted in postponement of ablation therapy in 4 patients. In 2 patients, extracardiac findings (pulmonary emboli and adenocarcinoma of the lung) were of potentially life-saving consequence. Conclusions: In patients undergoing multislice computed tomography angiography of the thorax in anticipation of planned catheter ablation therapy for the treatment of atrial fibrillation, unexpected findings are common and of potentially significant value. In comparison, there is a higher prevalence of unexpected extracardiac, rather than cardiac findings. Further investigation of these findings may lead to postponement of ablation therapy, but may also be of potentially lifesaving consequence.

  5. Non Invasive ECG Mapping to Guide Catheter Ablation

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    Ashok J. Shah; Han S. Lim; Seigo Yamashita; Stephan Zellerhoff; Benjamin Berte; Saagar Mahida; Darren Hooks; Nora Aljefairi; Nicolas Derval; Arnaud Denis; Frederic Sacher; Pierre Jais; Remi Dubois; Meleze Hocini; Michel Haissaguerre

    2014-10-01

    Full Text Available Since more than 100 years, 12-lead electrocardiography (ECG is the standard-of-care tool, which involves measuring electrical potentials from limited sites on the body surface to diagnose cardiac disorder, its possible mechanism and the likely site of origin. Several decades of research has led to the development of a 252-lead-ECG and CT-scan based, three dimensional, electro-imaging modality to non-invasively map abnormal cardiac rhythms including fibrillation. These maps provide guidance towards ablative therapy and thereby help advance the management of complex heart rhythm disorders. Here, we describe the clinical experience obtained using non-invasive technique in mapping the electrical disorder and guide the catheter ablation of atrial arrhythmias (premature atrial beat, atrial tachycardia, atrial fibrillation, ventricular arrhythmias (premature ventricular beats and ventricular pre-excitation (Wolff-Parkinson-White syndrome.

  6. Monopole antennas for microwave catheter ablation

    Energy Technology Data Exchange (ETDEWEB)

    Labonte, S.; Blais, A.; Legault, S.R.; Ali, H.O.; Roy, L. [Univ. of Ottawa, Ontario (Canada). Dept. of Electrical Engineering

    1996-10-01

    The authors study the characteristics of various monopole antennas for microwave catheter ablation of the endocardium. The investigation is done with a computer model based on the finite-element method in the frequency domain. Three monopole geometries are considered: open-tip, dielectric-tip, and metal-tip. Calculations are made for the magnetic field, the reflection coefficient and the power deposition pattern of the antennas immersed in normal saline. The theoretical results are compared with measurements performed on prototypes and good agreement is obtained. The antenna characteristics suggest that the metal-tip monopole best fulfills the requirements of catheter ablation. The computer model is then used to compare metal-tip monopoles of different dimensions and to determine design trade-offs.

  7. Monitoring Atrial Fibrillation After Catheter Ablation

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    Giovanni B Forleo, MD PhD; MAssimo Moltrasio, MD; Michela Casella MD, PhD; Antonio Dello Russo MD, PhD; Getano Fassini, MD; Manfredi Tesauro, MD, PhD; Claudio Tondo, MD, PhD.

    2014-04-01

    Full Text Available Although catheter ablation is an effective treatment for recurrent atrial fibrillation (AF, there is no consensus on the definition of success or follow-up strategies. Symptoms are the major motivation for undergoing catheter ablation in patients with AF, however it is well known that reliance on perception of AF by patients after AF ablation results in an underestimation of recurrence of the arrhythmia. Because symptoms of AF occurrence may be misleading, a reliable assessment of rhythm outcome is essential for the definition of success in both clinical care and research trials. Continuous rhythm monitoring over long periods of time is superior to intermittent recording using external monitors to detect the presence of AF episodes and to quantify the AF burden. Today, new devices implanted subcutaneously using a minimally invasive technique have been developed for continuous AF monitoring. Implantable devices keep detailed information about arrhythmia recurrences and might allow identification of very brief episodes of AF, the significance of which is still uncertain. In particular, it is not known whether there is any critical value of daily AF burden that has a prognostic significance. This issue remains an area of active discussion, debate and investigation. Further investigation is required to determine if continuous AF monitoring with implantable devices is effective in reducing stroke risk and facilitating maintenance of sinus rhythm after AF ablation.

  8. 3D ablation catheter localisation using individual C-arm x-ray projections

    Science.gov (United States)

    Haase, C.; Schäfer, D.; Dössel, O.; Grass, M.

    2014-11-01

    Cardiac ablation procedures during electrophysiology interventions are performed under x-ray guidance with a C-arm imaging system. Some procedures require catheter navigation in complex anatomies like the left atrium. Navigation aids like 3D road maps and external tracking systems may be used to facilitate catheter navigation. As an alternative to external tracking a fully automatic method is presented here that enables the calculation of the 3D location of the ablation catheter from individual 2D x-ray projections. The method registers a high resolution, deformable 3D attenuation model of the catheter to a 2D x-ray projection. The 3D localization is based on the divergent beam projection of the catheter. On an individual projection, the catheter tip is detected in 2D by image filtering and a template matching method. The deformable 3D catheter model is adapted using the projection geometry provided by the C-arm system and 2D similarity measures for an accurate 2D/3D registration. Prior to the tracking and registration procedure, the deformable 3D attenuation model is automatically extracted from a separate 3D cone beam CT reconstruction of the device. The method can hence be applied to various cardiac ablation catheters. In a simulation study of a virtual ablation procedure with realistic background, noise, scatter and motion blur an average 3D registration accuracy of 3.8 mm is reached for the catheter tip. In this study four different types of ablation catheters were used. Experiments using measured C-arm fluoroscopy projections of a catheter in a RSD phantom deliver an average 3D accuracy of 4.5 mm.

  9. Real time assessment of RF cardiac tissue ablation with optical spectroscopy

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    Demos, S G; Sharareh, S

    2008-03-20

    An optical spectroscopy approach is demonstrated allowing for critical parameters during RF ablation of cardiac tissue to be evaluated in real time. The method is based on incorporating in a typical ablation catheter transmitting and receiving fibers that terminate at the tip of the catheter. By analyzing the spectral characteristics of the NIR diffusely reflected light, information is obtained on such parameters as, catheter-tissue proximity, lesion formation, depth of penetration of the lesion, formation of char during the ablation, formation of coagulum around the ablation site, differentiation of ablated from healthy tissue, and recognition of micro-bubble formation in the tissue.

  10. Neuropsychological Decline After Catheter Ablation of Atrial Fibrillation

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    Schwarz, N

    2011-09-01

    Full Text Available The article “Neuropsychological decline after cath- eter ablation of atrial fibrillation” by Schwarz et al. is the first publication that focused on cognitive side effects of elective circumferential pulmonary vein isolation (PVI.1 Adverse neuropsychological changes after left atrial catheter ablation, as report- ed in this paper, were found in verbal memory and the result, conjoined with ischemic brain lesions, might represent cerebral side-effects of the ablation procedure.

  11. Cardiac Remodeling After Atrial Fibrillation Ablation

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    Li-Wei Lo, MD; Shih-Ann Chen, MD

    2013-06-01

    Full Text Available Radiofrequency catheter ablation procedures are considered a reasonable option for patients with symptomatic, drug refractory atrial fibrillation (AF. Ablation procedures have been reported to effectively restore sinus rhythm and provide long-term relief of symptoms. Both electrical and structural remodeling occurs with AF. A reversal of the electrical remodeling develops within 1 week after restoration to sinus rhythm following the catheter ablation. The recovery rate is faster in the right atrium than the left atrium. Reverse structural remodeling takes longer and is still present 2 to 4 months after restoration of sinus rhythm. The left atrial transport function also improves after successful catheter ablation of AF. Left atrial strain surveys from echocardiography are able to identify patients who respond to catheter ablation with significant reverse remodeling after ablation. Pre-procedural delayed enhancement magnetic resonance imaging is also able to determine the degree of atrial fibrosis and is another tool to predict the reverse remodeling after ablation. The remodeling process is complex if recurrence develops after ablation. Recent evidence shows that a combined reverse electrical and structural remodeling occurs after ablation of chronic AF when recurrence is paroxysmal AF. Progressive electrical remodeling without any structural remodeling develops in those with recurrence involving chronic AF. Whether progressive atrial remodeling is the cause or consequence during the recurrence of AF remains obscure and requires further study.

  12. Radiofrequency catheter ablation of Type 1 atrial flutter using a large-tip electrode catheter and high-power radiofrequency energy generator.

    Science.gov (United States)

    Feld, Gregory K

    2004-11-01

    Recent studies have demonstrated a high degree of efficacy of 8 mm electrode-tipped or saline-irrigated-tip catheters for ablation of atrial flutter (AFL). These catheters have a theoretical advantage as they produce a large ablation lesion. However, large-tip ablation catheters have a larger surface area and require a higher power radiofrequency (RF) generator with up to 100 W capacity to produce adequate ablation temperatures (50-60 degrees C). The potential advantages of a large-tip ablation catheter and high-power RF generator include the need for fewer energy applications, shorter procedure and fluoroscopy times, and greater efficacy. Therefore, the safety and efficacy of AFL ablation using 8 or 10 mm electrode catheters and a 100-W RF generator was studied using the Boston Scientific, Inc., EPT-1000 XP cardiac ablation system. There were 169 patients, aged 61 +/- 12 years involved. Acute end points were bidirectional isthmus block and no inducible AFL. Following ablation, patients were seen at 1, 3 and 6 months, with event monitoring performed weekly and for any symptoms. Three quality of life surveys were completed during follow-up. Acute success was achieved in 158 patients (93%), with 12 +/- 11 RF energy applications. The efficacy of 8 and 10 mm electrodes did not differ significantly. The number of RF energy applications (10 +/- 8 vs. 14 +/- 8) and ablation time (0.5 +/- 0.4 vs. 0.8 +/- 0.6 h) were less with 10 mm compared with 8 mm electrodes (p free of symptoms at 12 and 24 months, respectively. Ablation of AFL improved quality of life scores (p generator was safe, effective and improved quality of life. The number and duration of RF applications was lower with 10 mm compared with 8 mm electrode catheters. PMID:16293039

  13. 三维标测系统指导下复杂心律失常的经导管射频消融治疗%Three-dimensional mapping for radiofrequency catheter ablation of complex cardiac arrhythmias

    Institute of Scientific and Technical Information of China (English)

    洪浪; 王洪; 赖珩莉; 尹秋林; 陈章强; 陆林祥; 邱赞; 肖承伟

    2009-01-01

    目的:探讨在三维标测系统指导下,经导管复杂心律失常射频消融治疗的有效性与安全性. 方法:选择2006年2月至2008年9月住院患者98例,其中阵发性房颤50例、持续性或永久性房颤6例、心房扑动9例、房性心动过速(房速)9例、室性心动过速(室速)或频发室性早搏24例.在EnSite NavX或Array系统(72例)或CARTO系统(26例)指导下进行射频消融手术. 结果:84例一次手术成功(85.71%),7例再次导管消融成功,成功率合计92.86%.50例房颤一次手术成功,5例再次消融后3例成功.9例心房扑动患者中7例一次手术成功,1例复发再次消融成功.9例房速中7例一次手术成功,1例复发再次消融成功.24例室速、室早患者中20例一次消融成功,4例行再次消融2例成功.共有并发症6例:心包填塞4例,左前降支远端栓塞1例、术后肺栓塞1例. 结论:三维标测系统可清晰地显示心脏三维立体结构,对复杂疑难心律失常的射频消融治疗具有较好的指导作用,提高消融的成功率并增加手术安全性.%Objective:To explore the validity and safety of radiofrequeney catheter ablation of complex cardiac arrhythmias guided by a three-dimensional mapping system. Methods.. A cohort of 98 consecutive inpatients were registered from February 2006 to September 2008, of which 68 cases were male and 30 cases were female, with an average age of (50.2 ± 19. 7) years ranging from 9 to 88 years of age. These patients suffered from various arrhythmias including paroxysmal atrial fibrillation (50 cases), persistent or permanent atrial fibrillation (6 cases), atrial flutter (9 cases), atrial tachy-cardia (9 cases), ventricular tachycardia or frequent episode ventricular premature beat (24 cases). A total of 72 cases underwent radiofrequency catheter ablation of arrhythmias guided by an En-Site3000/NavX or Array mapping system, and 26 cases guided by a CARTO mapping system. Re-suits:Successful ablation of

  14. Optimizing safety and efficacy of catheter ablation procedures

    NARCIS (Netherlands)

    F. Akca (Ferdi)

    2015-01-01

    markdownabstractAbstract In this thesis new developments in the field of invasive electrophysiology are studied and discussed. The aim of this work is to find strategies to optimize safety and efficacy of catheter ablation procedures. The most important developments that are studied in this thesis

  15. Typical flutter ablation as an adjunct to catheter ablation of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Dipen Shah

    2008-12-01

    Full Text Available Typical atrial flutter and atrial fibrillation are frequently observed to coexist(1 .  In the current context of interventional electrophysiology, curative or at least definitive ablation is available for both arrhythmias. Despite their coexistence, it is not clear whether typical flutter ablation is necessary in all patients undergoing catheter ablation of atrial fibrillation. The following review explores the pathophysiology of both arrhythmias, their interrelationships and the available data pertaining to this theme.

  16. Irrigated Tip Catheters for Radiofrequency Ablation in Ventricular Tachycardia

    Directory of Open Access Journals (Sweden)

    Andreas Müssigbrodt

    2015-01-01

    Full Text Available Radiofrequency (RF ablation with irrigated tip catheters decreases the likelihood of thrombus and char formation and enables the creation of larger lesions. Due to the potential dramatic consequences, the prevention of thromboembolic events is of particular importance for left-sided procedures. Although acute success rates of ventricular tachycardia (VT ablation are satisfactory, recurrence rate is high. Apart from the progress of the underlying disease, reconduction and the lack of effective transmural lesions play a major role for VT recurrences. This paper reviews principles of lesion formation with radiofrequency and the effect of tip irrigation as well as recent advances in new technology. Potential areas of further development of catheter technology might be the improvement of mapping by better substrate definition and resolution, the introduction of bipolar and multipolar ablation techniques into clinical routine, and the use of alternative sources of energy.

  17. Real-time x-ray fluoroscopy-based catheter detection and tracking for cardiac electrophysiology interventions

    Energy Technology Data Exchange (ETDEWEB)

    Ma Yingliang; Housden, R. James; Razavi, Reza; Rhode, Kawal S. [Division of Imaging Sciences and Biomedical Engineering, King' s College London, London SE1 7EH (United Kingdom); Gogin, Nicolas; Cathier, Pascal [Medisys Research Group, Philips Healthcare, Paris 92156 (France); Gijsbers, Geert [Interventional X-ray, Philips Healthcare, Best 5680 DA (Netherlands); Cooklin, Michael; O' Neill, Mark; Gill, Jaswinder; Rinaldi, C. Aldo [Department of Cardiology, Guys and St. Thomas' Hospitals NHS Foundation Trust, London SE1 7EH (United Kingdom)

    2013-07-15

    Purpose: X-ray fluoroscopically guided cardiac electrophysiology (EP) procedures are commonly carried out to treat patients with arrhythmias. X-ray images have poor soft tissue contrast and, for this reason, overlay of a three-dimensional (3D) roadmap derived from preprocedural volumetric images can be used to add anatomical information. It is useful to know the position of the catheter electrodes relative to the cardiac anatomy, for example, to record ablation therapy locations during atrial fibrillation therapy. Also, the electrode positions of the coronary sinus (CS) catheter or lasso catheter can be used for road map motion correction.Methods: In this paper, the authors present a novel unified computational framework for image-based catheter detection and tracking without any user interaction. The proposed framework includes fast blob detection, shape-constrained searching and model-based detection. In addition, catheter tracking methods were designed based on the customized catheter models input from the detection method. Three real-time detection and tracking methods are derived from the computational framework to detect or track the three most common types of catheters in EP procedures: the ablation catheter, the CS catheter, and the lasso catheter. Since the proposed methods use the same blob detection method to extract key information from x-ray images, the ablation, CS, and lasso catheters can be detected and tracked simultaneously in real-time.Results: The catheter detection methods were tested on 105 different clinical fluoroscopy sequences taken from 31 clinical procedures. Two-dimensional (2D) detection errors of 0.50 {+-} 0.29, 0.92 {+-} 0.61, and 0.63 {+-} 0.45 mm as well as success rates of 99.4%, 97.2%, and 88.9% were achieved for the CS catheter, ablation catheter, and lasso catheter, respectively. With the tracking method, accuracies were increased to 0.45 {+-} 0.28, 0.64 {+-} 0.37, and 0.53 {+-} 0.38 mm and success rates increased to 100%, 99

  18. Real-time x-ray fluoroscopy-based catheter detection and tracking for cardiac electrophysiology interventions

    International Nuclear Information System (INIS)

    Purpose: X-ray fluoroscopically guided cardiac electrophysiology (EP) procedures are commonly carried out to treat patients with arrhythmias. X-ray images have poor soft tissue contrast and, for this reason, overlay of a three-dimensional (3D) roadmap derived from preprocedural volumetric images can be used to add anatomical information. It is useful to know the position of the catheter electrodes relative to the cardiac anatomy, for example, to record ablation therapy locations during atrial fibrillation therapy. Also, the electrode positions of the coronary sinus (CS) catheter or lasso catheter can be used for road map motion correction.Methods: In this paper, the authors present a novel unified computational framework for image-based catheter detection and tracking without any user interaction. The proposed framework includes fast blob detection, shape-constrained searching and model-based detection. In addition, catheter tracking methods were designed based on the customized catheter models input from the detection method. Three real-time detection and tracking methods are derived from the computational framework to detect or track the three most common types of catheters in EP procedures: the ablation catheter, the CS catheter, and the lasso catheter. Since the proposed methods use the same blob detection method to extract key information from x-ray images, the ablation, CS, and lasso catheters can be detected and tracked simultaneously in real-time.Results: The catheter detection methods were tested on 105 different clinical fluoroscopy sequences taken from 31 clinical procedures. Two-dimensional (2D) detection errors of 0.50 ± 0.29, 0.92 ± 0.61, and 0.63 ± 0.45 mm as well as success rates of 99.4%, 97.2%, and 88.9% were achieved for the CS catheter, ablation catheter, and lasso catheter, respectively. With the tracking method, accuracies were increased to 0.45 ± 0.28, 0.64 ± 0.37, and 0.53 ± 0.38 mm and success rates increased to 100%, 99.2%, and 96

  19. Catheter ablation of atrial fibrillation in a patient with dextrocardia: what is the challenge?

    Institute of Scientific and Technical Information of China (English)

    WANG Xin-hua; SHI Hai-feng; HAN Bing; TAN Hong-wei; JIANG Wei-feng; LIU Xu

    2010-01-01

    @@ Catheter ablation has been an established strategy for treating paroxysmal atrial fibrillation (AF).Pulmonary vein isolation is the predominant approach of catheter ablation. This procedure is characterized as transseptal catheterization and point-by-point ablation around the ipsilateral pulmonary veins (PVs). Although catheter ablation can be safely performed in a heart with normal structures, it may be challenging to be performed in a dextrocardia.

  20. Catheter ablation of atrial fibrillation in the elderly

    Science.gov (United States)

    Lioni, Louiza; Letsas, Konstantinos P.; Efremidis, Michael; Vlachos, Konstantinos; Giannopoulos, Georgios; Kareliotis, Vasileios; Deftereos, Spyridon; Sideris, Antonios

    2014-01-01

    Background Atrial fibrillation (AF) catheter ablation has emerged as a promising treatment strategy for AF, but has not been widely adopted in the elderly population. The present study aimed to determine the safety and efficacy of AF catheter ablation in the elderly population. Methods and Results The study population consisted of 316 patients with paroxysmal AF who underwent left atrial ablation. Ninety-five patients were ≥ 65 years (48 males, mean age 68.9 ± 3.0 years old) and 221 patients were < 65 years old (130 males, mean age 52.5 ± 10.4 years old). After a mean follow-up period of 34.0 ± 15.1 months, 55 (57.9%) patients in the elderly group were free from arrhythmia recurrence compared with 149 (67.4%) patients in the younger group (P = 0.169). Procedural complications were uncommon in both study groups. In logistic regression analysis, left atrial diameter (P = 0.003), hypertension (P = 0.001), dyslipidemia (P = 0.039), and coronary artery disease (P = 0.018) were independent predictors of AF recurrence in the elderly population. Conclusions Catheter ablation of AF is safe and effective in older patients. Invasive strategies should be considered as an alternative choice in symptomatic elderly patients with AF. PMID:25593577

  1. Catheter ablation of atrial fibrillation in the elderly

    Institute of Scientific and Technical Information of China (English)

    Louiza Lioni; Konstantinos P Letsas; Michael Efremidis; Konstantinos Vlachos; Georgios Giannopoulos; Vasileios Kareliotis; Spyridon Deftereos; Antonios Sideris

    2014-01-01

    Background Atrial fibrillation (AF) catheter ablation has emerged as a promising treatment strategy for AF, but has not been widely adopted in the elderly population. The present study aimed to determine the safety and efficacy of AF catheter ablation in the elderly popula-tion. Methods and Results The study population consisted of 316 patients with paroxysmal AF who underwent left atrial ablation. Ninety-five patients were≥65 years (48 males, mean age 68.9 ± 3.0 years old) and 221 patients were<65 years old (130 males, mean age 52.5 ± 10.4 years old). After a mean follow-up period of 34.0 ± 15.1 months, 55 (57.9%) patients in the elderly group were free from ar-rhythmia recurrence compared with 149 (67.4%) patients in the younger group (P=0.169). Procedural complications were uncommon in both study groups. In logistic regression analysis, left atrial diameter (P=0.003), hypertension (P=0.001), dyslipidemia (P=0.039), and coronary artery disease (P=0.018) were independent predictors of AF recurrence in the elderly population. Conclusions Catheter ablation of AF is safe and effective in older patients. Invasive strategies should be considered as an alternative choice in symptomatic elderly patients with AF.

  2. Reduction of radiation exposure in catheter ablation of atrial fibrillation: Lesson learned

    Institute of Scientific and Technical Information of China (English)

    Roberto; De; Ponti

    2015-01-01

    Over the last decades, the concern for the radiation injury hazard to the patients and the professional staff has increased in the medical community. Since there is no magnitude of radiation exposure that is known to be completely safe, the use of ionizing radiation during medical diagnostic or interventional procedures should be as low as reasonably achievable(ALARA principle). Nevertheless, in cardiovascular medicine, radiation exposure for coronary percutaneous interventions or catheter ablation of cardiac arrhythmias may be high: for ablation of a complex arrhythmia, such as atrial fibrillation, the mean dose can be > 15 m Sv and in some cases > 50 m Sv. In interventional electrophysiology, although fluoroscopy has been widely used since the beginning to navigate catheters in the heart and the vessels and to monitor their position, the procedure is not based on fluoroscopic imaging. Therefore, nonfluoroscopic three-dimensional systems can be used to navigate electrophysiology catheters in the heart with no or minimal use of fluoroscopy. Although zerofluoroscopy procedures are feasible in limited series, there may be difficulties in using no fluoroscopy on a routine basis. Currently, a significant reduction in radiation exposure towards near zero-fluoroscopy procedures seems a simpler task to achieve, especially in ablation of complex arrhythmias, such as atrial fibrillation. The data reported in the literature suggest the following three considerations. First, the use of the non-fluoroscopic systems is associated with a consistent reduction in radiation exposure in multiple centers: the more sophisticated and reliable this technology is, the higher the reduction in radiation exposure. Second, the use of these systems does not automatically lead to reduction of radiation exposure, but an optimized workflow should be developed and adopted for a safe non-fluoroscopic navigation of catheters. Third, at any level of expertise, there is a specific learning curve for

  3. Temperature-controlled irrigated tip radiofrequency catheter ablation: comparison of in vivo and in vitro lesion dimensions for standard catheter and irrigated tip catheter with minimal infusion rate

    DEFF Research Database (Denmark)

    Petersen, H H; Chen, X; Pietersen, A;

    1998-01-01

    In patients with ventricular tachycardias due to structural heart disease, catheter ablation cures <60% partly due to the limited lesion size after conventional radiofrequency ablation. Irrigated tip radiofrequency ablation using power control and high infusion rates enlarges lesion size, but has...... increased risk of cratering. The present study explores irrigated tip catheter ablation in temperature-controlled mode, target temperature 60 degrees C, using an irrigation rate of 1 mL/min, comparing this to conventional catheter technique, target temperature 80 degrees C....

  4. Clinical efficacy and safety of catheter ablation for atrial fibrillation in elderly patients

    Institute of Scientific and Technical Information of China (English)

    董静

    2013-01-01

    Objective To evaluate the clinical efficacy and safty of catheter ablation for atrial fibrillation in elderly patients.Methods From September 2008 to October 2011,a total of 420 consecutive patients undergoing cathete rablation

  5. Catheter ablation of a polymorphic ventricular tachycardia inducing monofocal premature ventricular complex.

    Science.gov (United States)

    Uemura, Takashi; Yamabe, Hiroshige; Tanaka, Yasuaki; Morihisa, Kenji; Kawano, Hiroaki; Kaikita, Koichi; Sumida, Hitoshi; Sugiyama, Seigo; Ogawa, Hisao

    2008-01-01

    Ventricular tachycardia originating from the right ventricular outflow tract (RVOT) is considered benign, but sometimes it causes polymorphic ventricular tachycardia and ventricular fibrillation, resulting in sudden cardiac death. A 58-year-old woman without structural heart disease was admitted for evaluation of recurrent episodes of syncope. Surface ECG showed frequent repetitive premature ventricular contraction (PVC) of RVOT origin. Polymorphic ventricular tachycardia triggered by the same PVC was documented by Holter ECG during an episode of syncope. Radiofrequency catheter ablation was performed to eradicate this PVC. No polymorphic ventricular tachycardia has developed after the procedure, and the patient has had no recurrence of syncope.

  6. Catheter ablation of a monofocal premature ventricular complex triggering idiopathic ventricular fibrillation.

    Science.gov (United States)

    Takatsuki, S; Mitamura, H; Ogawa, S

    2001-07-01

    A 62 year old man was admitted for evaluation of recurrent episodes of syncope. A surface ECG showed frequent repetitive premature ventricular complexes of right ventricular outflow tract origin. Ventricular fibrillation was inducible by programmed electrical stimulation but otherwise cardiac evaluation was unremarkable. A diagnosis of idiopathic ventricular fibrillation was made and an implantable cardioverter-defibrillator (ICD) was installed. However, spontaneous ventricular fibrillation recurred, requiring repeated ICD discharges. The ventricular fibrillation was reproducibly triggered by a single premature ventricular complex with a specific QRS morphology. Radiofrequency catheter ablation was carried out to eradicate this complex. No ventricular fibrillation has developed after this procedure, and the patient does not require drug treatment.

  7. Real-time circumferential mapping catheter tracking for motion compensation in atrial fibrillation ablation procedures

    Science.gov (United States)

    Brost, Alexander; Bourier, Felix; Wimmer, Andreas; Koch, Martin; Kiraly, Atilla; Liao, Rui; Kurzidim, Klaus; Hornegger, Joachim; Strobel, Norbert

    2012-02-01

    Atrial fibrillation (AFib) has been identified as a major cause of stroke. Radiofrequency catheter ablation has become an increasingly important treatment option, especially when drug therapy fails. Navigation under X-ray can be enhanced by using augmented fluoroscopy. It renders overlay images from pre-operative 3-D data sets which are then fused with X-ray images to provide more details about the underlying soft-tissue anatomy. Unfortunately, these fluoroscopic overlay images are compromised by respiratory and cardiac motion. Various methods to deal with motion have been proposed. To meet clinical demands, they have to be fast. Methods providing a processing frame rate of 3 frames-per-second (fps) are considered suitable for interventional electrophysiology catheter procedures if an acquisition frame rate of 2 fps is used. Unfortunately, when working at a processing rate of 3 fps, the delay until the actual motion compensated image can be displayed is about 300 ms. More recent algorithms can achieve frame rates of up to 20 fps, which reduces the lag to 50 ms. By using a novel approach involving a 3-D catheter model, catheter segmentation and a distance transform, we can speed up motion compensation to 25 fps which results in a display delay of only 40 ms on a standard workstation for medical applications. Our method uses a constrained 2-D/3-D registration to perform catheter tracking, and it obtained a 2-D tracking error of 0.61 mm.

  8. Radiofrequency catheter ablation maintains its efficacy better than antiarrhythmic medication in patients with paroxysmal atrial fibrillation

    DEFF Research Database (Denmark)

    Raatikainen, M J Pekka; Hakalahti, Antti; Uusimaa, Paavo;

    2015-01-01

    BACKGROUND: The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) is a randomized trial comparing radiofrequency catheter ablation (RFA) to antiarrhythmic drugs (AADs) as first-line treatment of paroxysmal atrial fibrillation (PAF). In order...

  9. The mechanism of lesion formation by focused ultrasound ablation catheter for treatment of atrial fibrillation

    Science.gov (United States)

    Sinelnikov, Y. D.; Fjield, T.; Sapozhnikov, O. A.

    2009-10-01

    The application of therapeutic ultrasound for the treatment of atrial fibrillation (AF) is investigated. The results of theoretical and experimental investigation of ultrasound ablation catheter are presented. The major components of the catheter are the high power cylindrical piezoelectric element and parabolic balloon reflector. Thermal elevation in the ostia of pulmonary veins is achieved by focusing the ultrasound beam in shape of a torus that transverses the myocardial tissue. High intensity ultrasound heating in the focal zone results in a lesion surrounding the pulmonary veins that creates an electrical conduction blocks and relief from AF symptoms. The success of the ablation procedure largely depends on the correct choice of reflector geometry and ultrasonic power. We present a theoretical model of the catheter’s acoustic field and bioheat transfer modeling of cardiac lesions. The application of an empirically derived relation between lesion formation and acoustic power is shown to correlate with the experimental data. Developed control methods combine the knowledge of theoretical acoustics and the thermal lesion formation simulations with experiment and thereby establish dosimetry that contributes to a safe and effective ultrasound ablation procedure.

  10. Three-dimensional tracking of cardiac catheters using an inverse geometry x-ray fluoroscopy system

    Energy Technology Data Exchange (ETDEWEB)

    Speidel, Michael A.; Tomkowiak, Michael T.; Raval, Amish N.; Van Lysel, Michael S. [Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States); Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin 53705 (United States); Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53792 (United States); Department of Medicine and Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin 53792 (United States)

    2010-12-15

    Purpose: Scanning beam digital x-ray (SBDX) is an inverse geometry fluoroscopic system with high dose efficiency and the ability to perform continuous real-time tomosynthesis at multiple planes. This study describes a tomosynthesis-based method for 3D tracking of high-contrast objects and present the first experimental investigation of cardiac catheter tracking using a prototype SBDX system. Methods: The 3D tracking algorithm utilizes the stack of regularly spaced tomosynthetic planes that are generated by SBDX after each frame period (15 frames/s). Gradient-filtered versions of the image planes are generated, the filtered images are segmented into object regions, and then a 3D coordinate is calculated for each object region. Two phantom studies of tracking performance were conducted. In the first study, an ablation catheter in a chest phantom was imaged as it was pulled along a 3D trajectory defined by a catheter sheath (10, 25, and 50 mm/s pullback speeds). SBDX tip tracking coordinates were compared to the 3D trajectory of the sheath as determined from a CT scan of the phantom after the registration of the SBDX and CT coordinate systems. In the second study, frame-to-frame tracking precision was measured for six different catheter configurations as a function of image noise level (662-7625 photons/mm{sup 2} mean detected x-ray fluence at isocenter). Results: During catheter pullbacks, the 3D distance between the tracked catheter tip and the sheath centerline was 1.0{+-}0.8 mm (mean {+-}one standard deviation). The electrode to centerline distances were comparable to the diameter of the catheter tip (2.3 mm), the confining sheath (4 mm outside diameter), and the estimated SBDX-to-CT registration error ({+-}0.7 mm). The tip position was localized for all 332 image frames analyzed and 83% of tracked positions were inside the 3D sheath volume derived from CT. The pullback speeds derived from the catheter trajectories were within 5% of the programed pullback speeds

  11. Automated Pointing of Cardiac Imaging Catheters.

    Science.gov (United States)

    Loschak, Paul M; Brattain, Laura J; Howe, Robert D

    2013-12-31

    Intracardiac echocardiography (ICE) catheters enable high-quality ultrasound imaging within the heart, but their use in guiding procedures is limited due to the difficulty of manually pointing them at structures of interest. This paper presents the design and testing of a catheter steering model for robotic control of commercial ICE catheters. The four actuated degrees of freedom (4-DOF) are two catheter handle knobs to produce bi-directional bending in combination with rotation and translation of the handle. An extra degree of freedom in the system allows the imaging plane (dependent on orientation) to be directed at an object of interest. A closed form solution for forward and inverse kinematics enables control of the catheter tip position and the imaging plane orientation. The proposed algorithms were validated with a robotic test bed using electromagnetic sensor tracking of the catheter tip. The ability to automatically acquire imaging targets in the heart may improve the efficiency and effectiveness of intracardiac catheter interventions by allowing visualization of soft tissue structures that are not visible using standard fluoroscopic guidance. Although the system has been developed and tested for manipulating ICE catheters, the methods described here are applicable to any long thin tendon-driven tool (with single or bi-directional bending) requiring accurate tip position and orientation control.

  12. RADIOFREQUENCY CATHETER ABLATION OF PERMANENT ATRIAL FIBRILLATION UNDER GUIDANCE OF CARTO-MERGE TECHNIQUE

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective To investigate the feasibility and effectiveness of radiofrequency catheter ablation (RFCA) to treat permanent atrial fibrillation (AF) under the guidance of Carto-Merge technique.Methods Fifteen male patients with permanent AF underwent RFCA under the guidance of Carto-Merge technique. The mean age was 54. 00 ± 10. 44 years, and duration of AF was 23.66 ± 14. 93 months. Cardiac magnetic resonance angiography (MRA) was performed to obtain pre-procedural three-dimensional (3D) images on the anatomy of left atrium (LA) and pulmonary veins (PVs) before RFCA procedure. Then the electroanatomical map was integrated with 3D images of MRA to form Carto-Merge map that guided step-by-step ablation strategy of permanent AF. Circumferential PV ablation was performed first until complete PVs electric isolation confirmed by Lasso catheter. If AF was not terminated, lesion lines on roof of LA, mitral isthmus, and tricuspid isthmus were produced.Results The episodes of AF were terminated during RFCA in 2 patients, by direct current cardioversion in the remaining 13 patients. Transient AF occurred in 2 patients after ablation on 1st day and 1st week respectively, AF terminated spontaneously not long after taking metoprolol. One patient developed persistent atrial flutter (AFL) in 2 months after procedure and AFL was eliminated by the second ablation. Persistent AF recurred on 1st day, 1st and 5th week respectively in 3 patients, and did not terminate after 3 months even though amiodarone was given The remaining 12 patients were all free of AF during 2-11 months of follow-up. The recent success rate for RFCA of permanent AF was 80%.Conclusions Carto-Merge technique can effectively guide RFCA of permanent AF. When combined with single Lasso mapping, it can simplify the mapping, lower expenses, and enhance the success rate of RFCA of permanent AF.

  13. 射频导管消融术中的抗凝与血栓栓塞性并发症%Thromboembolic complications and anticoagulate treatment of cardiac radiofrequency catheter ablation

    Institute of Scientific and Technical Information of China (English)

    杨新春; 李延辉

    2002-01-01

    @@ 射频导管消融术(radiofrequency catheter ablation,RF-CA)自1987年应用于临床以来,目前已成为快速心律失常有效、安全的非药物治疗手段,对一些心律失常已成为一线治疗方法[1-4].虽然RFCA具有创伤小、安全、根治、成功率高、恢复快等优点,但也存在一些并发症[5,6],如心脏穿孔、房室阻滞、气胸、和血管并发症等.左心消融操作所致的血栓栓塞也是受关注的问题[7,8].

  14. Safety of atrial fibrillation ablation with novel multi-electrode array catheters on uninterrupted anticoagulation-a single-center experience.

    LENUS (Irish Health Repository)

    Hayes, Christopher Ruslan

    2012-02-01

    INTRODUCTION: A recent single-center report indicated that the performance of atrial fibrillation ablation in patients on uninterrupted warfarin using a conventional deflectable tip electrode ablation catheter may be as safe as periprocedural discontinuation of warfarin and bridging with heparin. Novel multi-electrode array catheters for atrial fibrillation ablation are currently undergoing clinical evaluation. While offering the possibility of more rapid atrial fibrillation ablation, they are stiffer and necessitate the deployment of larger deflectable transseptal sheaths, and it remains to be determined if they increase the risk of cardiac perforation and vascular injury. Such potential risks would have implications for a strategy of uninterrupted periprocedural anticoagulation. METHOD AND RESULTS: We audited the safety outcomes of our atrial fibrillation ablation procedures using multi-electrode array ablation catheters in patients on uninterrupted warfarin (CHADS2 score>or=2) and in patients not on warfarin (uninterrupted aspirin). Two bleeding complications occurred in 49 patients on uninterrupted warfarin, both of which were managed successfully without longterm sequelae, and no bleeding complication occurred in 32 patients not on warfarin (uninterrupted aspirin). There were no thromboembolic events or other complication with either anticoagulant regimen. CONCLUSION: Despite the larger diameter and increased stiffness of multi-electrode array catheters and their deflectable transseptal sheaths, their use for catheter ablation in patients with atrial fibrillation on uninterrupted warfarin in this single-center experience does not appear to be unsafe, and thus, an adequately powered multicenter prospective randomized controlled trial should be considered.

  15. Efficacy of catheter ablation of atrial fibrillation beyond HATCH score

    Institute of Scientific and Technical Information of China (English)

    TANG Ri-bo; DONG Jian-zeng; LONG De-yong; YU Rong-hui; NING Man; JIANG Chen-xi; SANG Cai-hua; LIU Xiao-hui; MA Chang-sheng

    2012-01-01

    Background HATCH score is an established predictor of progression from paroxysmal to persistent atrial fibrillation (AF).The purpose of this study was to determine if HATCH score could predict recurrence after catheter ablation of AF.Methods The data of 488 consecutive paroxysmal AF patients who underwent an index circumferential pulmonary veins (PV) ablation were retrospectively analyzed.Of these patients,250 (51.2%) patients had HATCH score=0,185(37.9%) patients had HATCH score=1,and 53 (10.9%) patients had HATCH score >2 (28 patients had HATCH score=2,23 patients had HATCH score=3,and 2 patients had HATCH score=4).Results The patients with HATCH score >2 had significantly larger left atrium size,the largest left ventricular end systolic diameter,and the lowest ejection fraction.After a mean follow-up of (823±532) days,the recurrence rates were 36.4%,37.8% and 28.3% from the HATCH score=0,HATCH score=1 to HATCH score >2 categories (P=0.498).Univariate analysis revealed that left atrium size,body mass index,and failure of PV isolation were predictors of AF recurrence.After adjustment for body mass index,left atrial size and PV isolation,the HATCH score was not an independent predictor of recurrence (HR=0.92,95% confidence interval=0.76-1.12,P=0.406) in multivariate analysis.Conclusion HATCH score has no value in prediction of AF recurrence after catheter ablation.

  16. Successful radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with dextrocardia due to unilateral pulmonary agenesis: a case report

    Directory of Open Access Journals (Sweden)

    Aksu T

    2015-02-01

    Full Text Available Tolga Aksu, Tumer Erdem Guler, Ebru Golcuk, Ismail Erden, Kazim Serhan Ozcan Department of Cardiology, Kocaeli Derince Education and Research Hospital, Derince, Kocaeli, Turkey Abstract: Radiofrequency catheter ablation of the slow pathway is considered to be the treatment of choice for patients with atrioventricular nodal reentrant tachycardia. We report a 34-year-old female with mirror image dextrocardia due to unilateral pulmonary agenesis who underwent successful slow pathway ablation for typical atrioventricular nodal reentrant tachycardia. Using contrast injection, cardiac anatomy was identified in a short time and successfully ablated. Keywords: dextrocardia, AVNRT, ablation, pulmonary agenesis

  17. Short and middle term outcome of radiofrequency catheter ablation for paroxysmal and sustained atrial fibrillation

    International Nuclear Information System (INIS)

    The aim of this study was to assess short and middle term outcome of radiofrequency catheter ablation for drug-refractory paroxysmal and sustained atrial fibrillation. Subjects were 30 patients of atrial fibrillation (19 paroxysmal, 11 sustained) who underwent extensive pulmonary vein isolation from January 2007 to August 2009 in our department. Twenty three men and seven women, aged from 44 to 76 years, were enrolled. Follow-up period was one to 32 months. Drug free success was 33%, but symptoms and electrocardiogram (EGG) findings were improved in 93 % of the patients by administration of anti-arrhythmic agents. Five of the six patients with bradycardia-tachycardia syndrome was free from pacemaker implantation. Left ventricular ejection fraction was improved in two patients with dilated cardiomyopathy (DCM)-like left ventricular dysfunction. One case had cardiac tamponade and transient ST elevation due to right coronary air embolism were observed in two cases. There were no death and no cerebrovascular events during the procedures and follow-up periods. In conclusion, radiofrequency catheter ablation for paroxysmal and sustained atrial fibrillation in our department may be highly acceptable new method for improving the symptoms and clinical signs of the patients. (author)

  18. Visualization of catheter ablation for atrial fibrillation:Impact of devices and anatomy

    Institute of Scientific and Technical Information of China (English)

    Mark; A; Benscoter; Paul; A; Iaizzo

    2015-01-01

    Endocardial access to the left atrium is commonly achieved to treat patients with atrial fibrillation, using different device delivery systems for cardiac ablation. But the large variation in human anatomy presses the limits of existing medical devices. In this unique study, we directly visualized the device-tissue interface in fresh reanimated human hearts using Visible Heart?? methodologies. Our goal was to better understand any opportunities to improve therapeutic approaches. The visual images obtained in this study(also featured in this article) allow a more intimate grasp of the key steps required in various ablation procedures, as well as some limitations of current device designs. These images show the potential risks of conducting transseptal punctures and the difficulties of placing catheter tips in certain scenarios(e.g., when creating circumferential lesions); they also demonstrate potential problems that could occur while attempting to place catheter tips on such anatomies like the mitral isthmus. In our analysis of these images, we focus on where enhancements are needed to refine device functionality.

  19. Catheter selection for ablation of the cavotricuspid isthmus for treatment of typical atrial flutter.

    Science.gov (United States)

    Da Costa, Antoine; Jamon, Yann; Romeyer-Bouchard, Cécile; Thévenin, Jérôme; Messier, Marc; Isaaz, Karl

    2006-11-01

    Radiofrequency catheter ablation (RFA) represents the first line therapy of the cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) with a high efficacy and low secondary effects. RFA of CTI-dependent AFL can be performed by using various types of ablation catheters. Recent evaluations comparing externally cooled tip RFA (ecRFA) catheters and large-tip (8 mm) catheters have revealed that these catheters have a higher efficacy for CTI-AFL ablation compared to 4-mm catheters. The reliability of RFA catheters for AFL is variable and an optimal catheter selection may enhance the RFA effectiveness. The main goal of this article is to review the elements that improve the management of CTI RFA. Preliminary examinations of histopathologic and anatomical elements that may interfere with conventional CTI RFA are presented. Experimental studies concerning the electrobiology of large-tip and cooled-tip catheters are compared. The different catheter designs between cooled-tip and 8-mm-tip catheters are examined (size of the deflectable curve, rotation stability, and size of the distal nonsteerable catheter part) because of their critical role in CTI RFA results. A thorough review of clinical trials of each catheter is presented, and comparison of both catheters in this clinical setting is analyzed. In addition, the role of CTI morphology on AFL RF duration is underlined such as the value of right atrial angiography as an adjunct tool for CTI RFA catheter selection. Based on randomized studies, 8-mm-tip catheters seem to be more effective for ablation in case of straight angiographic isthmus morphology. On the other hand, ecRFA catheters appear to be more effective in cases of complex CTI anatomy or difficult CTI RFA. To reduce X-ray exposition and RFA application time, few studies report that CTI angiographic evaluation before RFA allows a catheter selection based on both CTI morphology and length. Moreover, preliminary data of randomized studies showed that an

  20. Body Mass Index, Quality of Life, and Catheter Ablation in Patients with Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Ethan R. Ellis, M.D

    2012-12-01

    Full Text Available Atrial fibrillation and obesity are interlinked epidemics and both impair quality of life. As the prevalence of both conditions in the US continues to rise, so will the number of obese patients with atrial fibrillation referred for catheter ablation. Catheter ablation has already been shown to significantly improve quality of life in patients with atrial fibrillation. Until recently, there has been little attention to the effects of catheter ablation on quality of life specifically in obese patients with atrial fibrillation. This paper will review what is known about the effects of atrial fibrillation and obesity on quality of life and how quality of life is affected by catheter ablation for atrial fibrillation in obese patients.

  1. Reversal of pulmonary vein remodeling after catheter ablation of atrial fibrillation

    OpenAIRE

    Wu, Jia-hui; Li, Hung-Kei; Couri, Daniel M; Araoz, Philip A; Lee, Ying-Hsiang; Ma, Chang-Sheng; Packer, Douglas L.; Cha, Yong-Mei

    2016-01-01

    Background Pulmonary veins (PV) and the atria undergo electrical and structural remodeling in atrial fibrillation (AF). This study aimed to determine PV and left atrial (LA) reverse remodeling after catheter ablation for AF assessed by chest computed tomography (CT). Methods PV electrophysiologic studies and catheter ablation were performed in 63 patients (68% male; mean ± SD age: 56 ± 10 years) with symptomatic AF (49% paroxysmal, 51% persistent). Chest CT was performed before and 3 months a...

  2. Reinforce the study of treatment of atrial fibrillation by catheter ablation

    Institute of Scientific and Technical Information of China (English)

    HUANG Cong-xin

    2005-01-01

    @@ In the past decade, there is a great progress in the treatment of atrial fibrillation (AF) by transcatheter ablation. The catheter-based procedures have developed from Maze-like linear lesion, focal lesion to segmental electrical isolation of pulmonary veins and circumferential ablation under guidance of anatomical mapping, ablation energy developed from radiofrequency to multiple energy such as radiofrequency, ultrasound and cryoablation; and success rate has risen to 90% from around 30% in the past.1 Catheter ablation has been widely accepted as a treatment of AF and tends to substitute pharmacological therapy and become first-line treatment gradually. It must point out that, however, catheter ablation of AF is not perfect and there are many issues desiderating resolution.

  3. Catheter ablation of persistent atrial fibrillation in a patient with dextrocardia

    Institute of Scientific and Technical Information of China (English)

    XUE Zeng-ming; SANG Cai-hua; DONG Jian-zeng; MA Chang-sheng

    2012-01-01

    The technique of catheter ablation for atrial fibrillation (AF) has advanced rapidly over the last ten years.Catheter ablation of AF with special anatomy like dextrocardia was seldomly reported,1,2 which may be difficult for its complex anatomy.Three-dimensional electroanatomical mapping system and image integration system may be helpful during the procedure.We report a case with drug refractory persistent AF and dextrocardia,who underwent an ablation procedure.%Dextrocardia is a rare anomaly where the heart is located on the right side of the chest instead of the normal left side.Ablation of atrial fibrillation (AF) with such an inverted anatomy may be challenging for the manipulation of the catheters.Here we report a case of dextrocardia who underwent ablation for persistent AF guided by image integration system.

  4. Atrium-atrioventricular node block: an unusual complication during catheter ablation of persistent atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    MIAO Cheng-long; SANG Cai-hua; DONG Jian-zeng; MA Chang-sheng

    2011-01-01

    Ablation of persistent atrial fibrillation is still a challenge for the ablationist. Extensive ablation is required under some conditions and could lead to some unintended complications. Here we report a case of atrium-atrioventricular node block complicating multiple catheter ablation procedures for persistent atrial fibrillation. After extensive ablation, including circumferential pulmonary vein ablation, linear ablation at the left atrial roof, mitral isthmus, atrial septum, cavotricuspid isthmus, and complex fractionated atrial electrogram ablation, conduction obstacle was found, and sinus impulse could not travel from the right atrium, atrial septum and left atrium to atrioventricular node. The case indicated that intensive ablation at some key sites, especially the interatrial septum, should be careful during ablation of atrial fibrillation.

  5. Safety of pulmonary vein isolation and left atrial complex fractionated atrial electrograms ablation for atrial fibrillation with phased radiofrequency energy and multi-electrode catheters

    NARCIS (Netherlands)

    Mulder, A.A.W.; Balt, J.C.; Wijffels, M.C.; Wever, E.F.; Boersma, L.V.

    2012-01-01

    AIMS: Recently, a multi-electrode catheter system using phased radiofrequency (RF) energy was developed specifically for atrial fibrillation (AF) ablation: the pulmonary vein ablation catheter (PVAC), the multi-array septal catheter (MASC), and the multi-array ablation catheter (MAAC). Initial resul

  6. Catheter Ablation of Atrial Fibrillation Raises the Plasma Level of NGF-β Which Is Associated with Sympathetic Nerve Activity

    OpenAIRE

    Park, Jae Hyung; Hong, Sung Yu; Wi, Jin; Lee, Da Lyung; Joung, Boyoung; Lee, Moon Hyoung; Pak, Hui-Nam

    2015-01-01

    Purpose The expression of nerve growth factor-β (NGF-β) is related to cardiac nerve sprouting and sympathetic hyper innervation. We investigated the changes of plasma levels of NGF-β and the relationship to follow-up heart rate variability (HRV) after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Materials and Methods This study included 147 patients with AF (117 men, 55.8±11.5 years, 106 paroxysmal AF) who underwent RFCA. The plasma levels of NGF-β were quantified usin...

  7. [Catheter ablation in patients with atrial fibrillation: what will change in daily practice?].

    Science.gov (United States)

    van der Voort, Pepijn H

    2013-01-01

    A recent publication compared catheter ablation and antiarrhythmic drugs as initial therapy for paroxysmal atrial fibrillation. No difference was seen in the primary endpoint of the cumulative AF burden over two years. The burden of AF was documented objectively by a series of 7-day continuous ECG recordings; a method that will evolve as a gold standard for measuring the AF burden. The major shortcoming of the study was an obsolete ablation endpoint, lacking verification of pulmonary vein isolation. Other drawbacks were the fact that ablations were not exclusively carried out in high-volume centres and a high cross-over rate in the drug group. Also, although the primary endpoint was not significantly different, several secondary outcomes obviously favoured ablation. Outcomes in both the ablation and drug groups were relatively good, and this study will not change the current practice for the majority of paroxysmal AF patients, although catheter ablation could be performed as the initial therapy. PMID:23548191

  8. Plasma YKL-40 is elevated in patients with recurrent atrial fibrillation after catheter ablation

    DEFF Research Database (Denmark)

    Henningsen, Kristoffer Mads; Nilsson, Brian; Johansen, Julia S;

    2010-01-01

    -81) with paroxysmal/persistent AF were treated with RF catheter ablation; Holter monitoring for 14 days was performed before ablation and after 3 months. Recurrent symptomatic AF or atrial tachycardia >10 min was considered failure, and the patients were offered a second ablation session. YKL-40 was determined...... to ablation compared to patients with recurrence of AF (31 vs. 62 microg/l, P = 0.029). Plasma YKL-40 was not an independent predictor of recurrence of AF after ablation. No significant changes in plasma YKL-40 levels were seen from baseline to follow-up at 12 months. CONCLUSION: In patients with paroxysmal...

  9. Electrocardiographic characteristics and catheter ablation of left ventricular epicardial tachycardia originating from the different parts of great cardiac vein%心大静脉不同部位室性心律失常的心电图特征及射频导管消融治疗

    Institute of Scientific and Technical Information of China (English)

    官学强; 李嘉; 李岳春; 季亢挺; 殷日鹏; 林加锋

    2011-01-01

    Objective To investigate the electrocardiographic characteristics ofpremature ventricular contractions (PVCs) and ventricular tachycardia (VT) originating from the different parts of great cardiac vein (GCV) and to evaluate the efficacy and safety of radio frequency catheter ablation (RFCA).Methods Four patients with PVCs/VTs, including 2 cases of PVC, 1 sustained VT and 1 non- sustained VT, underwent electrophysiologic study using conventional mapping techniques and also received catheter ablation for the arrhythmias via GCV.Mapping and RF energy application at endocardial sites of left and right ventricular outflow tract (LVOT, RVOT) or mitral annulus did not eliminate the arrhythmias in all the patients.The arrhythmias were finally mapped and ablated from coronary venous system.Electrocardiographic characteristics were analyzed in cases with successful ablation via the distalpart (located proximal to the origin of anterior interventricular vein) or the most distal part (located distal to the origin of anterior interventricular vein) of GCV.Results Only 1 case succeeded in the first procedure of catheter ablation using the common temperature- controlled catheter, other 3 cases failed due to unable to delivered RF energy with high impedance within coronary sinus.The arrhythmias in 2 of 3 cases were successfully ablated using irrigated- tip catheter under the guide of Ensite3000 NavXin the second procedure, with the overall success rate of 75 % (3/4).The successful ablation site was located in the distalpart of GCV in 1 patient, the most distal part of GCV in 2 cases.The earliest epicardial activation was preceding the onset of the QRS complex by (36.00± 2.65) ms, and there were atrialand ventricular potentias in sinus rhythm at the successful ablation sites.Pacing reproduced QRS morphology that was similar to the clinical PVCs/VTs in all patients (2 patients with 11/12- lead and 2 patients with 12/12- lead concordance of major and minor deflections

  10. Association between CHADS2 score and long-term atrial fibrillation recurrence rate after catheter ablation

    Institute of Scientific and Technical Information of China (English)

    胡晓锋

    2014-01-01

    Objective To investigate the association between CHADS2score and long-term(≥3 years)outcomes post catheter ablation in patients with atrial fibrillation(AF).Methods AF patients who received single catheter ablation in our hospital from January 2004 to March 2009 in our department were included and patients received regular follow-up.AF recurrence was defined as the occurrence of atrial arrhythmias(AF,atrial flutter and atrial tachycardia)recorded by electrocardiogram monitor(≥30 seconds)after ablation during follow-up period(after

  11. Remote Magnetic Navigation: A Focus on Catheter Ablation of Ventricular Arrhythmias.

    Science.gov (United States)

    Aagaard, Philip; Natale, Andrea; Briceno, David; Nakagawa, Hiroshi; Mohanty, Sanghamitra; Gianni, Carola; Burkhardt, J David; DI Biase, Luigi

    2016-03-01

    VT ablation is based on percutaneous catheter insertion under fluoroscopic guidance to selectively destroy (i.e., ablate) myocardial tissue regions responsible for the initiation or propagation of ventricular arrhythmias. Although the last decade has witnessed a rapid evolution of ablation equipment and techniques, the control over catheter movement during manual ablation has remained largely unchanged. Moreover, the procedures are long, and require ergonomically unfavorable positions, which can lead to operator fatigue. In an attempt to overcome these constraints, several technical advancements, including remote magnetic navigation (RMN), have been developed. RMN utilizes a magnetic field to remotely manipulate specially designed soft-tip ablation catheters anywhere in the x, y, or z plane inside the patient's chest. RMN also facilitates titration of the contact force between the catheter and the myocardial tissue, which may reduce the risk of complications while ensuring adequate lesion formation. There are several non-randomized studies showing that RMN has similar efficacy to manual ablation, while complication rates and total radiation exposure appears to be lower. Although these data are promising, larger randomized studies are needed to prove that RMN is superior to manual ablation of VT.

  12. Evaluation of the Pulmonary Veins and Left Atrial Volume using Multidetector Computed Tomography in Patients Undergoing Catheter Ablation for Atrial Fibrillation

    OpenAIRE

    Ito, Hiroki; Dajani, Khaled A.

    2009-01-01

    Catheter ablation is an evolving treatment option in patients with atrial fibrillation. Contrast enhanced electrocardiogram-gated multi-detector computed tomography (MDCT) has rapidly evolved over the past few years into an important tool in the diagnosis of coronary atherosclerosis. There is increasing recognition that MDCT is a useful tool to evaluate non-coronary structures, such as cardiac chambers, valves, the coronary sinus and adjacent structures including pulmonary veins. In particula...

  13. Recurrence of arrhythmia following short-term oral AMIOdarone after CATheter ablation for atrial fibrillation

    DEFF Research Database (Denmark)

    Darkner, Stine; Chen, Xu; Hansen, Jim;

    2014-01-01

    AIMS: Patients undergoing catheter ablation for atrial fibrillation (AF) often experience recurrent arrhythmias within the first few months post-ablation. We aimed to investigate whether short-term use of amiodarone to prevent early arrhythmias following radiofrequency ablation for AF could reduce...... period. CONCLUSION: Short-term oral amiodarone treatment following ablation for paroxysmal or persistent AF did not significantly reduce recurrence of atrial tachyarrhythmias at the 6-month follow-up, but it more than halved atrial arrhythmia related hospitalization and cardioversion rates during...

  14. The Role of Atrial Fibrillation Catheter Ablation in Patients with Congestive Heart Failure: “Burning”for a Cure

    OpenAIRE

    Dimpi Patel; Mohammed Khan

    2011-01-01

    Atrial Fibrillation (AF) and congestive heart failure (CHF) often co-exist. Catheter ablation is increasingly used to cure AF related to CHF.Clinical evidence supports the feasibil- ity of catheter ablation as a treatment option in drug refractory AF patients with CHF.Investiga- tors have reported an improvement in ejection fraction, quality of life, and functional capacity

  15. Capturing Pain in the Cortex during General Anesthesia: Near Infrared Spectroscopy Measures in Patients Undergoing Catheter Ablation of Arrhythmias.

    Directory of Open Access Journals (Sweden)

    Barry D Kussman

    Full Text Available The predictability of pain makes surgery an ideal model for the study of pain and the development of strategies for analgesia and reduction of perioperative pain. As functional near-infrared spectroscopy reproduces the known functional magnetic resonance imaging activations in response to a painful stimulus, we evaluated the feasibility of functional near-infrared spectroscopy to measure cortical responses to noxious stimulation during general anesthesia. A multichannel continuous wave near-infrared imager was used to measure somatosensory and frontal cortical activation in patients undergoing catheter ablation of arrhythmias under general anesthesia. Anesthetic technique was standardized and intraoperative NIRS signals recorded continuously with markers placed in the data set for the timing and duration of each cardiac ablation event. Frontal cortical signals only were suitable for analysis in five of eight patients studied (mean age 14 ± 1 years, weight 66.7 ± 17.6 kg, 2 males. Thirty ablative lesions were recorded for the five patients. Radiofrequency or cryoablation was temporally associated with a hemodynamic response function in the frontal cortex characterized by a significant decrease in oxyhemoglobin concentration (paired t-test, p<0.05 with the nadir occurring in the period 4 to 6 seconds after application of the ablative lesion. Cortical signals produced by catheter ablation of arrhythmias in patients under general anesthesia mirrored those seen with noxious stimulation in awake, healthy volunteers, during sedation for colonoscopy, and functional Magnetic Resonance Imaging activations in response to pain. This study demonstrates the feasibility and potential utility of functional near-infrared spectroscopy as an objective measure of cortical activation under general anesthesia.

  16. Pulmonary vein isolation during cryoballoon ablation using the novel Achieve inner lumen mapping catheter: a feasibility study.

    NARCIS (Netherlands)

    Chierchia, G.B.; Asmundis, C. de; Namdar, M.; Westra, S.W.; Kuniss, M.; Sarkozy, A.; Bayrak, F.; Ricciardi, D.; Casado-Arroyo, R.; Rodriguez Manero, M.; Rao, J.Y.; Smeets, J.; Brugada, P.

    2012-01-01

    AIMS: Cryoballoon (CB) ablation has proven very effective in achieving pulmonary vein isolation (PVI). The Achieve catheter (AC) is a novel inner lumen catheter designed to be used in conjunction with the CB, which serves the double purpose of a guidewire and a mapping catheter. We aimed to evaluate

  17. Atrial fibrillation radiofrequency ablation: safety using contact force catheter in a low-volume centre

    Directory of Open Access Journals (Sweden)

    Diego Vaccari, MD; Daniele Giacopelli, MSc; Eros Rocchetto, MSc; Sabina Vittadello, MD; Roberto Mantovan, MD; Gianfilippo Neri, MD

    2014-08-01

    Full Text Available The tip-to-tissue contact force (CF has been identified as a potential determinant of lesion quality during radiofrequency (RF ablation. The aim of this paper is to report the experience of a single low-volume centre in the atrial fibrillation (AF ablation procedure with an RF catheter capable of measuring this parameter. CF data and their possible implications on patient safety are presented. Thirty-nine consecutive patients suffering of paroxysmal or permanent AF received percutaneous ablation with the novel catheter studied. Procedural characteristics, CF applied and safety events related to the procedure were reported. During RF application the mean CF value was 17 ± 3 g, with a maximum mean value of 37 ± 8 g. CF value never exceeds 62 g and in the 74% of the RF applications ranged between 10 g and 30 g. No complication related to the catheter manipulation or to the energy delivered was observed. This study of a single centre with a low level of experience in AF ablation suggests that the ability to measure CF may provide additional useful information to the operator. It ensures uniform ablations, with little variability in the catheter manipulations, and it avoids excessive contact forces increasing the patient safety.

  18. 2D/3D registration using only single-view fluoroscopy to guide cardiac ablation procedures: a feasibility study

    Science.gov (United States)

    Fallavollita, Pascal

    2010-02-01

    The CARTO XP is an electroanatomical cardiac mapping system that provides 3D color-coded maps of the electrical activity of the heart, however it is expensive and it can only use a single costly magnetic catheter for each patient intervention. Aim: To develop an affordable fluoroscopic navigation system that could shorten the duration of RF ablation procedures and increase its efficacy. Methodology: A 4-step filtering technique was implemented in order to project the tip electrode of an ablation catheter visible in single-view C-arm images in order to calculate its width. The width is directly proportional to the depth of the catheter. Results: For phantom experimentation, when displacing a 7- French catheter at 1cm intervals away from an X-ray source, the recovered depth using a single image was 2.05 +/- 1.47 mm, whereas depth errors improved to 1.55 +/- 1.30 mm when using an 8-French catheter. In clinic experimentation, twenty posterior and left lateral images of a catheter inside the left ventricle of a mongrel dog were acquired. The standard error of estimate for the recovered depth of the tip-electrode of the mapping catheter was 13.1 mm and 10.1 mm respectively for the posterior and lateral views. Conclusions: A filtering implementation using single-view C-arm images showed that it was possible to recover depth in phantom study and proved adequate in clinical experimentation based on isochronal map fusion results.

  19. 射频导管消融犬左束支电位对心脏电机械活动的影响%Effect of left bundle potential on cardiac electro-mechanical activity in dogs with radiofrequency catheter ablation

    Institute of Scientific and Technical Information of China (English)

    付柳静; 王冬梅; 梁延春; 于海波; 李世倍; 许国卿; 王祖禄; 韩雅玲

    2012-01-01

    目的 探讨射频导管消融犬左束支电位(LBP)对心脏传导及心功能的影响,以及犬左束支传导阻滞(LBBB)模型的制备方法.方法 应用射频消融导管在10只实验犬左心室内膜标测到LBP处进行消融,观察能否成功制备犬LBBB模型以及其对心脏传导的影响.对成功复制LBBB的模型犬应用超声心动图比较LBBB前后心脏收缩功能及舒张功能的变化.结果 10只犬接受LBP处消融后,8只(80%)成功制备LBBB模型.消融靶点处心房与心室电压比值<1:10,局部记录的LBP至心室电位间期为17.1±3.2(12~22)ms,消融后QRS波宽度由52.8±4.8ms增至100.5±11.1ms(P<0.001),而PR间期、AH间期、HV间期无明显变化.另外2只犬在LBP至心室电位间期分别为30ms、32ms处消融,导致完全性房室传导阻滞.8只犬发生LBBB后超声心动图检查示:收缩功能指标左室射血分数和主动脉血流速度积分降低(P<0.05);舒张功能指标E/A下降为<1,伴有等容舒张时间和二尖瓣减速时间延长(P<0.05);出现显著室间与室内不同步,表现为间隔后壁运动延迟及左右心室射血前期时间差明显延长(P<0.001).结论 射频导管消融左束支电位可导致LBBB,是制备犬LBBB模型成功率较高的方法,但有发生完全性房室传导阻滞的危险.LBBB即刻可导致左室激动延迟,左右室间及左室内收缩不同步,左心室收缩及舒张功能降低.%Objective To investigate the effect of left bundle branch potential (LBP) on cardiac conduction and function in dogs with radiofrequency catheter ablation, and explore method for reproducing left bundle branch block (LBBB) model in dogs. Methods LBP was mapped and ablated by radiofrequency catheter in the left ventricular endocardium in 10 dogs to observe whether LBBB model was prepared successfully. Echocardiography was performed before and after LBBB in the successfully-prepared LBBB models to study the systolic and diastolic function of

  20. Useful clinical features for the selection of ideal patients with strial fibrillation for mapping and catheter ablation

    Directory of Open Access Journals (Sweden)

    Mehta Niraj

    2002-01-01

    Full Text Available OBJECTIVE: To identify useful clinical characteristics for selecting patients eligible for mapping and ablation of atrial fibrillation. METHODS: We studied 9 patients with atrial fibrillation, without structural heart disease, associated with: 1 antiarrhythmic drugs, 2 symptoms of low cardiac output, and 3 intention to treat. Seven patients had paroxysmal atrial fibrillation and 2 had recurrent atrial fibrillation. RESULTS: In the 6 patients who underwent mapping (all had paroxysmal atrial fibrillation, catheter ablation was successfully carried out in superior pulmonary veins in 5 patients (the first 3 in the left superior pulmonary vein and the last 2 in the right superior pulmonary vein. One patient experienced a recurrence of atrial fibrillation after 10 days. We observed that patients who had short episodes of atrial fibrillation on 24-hour Holter monitoring before the procedure were those in whom mapping the focus of tachycardia was possible. Tachycardia was successfully suppressed in 4 of 6 patients. The cause of failure was due to the impossibility of maintaining sinus rhythm long enough for efficient mapping. CONCLUSION: Patients experiencing short episodes of atrial fibrillation during 24-hour Holter monitoring were the most eligible for mapping and ablation, with a final success rate of 66%, versus the global success rate of 44%. Patients with persistent atrial fibrillation were not good candidates for focal ablation.

  1. Verification of pulmonary vein isolation during single transseptal cryoballoon ablation: a comparison between the classical circular mapping catheter and the inner lumen mapping catheter

    NARCIS (Netherlands)

    Chierchia, G.B.; Namdar, M.; Sarkozy, A.; Sorgente, A.; Asmundis, C. de; Casado-Arroyo, R.; Capulzini, L.; Bayrak, F.; Rodriguez-Manero, M.; Ricciardi, D.; Rao, J.Y.; Overeinder, I.; Paparella, G.; Brugada, P.

    2012-01-01

    AIMS: Cryoballoon ablation has proven very effective in achieving pulmonary vein isolation (PVI). The novel Achieve inner lumen mapping catheter designed to be used in conjunction with the cryoballoon, serves as both a guidewire and a mapping catheter. To our knowledge, this is the first study compa

  2. Predictive value of HATCH score on atrial fibrillation recurrence post radiofrequency catheter ablation

    Institute of Scientific and Technical Information of China (English)

    缪丹丹

    2012-01-01

    Objective To determine the predictive value of HATCH score on recurrence of atrial fibrillation(AF) after radiofrequency catheter ablation (RFCA). Methods The data of 123 consecutive AF patients(74 paroxysmal and 49 persistent AF) who underwent RFCA between April 2009 and December 2010 in our department were retrospectively

  3. Reversal of premature ventricular complex-induced cardiomyopathy following successful radiofrequency catheter ablation.

    Science.gov (United States)

    Efremidis, Michalis; Letsas, Konstantinos P; Sideris, Antonios; Kardaras, Fotios

    2008-06-01

    Premature ventricular complex (PVC)-induced cardiomyopathy is an underappreciated cause of left-ventricular (LV) dysfunction. The present report describes the case of an elderly man with a very high burden of monomorphic PVCs and LV dysfunction. Elimination of the left ventricular focus following radiofrequency catheter ablation resulted in reversal of cardiomyopathy.

  4. Tissue temperatures and lesion size during irrigated tip catheter radiofrequency ablation: an in vitro comparison of temperature-controlled irrigated tip ablation, power-controlled irrigated tip ablation, and standard temperature-controlled ablation

    DEFF Research Database (Denmark)

    Petersen, H H; Chen, X; Pietersen, A;

    2000-01-01

    The limited success rate of radiofrequency catheter ablation in patients with ventricular tachycardias related to structural heart disease may be increased by enlarging the lesion size. Irrigated tip catheter ablation is a new method for enlarging the size of the lesion. It was introduced...... in the power-controlled mode with high power and high infusion rate, and is associated with an increased risk of crater formation, which is related to high tissue temperatures. The present study explored the tissue temperatures during temperature-controlled irrigated tip ablation, comparing it with standard...... temperature-controlled ablation and power-controlled irrigated tip ablation. In vitro strips of porcine left ventricular myocardium were ablated. Temperature-controlled irrigated tip ablation at target temperatures 60 degrees C, 70 degrees C, and 80 degrees C with infusion of 1 mL saline/min were compared...

  5. Optimization of Catheter Ablation of Atrial Fibrillation: Insights Gained from Clinically-Derived Computer Models

    Directory of Open Access Journals (Sweden)

    Jichao Zhao

    2015-05-01

    Full Text Available Atrial fibrillation (AF is the most common heart rhythm disturbance, and its treatment is an increasing economic burden on the health care system. Despite recent intense clinical, experimental and basic research activity, the treatment of AF with current antiarrhythmic drugs and catheter/surgical therapies remains limited. Radiofrequency catheter ablation (RFCA is widely used to treat patients with AF. Current clinical ablation strategies are largely based on atrial anatomy and/or substrate detected using different approaches, and they vary from one clinical center to another. The nature of clinical ablation leads to ambiguity regarding the optimal patient personalization of the therapy partly due to the fact that each empirical configuration of ablation lines made in a patient is irreversible during one ablation procedure. To investigate optimized ablation lesion line sets, in silico experimentation is an ideal solution. 3D computer models give us a unique advantage to plan and assess the effectiveness of different ablation strategies before and during RFCA. Reliability of in silico assessment is ensured by inclusion of accurate 3D atrial geometry, realistic fiber orientation, accurate fibrosis distribution and cellular kinetics; however, most of this detailed information in the current computer models is extrapolated from animal models and not from the human heart. The predictive power of computer models will increase as they are validated with human experimental and clinical data. To make the most from a computer model, one needs to develop 3D computer models based on the same functionally and structurally mapped intact human atria with high spatial resolution. The purpose of this review paper is to summarize recent developments in clinically-derived computer models and the clinical insights they provide for catheter ablation.

  6. 心腔内超声指导下消融左心室前组乳头肌起源的室性心律失常%Radiofrequency catheter ablation of ventricular arrhythmias originating from left ventricular anterior papillary muscle guided by intra-cardiac echocardiography

    Institute of Scientific and Technical Information of China (English)

    余金波; 杨兵; 张凤祥; 居维竹; 杨刚; 陈红武; 顾凯; 郦明芳; 陈明龙

    2015-01-01

    目的报道单中心应用心腔内超声( ICE)指导射频导管消融治疗特发性左心室前组乳头肌起源室性心律失常的标测与消融的结果。方法2012年2月至2013年8月在南京医科大学第一附属医院心血管内科行ICE指导下射频导管消融治疗左心室前组乳头肌起源室性心律失常患者6例。其中室性心动过速(室速)合并室性早搏(室早)者3例、频发室早者3例,男4例,女2例,年龄14~52(35.1±15.2)岁,均无器质性心脏病证据,3例患者既往有1~4次消融失败史。结果6例患者室速及室早均即刻消融成功,靶点处双极电图较体表QRS波起始提前20~30(24.8±4.1)ms,分别位于乳头肌尖端2例、中段2例及基底部各2例,其中3例患者在室速或室早时靶点处可记录到提前的高频电位。4例患者经动脉逆行途径消融成功,2例经动脉逆行途径失败后,经穿刺房间隔顺行法消融成功。平均随访(18.9±7.3)个月后,1例患者复发。所有患者均未出现并发症。结论应用ICE指导可提高左心室前组乳头肌起源室性心律失常消融成功率,部分患者需采用穿刺房间隔途径顺行法消融。%Objective To investigate the feasibility and efficacy of mapping and radiofrequency cathe-ter ablation( RFCA) of ventricular arrhythmias( VA) originating from the left ventricular anterior papillary mus-cle(LV-APM)guided by intra-cardiac echocardiography(ICE). Methods Six consecutive patients(4 men, aged from 14 to 52 years) without structural heart disease underwent catheter ablation of VA originating from the LV-APM guided by ICE. Results Three patients had premature ventricular contractions ( PVC ) , two patients had nonsustained ventricular tachycardia(VT)and PVC,the remain patient had sustained VT and PVC. Three patients had one to four times previous failed ablation guided by electroanatomic mapping system. All VA were successfully eliminated by catheter ablation. The earliest site of

  7. Impact of different ablation strategies on the delayed cure after trans-catheter ablation for treating patients with atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    DONG Jian-zeng; MA Chang-sheng; LIU Xing-peng; LONG De-yong; LIU Xiao-qing; WANG Jing; Fang Dong-ping; HAO Peng; LI Yong-sheng; LIU Chuang

    2005-01-01

    Background Delayed cure had been observed in recurrent cases after index ablation of atrial fibrillation (AF), however, its mechanism and incidence have not been elucidated in detail. This study aims to investigate the impact of different ablation strategies on the incidence of delayed cure and its possible mechanisms after trans-catheter ablation of AF. Methods One hundred and fifty-one consecutive cases with highly symptomatic, drug refractory AF were included in this study [M/F=109/42, mean age (56.0±11.2) (18-79) years]. Segmental pulmonary vein ablation (SPVA) was performed in 83 patients with the guidance of circular mapping catheter (SPVA Group), circumferential PV linear ablation (CPVA) was carried out in the rest 68 cases under the guidance of 3 dimensional mapping system in conjunction with circular mapping catheter (CPVA Group). Delayed cure was defined as that early recurrence of atrial tachyarrhythmias (AF, atrial tachycardia, or atrial flutter) after ablation procedure was no longer observed during subsequent follow-up, and stable sinus rhythm was maintained ≥2 months. Results Early recurrence of atrial tachyarrhythmias was detected in 41 cases from SPVA group and 23 cases from CPVA group, and delayed cure occurred in 21.9% (9/41) of the cases from SPVA group and 47.8% (11/23) of the cases from CPVA group, more delayed cure in later group was observed (P<0.05). Meanwhile, patients in SPVA group took a longer time to achieve a delayed cure [(27.0±18.0) days vs (14.0±8.1) days, P<0.05], and presented more recurrent episodes [(3.50±1.08) times a week vs (2.42±1.11) times a week, P<0.05]. However, recurrent episodes after index ablation were markedly decreased in cases with delayed cure from both groups (P<0.05). Conclusions Despite of an early recurrence of atrial tachyarrhythimas after index ablation of AF, delayed cure occurs in a significant number of patients undergoing either SPVA or CPVA. However, different ablation strategies place

  8. Acquiring Multiview C-Arm Images to Assist Cardiac Ablation Procedures

    Directory of Open Access Journals (Sweden)

    Pascal Fallavollita

    2010-01-01

    Full Text Available CARTO XP is an electroanatomical cardiac mapping system that provides 3D color-coded maps of the electrical activity of the heart; however it is expensive and it can only use a single costly magnetic catheter for each patient intervention. Our approach consists of integrating fluoroscopic and electrical data from the RF catheters into the same image so as to better guide RF ablation, shorten the duration of this procedure, increase its efficacy, and decrease hospital cost when compared to CARTO XP. We propose a method that relies on multi-view C-arm fluoroscopy image acquisition for (1 the 3D reconstruction of the anatomical structure of interest, (2 the robust temporal tracking of the tip-electrode of a mapping catheter between the diastolic and systolic phases and (3 the 2D/3D registration of color coded isochronal maps directly on the 2D fluoroscopy image that would help the clinician guide the ablation procedure much more effectively. The method has been tested on canine experimental data.

  9. Radiofrequency ablation with a vibrating catheter: A new method for electrode cooling.

    Science.gov (United States)

    Yu, Kaihong; Yamashita, Tetsui; Shingyochi, Shigeaki; Matsumoto, Kazuo; Ohta, Makoto

    2016-05-01

    A new electrode cooling system using a vibrating catheter is described for conditions of low blood flow when saline irrigation cannot be used. Vibrations of the catheter are hypothesized to disturb blood flow around the electrode, leading to increased convective cooling of the electrode. The aim of this study is to confirm the cooling effect of vibration and investigate the associated mechanisms. As methods, an in vitro system with polyvinyl alcohol-hydrogel (PVA-H) as ablated tissue and saline flow in an open channel was used to measure changes in electrode and tissue temperatures under vibration of 0-63 Hz and flow velocity of 0-0.1 m/s. Flow around the catheter was observed using particle image velocimetry (PIV). Results show that under conditions of no flow, electrode temperatures decreased with increasing vibration frequency, and in the absence of vibrations, electrode temperatures decreased with increasing flow velocity. In the presence of vibrations, electrode temperatures decreased under conditions of low flow velocity, but not under those of high flow velocity. PIV analyses showed disturbed flow around the vibrating catheter, and flow velocity around the catheter increased with higher-frequency vibrations. In conclusion, catheter vibration facilitated electrode cooling by increasing flow around the catheter, and cooling was proportional to vibration frequency.

  10. Robust tracking of a virtual electrode on a coronary sinus catheter for atrial fibrillation ablation procedures

    Science.gov (United States)

    Wu, Wen; Chen, Terrence; Strobel, Norbert; Comaniciu, Dorin

    2012-02-01

    Catheter tracking in X-ray fluoroscopic images has become more important in interventional applications for atrial fibrillation (AF) ablation procedures. It provides real-time guidance for the physicians and can be used as reference for motion compensation applications. In this paper, we propose a novel approach to track a virtual electrode (VE), which is a non-existing electrode on the coronary sinus (CS) catheter at a more proximal location than any real electrodes. Successful tracking of the VE can provide more accurate motion information than tracking of real electrodes. To achieve VE tracking, we first model the CS catheter as a set of electrodes which are detected by our previously published learning-based approach.1 The tracked electrodes are then used to generate the hypotheses for tracking the VE. Model-based hypotheses are fused and evaluated by a Bayesian framework. Evaluation has been conducted on a database of clinical AF ablation data including challenging scenarios such as low signal-to-noise ratio (SNR), occlusion and nonrigid deformation. Our approach obtains 0.54mm median error and 90% of evaluated data have errors less than 1.67mm. The speed of our tracking algorithm reaches 6 frames-per-second on most data. Our study on motion compensation shows that using the VE as reference provides a good point to detect non-physiological catheter motion during the AF ablation procedures.2

  11. Post-procedural Dabigatran Versus Interrupted Warfarin Therapy Following Catheter Ablation for Atrial Fibrillation

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    Jeffrey Lin, MD; Sharon Shen, MD; Prashant Bhave, MD; Bradley Knight, MD; Martha Bohn, RN, BSN; Evaldas Giedrimas, MD; Taral K. Patel, MD; Alexandru Chicos, MD; Jeffrey Goldberger, MD; Leonard Ilkhanoff, MD, MS; Susan Kim, MD; Albert Lin, MD; Rod Passman, MD, MSCE.

    2014-02-01

    Full Text Available Purpose: Patients undergoing catheter ablation for atrial fibrillation (AF are at a higher risk of thromboembolic events post-procedure and therefore require therapeutic anticoagulation after ablation. Anticoagulation strategies include performing the procedure on or off therapeutic warfarin, though the latter approach requires post-procedure bridging therapy with low molecular-weight heparin (LMWH until a therapeutic INR is achieved. The purpose of this study is to compare the safety and efficacy of post-ablation dabigatran as compared to warfarin with LMWH bridging. Methods: We performed a single-center retrospective analysis of consecutive patients who underwent catheter ablation for AF between January 2010 and December 2012 and received either post-procedure warfarin with a LMWH bridge or dabigatran. Warfarin was started the night of ablation; LMWH was started the next morning and continued until the INR was ≥ 2.0. Dabigatran was started the morning post-ablation. Results: The analysis included 324 patients. Of these, mean age was 60 ± 9 years, 78% were male, 81% had CHADS2 scores of 0 or 1, and 181 (56% received dabigatran post-ablation. Patients who received dabigatran had lower CHADS2 scores and were more likely to be in NYHA Class I. At 30-days post-procedure, there were 0 thromboembolic or bleeding complications in the dabigatran group versus 4 (2.8% in the warfarin group (p=0.037. There were no deaths in either group at 30 days post-ablation. Conclusions: Post-ablation dabigatran appears safe and efficacious compared to an interrupted warfarin strategy with LMWH bridging.

  12. Determination of lesion size by ultrasound during radiofrequency catheter ablation.

    Science.gov (United States)

    Awad, S; Eick, O

    2003-01-01

    The catheter tip temperature that is used to control the radiofrequency generator output poorly correlates to lesion size. We, therefore, evaluated lesions created in vitro using a B-mode ultrasound imaging device as a potential means to assess lesion generation during RF applications non-invasively. Porcine ventricular tissue was immersed in saline solution at 37 degrees C. The catheter was fixed in a holder and positioned in a parallel orientation to the tissue with an array transducer (7.5 MHz) app. 3 cm above the tissue. Lesions were produced either in a temperature controlled mode with a 4-mm tip catheter with different target temperatures (50, 60, 70 and 80 degrees C, 80 W maximum output) or in a power controlled mode (25, 50 and 75 W, 20 ml/min irrigation flow) using an irrigated tip catheter. Different contact forces (0.5 N, 1.0 N) were tested, and RF was delivered for 60 s. A total of 138 lesions was produced. Out of these, 128 could be identified on the ultrasound image. The lesion depth and volume was on average 4.1 +/- 1.6 mm and 52 +/- 53 mm3 as determined by ultrasound and 3.9 +/- 1.7 mm and 52 +/- 55 mm3 as measured thereafter, respectively. A linear correlation between the lesion size determined by ultrasound and that measured thereafter was demonstrated with a correlation coefficient of r = 0.87 for lesion depth and r = 0.93 for lesion volume. We conclude that lesions can be assessed by B-mode ultrasound imaging. PMID:12910859

  13. Outcome of catheter ablation of atrial fibrillation in patients with prior ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    LI Song-nan; KANG Jun-ping; DU Xin; HE Xiao-nan; LONG De-yong; YU Rong-hui; FANG Ri-bo

    2013-01-01

    Background Catheter ablation for atrial fibrillation (AF) has been demonstrated to be effective in a subsets of patients with AF.However,very few data are available in regard to patients with prior history of stroke undergoing catheter ablation.This study aimed to investigate the outcome of catheter ablation in AF patients with prior ischemic stroke.Methods Between January 2008 and December 2011,of 1897 consecutive patients who presented at Beijing An Zhen Hospital for treatment of drug-refractory AF,172 (9.1%) patients in the study population had a history of ischemic stroke.All patients underwent catheter ablation and were followed up to assess maintenance of sinus rhythm and recurrence of symptomatic stroke.Results Among these 1897 patients,1768 (93.2%) who had complete follow-up information for a minimum of six months were included in the final analysis.Patients in the stroke group (group Ⅰ) and the no-stroke group (group Ⅱ) were similar in regards to gender,body mass index (BMI),history of diabetes,type of AF,and left atrial size.The patients in group Ⅰ were older than those in group Ⅱ,and had a higher incidence of hypertension,chronic heart failure,lower left ventricular ejection fraction (LVEF),and higher CHADS2 scores.Six months after ablation,107 (68.6%) patients in group Ⅰ and 1403 (87.1%) in group Ⅱ had discontinued warfarin treatment (P <0.001).During a median follow-up of (633±415)days,65 patients in the group Ⅰ and 638 in group Ⅱ experienced AF recurrence,and five patients in group Ⅰ and 28 in group Ⅱ developed symptomatic stroke.The rates of AF recurrence and recurrent stroke were similar between group Ⅰ and group Ⅱ (41.7% vs.39.6%,P=-0.611; 3.2% vs.1.7%,P=0.219; respectively).Conclusion Catheter ablation of AF in patients with prior stroke is feasible and efficient.

  14. Radiofrequency catheter ablation of atrial tachycardias related to myocardial scar or incision

    Institute of Scientific and Technical Information of China (English)

    Jianqiang HU; Jiang CAO; Shengqiang WANG; Yongwen QIN; Bingyan ZHOU

    2006-01-01

    Intra-atrial re-entrant tachycardias (IARTs) are common late after heart surgery. Conventional mapping and ablation is relatively difficult because of the complicated anatomy and multiple potential re-entry loops. In this study we aimed to evaluate the electrophysiological characteristics and radiofrequency catheter ablation of atrial tachycardia (AT) induced by myocardial scar or incision. Methods In 6 patients (three male and three female, aged 33.3+ 11.8 years) who had AT related to myocardial scar or incision,electrophysiological study and radiofrequency catheter ablation (RFCA) were performed. Earliest activation combined with entrainment mapping was adopted to determine a critical isthmus. Results Re-entry related to the lateral atriotomy scar was inducible in 5 of6 patients. With entrainment mapping, the PPI (post-pacing interval)-TCL (tachycardia cycle length) difference was <30 ms when pacing at the inferior margins of the right lateral atriotomy scar. Among them, 3 patients had successful linear ablation between scar area to inferior vena cava, and 2 patients between scar area to tricuspid annulus. Re-entry involving an ASD patch was demonstrated in 1 of 6 patients. PPI-TCL differences <30 ms were observed when entraining tachycardia at sites near the septal patch. But linear ablation failed in terminating AT. There was no complication during procedure. No recurrence of AT related to incision was observed during follow-up except for the failed patient. Conclusion Under conventional electrophysiological mapping, adopting linear ablation from scar area to anatomic barrier, successful ablation can be obtained in patients with IRATs related to myocardial scar or incision.

  15. An event-driven distributed processing architecture for image-guided cardiac ablation therapy.

    Science.gov (United States)

    Rettmann, M E; Holmes, D R; Cameron, B M; Robb, R A

    2009-08-01

    Medical imaging data is becoming increasing valuable in interventional medicine, not only for preoperative planning, but also for real-time guidance during clinical procedures. Three key components necessary for image-guided intervention are real-time tracking of the surgical instrument, aligning the real-world patient space with image-space, and creating a meaningful display that integrates the tracked instrument and patient data. Issues to consider when developing image-guided intervention systems include the communication scheme, the ability to distribute CPU intensive tasks, and flexibility to allow for new technologies. In this work, we have designed a communication architecture for use in image-guided catheter ablation therapy. Communication between the system components is through a database which contains an event queue and auxiliary data tables. The communication scheme is unique in that each system component is responsible for querying and responding to relevant events from the centralized database queue. An advantage of the architecture is the flexibility to add new system components without affecting existing software code. In addition, the architecture is intrinsically distributed, in that components can run on different CPU boxes, and even different operating systems. We refer to this Framework for Image-Guided Navigation using a Distributed Event-Driven Database in Real-Time as the FINDER architecture. This architecture has been implemented for the specific application of image-guided cardiac ablation therapy. We describe our prototype image-guidance system and demonstrate its functionality by emulating a cardiac ablation procedure with a patient-specific phantom. The proposed architecture, designed to be modular, flexible, and intuitive, is a key step towards our goal of developing a complete system for visualization and targeting in image-guided cardiac ablation procedures.

  16. Unconscious sedation/analgesia with propofol versus conscious sedation with fentanyl/midazolam for catheter ablation of atrial fibrillation: a prospective, randomized study

    Institute of Scientific and Technical Information of China (English)

    TANG Ri-bo; MA Chang-sheng; DONG Jian-zeng; ZHAO Wen-du; LIU Xing-peng; KANG Jun-ping; LONG De-yong; YU Rong-hui; HU Fu-li; LIU Xiao-hui

    2007-01-01

    @@ Catheter ablation of atrial fibrillation (AF) has been increased dramatically recently.1 However, it is an unpleasant procedure with intolerable pain without sedation. Propofol and fentanyl/midazolam have been widely used in painful clinical examination and cardiovascular procedures with established safety and efficacy.2,3 Propofol, alfentanyl and midazolam were administrated for catheter ablation in some electrophysiological labs for a less painful procedure.4However, there is few published work on the sedation regimen for catheter ablation of AF.

  17. Ventricular Dyssynchrony and Function Improve following Catheter Ablation of Nonseptal Accessory Pathways in Children

    Directory of Open Access Journals (Sweden)

    Sylvia Abadir

    2013-01-01

    Full Text Available Introduction. Paradoxical or hypokinetic interventricular septal motion has been described in patients with septal or paraseptal accessory pathways. Data regarding nonseptal pathways is limited. Methods and Results. We quantified left ventricular dyssynchrony and function in 16 consecutive children, 14.2±3.7 years, weighing 53 ± 17 kg, prior to and following catheter ablation of bidirectional septal (N=6 and nonseptal (N=10 accessory pathways. Following ablation, the left ventricular ejection fraction increased by 4.9±2.1% (P=0.038 from a baseline value of 57.0%±7.8%. By tissue Doppler imaging, the interval between QRS onset and peak systolic velocity (Ts decreased from a median of 33.0 ms to 18.0 ms (P=0.013. The left ventricular ejection fraction increased to a greater extent following catheter ablation of nonseptal (5.9%±2.6%, P=0.023 versus septal (2.5%±4.1%, P=0.461 pathways. The four patients with an ejection fraction 50% after ablation. Similarly, the improvement in dyssynchrony was more marked in patients with nonseptal versus septal pathways (difference between septal and lateral wall motion delay before and after ablation 20.6±7.1 ms (P=0.015 versus 1.4±11.4 ms (P=0.655. Conclusion. Left ventricular systolic function and dyssynchrony improve after ablation of antegrade-conducting accessory pathways in children, with more pronounced changes noted for nonseptal pathways.

  18. Regional pericarditis status post cardiac ablation: A case report

    Directory of Open Access Journals (Sweden)

    Joseph Orme

    2014-01-01

    Full Text Available Context: Regional pericarditis is elusive and difficult to diagnosis. Healthcare providers should be familiar with post-cardiac ablation complications as this procedure is now widespread and frequently performed. The management of regional pericarditis differs greatly from that of acute myocardial infarction. Case report: A 52 year-old male underwent atrial fibrillation ablation and developed severe mid-sternal chest pain the following day with electrocardiographic findings suggestive of acute myocardial infarction, and underwent coronary angiography, a left ventriculogram, and 2D transthoracic echocardiogram, all of which were unremarkable without evidence of obstructive coronary disease, wall motion abnormalities, or pericardial effusions. Ultimately, the patient was diagnosed with regional pericarditis. After diagnosis, the patient′s presenting symptoms resolved with treatment including nonsteroidal anti-inflammatory agents and colchicine. Conclusion: This is the first reported case study of regional pericarditis status post cardiac ablation. Electrocardiographic findings were classic for an acute myocardial infarction; however, coronary angiography and left ventriculogram demonstrated no acute coronary occlusion or ventricular wall motion abnormalities. Healthcare professionals must remember that the electrocardiographic findings in pericarditis are not always classic and that pericarditis can occur status post cardiac ablation.

  19. Improvements in determination of cardiac output with a Swan-Ganz catheter.

    Science.gov (United States)

    Sakagami, M; Kuwana, K; Nakanishi, H; Sakai, K

    1990-01-01

    The time constant for heat transfer may affect exact determination of cardiac output with Swan-Ganz catheters. Commercially available Swan-Ganz catheters are provided with thermistors with varying time constants. Current monitoring of cardiac output is not corrected for these time constants, so the conventional method of determining cardiac output using the equation of Stewart-Hamilton produces marked errors. The authors propose a new method of determining cardiac output with Swan-Ganz catheters with varying time constants from thermal dilution curve data based on Newton's cooling law. Values for blood flow rate determined by the new method using a completely stirred tank of original design, mimicking the natural heart and using bovine blood, are almost the same as values observed at varying saline infusion volumes, saline temperatures, and saline infusion times.

  20. Stroke risk associated with balloon based catheter ablation for atrial fibrillation: Rationale and design of the MACPAF Study

    Directory of Open Access Journals (Sweden)

    Schultheiss Heinz-Peter

    2010-07-01

    Full Text Available Abstract Background Catheter ablation of the pulmonary veins has become accepted as a standard therapeutic approach for symptomatic paroxysmal atrial fibrillation (AF. However, there is some evidence for an ablation associated (silent stroke risk, lowering the hope to limit the stroke risk by restoration of rhythm over rate control in AF. The purpose of the prospective randomized single-center study "Mesh Ablator versus Cryoballoon Pulmonary Vein Ablation of Symptomatic Paroxysmal Atrial Fibrillation" (MACPAF is to compare the efficacy and safety of two balloon based pulmonary vein ablation systems in patients with symptomatic paroxysmal AF. Methods/Design Patients are randomized 1:1 for the Arctic Front® or the HD Mesh Ablator® catheter for left atrial catheter ablation (LACA. The predefined endpoints will be assessed by brain magnetic resonance imaging (MRI, neuro(psychological tests and a subcutaneously implanted reveal recorder for AF detection. According to statistics 108 patients will be enrolled. Discussion Findings from the MACPAF trial will help to balance the benefits and risks of LACA for symptomatic paroxysmal AF. Using serial brain MRIs might help to identify patients at risk for LACA-associated cerebral thromboembolism. Potential limitations of the study are the single-center design, the existence of a variety of LACA-catheters, the missing placebo-group and the impossibility to assess the primary endpoint in a blinded fashion. Trial registration clinicaltrials.gov NCT01061931

  1. Left ventricular papillary muscle ablation in canines by ultrasound ablation catheter%犬左室乳头肌的导管超声消融***★

    Institute of Scientific and Technical Information of China (English)

    王岐凤; 王志刚; 黄晶

    2013-01-01

    electrocardiogram was recorded. The abutting relationship between the catheter and papil ary muscle was adjusted with transthoracic echocardiography image in order to keep the excel ent contact between the catheter and papil ary muscle. Then, 50 W/cm² acoustic intensity was applied to ablate the papil ary muscle for 60 seconds. RESULTS AND CONCLUSION: Al the animals were normal y survived during the observation period, the anatomical structure of papil ary muscle was clearly displayed on the transthoracic echocardiography image, and the relative position and abutting relationship between catheter and papil ary muscle could be confirmed with the transthoracic echocardiography image. After cutting the animal myocardium, the ablation lesions in the papil ary muscle could be seen, which was white in central and light red around and a clear boundary with the surrounding normal myocardium. The clear boundary between ablation lesions and the surrounding tissues could be seen under light microscope, and many necrotic cardiomyocytes were observed in the ablation lesion which space was increased and infiltrated with red blood cel s. No associated complications of ablation (such as thromboembolism, myocardial burned or perforation and cardiac rupture) were detected. The catheter could achieve the ablation of deep papil ary muscle effectively and safely by transthoracic echocardiography real-time monitoring.

  2. Success of Radiofrequency Catheter Ablation of Atrial Fibrillation: Does Obesity Influence the Outcomes?

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    Dhanunjaya R. Lakkireddy

    2008-05-01

    Full Text Available Background Catheter ablation of atrial fibrillation (AF is an increasingly popular therapeutic option for symptomatic patients who have failed multiple antiarrhythmic drugs (AADs. Patients of higher body mass index often fail direct current cardioversion. The role of body mass index (BMI on the success of AF ablation is not well understood. Methods We prospectively studied 511 patients who underwent AF ablation at the Cleveland Clinic Foundation between 2002 and 2005. Patients were divided into four classes based on their BMI: Class I ( 25; Class II (25.1-30; Class III (30.1-35 and Class IV (>35. These groups were compared for baseline demographic and clinical characteristics. Any recurrence of AF after 3 months of ablation was considered as failure. All classes were followed for at least 12 months and rates of failure were compared. Results Based on their BMI, 25% of patients were assigned to class I, 37% in class II, 21% in class III and 16% in class IV. Patients of higher classification (class III or IV were more likely to be male (p<0.001, diabetic (p<0.001, smokers (p=0.002, with coronary artery disease (=0.018, left atrial enlargement (p=0.015 and longstanding AF (p=0.007. Severity of obesity as measured by BMI had a direct correlation to early (p=0.05 and late (p=0.01 recurrence of AF. Conclusion Obesity is significantly associated with long-term AF recurrence after catheter ablation. Higher incidence of smoking & left atrial enlargement may possibly contribute to higher failure rates in this sub-group of patients.

  3. Evaluation of left ventricular scar identification from contrast enhanced magnetic resonance imaging for guidance of ventricular catheter ablation therapy

    Science.gov (United States)

    Rettmann, M. E.; Lehmann, H. I.; Johnson, S. B.; Packer, D. L.

    2016-03-01

    Patients with ventricular arrhythmias typically exhibit myocardial scarring, which is believed to be an important anatomic substrate for reentrant circuits, thereby making these regions a key target in catheter ablation therapy. In ablation therapy, a catheter is guided into the left ventricle and radiofrequency energy is delivered into the tissue to interrupt arrhythmic electrical pathways. Low bipolar voltage regions are typically localized during the procedure through point-by-point construction of an electroanatomic map by sampling the endocardial surface with the ablation catheter and are used as a surrogate for myocardial scar. This process is time consuming, requires significant skill, and has the potential to miss low voltage sites. This has led to efforts to quantify myocardial scar preoperatively using delayed, contrast-enhanced MRI. In this paper, we evaluate the utility of left ventricular scar identification from delayed contrast enhanced magnetic resonance imaging for guidance of catheter ablation of ventricular arrhythmias. Myocardial infarcts were created in three canines followed by a delayed, contrast enhanced MRI scan and electroanatomic mapping. The left ventricle and myocardial scar is segmented from preoperative MRI images and sampled points from the procedural electroanatomical map are registered to the segmented endocardial surface. Sampled points with low bipolar voltage points visually align with the segmented scar regions. This work demonstrates the potential utility of using preoperative delayed, enhanced MRI to identify myocardial scarring for guidance of ventricular catheter ablation therapy.

  4. RADIOFREQUENCY CURRENT CATHETER ABLATION OF THE LEFT ATRIOVENTRICULAR ACCESSORY PATHWAYS WITH PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA

    Institute of Scientific and Technical Information of China (English)

    王静毅; 郭继鸿; 吴益明; 朱继红; 王伟民; 赵红; 刘喜荣; MichaelA.Lee

    1994-01-01

    Seventy patients with left atrioventricular accessory pathways and paroxysmal supraventricular tachycardia (PSVT) underwent radiofrequency catheter ablation (RFCA).The success rate was 94.3%.Among these pa-tients,26 had manifest preexcitation syndrome,and 44 had concealed preexcitation.Eighteen patients with con-cealed preexcitation underwent coronary sinus(CS) pacinga,and delta wave appeared in 15.The keys to successful RFCA were correct positioning of the radiofrequency (RF) catheter tip,A/V amplitude ratio,AV interval(in si-nus rhythm)and VA interval(during SVT or ventricular pacing).After 1-14 months of follow-up,two pa- tients had supraventricular tachycardia(SVT)recurrence.

  5. Development of a novel shock wave catheter ablation system--the first feasibility study in pigs.

    Directory of Open Access Journals (Sweden)

    Yuhi Hasebe

    Full Text Available Radio-frequency catheter ablation (RFCA using Joule heat has two fundamental weaknesses: the limited depth of treatment and the risk of thrombus formation. In contrast, focused shock wave (SW therapy could damage tissues at arbitrary depths without heat generation. Thus, we aimed to develop a SW catheter ablation (SWCA system that could compensate for the weaknesses of RFCA therapy.We developed a SWCA system where the SW generated by a Q-switched Holmium: yttrium aluminum garnet (YAG laser beam was reflected by a reflector attached to 14-Fr catheter tip and then was converged onto the focus. We examined the feasibility of our system on pigs in vivo. When applied using the epicardial approach, the SWCA caused persistent spheroidal lesions with mild superficial injury than the RFCA. The lesions were created to a depth based on the focal length (2.0 mm [2.36 ± 0.45 (SD mm immediately after procedure, n = 16]. When applied to the atrioventricular (AV node using the endocardial approach, the SWCA caused junctional escape rhythms in 2 pigs and AV block in 12 pigs (complete AV block in 9 in acute phase (n = 14. Nine of the 14 pigs survived with pacemakers for the long-term study, and the AV block persisted for 12.6 ± 3.9 (SD days in all surviving pigs. Histological examination showed AV nodal cell body atrophy in the acute phase and fibrotic lesions in the chronic phase. Importantly, no acute or chronic fatal complications were noted.Our novel SWCA system could be a promising modality as a non-thermal ablation method to compensate for the weaknesses of RFCA therapy. However, further research and development will be necessary as the current prototype still exhibited the presence of micro-thrombus formation in the animal studies.

  6. Modified multipurpose catheter enhances clinical utility for cardiac catheterizations.

    Science.gov (United States)

    Mannino, S C; Scavina, M; Palmer, S

    1994-10-01

    The Multipurpose technique for coronary arteriography employs a single catheter. The benefits are a reduction in the cost of the procedure and a shorter procedural time by experienced operators. To enhance the performance of these catheters, a modification was made in the materials and tip design, and these modifications were clinically evaluated in a small study. Compared to the control group of patients (n = 41), patients catheterized with the Multipurpose-SM (n = 43) were shown to have a shorter procedural time as measured by a reduced fluoroscopy time (7.08 min vs. 9.52 min, P = .007). This difference is statistically significant at a 95% confidence level and resulted in less radiation exposure to the operator and cath lab staff. The procedural time was significantly reduced by fewer catheter exchanges (19% study vs. 46% control; P = .006), which were needed to successfully complete the procedure. The new Multipurpose-SM catheter also demonstrated enhanced flexibility for cannulating coronary arteries with superior or anterior takeoffs. This study concludes that the utilization of a modified Multipurpose-SM catheter is safe and effective in cannulating both the left and right coronary arteries, bypass grafts, and performing left ventriculography. The primary benefits of using this modified catheter are reduced fluoroscopy time and the need for fewer catheter exchanges. PMID:7834732

  7. Prognostic impact of hs-CRP and IL-6 in patients undergoing radiofrequency catheter ablation for atrial fibrillation

    DEFF Research Database (Denmark)

    Henningsen, Kristoffer Mads Aaris; Nilsson, Brian; Bruunsgaard, Helle;

    2008-01-01

    months. Patients in SR had significantly lower left atrium diameter (p=0.007) and lower values of both IL-6 (p=0.007) and hs-CRP (p=0.018) at baseline before ablation. IL-6 concentration prior to ablation was an independent predictor of recurrent AF (p=0.027). Conclusion. In patients with a history...... of paroxysmal or persistent AF treated with RF catheter ablation, elevated levels of IL-6 and hs-CRP before ablation are independent predictors of recurrence of AF Udgivelsesdato: 2008/12/31...

  8. Radiofrequency Ablation of Accessory Pathways in Chil- dren with Complex Congenital Cardiac Lesions: A Report of Three Cases

    Directory of Open Access Journals (Sweden)

    Mohammad Dalili

    2015-10-01

    Full Text Available Catheter ablation is an accepted, highly effective modality of treatment for cardiac arrhythmias in children. The success rate depends on the operator’s experience, especially in cases involving complex anatomies. We hereby report our recent experience of successful ablation of accessory pathways in three children with complex congenital heart diseases.The first case was a 7-year-old girl with tricuspid atresia and a previous Glenn shunt, in whom a sub-epicardial overt accessory pathway was successfully ablated via the coronary sinus. The second case, a 9-year-old girl, received accessory pathway ablation via the fenestration of an extracardiac Fontan pathway. The third case was a 14-year-old boy with dextrocardia, common atrium, common ventricle, and a previous extracardiac Fontan operation, in whom ablation of a concealed accessory pathway was carried out retrogradely from the aorta. All the ablations were done in Rajaie Cardiovascular, Medical and Research Center, Tehran, and all the patients were discharged from the hospital without any complication.

  9. Impact of different termination modes on atrial fibrillation termination in catheter ablation of persistent atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    WANG Ping; MA Chang-sheng; DONG Jian-zeng; LONG De-yong; NING Man; TANG Ri-bo; YU Rong-hui; XUE Zeng-ming; SANG Cai-hua; JIANG Chen-xi

    2012-01-01

    Background The optimal endpoint for catheter ablation of persistent atrial fibrillation (AF) remains ambiguous.This study investigated the impact of AF termination as a procedural endpoint and the termination mode on long-term clinical outcome.Methods Two hundred and ninety-three patients who underwent stepwise ablation for persistent AF were categorized into the AF termination by ablation group and into the electrical cardioversion (CV) group.Subgroups were also analyzed based on different termination modes.Follow-up assessment included early recurrence and sinus rhythm (SR) maintenance.Results During initial ablation,33 patients (11.3%) were directly converted to SR,166 patients (56.7%) were converted to atrial tachycardia (AT) that subsequently restored SR with further ablation in 98 patients (33.4%),and a total of 162 patients (55.3%) underwent cardioversion due to persistent atrial arrhythmias.Comparison between termination by ablation and termination by cardioversion in patients exhibiting AF or AT revealed that no significant difference was observed in early recurrence (38.2% vs.43.8%,P=0.328) and SR maintenance (67.2% vs.59.8%,P=0.198) during the (23±7) months follow-up.Even after repeat ablation,the SR maintenance continued to exhibit no statistical difference in above two groups (72.5% vs.70.4%,P=0.686).Further analysis of subgroups,however,demonstrated that patients with AF terminated directly to SR experienced better clinical outcomes than other subgroups (P <0.05).Furthermore,atrial arrhythmias present during ablation have been implicated in prediction of recurrence mode:AF or AT (P <0.05).Conclusions Termination as a procedural endpoint is not associated with favorable long-term SR maintenance in persistent AF.AF methods that convert arrhythmia directly to SR have,however,been linked with improved clinical outcomes,although conversions to AT may not be correlated.Atrial arrhythmias observed during the ablation may be used to

  10. Structural and functional atrial remodeling in patients after catheter and surgical ablation of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Bockeria L.A.

    2016-03-01

    Full Text Available Atrial fibrillation (AF is the most common supraventricular arrhythmia which occurs in 1.5–2.0% of population. Morbidity of AF increased by 13% over the past two decades. Modern treatment of AF includes drug therapy, catheter radiofrequency ablation and various modifications of Cox Maze operations. The purpose of this review was to assess the atrial remodeling according to world literature. This involved a search of published articles in Medline, Web of Science, PubMed, Cochrane Central Register of Controlled Trials medical databases. During the primary stage of analysis 25 articles of 456 were identified. The researches carried out demonstrate that after catheter ablation and Cox Maze operation in patients with atrial fibrillation left atrium volume decrease, atrial contractile function improvment and sinus rhythm restoration are observed. In the absence of AF recurrence and postoperative atrial arrhythmias in early and late postoperative periods in some patients atrial remodeling is expressed. All data were confirmed by echocardiography, computer tomography and magnetic resonance imaging studies both before and after surgery.

  11. Radiofrequency catheter ablation: Relationship between fluoroscopic time and skin doses according to diagnoses. Basis to establish a quality assurance programme

    International Nuclear Information System (INIS)

    Radiofrequency Cardiac Catheter Ablation is an Interventional Radiology procedure of great complexity because the cardiologist needs a simultaneous evaluation of fluoroscopic images and electrophysiologic information. Therefore, the procedure typically involves extended fluoroscopic time that may cause radiation-skin injures to patients. Skin doses depend on many factors: equipment design features and its proper use, cardiologist practice, fluoroscopic time, irradiated areas, application of radiation protection recommendations, etc. We evaluate fluoroscopic time in relation to pathology and we estimate skin doses on 233 procedures at the Electrophysiology Laboratory in Casa de Galicia, Montevideo, Uruguay. Significant differences among the medians of fluoroscopic time were found in those procedures depending on diagnoses and results. Higher fluoroscopic time was found in flutter and auricular tachycardia (median was 83 minutes, p=0.0001). In successful procedures (almost 90%), median skin doses was 2.0 Grays (p=0.0001). On the basis of records information, the standard operating procedure and the clinical protocol, expanding close cooperation between the cardiologists and the experts in Radiation Protection will secure the establishment of an Assurance Quality Program. (author)

  12. Simulated evaluation of an intraoperative surface modeling method for catheter ablation by a real phantom simulation experiment

    Science.gov (United States)

    Sun, Deyu; Rettmann, Maryam E.; Packer, Douglas; Robb, Richard A.; Holmes, David R.

    2015-03-01

    In this work, we propose a phantom experiment method to quantitatively evaluate an intraoperative left-atrial modeling update method. In prior work, we proposed an update procedure which updates the preoperative surface model with information from real-time tracked 2D ultrasound. Prior studies did not evaluate the reconstruction using an anthropomorphic phantom. In this approach, a silicone heart phantom (based on a high resolution human atrial surface model reconstructed from CT images) was made as simulated atriums. A surface model of the left atrium of the phantom was deformed by a morphological operation - simulating the shape difference caused by organ deformation between pre-operative scanning and intra-operative guidance. During the simulated procedure, a tracked ultrasound catheter was inserted into right atrial phantom - scanning the left atrial phantom in a manner mimicking the cardiac ablation procedure. By merging the preoperative model and the intraoperative ultrasound images, an intraoperative left atrial model was reconstructed. According to results, the reconstruction error of the modeling method is smaller than the initial geometric difference caused by organ deformation. As the area of the left atrial phantom scanned by ultrasound increases, the reconstruction error of the intraoperative surface model decreases. The study validated the efficacy of the modeling method.

  13. Radiofrequency catheter ablation of idiopathic ventricular tachycardia and symptomatic premature ventricular contraction originating from valve annulus

    Institute of Scientific and Technical Information of China (English)

    WU Xiao-yu; LIANG Zhao-guang; TAN Zhen; GU Hong-yue; ZHANG Shu; LI Wei-min

    2008-01-01

    Background Radiofrequency catheter ablation (RFCA) has been established as an effective and curative therapy for ventricular tachycardia (VT) and severely symptomatic premature ventricular contraction (PVC) from the outflow tract in structurally normal hearts.This study aimed to investigate electrophysiologic characteristics and effects of RFCA for patients with idiopathic VT and symptomatic PVC originating from the valve annulus.Methods Characteristics of body surface electrocardiogram (ECG) and endocardiogram in a successful RFCA target were analyzed in 16 patients with idiopathic VT and symptomatic PVC originating from the valve annulus.Additionally,the ECG characteristics of vr or PVC were compared with those of manifest Wolff-Parkinson-White (WPW) syndrome originating from the same site of origin in 15 patients.Results Thirteen patients were successful,2 recurrent and 1 failed.The recurrent cases underwent successful ablation the second time guided by the Ensite 3000 mapping system.In all patients with the WPW syndrome,the characteristics of QRS morphology were well matched with those of the VT and PVC that originated from corresponding sites of origin.Conclusions RFCA is an effective curative therapy for VT and symptomatic PVC originating from the valve annulus.There are specific characteristics in ECG and the ablation site could be located by means of the WPW syndrome accessory pathway's algorithm.

  14. Patient specific optimization-based treatment planning for catheter-based ultrasound hyperthermia and thermal ablation

    Science.gov (United States)

    Prakash, Punit; Chen, Xin; Wootton, Jeffery; Pouliot, Jean; Hsu, I.-Chow; Diederich, Chris J.

    2009-02-01

    to model thermal ablation, including the addition of temperature dependent attenuation, perfusion, and tissue damage. Pilot point control at the target boundaries was implemented to control power delivery to each transducer section, simulating an approach feasible for MR guided procedures. The computer model of thermal ablation was evaluated on representative patient anatomies to demonstrate the feasibility of using catheter-based ultrasound thermal ablation for treatment of benign prostate hyperplasia (BPH) and prostate cancer, and to assist in designing applicators and treatment delivery strategies.

  15. Atrial conduction delay predicts atrial fibrillation in paroxysmal supraventricular tachycardia patients after radiofrequency catheter ablation.

    Science.gov (United States)

    Xu, Zhen-Xing; Zhong, Jing-Quan; Zhang, Wei; Yue, Xin; Rong, Bing; Zhu, Qing; Zheng, Zhaotong; Zhang, Yun

    2014-06-01

    This study aimed to assess whether intra- and inter-atrial conduction delay could predict atrial fibrillation (AF) for paroxysmal supraventricular tachycardia (PSVT) patients after successful treatment by radiofrequency catheter ablation (RFCA). Echocardiography examination was performed on 524 consecutive PSVT patients (15 patients were excluded). Left atrial dimension, right atrial diameter and intra- and inter-atrial conduction delay were measured before ablation. Patients were divided into group A (n = 32): occurrence of AF after the ablation and group B (n = 477): remained in sinus rhythm during follow-up. Receiver operating characteristic (ROC) curve analysis was performed to estimate the predictive value of intra- and inter-atrial conduction delay. Both intra- and inter-atrial conduction delay were higher in group A than in group B (4.79 ± 0.30 msec vs. 4.56 ± 0.32 msec; 21.98 ± 1.32 msec vs. 20.01 ± 1.33; p < 0.05). Binary logistic regression analysis showed that intra- and inter-atrial conduction were significant influential factors for the occurrence of AF (odds ratio [OR] = 13.577, 95% confidence interval [CI], 3.469-48.914; OR = 2.569, 95% CI, 1.909-3.459, p < 0.05). The ROC cure analysis revealed that intra-atrial conduction delay ≥ 4.45 msec and inter-atrial conduction delay ≥ 20.65 were the most optimal cut-off value for predicting AF in PSVT patients after RFCA. In conclusion, this is the first study to show that the intra- and inter-atrial conduction delay could effectively predict AF in post-ablation PSVT patients.

  16. Novel use of epidural catheter: Air injection for neuroprotection during radiofrequency ablation of spinal osteoid osteoma.

    Science.gov (United States)

    Doctor, J R; Solanki, S L; Patil, V P; Divatia, J V

    2016-01-01

    Osteoid osteoma (OO) is a benign bone tumor, with a male-female ratio of approximately 2:1 and mainly affecting long bones. Ten percent of the lesions occur in the spine, mostly within the posterior elements. Treatment options for OO include surgical excision and percutaneous imaging-guided radiofrequency ablation (RFA). Lesions within the spine have an inherent risk of thermal damage to the vital structure because of proximity to the neural elements. We report a novel use of the epidural catheter for air injection for the neuroprotection of nerves close to the OO of the spine. A 12-year-old and 30 kg male child with an OO of the L3 vertebra was taken up for RFA. His preoperative examinations were within normal limits. The OO was very close to the L3 nerve root. Under general anesthesia, lumbar epidural catheter was placed in the L3-L4 space under imaging guidance. Ten ml of aliquots of air was injected under imaging guidance to avoid injury to the neural structures due to RFA. The air created a gap between neural elements and the tumor and served as an insulating material thereby protecting the neural elements from damage due to the RFA. Postoperatively, the patient did not develop any neurological deficit. PMID:27375396

  17. Novel use of epidural catheter: Air injection for neuroprotection during radiofrequency ablation of spinal osteoid osteoma

    Science.gov (United States)

    Doctor, JR; Solanki, SL; Patil, VP; Divatia, JV

    2016-01-01

    Osteoid osteoma (OO) is a benign bone tumor, with a male-female ratio of approximately 2:1 and mainly affecting long bones. Ten percent of the lesions occur in the spine, mostly within the posterior elements. Treatment options for OO include surgical excision and percutaneous imaging-guided radiofrequency ablation (RFA). Lesions within the spine have an inherent risk of thermal damage to the vital structure because of proximity to the neural elements. We report a novel use of the epidural catheter for air injection for the neuroprotection of nerves close to the OO of the spine. A 12-year-old and 30 kg male child with an OO of the L3 vertebra was taken up for RFA. His preoperative examinations were within normal limits. The OO was very close to the L3 nerve root. Under general anesthesia, lumbar epidural catheter was placed in the L3-L4 space under imaging guidance. Ten ml of aliquots of air was injected under imaging guidance to avoid injury to the neural structures due to RFA. The air created a gap between neural elements and the tumor and served as an insulating material thereby protecting the neural elements from damage due to the RFA. Postoperatively, the patient did not develop any neurological deficit. PMID:27375396

  18. Surface evaluation of cardiac angiographic catheters after simulated use and reprocessing

    International Nuclear Information System (INIS)

    Reprocessing of single-use intravascular catheters is a common practice in public health services and hospitals. The determination of safe number of reprocessing cycles before the catheter integrity becomes compromised has been a priority issue. The present paper addresses the evaluating molecular and micro-structural integrity of reprocessed cardiac angiographic catheters. The Fourier Transform Infrared Spectroscopy and Scanning Electron Microscopy were carried out to elucidate morphological changes. The tensile test was performed on catheters to examine changes in bulk characteristics. In this work, samples of catheters were reprocessed until nine times and sterilized by hydrogen peroxide plasma. It was observed that the number of hydrogen-bonded carbonyls groups increased in 0.05 u.a. (p < 0.001) after each reprocessing cycle. The spectra indicated degradation products included acids, esters, alcohols, and small amounts of other products containing a carbonyl functional group. The micrographs revealed that only after the fourth reprocessing cycle the effect increased in the surface roughness was more pronounced. On the other hand, after each reprocessing cycle and as consequence of extensive aging of polyamide/polyurethane blends of the catheters surface, it was observed that the micro-fissures, micro-scratches and micro-pores increased in quantity and length. The mechanical test proved that the Young modulus increased in average 3.26 MPa (p = 0.0003) at increasing number of reprocessing cycles, also suggestive of crosslinking in this material.

  19. Prediction of Primary Slow-Pathway Ablation Success Rate According to the Characteristics of Junctional Rhythm Developed during the Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia

    Directory of Open Access Journals (Sweden)

    Maryam Moshkani Farahani

    2011-02-01

    Full Text Available Background: Nowadays, developed junctional rhythm (JR that occurs during slow-pathway radiofrequency (RF catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT has been focused upon as a highly sensitive surrogate end point for successful radiofrequency ablation. This study was conducted to assess the relationship between the presence and pattern of developed JR during the RF ablation of AVNRT and a successful outcome.Methods: Seventy-five patients aged between 14 and 88 who underwent slow-pathway RF ablation due to symptomatic AVNRT were enrolled into the study and received a total of 162 RF energy applications. Combined anatomic and electrogram mapping approach was used for slow-pathway RF ablation. The ablation procedure consisted of 60-second, 60 °C temperature-controlled energy delivery. After each ablation pulse, successful ablation was assessed according to the loss of AVNRT inducibility via isoproterenol infusion. Four different patterns were considered for the developed JR, namely sparse, intermittent, continuous, and transient block. Success ablation rate was assessed with respect to the position, pattern, and number of junctional beats.Results: Successful RF ablation with a loss of AVNRT inducibility was achieved in 43 (57.3% patients using 119 RF energy applications (73.5%. JR developed in 133 of the 162 (82.1% applications with a given sensitivity of 90.8% and low specificity of 41.9% as an end point of successful RF ablation, with a negative predictive value of 62.1%. The mean number of the developed junctional beats was significantly higher in the successful ablations (p value < 0.001, and the ROC analysis revealed that the best cut-off point of the cumulative junctional beats for identifying accurate AVNRT ablation therapy is 14 beats with 90.76 % sensitivity and 90.70% specificity. There were no significant differences in terms of successful ablation rates according to the four different patterns of JR and its

  20. Radiofrequency Ablation Mapping with Circumferential Catheter for Paroxys-mal Atrial Fibrillation Originating From the Pulmonary Veins

    Institute of Scientific and Technical Information of China (English)

    刘震; 吴书林; 杨平珍; 方咸宏; 李海杰; 陈泗林; 詹贤章; 薛玉梅

    2002-01-01

    Objectives To assessed thefeasibility and effectiveness of electrophysiologicalmapping of pulmonary veins with a circumferential 10-electrode catheter and radiofrequency catheter abla-tion therapy for patients with paroxysmal atrial fibril-lation. Background Standard mapping and ablationof focal sources of atrial fibrillation are associated withvery long procedure times and low efficacy. Mappingand ablation pulmonary veins guide with a circularcatheter could overcome these limitations. Methods16 patients [male 11, female 5, mean age (51 +14.5) years] with paroxysmal atrial fibrillation refrac-tory to antiarrhythmic drugs were included in thisgroup. A circumferential 10-electrode catheter wasused to pulmonary vein mapping during sinus rhythm orCSd pacing to determine the origin of atrial prematurecontractions. When the ablative target pulmonary veinwas found, the pulmonary vein potentials' distributionand activation were assessment pulmonary veins' ostialablation was performed at the segments showing earliestactivation of pulnonary vein potentials. The end pointwas designed: 1 ) elimination of pulmonary vein po-tential; 2) pulmonary vein potential dissociation fromatrial waves; 3) atrial ectopic beats disappear. ResultsA total of 36 pulmonary veins were ablated, in-cluding 16 left superior, 12 right superior, 7 left in-ferior and 1 right inferior. 1 pulmonary vein in 2 pa-tients was ablated, 2 pulmonary veins in 8 patientswere ablated, 3 pulmonary veins were ablated in 5patients and 4 pulmonary veins were ablated in 1 pa-tient. Procedure duration and fluoroscopy time respec-tively were 186.7 _+ 63.8 min and 51.5 + 15.0 min.During the follow-up 1- 12 months, 11 patients(68.7 % ) were free of AF without any antiarrhythmicdrugs, 2 of them were reablation, effective in 3/16(18.7%) and unsuccessful in 2/16 (12.6%) . 2cases recurred with atrial premature, 1 was treated withamiodarone and the other was repeat electrophysiologi-cal mapping and ablation, 5 cases with

  1. Catheter based radiofrequency ablation of renal nerves for the treatment of resistant hypertension

    Directory of Open Access Journals (Sweden)

    Markus P. Schlaich

    2013-03-01

    Full Text Available Introduction Resistant hypertension is a common and growing clinical problem characterized by the failure to attain target blood pressure levels despite adequate use of at least three antihypertensive agents. Objectives The aim of this article is to emphasize the role of novel approaches to treat resistant hypertension. Materials and methods After an excursus on the physiological role of renal nerves on kidney function, volume homeostasis and blood pressure control, this article describes the radiofrequency ablation technology to obtain kidneys denervation. Results Activation of the sympathetic nervous system plays a prominent role as a major regulator of circulatory and metabolic control. The kidneys have a particularly dense afferent sensory and efferent sympathetic innervation and are thereby strategically positioned to be origin as well as target of sympathetic activation. In this context, recent evidence suggests that a novel catheter-based approach to functionally denervate the human kidneys using radiofrequency ablation technology may provide a safe and effective treatment alternative for resistant hypertension and its adverse consequences. Conclusions Despite the availability of numerous safe and effective pharmacological therapies to treat elevated blood pressure, novel therapeutic approaches are warranted to improve the management and prognosis of patients with refractory hypertension. Several clinical trials are currently conducted and planned to further substantiate the blood pressure lowering efficacy of this novel renal denervation procedure.

  2. Serum uric acid levels correlate with recurrence of paroxysmal atrial fibrillation after catheter ablation

    Institute of Scientific and Technical Information of China (English)

    HE Xiao-nan; LI Song-nan; ZHAN Jin-liang; XIE Shuang-lun; ZHANG Zhi-jun; DONG Jian-zeng; YU Rong-hui

    2013-01-01

    Background Recently there has been a great deal of interest in the role of serum uric acid (SUA) in atrial fibrillation (AF).The objective of this study was to establish whether there is a relationship between levels of SUA and recurrence of paroxysmal AF after catheter ablation.Methods Three hundred and thirty patients diagnosed with paroxysmal AF were analyzed.Patients were categorized into quartiles on the basis of their pre-operative SUA measurement and follow-up,and Kaplan-Meier estimation with a Log-rank test was used for the analysis of the influence of SUA on the recurrence of AF.Pre-procedural clinical variables were correlated with the clinical outcome after ablation using multivariate Logistic analysis.A Cox proportional hazards model was used to estimate the relationship between SUA and the recurrence of AF.Results After a mean follow-up of (9.341±3.667) (range 3.0-16.3) months,recurrence rates from the lowest SUA quartile to the highest SUA quartile were 16.0%,26.4%,28.3%,and 29.3% respectively (P=0.014).After adjustment for gender,body mass index (BMI),hypertension,serum levels of high sensitivity C-reactive protein (hsCRP),triglyceride (TG),left atrial diameter (LA),estimated glomerular filtration rate (eGFR),and SUA,there was an increased risk of recurrence in subjects in the highest SUA quartile compared with those in the lowest quartile (hazard ratio 2.804,95% confidence interval 1.466-5.362,P=0.002).Following multivariate Logistical analysis,SUA was found to be an independent predictor of recurrence (hazard ratio 1.613,95% confidence interval 1.601-1.625,P=0.014).Conclusion In a retrospective study of patients with paroxysmal AF undergoing catheter ablation,elevated preoperative SUA levels were associated with a higher rate of recurrence of AF.

  3. Catheter fracture and cardiac migration of a totally implantable venous device

    Directory of Open Access Journals (Sweden)

    Kapadia Sumit

    2005-01-01

    Full Text Available Totally implantable venous devices (TIVD are increasingly being utilized for venous access for chemotherapy of oncological patients. These devices considerably improve the quality of life of patients requiring long-term chemotherapy. However, despite the great usefulness of TIVDs, their insertion and maintenance is not free of complications. Many early as well as late complications associated with these devices have been reported. We report an unusual, silent, but potentially hazardous complication of catheter fracture and cardiac migration in a 16-year-old girl, in whom the port had been unused for 9 months before presentation. Percutaneous retrieval was unsuccessful as the catheter end was embedded in the myocardium. The catheter was removed via a midline sternotomy without any further complications. We have also reviewed the literature about the possible mechanism of this complication and discussed methods to recognize and avoid it.

  4. An Endovascular Approach to the Entrapped Central Venous Catheter After Cardiac Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Desai, Shamit S., E-mail: shamit.desai@northwestern.edu [Northwestern Memorial Hospital, Department of Radiology (United States); Konanur, Meghana [Northwestern University Feinberg School of Medicine (United States); Foltz, Gretchen [Mallinckrodt Institute of Radiology at Washington University, Interventional Radiology (United States); Malaisrie, S. Chris [Northwestern Memorial Hospital, Department of Cardiothoracic Surgery (United States); Resnick, Scott, E-mail: sresnick@northwestern.edu [Northwestern University Feinberg School of Medicine, Department of Radiology, Interventional Radiology, Northwestern Memorial Hospital (United States)

    2016-03-15

    PurposeEntrapment of central venous catheters (CVC) at the superior vena cava (SVC) cardiopulmonary bypass cannulation site by closing purse-string sutures is a rare complication of cardiac surgery. Historically, resternotomy has been required for suture release. An endovascular catheter release approach was developed.Materials and MethodsFour cases of CVC tethering against the SVC wall and associated resistance to removal, suggestive of entrapment, were encountered. In each case, catheter removal was achieved using a reverse catheter fluoroscopically guided over the suture fixation point between catheter and SVC wall, followed by the placement of a guidewire through the catheter. The guidewire was snared and externalized to create a through-and-through access with the apex of the loop around the suture. A snare placed from the femoral venous access provided concurrent downward traction on the distal CVC during suture release maneuvers.ResultsIn the initial attempt, gentle traction freed the CVC, which fractured and was removed in two sections. In the subsequent three cases, traction alone did not release the CVC. Therefore, a cutting balloon was introduced over the guidewire and inflated. Gentle back-and-forth motion of the cutting balloon atherotomes successfully incised the suture in all three attempts. No significant postprocedural complications were encountered. During all cases, a cardiovascular surgeon was present in the interventional suite and prepared for emergent resternotomy, if necessary.ConclusionAn endovascular algorithm to the “entrapped CVC” is proposed, which likely reduces risks posed by resternotomy to cardiac surgery patients in the post-operative period.

  5. Do we need a pulmonary artery catheter in cardiac anesthesia? - An Indian perspective

    OpenAIRE

    Kanchi Muralidhar

    2011-01-01

    There has been considerable controversy regarding the use of pulmonary artery catheter (PAC) in clinical practice. Some studies have indicated poor outcome in patients who were monitored with PAC. However, these studies, which have condemned the use of PAC, were conducted on patients in intensive care units, where the clinical scenarios with regard to patients′ status are somewhat different as compared to those of a cardiac operating room. This study was designed to identify the indica...

  6. Acute and long term outcomes of catheter ablation using remote magnetic navigation for the treatment of electrical storm in patients with severe ischemic heart failure

    DEFF Research Database (Denmark)

    Jin, Qi; Jacobsen, Peter Karl; Pehrson, Steen;

    2015-01-01

    BACKGROUND: Catheter ablation with remote magnetic navigation (RMN) can offer some advantages compared to manual techniques. However, the relevant clinical evidence for how RMN-guided ablation affects electrical storm (ES) due to ventricular tachycardia (VT) in patients with severe ischemic heart...... failure (SIHF) is still limited. METHODS: Forty consecutive SIHF patients (left ventricular ejection fraction, 21 ± 6.9%) presenting with ES underwent ablation using RMN. All the patients received implantable cardioverter-defibrillators (ICDs) either before or after ablation. Acute ablation success...... before ablation (30% vs 69%, PRMN is safe and effective to suppress ES in SIHF patients. RMN...

  7. Fibrillation number based on wavelength and critical mass in patients who underwent radiofrequency catheter ablation for atrial fibrillation.

    Science.gov (United States)

    Hwang, Minki; Park, Junbeum; Lee, Young-Seon; Park, Jae Hyung; Choi, Sung Hwan; Shim, Eun Bo; Pak, Hui-Nam

    2015-02-01

    The heart characteristic length, the inverse of conduction velocity (CV), and the inverse of the refractory period are known to determine vulnerability to cardiac fibrillation (fibrillation number, FibN) in in silico or ex vivo models. The purpose of this study was to validate the accuracy of FibN through in silico atrial modeling and to evaluate its clinical application in patients with atrial fibrillation (AF) who had undergone radiofrequency catheter ablation. We compared the maintenance duration of AF at various FibNAF values using in silico bidomain atrial modeling. Among 60 patients (72% male, 54±13 years old, 82% with paroxysmal AF) who underwent circumferential pulmonary vein isolation (CPVI) for AF rhythm control, we examined the relationship between FibN AF and postprocedural AF inducibility or induction pacing cycle length (iPCL). Clinical FibNAF was calculated using left atrium (LA) dimension (echocardiogram), the inverse of CV, and the inverse of the atrial effective refractory periods measured at proximal and distal coronary sinus. In silico simulation found a positive correlation between AF maintenance duration and FibNAF ( R = 0.90, ). After clinical CPVI, FibNAF ( 0.296±0.038 versus 0.192±0.028, ) was significantly higher in patients with postprocedural AF inducibility ( n = 41) than in those without ( n = 19 ). Among 41 patients with postprocedural AF inducibility, FibNAF ( P = 0.935, ) had excellent correlations with induction pacing cycle length. FibNAF, based on LA mass and wavelength, correlates well with AF maintenance in computational modeling and clinical AF inducibility after CPVI. PMID:25343755

  8. Catheter ablation of atrial fibrillation in chronic heart failure: state-of-the-art and future perspectives.

    Science.gov (United States)

    Anselmino, Matteo; Matta, Mario; Castagno, Davide; Giustetto, Carla; Gaita, Fiorenzo

    2016-05-01

    Catheter ablation of atrial fibrillation (AFCA) is a widely recommended treatment for symptomatic atrial fibrillation (AF) patients refractory to pharmacological treatment. Catheter ablation of AF is becoming a therapeutic option also among patients with chronic heart failure (CHF), on top of optimal medical treatment, being this arrhythmia related to a higher risk of death and/or symptom's worsening. In fact, in this setting, clinical evidences are continuously increasing. The present systematic review pools all published experiences concerning AFCA among CHF patients, or patients with structural cardiomyopathies, in order to summarize procedural safety and efficacy in this specific population. Moreover, the effects of AFCA on functional class and quality of life and the different procedural protocols available are discussed. The present work, therefore, attempts to provide an evidence-based clinical perspective to optimize clinical indication and tailor procedural characteristics and endpoints to patients affected by CHF referred for AFCA. PMID:26857188

  9. Minimal use of fluoroscopy to reduce fetal radiation exposure during radiofrequency catheter ablation of maternal supraventricular tachycardia.

    Science.gov (United States)

    Raman, Ajay Sundara; Sharma, Saumya; Hariharan, Ramesh

    2015-04-01

    Electrophysiologic procedures in the young engender concern about the potential long-term effects of radiation exposure. This concern is manifold if such procedures are contemplated during pregnancy. Catheter ablations in pregnancy are indicated only in the presence of an unstable tachycardia that cannot be controlled by antiarrhythmic agents. This report describes the case of an 18-year-old pregnant woman and our stratagem to minimize irradiation of the mother and the fetus. PMID:25873828

  10. Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia guided by magnetic navigation system: a prospective randomized comparison with conventional procedure

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yu-xiao; LU Cai-yi; XUE Qiao; LI Ke; YAN Wei; ZHOU Sheng-hua

    2012-01-01

    Background Atrioventricular nodal reentrant tachycardia (AVNRT) is one of the most common paroxysmal supraventricular tachyarrhythmias.The aim of the study was to prospectively compare the characteristics of radiofrequency catheter ablation of AVNRT guided by a magnetic navigation system with the conventional procedure.Methods Patients with AVNRT diagnosed by electrophysiological tests were randomized into two groups.In the conventional technique group (CMT),a common 4-mm-tip quadrapolar temperature-controlled ablation catheter was used. In the magnetic navigation system guidance group (MNS), a magnetic 4-mm-tip quadrapolar temperature-controlled ablation catheter was used.The following parameters were collected and compared between the two groups: ablation procedure time,patient fluoroscopy time,operator fluoroscopy time,energy delivery numbers,maximal energy per deployment,success rate,complication rate and operative cost.Results Forty patients were enrolled and randomized into CMT and MNS groups.The age,gender,tachycardia history and basic cardiovascular diseases of the two groups were comparable (P >0.05).All procedures were conducted successfully without complications.No tachycardia recurred during the follow-up period of (9.3±2.6) months.In the MNS group,the patient and operator fluoroscopy times ((11.5±4.3) min,(4.2±1.5) min),energy delivery numbers (3.2±0.9),and maximal energy per deployment ((16.9±3.4) W) were shorter or lower than those of the CMT group ((14.3±6.2) min,(13.6±3.5) min,6.3±2.1,(23.7±1.3) W,respectively) (P <0.05).But the operative cost for the MNS group was higher than that of the CMT group (P <0.01 ).Conclusion Magnetic navigation system guided radiofrequency catheter ablation of AVNRT has the advantages of shorter fluoroscopy time and lower energy delivery numbers and maximal energy per deployment compared to the present conventional ablation technique.

  11. Do we need a pulmonary artery catheter in cardiac anesthesia? - An Indian perspective

    Directory of Open Access Journals (Sweden)

    Kanchi Muralidhar

    2011-01-01

    Full Text Available There has been considerable controversy regarding the use of pulmonary artery catheter (PAC in clinical practice. Some studies have indicated poor outcome in patients who were monitored with PAC. However, these studies, which have condemned the use of PAC, were conducted on patients in intensive care units, where the clinical scenarios with regard to patients′ status are somewhat different as compared to those of a cardiac operating room. This study was designed to identify the indications of PAC use in cardiac operating rooms. A questionnaire was mailed to anasthesiologists in cardiac centers and the response was analyzed.The practicing cardiac anesthesiologists recommended the use of PAC for following indications in cardiac surgery: coronary artery bypass grafting (CABG with poor left ventricular (LV function, LV aneurysmectomy, recent myocardial infarction (MI, pulmonary hypertension, diastolic dysfunction, acute ventricular septal rupture and insertion of left ventricular assist device (LVAD.The analysis of responses from practicing anesthesiologists clearly indicates that use of a PAC cannot be recommended as a matter of routine, but a definite role is suggested in selected groups of patients undergoing cardiac surgery.

  12. Cardiac shear-wave elastography using a transesophageal transducer: application to the mapping of thermal lesions in ultrasound transesophageal cardiac ablation

    Science.gov (United States)

    Kwiecinski, Wojciech; Bessière, Francis; Constanciel Colas, Elodie; Apoutou N'Djin, W.; Tanter, Mickaël; Lafon, Cyril; Pernot, Mathieu

    2015-10-01

    Heart rhythm disorders, such as atrial fibrillation or ventricular tachycardia can be treated by catheter-based thermal ablation. However, clinically available systems based on radio-frequency or cryothermal ablation suffer from limited energy penetration and the lack of lesion’s extent monitoring. An ultrasound-guided transesophageal device has recently successfully been used to perform High-Intensity Focused Ultrasound (HIFU) ablation in targeted regions of the heart in vivo. In this study we investigate the feasibility of a dual therapy and imaging approach on the same transesophageal device. We demonstrate in vivo that quantitative cardiac shear-wave elastography (SWE) can be performed with the device and we show on ex vivo samples that transesophageal SWE can map the extent of the HIFU lesions. First, SWE was validated with the transesophageal endoscope in one sheep in vivo. The stiffness of normal atrial and ventricular tissues has been assessed during the cardiac cycle (n=11 ) and mapped (n= 7 ). Second, HIFU ablation has been performed with the therapy-imaging transesophageal device in ex vivo chicken breast samples (n  =  3), then atrial (left, n= 2 ) and ventricular (left n=1 , right n=1 ) porcine heart tissues. SWE provided stiffness maps of the tissues before and after ablation. Areas of the lesions were obtained by tissue color change with gross pathology and compared to SWE. During the cardiac cycle stiffness varied from 0.5   ±   0.1 kPa to 6.0   ±   0.3 kPa in the atrium and from 1.3   ±   0.3 kPa to 13.5   ±   9.1 kPa in the ventricles. The thermal lesions were visible on all SWE maps performed after ablation. Shear modulus of the ablated zones increased to 16.3   ±   5.5 kPa (versus 4.4   ±   1.6 kPa before ablation) in the chicken breast, to 30.3   ±   10.3 kPa (versus 12.2   ±   4.3 kPa) in the atria and to 73.8   ±   13

  13. Cardiac shear-wave elastography using a transesophageal transducer: application to the mapping of thermal lesions in ultrasound transesophageal cardiac ablation.

    Science.gov (United States)

    Kwiecinski, Wojciech; Bessière, Francis; Colas, Elodie Constanciel; N'Djin, W Apoutou; Tanter, Mickaël; Lafon, Cyril; Pernot, Mathieu

    2015-10-21

    Heart rhythm disorders, such as atrial fibrillation or ventricular tachycardia can be treated by catheter-based thermal ablation. However, clinically available systems based on radio-frequency or cryothermal ablation suffer from limited energy penetration and the lack of lesion's extent monitoring. An ultrasound-guided transesophageal device has recently successfully been used to perform High-Intensity Focused Ultrasound (HIFU) ablation in targeted regions of the heart in vivo. In this study we investigate the feasibility of a dual therapy and imaging approach on the same transesophageal device. We demonstrate in vivo that quantitative cardiac shear-wave elastography (SWE) can be performed with the device and we show on ex vivo samples that transesophageal SWE can map the extent of the HIFU lesions. First, SWE was validated with the transesophageal endoscope in one sheep in vivo. The stiffness of normal atrial and ventricular tissues has been assessed during the cardiac cycle (n = 11) and mapped (n = 7). Second, HIFU ablation has been performed with the therapy-imaging transesophageal device in ex vivo chicken breast samples (n  =  3), then atrial (left, n = 2) and ventricular (left n = 1, right n = 1) porcine heart tissues. SWE provided stiffness maps of the tissues before and after ablation. Areas of the lesions were obtained by tissue color change with gross pathology and compared to SWE. During the cardiac cycle stiffness varied from 0.5   ±   0.1 kPa to 6.0   ±   0.3 kPa in the atrium and from 1.3   ±   0.3 kPa to 13.5   ±   9.1 kPa in the ventricles. The thermal lesions were visible on all SWE maps performed after ablation. Shear modulus of the ablated zones increased to 16.3   ±   5.5 kPa (versus 4.4   ±   1.6 kPa before ablation) in the chicken breast, to 30.3   ±   10.3 kPa (versus 12.2   ±   4.3 kPa) in the atria and to 73.8

  14. Low Cardiac Output Secondary to a Malpositioned Umbilical Venous Catheter: Value of Targeted Neonatal Echocardiography

    Directory of Open Access Journals (Sweden)

    Dany E. Weisz

    2014-05-01

    Full Text Available Systemic hypotension is common in very low birthweight preterm infants but the nature of the precipitating cause may be unclear. Targeted neonatal echocardiography (TnEcho is being increasingly used to support hemodynamic decisions in the neonatal intensive care unit (NICU, including identifying impairments in the transitional circulation of preterm infants, providing timely re-evaluation after institution of therapies and evaluating the placement of indwelling catheters. We present a case of a preterm infant with systemic hypotension and low cardiac output secondary to a large transatrial shunt induced by a malpositioned umbilical venous catheter. Repositioning of the line led to resolution of the hemodynamic disturbance and clinical instability, highlighting the utility of TnEcho in the NICU.

  15. Effective dose analysis of three-dimensional rotational angiography during catheter ablation procedures

    Science.gov (United States)

    Wielandts, J.-Y.; Smans, K.; Ector, J.; De Buck, S.; Heidbüchel, H.; Bosmans, H.

    2010-02-01

    There is increasing use of three-dimensional rotational angiography (3DRA) during cardiac ablation procedures. As compared with 2D angiography, a large series of images are acquired, creating the potential for high radiation doses. The aim of the present study was to quantify patient-specific effective doses. In this study, we developed a computer model to accurately calculate organ doses and the effective dose incurred during 3DRA image acquisition. The computer model simulates the exposure geometry and uses the actual exposure parameters, including the variation in tube voltage and current that is realized through the automatic exposure control (AEC). We performed 3DRA dose calculations in 42 patients referred for ablation on the Siemens Axiom Artis DynaCT system (Erlangen, Germany). Organ doses and effective dose were calculated separately for all projections in the course of the C-arm rotation. The influence of patient body mass index (BMI), dose-area product (DAP), collimation and dose per frame (DPF) rate setting on the calculated doses was also analysed. The effective dose was found to be 5.5 ± 1.4 mSv according to ICRP 60 and 6.6 ± 1.8 mSv according to ICRP 103. Effective dose showed an inversely proportional relationship to BMI, while DAP was nearly BMI independent. No simple conversion coefficient between DAP and effective dose could be derived. DPF reduction did not result in a proportional effective dose decrease. These paradoxical findings were explained by the settings of the AEC and the limitations of the x-ray tube. Collimation reduced the effective dose by more than 20%. Three-dimensional rotational angiography is associated with a definite but acceptable radiation dose that can be calculated for all patients separately. Their BMI is a predictor of the effective dose. The dose reduction achieved with collimation suggests that its use is imperative during the 3DRA procedure.

  16. Effective dose analysis of three-dimensional rotational angiography during catheter ablation procedures

    Energy Technology Data Exchange (ETDEWEB)

    Wielandts, J-Y; Ector, J; De Buck, S; Heidbuechel, H [Department of Electrophysiology-Cardiology, University Hospital Gasthuisberg, 49, Herestraat, 3000-Leuven (Belgium); Smans, K [Belgian Nuclear Research Centre (SCK-CEN), Radiation Protection, Dosimetry and Calibration, Boeretang, 2400-Mol (Belgium); Bosmans, H [Department of Radiology, University Hospital Gasthuisberg, 49, Herestraat, 3000-Leuven (Belgium)], E-mail: jean-yves.wielandts@uz.kuleuven.ac.be

    2010-02-07

    There is increasing use of three-dimensional rotational angiography (3DRA) during cardiac ablation procedures. As compared with 2D angiography, a large series of images are acquired, creating the potential for high radiation doses. The aim of the present study was to quantify patient-specific effective doses. In this study, we developed a computer model to accurately calculate organ doses and the effective dose incurred during 3DRA image acquisition. The computer model simulates the exposure geometry and uses the actual exposure parameters, including the variation in tube voltage and current that is realized through the automatic exposure control (AEC). We performed 3DRA dose calculations in 42 patients referred for ablation on the Siemens Axiom Artis DynaCT system (Erlangen, Germany). Organ doses and effective dose were calculated separately for all projections in the course of the C-arm rotation. The influence of patient body mass index (BMI), dose-area product (DAP), collimation and dose per frame (DPF) rate setting on the calculated doses was also analysed. The effective dose was found to be 5.5 {+-} 1.4 mSv according to ICRP 60 and 6.6 {+-} 1.8 mSv according to ICRP 103. Effective dose showed an inversely proportional relationship to BMI, while DAP was nearly BMI independent. No simple conversion coefficient between DAP and effective dose could be derived. DPF reduction did not result in a proportional effective dose decrease. These paradoxical findings were explained by the settings of the AEC and the limitations of the x-ray tube. Collimation reduced the effective dose by more than 20%. Three-dimensional rotational angiography is associated with a definite but acceptable radiation dose that can be calculated for all patients separately. Their BMI is a predictor of the effective dose. The dose reduction achieved with collimation suggests that its use is imperative during the 3DRA procedure.

  17. Influence of age and gender on complications of catheter ablation for atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Giuseppe Stabile; Emanuele Bertaglia; Carlo Pappone; Sakis Themistoclakis; Claudio Tondo; Alessandro Zorzi; Matteo Anselmino

    2015-04-01

    Full Text Available Background. Despite catheter ablation (CA has become an accepted treatment option for symptomatic, drug-resistant atrial fibrillation (AF, safety of this procedure continues to be cause for concern. Objective. Aim of the present multicenter study was to assess the influence of age and gender on incidence and severity of early CA complications. Methods. From January 1, 2011 to December 31, 2011, data from 2,323 consecutive patients who underwent CA (mean age 59.1+10.9; 72.3% male for AF in 29 Italian centres were collected. All complications occurring to the patients from admission to 30th post-procedural day were recorded. Results. Complications occurred in 94 patients (4.0%; of these 7 (0.30% developed permanent sequelae. There was a significant trend toward a greater incidence of complications with increasing age-group. In particular, the incidence of complications was 35/1066 (3.3% in patients 60 year-old (p=0.03. All 7 patients with permanent sequeale were older than 60. Females had a higher incidence of complications both among younger [13/231 (5.6% vs 22/915 (2.5%, p=0.02] and older patients [32/405 (7.9% vs 27/739 (3.5% p=0.001]. In subjects older than 60, 5/405 (1.2% females and 2/176 (0.3% males (p=0.04 suffered from permanent sequelae. Conclusion: In patients younger than 60 year-old CA of AF appears safe with a very low incidence (3.1% of complications and absence of permanent sequelae. Females are at higher risk in all age groups.

  18. 心房颤动导管消融:更上一层楼%Catheter ablation of atrial fibrillation: attain a higher stage

    Institute of Scientific and Technical Information of China (English)

    马长生; 陈新

    2010-01-01

    @@ 十余年来,心房颤动(房颤)导管消融已经从一项探索中的技术发展为广泛应用的房颤治疗方法,其进展日新月异.目前,房颤导管消融的技术更成熟,风险效益比更明确,普及更广泛,已然进入了快速发展的成熟时期.%Catheter ablation has emerged as an effective rhythm control solution for atrial fibrillation (AF). It was proved by recently published randomized studies that catheter ablation was superior to antiarrhythmic drugs in sinus rhythm maintenance. It was also shown that catheter ablation could reduce the incidence of stroke in patients with AF. With regard to these new evidences,it is recommended that catheter ablation of AF can be chosen as a first-line theray in selected patients in national and international guidelines for management of AF. Catheter ablation of AF is marching on a new stage.

  19. MODERN APPROACHES TO ANTICOAGULANT THERAPY DURING CATHETER ABLATION TREATMENT OF NON-VALVULAR ATRIAL FIBRILLATION

    OpenAIRE

    E. A. Belikov; K. V. Davtyan; O. N. Tkacheva

    2015-01-01

    Prevention of thromboembolic complications in patients with atrial fibrillation during catheter pulmonary veins isolation is discussed. This subject review is presented with special consideration to new anticoagulants.

  20. Acute fatal pulmonary vein occlusion after catheter ablation of atrial fibrillation

    DEFF Research Database (Denmark)

    Nilsson, Brian; Chen, Xu; Pehrson, Steen;

    2004-01-01

    the ablation procedure. Selective autopsy of the left lung revealed diffuse alveolar damage, disseminated intravascular coagulation, multiple thrombi formation, and haemorrhagic infarctions. CONCLUSIONS: PV stenosis may occur very early after the ablation procedure. Delayed diagnosis can be fatal. The early...

  1. Atrial rhythm influences catheter tissue contact during radiofrequency catheter ablation of atrial fibrillation: comparison of contact force between sinus rhythm and atrial fibrillation.

    Science.gov (United States)

    Matsuda, Hisao; Parwani, Abdul Shokor; Attanasio, Philipp; Huemer, Martin; Wutzler, Alexander; Blaschke, Florian; Haverkamp, Wilhelm; Boldt, Leif-Hendrik

    2016-09-01

    Catheter tissue contact force (CF) is an important factor for durable lesion formation during radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Since CF varies in the beating heart, atrial rhythm during RFCA may influence CF. A high-density map and RFCA points were obtained in 25 patients undergoing RFCA of AF using a CF-sensing catheter (Tacticath, St. Jude Medical). The operators were blinded to the CF information. Contact type was classified into three categories: constant, variable, and intermittent contact. Average CF and contact type were analyzed according to atrial rhythm (SR vs. AF) and anatomical location. A total of 1364 points (891 points during SR and 473 points during AF) were analyzed. Average CFs showed no significant difference between SR (17.2 ± 11.3 g) and AF (17.2 ± 13.3 g; p = 0.99). The distribution of points with an average CF of ≥20 and <10 g also showed no significant difference. However, the distribution of excessive CF (CF ≥40 g) was significantly higher during AF (7.4 %) in comparison with SR (4.2 %; p < 0.05). At the anterior area of the right inferior pulmonary vein (RIPV), the average CF during AF was significantly higher than during SR (p < 0.05). Constant contact was significantly higher during AF (32.2 %) when compared to SR (9.9 %; p < 0.01). Although the average CF was not different between atrial rhythms, constant contact was more often achievable during AF than it was during SR. However, excessive CF also seems to occur more frequently during AF especially at the anterior part of RIPV.

  2. Unintended Thermal Injuries from Radiofrequency Ablation: Organ Protection with an Angioplasty Balloon Catheter in an Animal Model

    Directory of Open Access Journals (Sweden)

    Martha-Grace Knuttinen

    2014-01-01

    Full Text Available Objectives: The aim of this study was to investigate a novel approach of using a balloon catheter as a protective device to separate liver from the diaphragm or nearby bowel during radiofrequency ablation (RFA of hepatic dome tumors in an animal model. Materials and Methods: All experimental procedures were approved by animal Institutional Review Board. Using a 3 cm RF needle electrode, 70 hepatic ablation zones were created using ultrasound in 7 pigs. 50 lesions were created using balloon interposition between liver and diaphragm; 20 lesions were created using the balloon device interposed posteriorly between liver and bowel. Additional 21 control lesions were performed. Animals were sacrificed immediately; diaphragm and bowel were then visually inspected and sectioned. Diaphragmatic and bowel injury was then classified according to the depth of thickness. Results: Control lesions caused full thickness injury, either to diaphragm or bowel. During ablation of lesions with balloon interposition, there was significantly less diaphragmatic injury, P < 0.001 and less bowel injury, P < 0.01. Conclusion: Using balloon interposition as a protective device has advantages over previous saline infusion or CO 2 insufflation, providing a safe way to expand percutaneous RFA of liver tumors located on the undersurface of the diaphragm. In addition, this method may be used in protection of other organs adjacent to areas being ablated.

  3. Catheter-Based Educational Experiences: A Canadian Survey of Current Residents and Recent Graduates in Cardiac Surgery.

    Science.gov (United States)

    Juanda, Nadzir; Chan, Vincent; Chan, Ryan; Rubens, Fraser D

    2016-03-01

    The past decade has witnessed significant developments in the use of catheter-based therapies in cardiovascular medicine. We sought to assess the educational opportunities for cardiac surgery trainees to determine their readiness for participation in these strategies. A web-based survey was distributed to current residents, recent graduates, and program directors in Canadian cardiac surgery residency programs from 2008-2013. The survey was distributed to 110 residents and graduates. Forty-five percent completed the survey. Thirty-five percent expressed that they experienced resistance organizing their rotations because they had to compete with non-cardiac surgery colleagues, and 6 were denied local cardiac catheterization rotations. By the end of the rotation, 56% were comfortable performing a diagnostic cardiac catheterization independently. Exposure to being the operator performing diagnostic catheterization was significantly associated with the positive perception of being able to perform a diagnostic catheterization independently (odds ratio [OR], 5.14; 95% confidence interval [CI], 1.33-19.81; P = 0.017). Eighty-eight percent of respondents expressed the need for more exposure in catheter-based rotations. Seven of 11 program directors completed the survey. All believed such rotations should be mandatory and foresaw a bigger role for hybrid catheter-based/cardiac surgery procedures in the future. Trainees and program directors perceive that increased exposure to catheter-based therapies is important to career development as a cardiac surgeon. This survey will contribute to the development of a cardiac surgery training curriculum as we foresee more hybrid and team procedures.

  4. Useful clinical features for the selection of ideal patients with strial fibrillation for mapping and catheter ablation

    OpenAIRE

    Mehta Niraj; Távora Maria Zildany Pinheiro; Takeschita Noriaki; Figueiredo Edilberto; Lourenço Ricardo M.; Germiniani Hélio; Précoma Dalton

    2002-01-01

    OBJECTIVE: To identify useful clinical characteristics for selecting patients eligible for mapping and ablation of atrial fibrillation. METHODS: We studied 9 patients with atrial fibrillation, without structural heart disease, associated with: 1) antiarrhythmic drugs, 2) symptoms of low cardiac output, and 3) intention to treat. Seven patients had paroxysmal atrial fibrillation and 2 had recurrent atrial fibrillation. RESULTS: In the 6 patients who underwent mapping (all had paroxysmal atrial...

  5. Effect of Radiofrequency Catheter Ablation on Quality of Life in Patients with Wolff-Parkinson-White Syndrome

    Directory of Open Access Journals (Sweden)

    Shokhrukh Erkaboev

    2015-09-01

    Full Text Available Wolff-Parkinson-White (WPW syndrome is one of several disorders of the conduction system of the heart that are commonly referred to as pre-excitation syndromes. As the syndrome significantly reduces the patients’ quality of life (QoL, the purpose of the current study was to compare QoL scores in patients with WPW syndrome before and after a radiofrequency catheter ablation (RFA procedure. To assess the patients’ QoL, the MOS 36-Item Short-Form Health Survey was used. Immediate and long-term outcomes of radiofrequency catheter ablation were analyzed in 60 patients diagnosed with WPW syndrome, 41(68.3% men and 19(31.7% women. As compared with the controls (28 apparently healthy persons, patients with WPW syndrome before RFA experienced significant reduction in both physical and mental health components. RFA was found effective in 93.3% of patients with WPW syndrome. At 3 months after RFA, patients showed significant improvement in both physical (13.5% and mental (17.2% health components; at 12 months, QoL parameters reached those of the controls.

  6. Intra-cardiac echocardiography in alcohol septal ablation

    DEFF Research Database (Denmark)

    Cooper, Robert M; Shahzad, Adeel; Newton, James;

    2015-01-01

    Alcohol septal ablation (ASA) in hypertrophic obstructive cardiomyopathy reduces left ventricular outflow tract gradients. A third of patients do not respond; inaccurate localisation of the iatrogenic infarct can be responsible. Transthoracic echocardiography (TTE) using myocardial contrast can...

  7. Ventricular Tachycardia Arising from Cardiac Crux: Electrocardiogram Recognition and Site of Ablation.

    Science.gov (United States)

    Larroussi, Leila; Badhwar, Nitish

    2016-03-01

    This case highlights idiopathic ventricular tachycardia (VT) arising from the crux of the heart. It is seen in patients without structural heart disease and can present as rapid hemodynamically unstable VT leading to cardiac arrest. 12 lead ECG showing RBBB with Q waves in inferior leads, precordial MDI>0.55 and Rablated in the epicardial cardiac crux through percutaneous pericardial access. PMID:26920178

  8. Draining Fluids through a Peritoneal Catheter in Newborns after Cardiac Surgery Helps to Control Fluid Balance

    Directory of Open Access Journals (Sweden)

    Elisa Ruano Cea

    2010-01-01

    Full Text Available Dialysis can be used in severe cases, but may not be well tolerated. In such patients, peritoneal drainage could be an alternative option for fluid removal. We report the case of a newborn with a truncus arteriosus who developed postoperatively a complicated clinical course with right ventricular dysfunction, prerenal condition as well as fluid overload despite diuretic therapy. Dialysis was indicated for fluid removal. Peritoneal dialysis was started using a surgically placed Tenckhoff catheter and stopped due to inefficacy and leaks and no other modalities of dialysis were used. However, the catheter was left in place over a period of two months for fluid drainage and removed because of unexplained fever. In order to determine the effect of peritoneal drainage, we selected a period of one week before and one week after the removal of the drain to compare daily clinical data, urine electrolytes and renal function and found a positive effect on fluid balance control. We conclude that the fluid removal by continuous peritoneal drainage is a simple and safe alternative that can be used to control fluid balance in infants after cardiac surgery.

  9. Draining Fluids through a Peritoneal Catheter in Newborns after Cardiac Surgery Helps to Control Fluid Balance.

    Science.gov (United States)

    Ruano Cea, Elisa; Jouvet, Philippe; Vobecky, Suzanne; Merouani, Aicha

    2010-01-01

    Dialysis can be used in severe cases, but may not be well tolerated. In such patients, peritoneal drainage could be an alternative option for fluid removal. We report the case of a newborn with a truncus arteriosus who developed postoperatively a complicated clinical course with right ventricular dysfunction, prerenal condition as well as fluid overload despite diuretic therapy. Dialysis was indicated for fluid removal. Peritoneal dialysis was started using a surgically placed Tenckhoff catheter and stopped due to inefficacy and leaks and no other modalities of dialysis were used. However, the catheter was left in place over a period of two months for fluid drainage and removed because of unexplained fever. In order to determine the effect of peritoneal drainage, we selected a period of one week before and one week after the removal of the drain to compare daily clinical data, urine electrolytes and renal function and found a positive effect on fluid balance control. We conclude that the fluid removal by continuous peritoneal drainage is a simple and safe alternative that can be used to control fluid balance in infants after cardiac surgery. PMID:20379389

  10. Recurrence of atrial fibrillation after successful radiofrequency catheter ablation of accessory pathway in patients with Wolff-Parkinson-White syndrome

    Directory of Open Access Journals (Sweden)

    Mujović Nebojša

    2010-01-01

    Full Text Available Introduction. Paroxysmal atrial fibrillation (AF occurs in 11.5-39% of the patients with Wolff-Parkinson-White (WPW syndrome and frequently, but not always, disappears after successful accessory pathway (AP ablation. Objective. To determine AF recurrence rate, time to AF recurrence and predictors of AF recurrence after radiofrequency (RF catheter-ablation of AP in WPW-patients with AF. Methods. Data from 245 consecutive patients with WPW-syndrome who underwent RF catheter-ablation of AP were analyzed. A total of 52 patients (43 men, mean age: 42.5±14.1 years with preablation history of spontaneous AF were followed up after definitive AP ablation. At baseline, structural heart disease and comorbidities were diagnosed in 19.2% and 21.2% of the patients, respectively. Results. During the follow-up of 5.2±3.7 years, 3 patients (5.7% died; one of these patients, previously known for recurrent AF, died from ischaemic stroke. Symptomatic recurrence of AF was detected in 9 of 52 patients (17.3%. In 66.7% of these patients, AF recurrence was identified in the first year following the procedure. Kaplan-Meier analysis demonstrated that freedom from recurrent AF after 3 months was 94.2%, after 1 year 87.5% and after 4 years 84.3%. Univariate analysis showed that older age (p=0.023, presence of structural heart disease (p=0.05 and dilated left atrium (p=0.013 were significantly related to AF recurrence. However, using multivariate Cox regression, older age was the only independent predictor of AF recurrence (HR=2.44 for every life decade; p=0.006. Analysis of ROC curves showed that, after the age of 36, the risk of AF recurrence abruptly increased. Conclusion. Symptomatic recurrence of AF was detected in 17% of WPW-patients after definite RF ablation of AP. The timedependent occurrence of AF recurrences and age-dependent increase in the rate of AF recurrence were identified. Closer follow-up and/or extension of drug therapy in older patients, at least in

  11. Image-based modeling and characterization of RF ablation lesions in cardiac arrhythmia therapy

    Science.gov (United States)

    Linte, Cristian A.; Camp, Jon J.; Rettmann, Maryam E.; Holmes, David R.; Robb, Richard A.

    2013-03-01

    In spite of significant efforts to enhance guidance for catheter navigation, limited research has been conducted to consider the changes that occur in the tissue during ablation as means to provide useful feedback on the progression of therapy delivery. We propose a technique to visualize lesion progression and monitor the effects of the RF energy delivery using a surrogate thermal ablation model. The model incorporates both physical and physiological tissue parameters, and uses heat transfer principles to estimate temperature distribution in the tissue and geometry of the generated lesion in near real time. The ablation model has been calibrated and evaluated using ex vivo beef muscle tissue in a clinically relevant ablation protocol. To validate the model, the predicted temperature distribution was assessed against that measured directly using fiberoptic temperature probes inserted in the tissue. Moreover, the model-predicted lesions were compared to the lesions observed in the post-ablation digital images. Results showed an agreement within 5°C between the model-predicted and experimentally measured tissue temperatures, as well as comparable predicted and observed lesion characteristics and geometry. These results suggest that the proposed technique is capable of providing reasonably accurate and sufficiently fast representations of the created RF ablation lesions, to generate lesion maps in near real time. These maps can be used to guide the placement of successive lesions to ensure continuous and enduring suppression of the arrhythmic pathway.

  12. Effect of Twisted Fiber Anisotropy in Cardiac Tissue on Ablation with Pulsed Electric Fields

    Science.gov (United States)

    Xie, Fei; Zemlin, Christian W.

    2016-01-01

    Background Ablation of cardiac tissue with pulsed electric fields is a promising alternative to current thermal ablation methods, and it critically depends on the electric field distribution in the heart. Methods We developed a model that incorporates the twisted anisotropy of cardiac tissue and computed the electric field distribution in the tissue. We also performed experiments in rabbit ventricles to validate our model. We find that the model agrees well with the experimentally determined ablation volume if we assume that all tissue that is exposed to a field greater than 3 kV/cm is ablated. In our numerical analysis, we considered how tissue thickness, degree of anisotropy, and electrode configuration affect the geometry of the ablated volume. We considered two electrode configurations: two parallel needles inserted into the myocardium (“penetrating needles” configuration) and one circular electrode each on epi- and endocardium, opposing each other (“epi-endo” configuration). Results For thick tissues (10 mm) and moderate anisotropy ratio (a = 2), we find that the geometry of the ablated volume is almost unaffected by twisted anisotropy, i.e. it is approximately translationally symmetric from epi- to endocardium, for both electrode configurations. Higher anisotropy ratio (a = 10) leads to substantial variation in ablation width across the wall; these variations were more pronounced for the penetrating needle configuration than for the epi-endo configuration. For thinner tissues (4 mm, typical for human atria) and higher anisotropy ratio (a = 10), the epi-endo configuration yielded approximately translationally symmetric ablation volumes, while the penetrating electrodes configuration was much more sensitive to fiber twist. Conclusions These results suggest that the epi-endo configuration will be reliable for ablation of atrial fibrillation, independently of fiber orientation, while the penetrating electrode configuration may experience problems when the

  13. Ten year follow-up after radiofrequency catheter ablation for atrioventricular nodal reentrant tachycardia in the early days forever cured, or a source for new arrhythmias?

    NARCIS (Netherlands)

    Kimman, GP; Bogaard, MD; Van Hemel, NM; Van Dessel, PFHM; Jessurun, ER; Theuns, DAMJ; Jordaens, LJ; Wever, Eric F. D.

    2005-01-01

    Background: Radiofrequency (1717) catheter ablation is highly effective with a low complication rate. However, lesions created by RF energy are irreversible, inhomogeneous, and therefore potentially proarrhythmic. Objectives: The aim of this study was to examine the magnitude and importance of long-

  14. Long-term follow-up after catheter ablation for atrioventricular nodal reentrant tachycardia: A comparison of cryothermal and radiofrequency energy in a large series of patients

    NARCIS (Netherlands)

    B. Schwagten (Bruno); S.P. Knops (Simon); P. Janse (Petter); G-J.P. Kimman (Geert-Jan); Y. van Belle (Yves); T. Szili-Torok (Tamas); L.J.L.M. Jordaens (Luc)

    2011-01-01

    textabstractBackground: Radiofrequency (RF) catheter ablation for atrioventricular nodal reentrant tachycardia (AVNRT) is highly successful but carries a risk for inadvertent atrioventricular block. Cryoablation (cryo) has the potential to assess the safety of a site before the energy is applied. Pu

  15. Radiofrequency and microwave tumor ablation in patients with implanted cardiac devices: Is it safe?

    Energy Technology Data Exchange (ETDEWEB)

    Skonieczki, Brendan D., E-mail: bskonieczki@lifespan.org [Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University/Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903 (United States); Wells, Catherine, E-mail: cwells1@bidmc.harvard.edu [Department of Radiology, Harvard Medical School/Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215 (United States); Wasser, Elliot J., E-mail: ewasser@lifespan.org [Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University/Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903 (United States); Dupuy, Damian E., E-mail: ddupuy@lifespan.org [Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University/Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903 (United States)

    2011-09-15

    Purpose: To identify malfunction of implanted cardiac devices during or after thermal ablation of tumors in lung, kidney, liver or bone, using radiofrequency (RF) or microwave (MW) energy. Materials and methods: After providing written consent, 19 patients (15 men and 4 women; mean age 78 years) with pacemakers or pacemaker/defibrillators underwent 22 CT image-guided percutaneous RF or MW ablation of a variety of tumors. Before and after each procedure, cardiac devices were interrogated and reprogrammed by a trained cardiac electrophysiology fellow. Possible pacer malfunctions included abnormalities on electrocardiographic (EKG) monitoring and alterations in device settings. Our institutional review board approved this Health Insurance Portability and Accountability Act-compliant study. Informed consent for participation in this retrospective study was deemed unnecessary by our review board. Results: During 20 of 22 sessions, no abnormalities were identified in continuous, EKG tracings or pacemaker functions. However, in two sessions significant changes, occurred in pacemaker parameters: inhibition of pacing during RF application in one, session and resetting of mode by RF energy in another session. These changes did not, result in hemodynamic instability of either patient. MW ablation was not associated with, any malfunction. In all 22 sessions, pacemakers were undamaged and successfully reset to original parameters. Conclusion: RF or MW ablation of tumors in liver, kidney, bone and lung can be performed safely in patients with permanent intra-cardiac devices, but careful planning between radiology and cardiology is essential to avoid adverse outcomes.

  16. Catheter Ablation to Treat Supraventricular Arrhythmia in Children and Adults With Congenital Heart Disease: What We Know and Where We Are Going

    Science.gov (United States)

    Thomas, Patricia E.; Macicek, Scott L.

    2016-01-01

    Background: Catheter ablation has been used to manage supraventricular arrhythmia in children since 1990. This article reviews the history of catheter ablation used to treat arrhythmia in children and discusses new frontiers in the field. We also address ablation in adult patients with a history of congenital heart disease (CHD) that was diagnosed and initially treated in childhood. Methods: We conducted an evidence-based literature review to gather available data on ablation for supraventricular tachycardia in children and adult patients with CHD. Results: Ablations can be performed safely and effectively in children. Complication rates are higher in children arrhythmia. A paucity of data is available on ablation in adult patients with CHD. Conclusion: Electrophysiology for pediatric and adult patients with CHD is a rapidly growing and progressing field. We benefit from continuous development of ablation techniques for adults with structurally normal hearts and have the unique challenge and responsibility to ensure the safe and effective application of these techniques in the vulnerable population of pediatric and adult patients with CHD. PMID:27660579

  17. Plasma microRNAs are associated with atrial fibrillation and change after catheter-ablation (the miRhythm Study)

    Science.gov (United States)

    McManus, David D.; Tanriverdi, Kahraman; Lin, Honghuang; Esa, Nada; Kinno, Menhel; Mandapati, Divakar; Tam, Stanley; Okike, Okike N.; Ellinor, Patrick T.; Keaney, John F.; Donahue, J, Kevin; Benjamin, Emelia J.; Freedman, Jane E.

    2014-01-01

    Background MicroRNAs (miRNAs) are associated with cardiovascular disease (CVD), control gene expression, and are detectable in the circulation. Objective To test the hypothesis that circulating miRNAs would be associated with atrial fibrillation (AF). Methods Using a prospective study design powered to detect subtle differences in miRNAs, we quantified plasma expression of 86 miRNAs by high-throughput quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) in 112 participants with AF and 99 without AF. To examine parallels between cardiac and plasma miRNA profiles, we quantified atrial tissue and plasma miRNA expression using qRT-PCR in 31 participants undergoing surgery. We also explored the hypothesis that lower AF burden after ablation would be reflected in the circulating blood pool by examining change in plasma miRNAs after AF ablation (n=47). Results The mean age of the cohort was 59 years. 58% of participants were men. Plasma miRs-21 and 150 were 2-fold lower in participants with AF than in those without AF after adjustment (p ≤ 0.0006). Plasma levels of miRs-21 and 150 were also lower in participants with paroxysmal AF than in those with persistent AF (p <0.05). Expression of miR-21, but not miR-150, was lower in atrial tissue from patients with AF compared to no AF (p<0.05). Plasma levels of miRs-21 and 150 increased 3-fold after AF ablation (p ≤ 0.0006). Conclusions Cardiac miRs-21 and 150 are known to regulate genes implicated in atrial remodeling. Our findings show associations between plasma miRs-21 and 150 and AF, suggesting that circulating miRNAs provide insights into cardiac gene regulation. PMID:25257092

  18. Safety and efficacy of cryothermal and radiofrequency catheter ablation in treatment of typical atrial flutter

    Institute of Scientific and Technical Information of China (English)

    WANG Fang; HUANG Cong-xin; CHEN Gang; ZHANG Feng; MENG Wei-dong; SUN Bao-gui

    2007-01-01

    @@ Radiofrequency (RF) ablation of the critical isthmus between the tricuspid annulus and the inferior vena cava is commonly used to treat typical atrial flutter (AFL).1 This has become the first line therapy in Europe and in the US due to its high success rate and significant improvement in quality of life compared with conventional medical therapy.2 Sizeable lesions are required to achieve persistent bidirectional conduction block (BCB), which is the best endpoint to ensurelong-term success.3,4 Cooling the ablation electrode by irrigation has been shown to prevent both overheating of the electrode-tissue interface and impedance rise during RF delivery, allowing greater power delivery and larger,deeper lesion.5 Recent studies showed that pain-free cryoablation was comparable to RF ablation regardingthe short and long-term clinical success rate and safety.6However, no studies have shown that cryoablation is superior to the irrigation RF ablation. In this study, we compared the efficacy and safety of cryoablation with the irrigation radiofrequency ablation technologies for typical AFL.

  19. Effect of pretreatment with aspirin and ticlopidine on the change of platelet aggregability after radiofrequency catheter ablation

    Institute of Scientific and Technical Information of China (English)

    王利宏; 陈君柱; 郑良荣; 陶谦民

    2002-01-01

    Eighty-two patients with supraventricular tachycardia undergoing radi o frequency catheter ablation (RFCA) were studied to observe the inhibition effect of aspirin and ticlopidine on platelet aggregability (PAG) and thromboxane B2 (T XB2) of the blood samples. Patients were divided into aspirin group A, ticlopi di ne group B, aspirin+ticlopidine group C and control group D. PAG and TXB2 were i ncreased clearly after RFCA in all groups (P<0.001). Treatment with aspirin or t iclopidine before operation could reduce the platelet aggregability caused by RF CA and the joint effect of two drugs(change rate of group A:52.51±12.51%; group B:54.78±11.27%;group C: 30.51±10.59%;group D:91.75±21.43%; P<0.05)was st udie d. The much decreased platelet aggregability after antiplatelet therapy was evid ence of the potential benefit of the treatment in preventing thromboembolism aft er ablation. Pretreatment with aspirin and ticlopidine together is a good way to decrease palatelet aggregability after RFCA.

  20. Effect of pretreatment with aspirin and ticlopidine on the change of platelet aggregability after radiofrequency catheter ablation

    Institute of Scientific and Technical Information of China (English)

    王利宏; 陈君柱; 郑良荣; 陶谦民

    2002-01-01

    Eighty-two patients with supraventricular tachycardia undergoing radiofrequency catheter ablation (RFCA) were studied to observe the inhibition effect of aspirin and ticlopidine on platelet aggregability(PAG) and thromboxane B2(TXB2) of the blood samples.Patients were divided into aspirin group A.ticlopidine group B.aspirin+ticlopidine group C and control group D.PAG and TXB2 were increased clearly after RFCA in all groups(P<0.001).Treatment with aspirin or ticlopidine before operation could reduce the patelet aggregability caused by RFCA and the joint effect of two drugs(change rate of group A:52.51±12.51%;group B:54.78±11.27%;group C:30.51±10.59%;group D:91.75±21.43%;(P<0.05)was studied .The much decreased platelet aggregability after antiplatelet therapy was evidence of the potential benefit of the treatment in preventing thromboembolism after ablation.Pretreatment with aspirin and ticlopidine together is a good way to decrease palateler aggregability after RFCA.

  1. Increased resting heart rate following radiofrequency catheter ablation for atrial fibrillation

    DEFF Research Database (Denmark)

    Nilsson, Brian; Chen, Xu; Pehrson, Steen;

    2005-01-01

    the procedure. RESULTS: Following PV isolation, the mean HR significantly increased from 58 +/- 10 bpm at baseline to 67 +/- 12 bpm at one month, 71 +/- 13 bpm at three months, 69 +/- 12 bpm at six months, 69 +/- 13 at nine months, and 70 +/- 13 at 12 months follow-up. The ablation success significantly...... correlated with the increase in HR at one month follow-up. In three patients the mean HR increased > 25 bpm resulting in symptoms necessitating therapy with rate-controlling drugs. CONCLUSION: PV isolation in patients with AF may result in increased HR, which positively correlated with the ablation success...

  2. Comparison of Conventional versus Steerable-Catheter Guided Coronary Sinus Lead Positioning in Patients Undergoing Cardiac Resynchronization Device Implantation.

    Directory of Open Access Journals (Sweden)

    Fikret Er

    Full Text Available The aim of this study was to compare conventional versus steerable catheter guided coronary sinus (CS cannulation in patients with advanced heart failure undergoing cardiac resynchronization therapy (CRT.Steerable catheter guided coronary sinus cannulation could reduce fluoroscopy time and contrast medium use during CRT implantation.176 consecutive patients with ischemic and non-ischemic heart failure undergoing CRT implantation from January 2008 to December 2012 at the University Hospital of Cologne were identified. During the study period two concurrent CS cannulation techniques were used: standard CS cannulation technique (standard-group, n = 113 and CS cannulation using a steerable electrophysiology (EP catheter (EPCath-group, n = 63. Propensity-score matched pairs of conventional and EP-catheter guided CS cannulation made up the study population (n = 59 pairs. Primary endpoints were total fluoroscopy time and contrast medium amount used during procedure.The total fluoroscopy time was 30.9 min (interquartile range (IQR, 19.9-44.0 min in the standard-group and 23.4 min (IQR, 14.2-34-2 min in the EPCath-group (p = 0.011. More contrast medium was used in the standard-group (60.0 ml, IQR, 30.0-100 ml compared to 25.0 ml (IQR, 20.0-50.0 ml in the EPCath-group (P<0.001.Use of steerable EP catheter was associated with significant reduction of fluoroscopy time and contrast medium use in patients undergoing CRT implantation.

  3. Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia: Success Rates and Complications during 14 Years of Experience

    Directory of Open Access Journals (Sweden)

    Mansour Moghaddam

    2010-05-01

    Full Text Available Background: Radiofrequency catheter ablation (RFCA has been introduced as the treatment of choice for supraventricular tachycardia. The aim of this study was to evaluate the success rate as well as procedural and in-hospital complications of RFCA for the treatment of atrioventricular nodal reentrant tachycardia (AVNRT.Methods: Between March 1995 and February 2009, 544 patients (75.9% female, age: 48.89 ± 13.19 years underwent 548 RFCAs for AVNRT in two large university hospitals. Echocardiography was performed for all the patients before and after the procedure. Electrocardiograms were recorded on digital multichannel systems (EP-Med or Bard EP system. Anticoagulation was initiated during the procedure.Results: From the 548 patients, 36 had associated arrhythmias, atrial flutter (4%, atrial fibrillation (0.7%, concurrent atrial fibrillation and atrial flutter (0.7%, and concealed atrioventricular pathway (0.4%. The overall success rate was 99.6%. There were 21 (3.9% transient III-degree AV blocks (up to a few seconds and 4 (0.7% prolonged II- or III-degree AV blocks, 2 (0.25% of which required permanent pacemaker insertion, 3(0.5% deep vein thrombosis, and one (0.2% arteriovenous fistula following the procedure. No difference was observed in the echocardiography parameters before and after the ablation.Conclusion: RFCA had a high success rate. The complication rate was generally low and in the above-mentioned centers it was similar to those in other large centers worldwide. Echocardiography showed no difference before and after the ablation. The results from this study showed that the risk of permanent II or III-degree AV block in patients undergoing RFCA was low and deep vein thrombosis was the second important complication. There was no risk of life-threatening complications.

  4. Electroporation ablation: A new energy modality for ablation of arrhythmogenic cardiac substrate

    NARCIS (Netherlands)

    van Driel, VJHM

    2016-01-01

    At the very end of the Direct Current (DC) era, low-energy DC ablation was demonstrated to cause myocardial lesions by non-thermal irreversible electroporation (IRE) (permanent formation of pores in the cell membrane, leading to cell death), without arcing and/or barotrauma. To eliminate rather smal

  5. 单导管射频消融治疗右室流出道室性期前收缩%Radiofrequency catheter ablation of premature ventricular contractions from right ventricular outflow tract by single catheter electrode

    Institute of Scientific and Technical Information of China (English)

    梁锦军; 黄鹤; 杨波; 万军; 唐艳红; 江洪; 黄从新

    2011-01-01

    AIM: To assess the clinical effects of ablation of premature ventricular contractions ( PVCs ) in right ventricular outflow tracl ( RVOT) using a single catheter electrode. METHODS: Single catheter technique for radiofrequency catheter ablation ( RFCA) was performed in 65 consecutive patients with severe symptomatic monomorphic PVCs originating within the RVOT. A 7-Fr, 4-mm-tip catheter was used for both mapping and ablation. Target sites were localized by pace mapping. Pace mapping demonstrated identical QRS complex configurations during pacing and during arrhythmia in at least 11 leads. RESULTS; Acute ablation success was achieved in 63/65 patients (96. 9% ). During the follow-up of ( 28 ± 13) months, recurrence and reablation were done in three patients (4. 6% ). Two of these patients remained arrhythmia-free. Surgical time was (50+27) min, and fluoroscopy time was (8. 1 ±3. 8) min. No ablation-related complications occurred during the follow-up of 15 -40 months. CONCLUSIONS; Single catheter technique is safe and effective for mapping and ablation of PVCs from RVOT.%目的:观察单导管射频消融治疗右室流出道室性期前收缩(室性早搏,室早)的安全性和临床效果.方法:经常规体检、生化检查、X线胸片、心脏彩超、长程心电图等各种检查后,入选65例患者,采用温控消融导管以起搏为主的方法进行标测,并对单导管射频消融的安全性和临床效果进行总结.结果:消融即刻成功率97%( 63/65),其中2例放弃消融术;随访15~40个月,有3例复发并再次手术,成功2例,总成功率为95%( 62/65),无复发.电生理检测和消融时间:(50±27) min;曝光时间:(8.1±3.8)min,所有患者术中及术后均未发生消融相关并发症.结论:单导管射频消融治疗右室流出道室早安全有效,并能减少消融操作及X线暴露时间.

  6. Intra-atrial endothelial lesion resulting from transseptal puncture for catheter ablation of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Samir M. Said

    2012-06-01

    Full Text Available Thromboembolic events are known complications of left atrial ablation therapy. We describe a complication which may also lead to systemic thromboembolism that has not been reported so far: the formation of a moving structure attached to the fossa ovalis after an attempted transseptal puncture in a 66-year old patient with symptomatic paroxysmal atrial fibrillation.

  7. The value of contact force sensing catheter in catheter ablation of atrial fibrillation%压力感知导管在心房颤动导管消融中的价值

    Institute of Scientific and Technical Information of China (English)

    乔宇; 姚焰; 吴灵敏; 侯炳波; 陈刚; 丁立刚; 张澍

    2015-01-01

    Objective The inability to create transmural lesions may cause atrial fibrillation recurrence after catheter ablation.The aim of the present study was to evaluate the catheter-tissue contact at different sites in left atrium with the contact force(CF) sensing catheter and the potential impact on ablation outcome.Methods Twenty-three patients with atrial fibrillation referred to Fuwai Hospital for the first-time catheter ablation from March to May,2014 were enrolled [21 males,(53.6± 10.6) years old,15 cases of paroxysmal atrial fibrillation].Without the contact indicating window,a single experienced operator attempted to achieve qualified contact in 15 left atrium sites (superior,middle and inferior part of the ridge between left pulmonary vein and left atrial appendage;left,middle and right part of the roof;posterior conjunction of left superior pulmonary vein and left inferior pulmonary vein;anterior,posterior conjunction of right superior pulmonary vein and right inferior pulmonary vein;superior,middle and inferior part of mitral isthmus;superior,middle and inferior part of septal isthmus) using the CF sensing catheter.The CF was recorded when qualified contact was considered according to the conventional criteria including electrogram amplitude,impedance,fluoroscopy and 3D navigation.Inadequate contact,qualified contact and excessive contact were defined when CF< 10 g,10-<40 g and ≥40 g,respectively.Results In total,345 points were recorded in 23 patients,with the median of the CF 25 g (Q l-Q3:10-23 g).Among them,points with inadequate,qualified and excessive contact were 85 (24.6%),241 (69.9%) and 19(5.5%),respectively.Superior,middle and inferior ridge were the most common sites with inadequate contact,with median CF 7 g (Q1-Q3:3-12 g)、8 g (Q1-Q3:4-12 g) and 10 g (Q1-Q3:4-22 g).Points with inadequate contact accounted for 56.5% (13/23),52.2% (12/23) and 47.8% (11/23),respectively.In contrast,right roof,superior and middle of septal isthmus

  8. Ultrasound-Guided Transesophageal High-Intensity Focused Ultrasound Cardiac Ablation in a Beating Heart: A Pilot Feasibility Study in Pigs.

    Science.gov (United States)

    Bessiere, Francis; N'djin, W Apoutou; Colas, Elodie Constanciel; Chavrier, Françoise; Greillier, Paul; Chapelon, Jean Yves; Chevalier, Philippe; Lafon, Cyril

    2016-08-01

    Catheter ablation for the treatment of arrhythmia is associated with significant complications and often-repeated procedures. Consequently, a less invasive and more efficient technique is required. Because high-intensity focused ultrasound (HIFU) enables the generation of precise thermal ablations in deep-seated tissues without harming the tissues in the propagation path, it has the potential to be used as a new ablation technique. A system capable of delivering HIFU into the heart by a transesophageal route using ultrasound (US) imaging guidance was developed and tested in vivo in six male pigs. HIFU exposures were performed on atria and ventricles. At the time of autopsy, visual inspection identified thermal lesions in the targeted areas in three of the animals. These lesions were confirmed by histologic analysis (mean size: 5.5 mm(2) × 11 mm(2)). No esophageal thermal injury was observed. One animal presented with bradycardia due to an atrio-ventricular block, which provides real-time confirmation of an interaction between HIFU and the electrical circuits of the heart. Thus, US-guided HIFU has the potential to minimally invasively create myocardial lesions without an intra-cardiac device. PMID:27158083

  9. Ablation of triadin causes loss of cardiac Ca2+ release units, impaired excitation–contraction coupling, and cardiac arrhythmias

    OpenAIRE

    Chopra, Nagesh; Yang, Tao; Asghari, Parisa; Moore, Edwin D.; Huke, Sabine; Akin, Brandy; Cattolica, Robert A.; Perez, Claudio F.; Hlaing, Thinn; Knollmann-Ritschel, Barbara E. C.; Jones, Larry R.; Pessah, Isaac N; Allen, Paul D.; Franzini-Armstrong, Clara; Knollmann, Björn C.

    2009-01-01

    Heart muscle excitation–contraction (E-C) coupling is governed by Ca2+ release units (CRUs) whereby Ca2+ influx via L-type Ca2+ channels (Cav1.2) triggers Ca2+ release from juxtaposed Ca2+ release channels (RyR2) located in junctional sarcoplasmic reticulum (jSR). Although studies suggest that the jSR protein triadin anchors cardiac calsequestrin (Casq2) to RyR2, its contribution to E-C coupling remains unclear. Here, we identify the role of triadin using mice with ablation of the Trdn gene (...

  10. Macro-reentrant atrial tachycardia conducting through a left superior vena cava after catheter ablation in a patient with paroxysmal atrial fibrillation.

    Science.gov (United States)

    Kurotobi, Toshiya; Kino, Naoto; Tonomura, Daisuke; Shimada, Yoshihisa

    2015-01-01

    A left superior vena cava can be a cause of cardiac rhythm or conduction abnormalities, and can also be the arrhythmogenic source of atrial fibrillation (AF) with connections to the coronary sinus and left atrium. In the present study, we report a case with a macro re-entrant atrial tachycardia that coursed through the left superior vena cava after a previous AF ablation, which successfully ablated paroxysmal AF.

  11. Response of high-sensitive C-reactive protein to catheter ablation of atrial fibrillation and its relation with rhythm outcome.

    Directory of Open Access Journals (Sweden)

    Jelena Kornej

    Full Text Available AIMS: This study investigated the possible association between hs-CRP as well as hs-CRP changes and rhythm outcome after AF catheter ablation. METHODS: We studied 68 consecutive patients with AF undergoing catheter ablation. hs-CRP levels were measured using commercially available assays before and 6 months after catheter ablation. Serial 7-day Holter ECGs were used to detect AF recurrences. RESULTS: Early AF recurrence (ERAF, within one week was observed in 38%, while late AF recurrence (LRAF, between 3 and 6 months occurred in 18% of the patients. None of the baseline clinical or echocardiographic variables was predictive of ERAF or LRAF. Baseline hs-CRP measured 2.07 ± 1.1 µg/ml and was not associated with ERAF and LRAF. At 6 months, hs-CRP levels were comparable with baseline values (2.14±1.19 µg/ml, p = 0.409 and were also not related with LRAF. However, patients with LRAF showed an hs-CRP increase from 2.03 ± 0.61 to 2.62 ± 1.52 µg/ml (p = 0.028. Patients with an hs-CRP change in the upper tertile (>0.2 µg/ml had LRAF in 32% as opposed to 11% (p = 0.042 in patients in the lower (<-0.3 µg/ml or intermediate (-0.3-0.2 µg/ml tertile. CONCLUSIONS: Changes in hs-CRP but not baseline hs-CRP are associated with rhythm outcome after AF catheter ablation. This finding points to a link between an inflammatory response and AF recurrence in this setting.

  12. Real-time optical monitoring of permanent lesion progression in radiofrequency ablated cardiac tissue (Conference Presentation)

    Science.gov (United States)

    Singh-Moon, Rajinder P.; Hendon, Christine P.

    2016-02-01

    Despite considerable advances in guidance of radiofrequency ablation (RFA) therapies for atrial fibrillation, success rates have been hampered by an inability to intraoperatively characterize the extent of permanent injury. Insufficient lesions can elusively create transient conduction blockages that eventually reconduct. Prior studies suggest significantly greater met-myoglobin (Mmb) concentrations in the lesion core than those in the healthy myocardium and may serve as a marker for irreversible tissue damage. In this work, we present real-time monitoring of permanent injury through spectroscopic assessment of Mmb concentrations at the catheter tip. Atrial wedges (n=6) were excised from four fresh swine hearts and submerged under pulsatile flow of warm (37oC) phosphate buffered saline. A commercial RFA catheter inserted into a fiber optic sheath allowed for simultaneous measurement of tissue diffuse reflectance (DR) spectra (500-650nm) during application of RF energy. Optical measurements were continuously acquired before, during, and post-ablation, in addition to healthy neighboring tissue. Met-myoglobin, oxy-myoglobin, and deoxy-myoglobin concentrations were extracted from each spectrum using an inverse Monte Carlo method. Tissue injury was validated with Masson's trichrome and hematoxylin and eosin staining. Time courses revealed a rapid increase in tissue Mmb concentrations at the onset of RFA treatment and a gradual plateauing thereafter. Extracted Mmb concentrations were significantly greater post-ablation (p<0.0001) as compared to healthy tissue and correlated well with histological assessment of severe thermal tissue destruction. On going studies are aimed at integrating these findings with prior work on near infrared spectroscopic lesion depth assessment. These results support the use of spectroscopy-facilitated guidance of RFA therapies for real-time permanent injury estimation.

  13. Association between epicardial adipose tissue volumes on 3-dimensional reconstructed CT images and recurrence of atrial fibrillation after catheter ablation

    International Nuclear Information System (INIS)

    Whether epicardial adipose tissue (EAT) is independently associated with atrial fibrillation (AF) and outcome after catheter ablation (CA) for AF remains unclear. Three-dimensional volume-rendering reconstructed images of EAT (total EAT) and EAT surrounding the left atrium (LA-EAT) were measured on 320-row multidetector computed tomography in 40 patients with AF (paroxysmal AF [PAF], n=24; persistent AF [PerAF], n=16) who underwent CA, and in 37 age-matched control patients. EAT volumes were as follows for the control, PAF and PerAF patients: total EAT, 138.3±45.2 cm3 vs. 158.3±47.2 cm3 vs. 226.4±93.3 cm3 (P3 vs. 41.3±15.3 cm3 vs. 66.8±35.1 cm3 (P3 vs. 106.2±27.3 cm3, P=0.021; LA-EAT: 34.0±10.6 cm3 vs. 21.8±6.9 cm3, P=0.0006). EAT volumes were greater in the 15 AF patients (37.5%) with post-ablation recurrence than in patients without recurrence (total EAT: 239.0±90.2 cm3 vs. 153.5±42.7 cm3, P=0.0002; LA-EAT: 69.6±35.5 cm3 vs. 40.7±13.9 cm3, P=0.0008). EAT volume increases in AF patients independent of conventional risk factors and is greater in patients with lone AF than in non-AF patients. EAT volume might be useful for predicting AF recurrence after CA. (author)

  14. Quantitative modeling of the accuracy in registering preoperative patient-specific anatomic models into left atrial cardiac ablation procedures

    Energy Technology Data Exchange (ETDEWEB)

    Rettmann, Maryam E., E-mail: rettmann.maryam@mayo.edu; Holmes, David R.; Camp, Jon J.; Cameron, Bruce M.; Robb, Richard A. [Biomedical Imaging Resource, Mayo Clinic College of Medicine, Rochester, Minnesota 55905 (United States); Kwartowitz, David M. [Department of Bioengineering, Clemson University, Clemson, South Carolina 29634 (United States); Gunawan, Mia [Department of Biochemistry and Molecular and Cellular Biology, Georgetown University, Washington D.C. 20057 (United States); Johnson, Susan B.; Packer, Douglas L. [Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905 (United States); Dalegrave, Charles [Clinical Cardiac Electrophysiology, Cardiology Division Hospital Sao Paulo, Federal University of Sao Paulo, 04024-002 Brazil (Brazil); Kolasa, Mark W. [David Grant Medical Center, Fairfield, California 94535 (United States)

    2014-02-15

    Purpose: In cardiac ablation therapy, accurate anatomic guidance is necessary to create effective tissue lesions for elimination of left atrial fibrillation. While fluoroscopy, ultrasound, and electroanatomic maps are important guidance tools, they lack information regarding detailed patient anatomy which can be obtained from high resolution imaging techniques. For this reason, there has been significant effort in incorporating detailed, patient-specific models generated from preoperative imaging datasets into the procedure. Both clinical and animal studies have investigated registration and targeting accuracy when using preoperative models; however, the effect of various error sources on registration accuracy has not been quantitatively evaluated. Methods: Data from phantom, canine, and patient studies are used to model and evaluate registration accuracy. In the phantom studies, data are collected using a magnetically tracked catheter on a static phantom model. Monte Carlo simulation studies were run to evaluate both baseline errors as well as the effect of different sources of error that would be present in a dynamicin vivo setting. Error is simulated by varying the variance parameters on the landmark fiducial, physical target, and surface point locations in the phantom simulation studies. In vivo validation studies were undertaken in six canines in which metal clips were placed in the left atrium to serve as ground truth points. A small clinical evaluation was completed in three patients. Landmark-based and combined landmark and surface-based registration algorithms were evaluated in all studies. In the phantom and canine studies, both target registration error and point-to-surface error are used to assess accuracy. In the patient studies, no ground truth is available and registration accuracy is quantified using point-to-surface error only. Results: The phantom simulation studies demonstrated that combined landmark and surface-based registration improved

  15. Quantitative modeling of the accuracy in registering preoperative patient-specific anatomic models into left atrial cardiac ablation procedures

    International Nuclear Information System (INIS)

    Purpose: In cardiac ablation therapy, accurate anatomic guidance is necessary to create effective tissue lesions for elimination of left atrial fibrillation. While fluoroscopy, ultrasound, and electroanatomic maps are important guidance tools, they lack information regarding detailed patient anatomy which can be obtained from high resolution imaging techniques. For this reason, there has been significant effort in incorporating detailed, patient-specific models generated from preoperative imaging datasets into the procedure. Both clinical and animal studies have investigated registration and targeting accuracy when using preoperative models; however, the effect of various error sources on registration accuracy has not been quantitatively evaluated. Methods: Data from phantom, canine, and patient studies are used to model and evaluate registration accuracy. In the phantom studies, data are collected using a magnetically tracked catheter on a static phantom model. Monte Carlo simulation studies were run to evaluate both baseline errors as well as the effect of different sources of error that would be present in a dynamicin vivo setting. Error is simulated by varying the variance parameters on the landmark fiducial, physical target, and surface point locations in the phantom simulation studies. In vivo validation studies were undertaken in six canines in which metal clips were placed in the left atrium to serve as ground truth points. A small clinical evaluation was completed in three patients. Landmark-based and combined landmark and surface-based registration algorithms were evaluated in all studies. In the phantom and canine studies, both target registration error and point-to-surface error are used to assess accuracy. In the patient studies, no ground truth is available and registration accuracy is quantified using point-to-surface error only. Results: The phantom simulation studies demonstrated that combined landmark and surface-based registration improved

  16. MR evaluation of pulmonary vein diameter reduction after radiofrequency catheter ablation of atrial fibrillation

    International Nuclear Information System (INIS)

    Fifty consecutive patients aged 52±12 years suffering from drug refractory atrial fibrillation (AF) underwent baseline and post-ablation MR angiography (MRA) at a mean follow-up of 4±3.5 months. Pulmonary vein (PV) disconnection was performed with a maximum energy delivery of 30 W. MRA allowed a two-plane measurement of each PV ostium. After ablation, no significant stenosis was observed, and only 1/194 (0.5%) and 3/194 (2%) PVs had a diameter reduction of 31-40% in the coronal and axial planes, respectively. There was a significant overall post-procedural PV narrowing of 4.9% in the coronal plane and 6.5% in the axial plane (P=ns between both planes). MRA is an efficient technique that can be used in pre- and postoperative evaluation of AF patients. Using a maximal power delivery limited to 30 W, no significant PV stenosis was observed at mid-term follow-up. Late PV anatomical assessment is needed to confirm these results on long-term follow-up. (orig.)

  17. MR evaluation of pulmonary vein diameter reduction after radiofrequency catheter ablation of atrial fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Anselme, Frederic; Savoure, Arnaud; Mabru, Mikael; Cribier, Alain [Rouen University Hospital, Department of Cardiology, Rouen (France); Gahide, Gerald [Rouen University Hospital, Department of Radiology and Laboratoire QuantIF, Rouen (France); Gerbaud, Edouard [Rouen University Hospital, Department of Cardiology, Rouen (France); Rouen University Hospital, Department of Radiology and Laboratoire QuantIF, Rouen (France); Dacher, Jean-Nicolas [Rouen University Hospital, Department of Radiology and Laboratoire QuantIF, Rouen (France); University Hospital, Department of Radiology, Rouen, Cedex (France)

    2006-11-15

    Fifty consecutive patients aged 52{+-}12 years suffering from drug refractory atrial fibrillation (AF) underwent baseline and post-ablation MR angiography (MRA) at a mean follow-up of 4{+-}3.5 months. Pulmonary vein (PV) disconnection was performed with a maximum energy delivery of 30 W. MRA allowed a two-plane measurement of each PV ostium. After ablation, no significant stenosis was observed, and only 1/194 (0.5%) and 3/194 (2%) PVs had a diameter reduction of 31-40% in the coronal and axial planes, respectively. There was a significant overall post-procedural PV narrowing of 4.9% in the coronal plane and 6.5% in the axial plane (P=ns between both planes). MRA is an efficient technique that can be used in pre- and postoperative evaluation of AF patients. Using a maximal power delivery limited to 30 W, no significant PV stenosis was observed at mid-term follow-up. Late PV anatomical assessment is needed to confirm these results on long-term follow-up. (orig.)

  18. Enhancing Cardiac Resynchronization Therapy for Patients with Atrial Fibrillation: The Role of AV Node Ablation

    Directory of Open Access Journals (Sweden)

    Jeff M. Berry, MD

    2012-04-01

    Full Text Available Cardiac resynchronization therapy (CRT has evolved as an effective therapy for patients with congestive heart failure (CHF and ventricular dyssynchrony, currently defined as a wide QRS on the electrocardiogram. While multiple randomized controlled trials have confirmed the favorable effects of CRT on mortality and heart failure symptoms for patients in sinus rhythm, only recently observational studies have begun to suggest a similar benefit for patients with atrial fibrillation (AF and dyssynchrony. Yet, implementing effective biventricular pacing in patients with AF can be problematic due to competing intrinsic AV conduction. For patients with depressed ejection fractions needing AV node (AVN ablation to control fast ventricular rates, biventricular pacing has been shown to be superior to right ventricular pacing alone. When consistent pacing (over 90% of the time cannot be achieved in AF patients due to a rapid ventricular response despite pharmacological therapy, AVN ablation should be considered. The additional benefit of performing AVN ablation to promote biventricular pacing in patients without rapid ventricular rates remains uncertain. A randomized controlled trial is needed to test the incremental benefit of AVN ablation to promote biventricular pacing in heart failure patients with AF and wide QRS.

  19. Acute success and short-term follow-up of catheter ablation of isthmus-dependent atrial flutter; a comparison of 8 mm tip radiofrequency and cryothermy catheters

    NARCIS (Netherlands)

    A.S. Thornton (Andrew); P. Janse (Petter); M. Alings (Marco); M.F. Scholten (Marcoen); J.M. Mekel; M. Miltenburg (Max); E. Jessurun; L.J.L.M. Jordaens (Luc)

    2008-01-01

    textabstractObjectives: To compare the acute success and short-term follow-up of ablation of atrial flutter using 8 mm tip radiofrequency (RF) and cryocatheters. Methods: Sixty-two patients with atrial flutter were randomized to RF or cryocatheter (cryo) ablation. Right atrial angiography was perfor

  20. IntravenousCorticosteroid Use Is Associated With Reduced Early Recurrence of Atrial Fibrillation Immediately Following Radiofrequency Catheter Ablation

    Directory of Open Access Journals (Sweden)

    Nitesh A. Sood MD

    2011-09-01

    Full Text Available Background Early recurrence of atrial fibrillation (ERAF occurs in up to 40% of patients after radiofrequency catheter ablation for atrial fibrillation (RFCA, increasing hospital stay, need for anti-arrhythmic medications (AADs and cardioversion, and, possibly, the risk of future AF. It has been postulated that inflammation plays a key role in developing ERAF. Short term postoperative use of corticosteroids to reduce ERAF post-RFCA has not been vigorously studied. Methods This was a case-control study of consecutive patients undergoing RFCA for the management of AF at a single-institution. RFCA was performed by a single operator from October 2005 through July 2009. Patients receiving intravenous corticosteroids immediately following the ablation and for 48 hours (6 doses constituted the treatment group. Controls received no intravenous corticosteroids during their hospitalization. All other management strategies were similar between the 2 groups, including the administration of AADs post- operatively. All patients had continuous electrocardiographic monitoring throughout their hospitalization. Multivariable logistic regression analysis was used to determine the impact of intravenous corticosteroids on ERAF defined as any AF>10 minutes during hospitalization. Results A total of 68 patients undergoing RFCA for the management of AF were included in this analysis. The overall ERAF rate, irrespective of intravenous corticosteroid use, was 23.5%. The administration of intravenous corticosteroids (n=37; mean±SD dexamethasone mean dose 11.9±4.6 mg/day; range 4-16 mg/day was associated with an 82% reduction in patients’ odds of ERAF (adjusted odds ratio; 0.18, 95% confidence interval [CI] 0.04 to 0.78 compared with those who did not receive corticosteroids (n=31. A dose-response effect was also observed, with a 17% reduction in ERAF odds for each dexamethasone mg-equivalent administered (adjusted odds ratio; 0.83, 95%CI 0.73 to 0.96. Conclusions The

  1. Multi-sequence magnetic resonance imaging integration framework for image-guided catheter ablation of scar-related ventricular tachycardia

    Science.gov (United States)

    Tao, Qian; Milles, Julien; van Huls van Taxis, Carine; Reiber, Johan H. C.; Zeppenfeld, Katja; van der Geest, Rob J.

    2012-02-01

    Catheter ablation is an important option to treat ventricular tachycardias (VT). Scar-related VT is among the most difficult to treat, because myocardial scar, which is the underlying arrhythmogenic substrate, is patient-specific and often highly complex. The scar image from preprocedural late gadolinium enhancement magnetic resonance imaging (LGE- MRI) can provide high-resolution substrate information and, if integrated at the early stage of the procedure, can largely facilitate the procedure with image guidance. In clinical practice, however, early MRI integration is difficult because available integration tools rely on matching the MRI surface mesh and electroanatomical mapping (EAM) points, which is only possible after extensive EAM has been performed. In this paper, we propose to use a priori information on patient posture and a multi-sequence MRI integration framework to achieve accurate MRI integration that can be accomplished at an early stage of the procedure. From the MRI sequences, the left ventricular (LV) geometry, myocardial scar characteristics, and an anatomical landmark indicating the origin of the left main coronary artery are obtained preprocedurally using image processing techniques. Thereby the integration can be realized at the beginning of the procedure after acquiring a single mapping point. The integration method has been evaluated postprocedurally in terms of LV shape match and actual scar match. Compared to the iterative closest point (ICP) method that uses high-intensity mapping (225+/-49 points), our method using one mapping point reached a mean point-to-surface distance of 5.09+/-1.09 mm (vs. 3.85+/-0.60 mm, p<0.05), and scar correlation of -0.51+/-0.14 (vs. -0.50+/-0.14, p=NS).

  2. Two-Year Follow-Up after Contact Force Sensing Radiofrequency Catheter and Second-Generation Cryoballoon Ablation for Paroxysmal Atrial Fibrillation: A Comparative Single Centre Study.

    Science.gov (United States)

    Kardos, Attila; Kis, Zsuzsanna; Som, Zoltan; Nagy, Zsofia; Foldesi, Csaba

    2016-01-01

    Background. There are little comparative data on catheter ablation of paroxysmal atrial fibrillation (AF) using the contact force radiofrequency (CF-RF) catheter versus the second-generation cryoballoon (CB2). Methods and results. This is a single center, retrospective, nonrandomized study of 98 patients with symptomatic, drug-refractory paroxysmal AF who underwent their first PVI ablation using either the CB2 (n = 40) or CF-RF (n = 58). The mean age was 60 years with 63% men, a mean LA size of 42 mm. The procedure duration (74 ± 17 versus 120 ± 49 minutes p < 0.05) was shorter for CB2 group; the fluoroscopy time (14 ± 17 versus 16 ± 5 minutes, p = 0.45) was similar. Complete PVI was achieved in 96% of patients with RF-CF and 98% with CB2. Phrenic nerve palsies (2 transient and 1 persistent) occurred exclusively in the CB2 group and 1 severe, nonlethal complication (pericardial tamponade) occurred in the CF-RF group. At 24-month follow-up, the success rate, defined as freedom from AF/atrial tachycardia (AT) after a single procedure without antiarrhythmic drug, was comparable in CF-RF group and CB2 group (65.5% versus 67%, resp., log rank p = 0.54). Conclusion. Both the CB2 and the RF-CF ablation appeared safe; the success rate at 2 years was comparable between both technologies. PMID:27314032

  3. Two-Year Follow-Up after Contact Force Sensing Radiofrequency Catheter and Second-Generation Cryoballoon Ablation for Paroxysmal Atrial Fibrillation: A Comparative Single Centre Study

    Directory of Open Access Journals (Sweden)

    Attila Kardos

    2016-01-01

    Full Text Available Background. There are little comparative data on catheter ablation of paroxysmal atrial fibrillation (AF using the contact force radiofrequency (CF-RF catheter versus the second-generation cryoballoon (CB2. Methods and results. This is a single center, retrospective, nonrandomized study of 98 patients with symptomatic, drug-refractory paroxysmal AF who underwent their first PVI ablation using either the CB2 (n=40 or CF-RF (n=58. The mean age was 60 years with 63% men, a mean LA size of 42 mm. The procedure duration (74±17 versus 120±49 minutes p<0.05 was shorter for CB2 group; the fluoroscopy time (14±17 versus 16±5 minutes, p=0.45 was similar. Complete PVI was achieved in 96% of patients with RF-CF and 98% with CB2. Phrenic nerve palsies (2 transient and 1 persistent occurred exclusively in the CB2 group and 1 severe, nonlethal complication (pericardial tamponade occurred in the CF-RF group. At 24-month follow-up, the success rate, defined as freedom from AF/atrial tachycardia (AT after a single procedure without antiarrhythmic drug, was comparable in CF-RF group and CB2 group (65.5% versus 67%, resp., log rank p=0.54. Conclusion. Both the CB2 and the RF-CF ablation appeared safe; the success rate at 2 years was comparable between both technologies.

  4. 3D/2D Registration of Mapping Catheter Images for Arrhythmia Interventional Assistance

    CERN Document Server

    Fallavollita, Pascal

    2009-01-01

    Radiofrequency (RF) catheter ablation has transformed treatment for tachyarrhythmias and has become first-line therapy for some tachycardias. The precise localization of the arrhythmogenic site and the positioning of the RF catheter over that site are problematic: they can impair the efficiency of the procedure and are time consuming (several hours). Electroanatomic mapping technologies are available that enable the display of the cardiac chambers and the relative position of ablation lesions. However, these are expensive and use custom-made catheters. The proposed methodology makes use of standard catheters and inexpensive technology in order to create a 3D volume of the heart chamber affected by the arrhythmia. Further, we propose a novel method that uses a priori 3D information of the mapping catheter in order to estimate the 3D locations of multiple electrodes across single view C-arm images. The monoplane algorithm is tested for feasibility on computer simulations and initial canine data.

  5. 3D/2D Registration of Mapping Catheter Images for Arrhythmia Interventional Assistance

    Directory of Open Access Journals (Sweden)

    Pascal Fallavollita

    2009-09-01

    Full Text Available Radiofrequency (RF catheter ablation has transformed treatment for tachyarrhythmias and has become first-line therapy for some tachycardias. The precise localization of the arrhythmogenic site and the positioning of the RF catheter over that site are problematic: they can impair the efficiency of the procedure and are time consuming (several hours. Electroanatomic mapping technologies are available that enable the display of the cardiac chambers and the relative position of ablation lesions. However, these are expensive and use custom-made catheters. The proposed methodology makes use of standard catheters and inexpensive technology in order to create a 3D volume of the heart chamber affected by the arrhythmia. Further, we propose a novel method that uses a priori 3D information of the mapping catheter in order to estimate the 3D locations of multiple electrodes across single view C-arm images. The monoplane algorithm is tested for feasibility on computer simulations and initial canine data.

  6. Method and apparatus for the guided ablative therapy of fast ventricular arrhythmia

    Science.gov (United States)

    Cohen, Richard J. (Inventor); Barley, Maya (Inventor)

    2010-01-01

    Method and apparatus for guiding ablative therapy of abnormal biological electrical excitation. The excitation from the previous excitatory wave is significant at the beginning of the next excitation. In particular, it is designed for treatment of fast cardiac arrhythmias. Electrical signals are acquired from recording electrodes, and an inverse dipole method is used to identify the site of origin of an arrhythmia. The location of the tip of an ablation catheter is similarly localized from signals acquired from the recording electrodes while electrical pacing energy is delivered to the tip of the catheter close to or in contact with the cardiac tissue. The catheter tip is then guided to the site of origin of the arrhythmia, and ablative radio frequency energy is delivered to its tip to ablate the site.

  7. Pheochromocytoma-induced atrial tachycardia leading to cardiogenic shock and cardiac arrest: resolution with atrioventricular node ablation and pacemaker placement.

    Science.gov (United States)

    Shawa, Hassan; Bajaj, Mandeep; Cunningham, Glenn R

    2014-12-01

    Pheochromocytoma should be considered in young patients who have acute cardiac decompensation, even if they have no history of hypertension. Atrioventricular node ablation and pacemaker placement should be considered for stabilizing pheochromocytoma patients with cardiogenic shock due to atrial tachyarrhythmias. A 38-year-old black woman presented with cardiogenic shock (left ventricular ejection fraction, cardiogenic shock and cardiac arrest unresolved by the placement of 2 different ventricular assist devices, but that was completely reversed by radiofrequency ablation of the atrioventricular node and the placement of a temporary pacemaker. We present the patient's clinical, laboratory, and imaging findings, and we review the relevant literature.

  8. Materials for Multifunctional Balloon Catheters With Capabilities in Cardiac Electrophysiological Mapping and Ablation Therapy

    OpenAIRE

    Kim, Dae-Hyeong; Lu, Nanshu; Ghaffari, Roozbeh; Kim, Yun-Soung; Lee, Stephen P.; Xu, Lizhi; Wu, Jian; Kim, Rak-Hwan; Song, Jizhou; Liu, Zhuangjian; Viventi, Jonathan; de Graff, Bassel; Elolampi, Brian; Mansour, Moussa; Slepian, Marvin J.

    2011-01-01

    Development of advanced surgical tools for minimally invasive procedures represents an activity of central importance to improvements in human health. A key materials challenge is in the realization of bio-compatible interfaces between the classes of semiconductor and sensor technologies that might be most useful in this context and the soft, curvilinear surfaces of the body. This paper describes a solution based on biocompatible materials and devices that integrate directly with the thin ela...

  9. :Influence of the duration of Holter monitoring on the detection of arrhythmia recurrences after catheter ablation of atrial fibrillation: implications for patient follow-up.

    Science.gov (United States)

    Dagres, Nikolaos; Kottkamp, Hans; Piorkowski, Christopher; Weis, Sebastian; Arya, Arash; Sommer, Philipp; Bode, Kerstin; Gerds-Li, Jin-Hong; Kremastinos, Dimitrios Th; Hindricks, Gerhard

    2010-03-18

    We investigated the influence of Holter duration on the detection of recurrences after ablation for atrial fibrillation (AF). Two-hundred-and-fifteen patients underwent a 7-day Holter ECG at 6 months after catheter ablation. We analyzed the number of patients who had a recurrence within the first 24, 48, 72 h etc. up to the total of 7 days. During the complete 7-day recording, 30% had a recurrence. All Holter durations ≤5 days would have detected significantly less patients with recurrence than the complete 7-day recording. A 24-hour Holter would have detected 59%, a 48-hour Holter 67% and a 72-hour Holter 80% of patients with recurrences, whereas a 4-day recording would have detected 91% of the recurrences that were detected with the complete 7-day recording. In conclusion, a Holter duration of less than 4 days misses a great portion of recurrences, whereas a 4-day recording might offer a reasonable compromise.

  10. Renal sympathetic denervation as an adjunct to catheter ablation for the treatment of ventricular electrical storm in the setting of acute myocardial infarction.

    Science.gov (United States)

    Hoffmann, Boris A; Steven, Daniel; Willems, Stephan; Sydow, Karsten

    2013-10-01

    We present a case of ventricular storm (VS) in a patient with acute ST-elevation myocardial infarction (STEMI). After initial successful thrombus extraction and percutaneous coronary intervention (PCI) of the proximal left anterior descending (LAD) coronary artery, a 63-year-old male patient showed recurrent monomorphic ventricular tachycardia (VT) and fibrillation (VF) episodes refractory to antiarrhythmic drug therapy. After initial successful VT ablation, fast VT and VF episodes remained an evident problem despite maximum antiarrhythmic drug therapy. Due to an increasing instability, renal sympathetic denervation (RDN) was performed. ICD interrogation and 24-hour Holter monitoring excluded recurrent episodes of VT or VF at a 6-month follow-up (FU) after discharge. This case highlights that RDN was effective and safely performed in a hemodynamically unstable patient with VS after STEMI and adjunct catheter ablation. RDN may open a new avenue for an adjunctive interventional bailout treatment of such highly challenging patients.

  11. Ablation of triadin causes loss of cardiac Ca2+ release units, impaired excitation-contraction coupling, and cardiac arrhythmias.

    Science.gov (United States)

    Chopra, Nagesh; Yang, Tao; Asghari, Parisa; Moore, Edwin D; Huke, Sabine; Akin, Brandy; Cattolica, Robert A; Perez, Claudio F; Hlaing, Thinn; Knollmann-Ritschel, Barbara E C; Jones, Larry R; Pessah, Isaac N; Allen, Paul D; Franzini-Armstrong, Clara; Knollmann, Björn C

    2009-05-01

    Heart muscle excitation-contraction (E-C) coupling is governed by Ca(2+) release units (CRUs) whereby Ca(2+) influx via L-type Ca(2+) channels (Cav1.2) triggers Ca(2+) release from juxtaposed Ca(2+) release channels (RyR2) located in junctional sarcoplasmic reticulum (jSR). Although studies suggest that the jSR protein triadin anchors cardiac calsequestrin (Casq2) to RyR2, its contribution to E-C coupling remains unclear. Here, we identify the role of triadin using mice with ablation of the Trdn gene (Trdn(-/-)). The structure and protein composition of the cardiac CRU is significantly altered in Trdn(-/-) hearts. jSR proteins (RyR2, Casq2, junctin, and junctophilin 1 and 2) are significantly reduced in Trdn(-/-) hearts, whereas Cav1.2 and SERCA2a remain unchanged. Electron microscopy shows fragmentation and an overall 50% reduction in the contacts between jSR and T-tubules. Immunolabeling experiments show reduced colocalization of Cav1.2 with RyR2 and substantial Casq2 labeling outside of the jSR in Trdn(-/-) myocytes. CRU function is impaired in Trdn(-/-) myocytes, with reduced SR Ca(2+) release and impaired negative feedback of SR Ca(2+) release on Cav1.2 Ca(2+) currents (I(Ca)). Uninhibited Ca(2+) influx via I(Ca) likely contributes to Ca(2+) overload and results in spontaneous SR Ca(2+) releases upon beta-adrenergic receptor stimulation with isoproterenol in Trdn(-/-) myocytes, and ventricular arrhythmias in Trdn(-/-) mice. We conclude that triadin is critically important for maintaining the structural and functional integrity of the cardiac CRU; triadin loss and the resulting alterations in CRU structure and protein composition impairs E-C coupling and renders hearts susceptible to ventricular arrhythmias. PMID:19383796

  12. The role of the accessory pathway radiofrequency catheter ablation in the secondary prevention of the malignant tachyarrhythmias in patients with Wolff-Parkinson-White syndrome

    Directory of Open Access Journals (Sweden)

    Mujović Nebojša

    2010-01-01

    Full Text Available Background/Aim. The occurrence of atrial fibrillation (AF in the presence of an accessory pathway (AP that conducts rapidly is potentially lethal because the rapid ventricular response may lead to ventricular fibrillation (VF. The aim of the study was to determine long-term efficacy of AP catheter-ablation using radiofrequency (RF current in secondary prevention of VF in WPW patients. Methods. Study included a total of 192 symptomatic WPW patients who underwent RF catheter-ablation of AP in our institution from 1994 to 2007 and were available for clinical follow-up for more than 3 months after procedure. Results. Before ablation, VF was recorded in total of 27 patients (14.1%. In 14 of patients (51.9% VF was the first clinical manifestation of WPW syndrome. A total of 35 VF episodes were identified in 27 patients. The occurrence of VF was preceded by physical activity or emotional stress in 17.1% of cases, by alcohol abuse in 2.9% and by inappropriate intravenous drug administration in 28.6%. In addition, no clear precipitating factor was identified in 40% of VF cases, while informations about activities preceding 11.4% of VF episodes were not available. The follow-up of 5.7 ± 3.3 years was obtained in all of 27 VF patients. Of the 20 patients who underwent successful AP ablation, all were alive, without syncope or ventricular tachyarrhythmias during long-term follow-up. In 4 of 7 unsuccessfully treated patients, recurrence of supraventricular tachycardia and/or preexcited atrial fibrillation were recorded; one of these patients suddenly died of VF, 6 years after procedure. Conclusion. In significant proportion of WPW patients, VF was the first clinical manifestation of WPW syndrome, often precipitated by physical activity, emotional stress or inappropriate drug administration. Successful elimination of AP by percutaneous RF catheter-ablation is highly effective in secondary prevention of life-threatening tachyarrhythmias in patients with

  13. Design and evaluation of a transesophageal HIFU probe for ultrasound-guided cardiac ablation: simulation of a HIFU mini-maze procedure and preliminary ex vivo trials.

    Science.gov (United States)

    Constanciel, Elodie; N'Djin, W Apoutou; Bessière, Francis; Chavrier, Françoise; Grinberg, Daniel; Vignot, Alexandre; Chevalier, Philippe; Chapelon, Jean Yves; Lafon, Cyril

    2013-09-01

    Atrial fibrillation (AF) is the most frequent cardiac arrhythmia. Left atrial catheter ablation is currently performed to treat this disease. Several energy sources are used, such as radio-frequency or cryotherapy. The main target of this procedure is to isolate the pulmonary veins. However, significant complications caused by the invasive procedure are described, such as stroke, tamponade, and atrioesophageal fistula, and a second intervention is often needed to avoid atrial fibrillation recurrence. For these reasons, a minimally-invasive device allowing performance of more complex treatments is still needed. High-intensity focused ultrasound (HIFU) can cause deep tissue lesions without damaging intervening tissues. Left atrial ultrasound-guided transesophageal HIFU ablation could have the potential to become a new ablation technique. The goal of this study was to design and test a minimally-invasive ultrasound-guided transesophageal HIFU probe under realistic treatment conditions. First, numerical simulations were conducted to determine the probe geometry, and to validate the feasibility of performing an AF treatment using a HIFU mini-maze (HIFUMM) procedure. Then, a prototype was manufactured and characterized. The 18-mm-diameter probe head housing contained a 3-MHz spherical truncated HIFU transducer divided into 8 rings, with a 5-MHz commercial transesophageal echocardiography (TEE) transducer integrated in the center. Finally, ex vivo experiments were performed to test the impact of the esophagus layer between the probe and the tissue to treat, and also the influence of the lungs and the vascularization on lesion formation. First results show that this prototype successfully created ex vivo transmural myocardial lesions under ultrasound guidance, while preserving intervening tissues (such as the esophagus). Ultrasound-guided transesophageal HIFU can be a good candidate for treatment of AF in the future. PMID:24658718

  14. 对比普通与灌注冷却射频消融电极在Ⅰ型心房扑动消融中的作用%Comparing the effects of common ablation catheter and irrigated ablation catheter on common atrial flutter

    Institute of Scientific and Technical Information of China (English)

    彭景添

    2001-01-01

    目的 对比普遍与灌注冷却射频消融电极在Ⅰ型心房扑动(CAFL)消融中的作用。方法 60例CAFL患者随机分为两组:普通射频消融电极治疗组(CRF)和灌注冷却射频消融电极治疗组(IRF),分别比较两组取得下腔静脉与三尖瓣环峡部双向阻滞的手术时间、X线照射时间、射频消融放电次数及放电时间、并观察消融时电能、阻抗以及温度的改变。结果 IRF组的手术时间、X线照射时间、射频消融时间均较CRF组短(P<0.01),放电次数也少(P<0.05),IRF组消融过程中阻抗变化小、电能稳定,温度差异不明显,而CRF组则相反,且有19例出现碳化现象,两组痛感差异无显著性,均无心包填塞、栓塞等并发症。结论 灌注冷却射频消融电极在CAFL消融中优越于普通射频消融电极。%Objective To compare the effects of common ablation catheter and irrigated ablation catheter on common atrial flutter (CAFL). Methods 60 patients with CAFL were randomly dividied into common catheter group (CRF, 30cases) and irrigated catheter group (IRF, 30 cases). The procedure duration, fluoroscopy duration and radio frequeney duration were studied. The RF energy, impedance and temparature during the ablation were observed. Results The duration of procedure, fluoroscopy time and radio frequency ablation time were significantly shorter in IRF group than those in CRF group (P<0.01), there was also a difference in the times of ablation between two groups (P<0.05). In IRF group, the variation of impedance, RF-energy and temperature during the ablation was small, but in CRF group, the variation was obvious and there were 19 cases with coagulum formation. The degree of the chest pain was similar between two groups, there were no serious complications such as pericardial effusion, thrombi etc. Conclusion Irrigated ablation catheter should be superior to common ablation catheter in CAFL ablation.

  15. Consequences of cardiac myocyte-specific ablation of KATP channels in transgenic mice expressing dominant negative Kir6 subunits

    OpenAIRE

    Tong, XiaoYong; Porter, Lisa M.; Liu, GongXin; Dhar-Chowdhury, Piyali; Srivastava, Shekhar; Pountney, David J.; Yoshida, Hidetada; Artman, Michael; Fishman, Glenn I.; Yu, Cindy; Iyer, Ramesh; Morley, Gregory E.; Gutstein, David E.; Coetzee, William A.

    2006-01-01

    Consequences of cardiac myocyte-specific ablation of KATP channels in transgenic mice expressing dominant negative Kir6 subunits. Am J Physiol Heart Circ Physiol 291: H543–H551, 2006. First published February 24, 2006; doi:10.1152/ajpheart.00051.2006.—Cardiac ATP-sensitive K+ (KATP) channels are formed by Kir6.2 and SUR2A subunits. We produced transgenic mice that express dominant negative Kir6.x pore-forming subunits (Kir6.1-AAA or Kir6.2-AAA) in cardiac myocytes by driving their expression ...

  16. Role of Intracardiac echocardiography in Atrial Fibrillation Ablation

    Directory of Open Access Journals (Sweden)

    Antonio Dello Russo, MD PhD

    2013-04-01

    Full Text Available In the recent years, several new evidences support catheter-based ablation as a treatment modality of atrial fibrillation (AF. Based on a plenty of different applications, intracardiac echocardiography (ICE is now a well-established technology in complex electrophysiological procedures, in particular in AF ablation. ICE contributes to improve the efficacy and safety of such procedures defining the anatomical structures involved in ablation procedures and monitoring in real time possible complications. In particular ICE allows: a correct identification of the endocardial structures; a guidance of transseptal puncture; an assessment of accurate placement of the circular mapping catheter; an indirect evaluation of evolving lesions during radiofrequency (RF energy delivery via visualization of micro and macrobubbles tissue heating; assessment of catheter contact with cardiac tissues. Recently, also the feasibility of the integration of electroanatomical mapping (EAM and intracardiac echocardiography has been demonstrated, combining accurate real time anatomical information with electroanatomical data. As a matter of fact, different techniques and ablation strategies have been developed throughout the years. In the setting of balloon-based ablation systems, recently adopted by an increasing number of centers, ICE might have a role in the choice of appropriate balloon size and to confirm accurate occlusion of pulmonary veins. Furthermore, in the era of minimally fluoroscopic ablation, ICE has successfully provided a contribute in reducing fluoroscopy time. The purpose of this review is to summarize the current applications of ICE in catheter based ablation strategies of atrial fibrillation, focusing-on electronically phased-array ICE.

  17. Catheter ablation of atrial fibrillation:is or not a bright road in the future?%心房颤动导管消融治疗:未来走向平坦之路?

    Institute of Scientific and Technical Information of China (English)

    马长生; 陈新

    2009-01-01

    Catheter ablation of atrial fibrillation (AF) has opened a new door to cure AF and is fundamental-ly changing our clinical practice. The emergence of novel anticoagulation drugs and antiarrhythmic agents also bring us great hope and enriches our therapeutic options. When we reconsider the strategy of AF with regards to symptom relief and prognosis improvement, perhaps we will achieve new understanding and judgment. The newly issued study by Forleo[1] evaluated the safety and efficacy of ablation therapy in type 2 diabetes mellitus patients with drug refractory AF. The results showed that patients who received a single ablation procedure but without medications were more free of AF than patients in the antiarrhythmic drugs (AADs) group(20% vs 57.1% ,P =0.001). In the ablation group, a significant improvement in quality-of-life (QoL) scores as compared with AADs group was also observed. Another A4 clinical trial was a randomized multicenter clinical study that compared the relative merits between pharmacology and catheter ablation of AF[2]. At the 1-year follow-up, patients in ablation group experienced lower re-currence than patients in AADs group (11% vs 77%, P <0.0001). Symptom score, exercise capacity, and QoL were significantly higher in the ablation group. The results of another trial PABA-CHF[3] identified pulmonary-vein isolation was superior to atrioventricular-node ablation with biventricular pacing in patients with heart failure on questionnaire score of QoL, 6-minute-walk distance and ejection fraction improvement. The observation of Nademanee[4] revealed that sinus rhythm was the most important independent favorable parameter for survival for high-risk patients with AF that un-dergo substrate ablation. For patients with sinus rhythm post-ablation the 5-year stroke rate was less than those who re-mained in AF and continued warfarin treatment (3% vs 23%, P =0.004). All of the above studies were consistent with the results of prior studies by Pappone, Oral

  18. Coil embolization of internal mammary artery injured during central vein catheter and cardiac pacemaker lead insertion

    Energy Technology Data Exchange (ETDEWEB)

    Chemelli, A.P. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria)], E-mail: Andreas.Chemelli@i-med.ac.at; Chemelli-Steingruber, I.E. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria); Bonaros, N. [Department of Cardiovascular Surgery, Innsbruck Medical University (Austria); Luckner, G. [Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University (Austria); Millonig, G. [Department of Gastroenterology and Hepatology, Innsbruck Medical University (Austria); Seppi, K. [Department of Neurology, Innsbruck Medical University (Austria); Lottersberger, C.; Jaschke, W. [Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck (Austria)

    2009-08-15

    Purpose: This study describes several cases of endovascular coil embolization of the proximal internal mammary artery injured by blind approach to the subclavian vein for central venous catheter or pacemaker lead insertion. Materials and methods: We conducted a retrospective analysis of five patients with iatrogenic arterial lesions of the internal mammary artery (IMA). The lesions occurred in three patients from a puncture of the subclavian vein during insertion of a central venous catheter and in two patients from a puncture of the subclavian vein for insertion of a pacemaker lead. Four patients had acute symptoms of bleeding with mediastinal hematoma and hematothorax and one patient was investigated in a chronic stage. A pseudoaneurysm was detected in all five patients. All four acute and hemodynamic unstable patients required hemodynamic support. Results: In all patients, embolization was performed using a coaxial catheter technique, and a long segment of the IMA adjacent distally and proximally to the source of bleeding was occluded with pushable microcoils. In one patient, additional mechanically detachable microcoils were used at the very proximal part of the IMA. Microcoil embolization of the IMA was successful in all patients, and the source of bleeding was eliminated in all patients. Conclusion: Transarterial coil embolization is a feasible and efficient method in treating acute bleeding and pseudoaneurysm of the IMA and should be considered if mediastinal hematoma or hemathorax occurs after blind puncture of the subclavian vein.

  19. 射频消融改良心脏自主神经治疗缓慢型心律失常%Radiofrequency Ablation of Bradyarrhythmia by Modification of Cardiac Autonomic Innervation

    Institute of Scientific and Technical Information of China (English)

    方芳

    2012-01-01

    心脏神经消融是治疗迷走神经介导的缓慢型心律失常的新方法.射频消融可选择性地造成迷走神经的损伤,改良窦房结和房室结的神经支配.对于部分间歇性高度房室传导阻滞、功能性窦房结功能障碍、神经心源性晕厥等患者,有可能作为起搏器和药物治疗的替代治疗手段.%Radiofrequency catheter ablation is a new technique for management of patients with dominantly adverse parasympathetic autonomic influence. Catheter ablation may inflict the vagal innervation of the sinus and atrioventricular nodes selectively. Cardiac vagal den-ervation may prevent pacemaker implantation in some patients with functional atrioventricular block, sinus dysfunction, and neurocardiogenic syncope.

  20. Assessment of pulmonary venous stenosis after radiofrequency catheter ablation for atrial fibrillation by magnetic resonance angiography: a comparison of linear and cross-sectional area measurements

    Energy Technology Data Exchange (ETDEWEB)

    Tintera, Jaroslav; Porod, Vaclav; Rolencova, Eva; Fendrych, Pavel [Institute for Clinical and Experimental Medicine, Department of Radiology, Prague 4 (Czech Republic); Cihak, Robert; Mlcochova, Hanka; Kautzner, Josef [Institute for Clinical and Experimental Medicine, Department of Cardiology, Prague 4 (Czech Republic)

    2006-12-15

    One of the recognised complications of catheter ablation is pulmonary venous stenosis. The aim of this study was to compare two methods of evaluation of pulmonary venous diameter for follow-up assessment of the above complication: (1) a linear approach evaluating two main diameters of the vein, (2) semiautomatically measured cross-sectional area (CSA). The study population consists of 29 patients. All subjects underwent contrast-enhanced magnetic resonance angiography (CeMRA) of the pulmonary veins (PVs) before and after the ablation; 14 patients were also scanned 3 months later. PV diameter was evaluated from two-dimensional multiplanar reconstructions by measuring either the linear diameter or CSA. A comparison between pulmonary venous CSA and linear measurements revealed a systematic difference in absolute values. This difference was not significant when comparing the relative change CSA and quadratic approximation using linear extents (linear approach). However, a trend towards over-estimation of calibre reduction was documented for the linear approach. Using CSA assessment, significant PV stenosis was found in ten PVs (8%) shortly after ablation. Less significant PV stenosis, ranging from 20 to 50% was documented in other 18 PVs (15%). CeMRA with CSA assessment of the PVs is suitable method for evaluation of PV diameters. (orig.)

  1. Larger low voltage zone in endocardial unipolar map compared with that in epicardial bipolar map indicates difficulty in eliminating ventricular tachycardia by catheter ablation.

    Science.gov (United States)

    Miyamoto, Koji; Noda, Takashi; Satomi, Kazuhiro; Wada, Mitsuru; Nakajima, Ikutaro; Ishibashi, Kohei; Okamura, Hideo; Noguchi, Teruo; Anzai, Toshihisa; Yasuda, Satoshi; Ogawa, Hisao; Shimizu, Wataru; Aiba, Takeshi; Kamakura, Shiro; Kusano, Kengo

    2016-08-01

    Patients with ischemic and non-ischemic cardiomyopathy often have substrate for ventricular tachycardia (VT) in the endocardium (ENDO), epicardium (EPI), and/or intramural. Although it has been reported that the ENDO unipolar (UNI) voltage map is useful in detecting EPI substrate, its feasibility to detect intramural scarring and its usefulness in radiofrequency catheter ablation (RFCA) remain unclear. To assess the relationship between the left ventricle (LV) ENDO UNI voltage map and the LV EPI bipolar (BIP) voltage map, and to determine the usefulness of the ENDO UNI voltage map to guide RFCA for VT in patients with cardiomyopathy undergoing combined ENDO- and EPI RFCA. Eleven patients with VT undergoing detailed ENDO and EPI electroanatomical mapping of the LV were included (mean age 59 ± 11 years, 9 men). We assessed the value of the LV ENDO UNI voltage map in identifying EPI and/or intramural substrate in these 11 patients with non-ischemic or ischemic cardiomyopathy. The underlying heart disease was dilated cardiomyopathy in 4 patients, cardiac sarcoidosis in 3, hypertrophic cardiomyopathy in 2, and ischemic heart disease in 2 patients. The mean LV ejection fraction was 24 ± 7 %. The low voltage zone (LVZ) was defined as maps using the transparency mode on CARTO software. We performed RFCA at the ENDO and EPI based on activation and/or substrate maps, targeting the LVZ and/or abnormal EGMs. The LVZ was present in the LV ENDO BIP voltage map in 10 of 11 patients (42 ± 33 cm(2)), and in the LV ENDO UNI voltage map in 10 of 11 patients (72 ± 45 cm(2)). The LVZ was present in the EPI BIP voltage map in 9 of 11 patients (70 ± 61 cm(2)), and the LVZ in the ENDO UNI voltage map was also seen in all 9 patients. The location of the LVZ in the EPI BIP map matched that in 45 ± 28 % of ENDO UNI voltage maps. The LVZ in the ENDO UNI voltage map was larger than that in the EPI BIP voltage map in 6 of 11 patients, and RFCA failed in 5 of these 6

  2. Modified Maze lines plus pulmonary vein isolation created by radiofrequency catheter ablation on the atrial wall to treat atrial fibrillation in elderly

    Institute of Scientific and Technical Information of China (English)

    Caiyi LU; Shiwen WANG; Xinping DU; Yinglong HOU; Qiao XUE; Xinli WU; Rui CHEN; Peng LIU

    2005-01-01

    Objective To evaluate the effect of modified Maze lines plus pulmonary vein (PV) isolation created by radiofrequency catheter ablation (RFCA) on atrial wall guided by a novel geometry mapping system in the treatment of elderly patients with paroxysmal atrial fibrillation (PAF). Methods After regular electrophysiological study, transseptal punctures were achieved twice with Swartz L1 and R1 sheaths. PV angiographies were conducted to evaluate their orifices and branches. A balloon electrode array catheter with 64 electrodes was put in the middle of the left atrium. Atrium geometry was constructed using Ensite 3000 Navx system. Two RFCA lesion loops and three lines (modified Maze) were created on left and right atrial walls. Each lesion point was ablated for 30 seconds with preset temperature 50 (ae) and energy 30W. The disappearance or 80% decrease of the amplitude of target atrial potential and 10 to 20(|), decrease of ablation impedance were used as an index of effective ablation. Results A total of 11 patients (7 male and 4 female, mean age, 68.7±5.1 years) were enrolled. PAF history was 7.9±4.5 years. PAF could not be prevented by mean 3.1±1.6 antiarrhythmic agents in 6.3±3.4 years. None of the patients had complications with structural heart disease or stroke. Left atrial diameter was 41.3±3.6 mm and LVEF was 59.2±3.7% on echocardiography. Two loops and three lines were completed with 67.8±13.1 (73-167) lesion points. Altogether 76-168 (89.4±15.3) lesion points were created in each patient. PAF could not be provoked by rapid burst pacing up to 600 beat per minute delivered from paroxysmal coronary sinus electrode pair.Complete PV electrical isolation was confirmed by three-dimensional activation mapping. Mean procedure time was 2.7±0.6 hours and fluoroscopy time was 17.8±9.4 minutes. Patients were discharged with oral aspirin and without antiarrhythmic agents. During follow up of 6.5±1.8 months, seven patients were PAF symptom free (63.6%). PAF

  3. Nonfluoroscopic radiofrequency catheter ablation of right-sided paroxysmal superventricular tachycardia guided by ensite NavX system%Ensite NavX引导下无X线透视射频导管消融治疗右侧阵发性室上性心动过速

    Institute of Scientific and Technical Information of China (English)

    刘小青; 周旭; 杨刚; 钟光珍; 石亮; 田颖; 李艳兵; 汪爱虎; 杨新春

    2011-01-01

    目的 探索Ensite NavX引导下无X线透视射频导管消融治疗右侧阵发性室上性心动过速(室上速)的可行性与安全性。方法 2010年6月至10月在我院接受导管射频消融治疗的右侧阵发性室上速患者20例,均无心脏血管结构异常,其中右侧房室旁路6例,房室结双径路14例。所有患者均在Ensite NavX三维导航标测系统引导下实施完全无X线透视的心脏电生理检查和射频导管消融治疗。结果 所有患者消融术成功,X线曝光时间均为0,消融术时间为65 ~ 125( 100.5 ±20.3)min,冠状静脉窦导管植入时间8 ~30( 14.9±6.6)min。所有患者没有发生消融术相关的并发症,随访15 ~90 d无复发。结论 初步经验显示Ensite NavX引导下无X线透视射频导管消融治疗阵发性室上速安全、可行,但需大样本的病例总结、验证。%Objective To probe the feasibility and safety of nonfluoroscopic catheter navigation for radiofrequency catheter ablation of right-sided paroxysmal superventricular tachycardia guided by Ensite NavX system. Methods Nonfluoroscopic radiofrequency catheter ablation navigated by Ensite NavX system was performed in 20 cases [mean age (53.4± 16. 1 ) yaers, range 24 ~ 74 years]of right-sided paroxysmal superventricular tachycardia with normal cardiac anatomy, including 6 cases with right accessory pathway and 14 cases with atrioventricular nodal reentrant tachycardia. Using Ensite NavX, right atrial and coronary sinus geometries were created with a deflectable decapolar catheter through the femoral veins, then the decapolar cathter was placed in coronary sinus. Quadripolar catheters were placed through the femoral veins into the high right atrium, His bundle, and right ventricular, respectively. Diagnostic electrophysiologic study and radiofrequency catheter ablation were performed in all patients without the use of fluoroscopy. Results The success rate of procedure was 100

  4. Skin Burn at the Site of Indifferent Electrode after Radiofrequency Catheter Ablation of AV Node for Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Subba Reddy Vanga, MBBS

    2008-07-01

    Full Text Available Radiofrequency Ablation of AV node with permanent pacemaker has been used to achieve rate control in persistent symptomatic atrial fibrillation. Although RF Ablation is safe, complications may occur in up to 3% of the procedures. A rare complication of 2nd degree skin burn at indifferent electrode site has been described here. This report highlights the rare but possible complication in patients undergoing such a procedure and help in preventing by taking appropriate measures.

  5. Skin Burn at the Site of Indifferent Electrode after Radiofrequency Catheter Ablation of AV Node for Atrial Fibrillation.

    Directory of Open Access Journals (Sweden)

    Dhanunjaya R Lakkireddy

    2008-07-01

    Full Text Available Radiofrequency Ablation of AV node with permanent pacemaker has been used to achieve rate control in persistent symptomatic atrial fibrillation. Although RF Ablation is safe, complications may occur in up to 3% of the procedures. A rare complication of 2nd degree skin burn at indifferent electrode site has been described here. This report highlights the rare but possible complication in patients undergoing such a procedure and help in preventing by taking appropriate measures.

  6. Evaluation of left atrial function by multidetector computed tomography before left atrial radiofrequency-catheter ablation: Comparison of a manual and automated 3D volume segmentation method

    Energy Technology Data Exchange (ETDEWEB)

    Wolf, Florian, E-mail: florian.wolf@meduniwien.ac.a [Department of Radiology, Medical University of Vienna, Vienna (Austria); Ourednicek, Petr [Philips Medical Systems, Prague (Czech Republic); Loewe, Christian [Department of Radiology, Medical University of Vienna, Vienna (Austria); Richter, Bernhard; Goessinger, Heinz David; Gwechenberger, Marianne [Department of Cardiology, Medical University of Vienna, Vienna (Austria); Plank, Christina; Schernthaner, Ruediger Egbert; Toepker, Michael; Lammer, Johannes [Department of Radiology, Medical University of Vienna, Vienna (Austria); Feuchtner, Gudrun M. [Department of Radiology, Innsbruck Medical University, Innsbruck (Austria); Institute of Diagnostic Radiology, University Hospital Zurich (Switzerland)

    2010-08-15

    Introduction: The purpose of this study was to compare a manual and automated 3D volume segmentation tool for evaluation of left atrial (LA) function by 64-slice multidetector-CT (MDCT). Methods and materials: In 33 patients with paroxysmal atrial fibrillation a MDCT scan was performed before radiofrequency-catheter ablation. Atrial function (minimal volume (LAmin), maximal volume (LAmax), stroke volume (SV), ejection fraction (EF)) was evaluated by two readers using a manual and an automatic tool and measurement time was evaluated. Results: Automated LA volume segmentation failed in one patient due to low LA enhancement (103HU). Mean LAmax, LAmin, SV and EF were 127.7 ml, 93 ml, 34.7 ml, 27.1% by the automated, and 122.7 ml, 89.9 ml, 32.8 ml, 26.3% by the manual method with no significant difference (p > 0.05) and high Pearsons correlation coefficients (r = 0.94, r = 0.94, r = 0.82 and r = 0.85, p < 0.0001), respectively. The automated method was significantly faster (p < 0.001). Interobserver variability was low for both methods with Pearson's correlation coefficients between 0.98 and 0.99 (p < 0.0001). Conclusions: Evaluation of LA volume and function with 64-slice MDCT is feasible with a very low interobserver variability. The automatic method is as accurate as the manual method but significantly less time consuming permitting a routine use in clinical practice before RF-catheter ablation.

  7. Comparison of the Effects of Intralipid 10% and 20% on Peripheral Catheter Ablation in a Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Farzaneh Mohammadi

    2016-03-01

    Results: Age of the patients ranged between two days and eight years. Esophageal atresia was the most common condition among patients receiving intravenous Intralipid infusion (8.3%. The mean duration of catheter survival was significantly shorter in patients receiving Intralipid 20% (28.77 vs. 68.23 h, P

  8. Impedance measurement to assess epicardial fat prior to RF intraoperative cardiac ablation: a feasibility study using a computer model

    International Nuclear Information System (INIS)

    Radiofrequency (RF) cardiac ablation is used to treat certain types of arrhythmias. In the epicardial approach, efficacy of RF ablation is uncertain due to the presence of epicardial adipose tissue interposed between the ablation electrode and the atrial wall. We planned a feasibility study based on a theoretical model in order to assess a new technique to estimate the quantity of fat by conducting bioimpedance measurements using a multi-electrode probe. The finite element method was used to solve the electrical problem. The results showed that the measured impedance profile coincided approximately with the epicardial fat profile measured under the probe electrodes and also that the thicker the epicardial fat, the higher the impedance values. When the lateral fat width was less than 4.5 mm, the impedance values altered, suggesting that measurements should always be conducted over a sizeable fat layer. We concluded that impedance measurement could be a practical method of assessing epicardial fat prior to RF intraoperative cardiac ablation, i.e. 'to map' the amount of adipose tissue under the probe. (note)

  9. Pulmonary Artery Catheter (PAC Accuracy and Efficacy Compared with Flow Probe and Transcutaneous Doppler (USCOM: An Ovine Cardiac Output Validation

    Directory of Open Access Journals (Sweden)

    Robert A. Phillips

    2012-01-01

    Full Text Available Background. The pulmonary artery catheter (PAC is an accepted clinical method of measuring cardiac output (CO despite no prior validation. The ultrasonic cardiac output monitor (USCOM is a noninvasive alternative to PAC using Doppler ultrasound (CW. We compared PAC and USCOM CO measurements against a gold standard, the aortic flow probe (FP, in sheep at varying outputs. Methods. Ten conscious sheep, with implanted FPs, had measurements of CO by FP, USCOM, and PAC, at rest and during intervention with inotropes and vasopressors. Results. CO measurements by FP, PAC, and USCOM were 4.0±1.2 L/min, 4.8±1.5 L/min, and 4.0±1.4 L/min, respectively, (=280, range 1.9 L/min to 11.7 L/min. Percentage bias and precision between FP and PAC, and FP and USCOM was −17 and 47%, and 1 and 36%, respectively. PAC under-measured Dobutamine-induced CO changes by 20% (relative 66% compared with FP, while USCOM measures varied from FP by 3% (relative 10%. PAC reliably detected −30% but not +40% CO changes, as measured by receiver operating characteristic area under the curve (AUC, while USCOM reliably detected ±5% changes in CO (AUC>0.70. Conclusions. PAC demonstrated poor accuracy and sensitivity as a measure of CO. USCOM provided equivalent measurements to FP across a sixfold range of outputs, reliably detecting ±5% changes.

  10. Right atrial volume calculated by multi-detector computed tomography. Useful predictor of atrial fibrillation recurrence after pulmonary vein catheter ablation

    International Nuclear Information System (INIS)

    We investigated whether right atrial (RA) volume could be used to predict the recurrence of atrial fibrillation (AF) after pulmonary vein catheter ablation (CA). We evaluated 65 patients with paroxysmal AF (mean age, 60+10 years, 81.5% male) and normal volunteers (57±14 years, 41.7% male). Sixty-four-slice multi-detector computed tomography was performed for left atrial (LA) and RA volume estimations before CA. The recurrence of AF was assessed for 6 months after the ablation. Both left and right atrial volumes were larger in the AF patients than the normal volunteers (LA: 99.7+33.2 ml vs. 59.7+17.4 ml; RA: 82.9+35.7 ml vs. 43.9+12 ml; P100 ml) for predicting the recurrence of AF was 81.3% in 13 of 16 patients with AF recurrence, and the specificity was 69.4% in 34 of 49 patients without recurrence. The sensitivity with large RA volumes (>87 ml) was 81.3% in 13 of 16 patients with AF recurrence, and the specificity was 75.5% in 37 of 49 patients without recurrence. RA volume is a useful predictor of the recurrence of AF, similar to LA volume. (author)

  11. Improvements in AF ablation outcome will be based more on technological advancement versus mechanistic understanding

    OpenAIRE

    Chen-yang Jiang, MD; Ru-hong Jiang, MS

    2014-01-01

    Atrial fibrillation(AF) is one of the most common cardiac arrhythmias. Catheter ablation has been proven with more effectiveness than antiarrhythmic drug in preventing clinical recurrences of AF, but the long-term outcome is still unsatisfactory. Ablation strategies have evolved based on progress in mechanistic understanding, and the technologies were advanced continuously. This article will review current mechanistic concepts and technological advancement in AF treatment, and summarize their...

  12. Design and Rationale of the PRAGUE-12 Trial: A Large, Prospective, Randomized, Multicenter Trial That Compares Cardiac Surgery With Left Atrial Surgical Ablation With Cardiac Surgery Without Ablation in Patients With Coronary and/or Valvular Heart Disease Plus Atrial Fibrillation

    OpenAIRE

    Straka, Zbyněk; Budera, Petr; Osmančík, Pavel; Vaněk, Tomáš; Hulman, Michal; Šmíd, Michal; Malý, Marek; Widimský, Petr

    2013-01-01

    Surgical ablation procedure can restore sinus rhythm (SR) in patients with atrial fibrillation (AF) undergoing cardiac surgery. However, it is not known whether it has any impact on clinical outcomes. There is a need for a randomized trial with long-term follow-up to study the outcome of surgical ablation in patients with coronary and/or valve disease and AF. Patients are prospectively enrolled and randomized either to group A (cardiac surgery with left atrial ablation) or group B (cardiac su...

  13. 高血压射频消融治疗导管的开发研究%Research and development of radiofrequency ablation catheter for treatment of hypertension

    Institute of Scientific and Technical Information of China (English)

    何凡; 陈旭东; 霍勇; 方唯一; 曾延华; 王露平; 李启阳; 窦永充

    2015-01-01

    Objective To introduce the overall design principles and structure of a radiofrequency ablation catheter for treatment of hypertension,and to validate the performance and practicability of this catheter in renal sympathetic radiofrequency ablation (RFA) performance.Methods The designed RFA catheter was tested for its different output setups in tissue ablation by measuring the actual radiofrequency output,real-time temperature and real-time impedance.Then,the RFA system was used in 8 adult pigs for radiofrequency ablation of bilateral renal arteries.The blood pressures at baseline,3 and 9 months postablation were measured.The tissues at the operative region were harvested and examined for the change in renal sympathetic nervation after the procedure.Results The RFA system was with good performance in real-time temperature and impedance measurement as well as radiofrequency (RF) output.The tissue ablation was completed as desired.The built-in RF software application of the system allowed for full-length dynamic control of the treatment,with functions of setting treatment parameters,automatic temperature control,data display,automatic storage,and alarming.The one-shot RF output dismissed the need for unnecessary operations such as rotation.The temperature measurement accuracy of the device was ± 0.1 ℃,and the temperature control accuracy ±0.15 ℃.All the performance fulfilled the clinical requirements of design.At 3 and 9 months after radiofrequency ablation,the blood pressure of the 8 adult pigs was reduced as compared with baseline[(10.6±4.4) mmHg(1 mmHg=0.133 kPa) vs (14.8±6.2) mmHg,(10.4±6.4) mmHg vs (21.2± 10.2) mmHg,all P<0.05].There were no findings for RF-related traumatic constricture of renal arteries or renal impairment.The peripheral sympathetic nerve fiber cells were complete degeneration and necrosis after the procedure compared with baseline.Conclusion The controllable renal sympathetic radiofrequency ablation catheter may be advantageous

  14. Visualization of transcoronary ablation of septal hypertrophy in patients with hypertrophic obstructive cardiomyopathy: a comparison between cardiac MRI, invasive measurements and echocardiography

    OpenAIRE

    Sohns, Christian; Sossalla, Samuel; Schmitto, Jan D; Jacobshagen, Claudius; Raab, Björn; Obenauer, Silvia; Maier, Lars S.

    2010-01-01

    Objective Hypertrophic obstructive cardiomyopathy (HOCM) is treated by surgical myectomy or transcoronary ablation of septal hypertrophy (TASH). The aim of this study was to visualize the feasibility, success and short-term results of TASH on the basis of cardiac MRI (CMR) in comparison with cardiac catheterization and echocardiography. Methods In this in vivo study, nine patients with HOCM were treated with TASH. Patients were evaluated by transthoracic echocardiography, invasive cardiac ang...

  15. Cardiac tamponade in an infant during contrast infusion through central venous catheter for chest computed tomography; Tamponamento cardiaco durante infusao de contraste em acesso venoso central para realizacao de tomografia computadorizada do torax em lactente

    Energy Technology Data Exchange (ETDEWEB)

    Daud, Danilo Felix; Campos, Marcos Menezes Freitas de; Fleury Neto, Augusto de Padua [Hospital Geral de Palmas, TO (Brazil)

    2013-11-15

    Complications from central venous catheterization include infectious conditions, pneumothorax, hemothorax and venous thrombosis. Pericardial effusion with cardiac tamponade hardly occurs, and in infants is generally caused by umbilical catheterization. The authors describe the case of cardiac tamponade occurred in an infant during chest computed tomography with contrast infusion through a central venous catheter inserted into the right internal jugular vein. (author)

  16. Increased NT-pro-B-type natriuretic peptide independently predicts outcome following catheter ablation of atrial fibrillation

    DEFF Research Database (Denmark)

    Nilsson, Brian; Goetze, Jens Peter; Chen, Xu;

    2009-01-01

    AIMS: To investigate whether NT-proBNP before ablation treatment and after exercise testing has predictive information regarding the clinical outcome following pulmonary vein isolation in patients with atrial fibrillation (AF). METHODS: NT-proBNP analysis were obtained before the ablation (before...... and after exercise test), and repeated at 1, 3, and 12 months after the final procedure. RESULTS: A total of 51 patients were included. At study entry, the median NT-proBNP concentration was 14.0 pmol/L (quartiles: 8.0 and 27.0). After the exercise test, the mean NT-proBNP value increased from 13.0 pmol....../L (quartiles: 7.5 and 26.0) to 15.0 pmol/L (quartiles: 9.0 and 34.0), p NT-proBNP concentration at baseline was 10.0 pmol/L (quartiles: 7...

  17. The cost-effectiveness of radiofrequency catheter ablation as first-line treatment for paroxysmal atrial fibrillation

    DEFF Research Database (Denmark)

    Aronsson, Mattias; Walfridsson, Håkan; Janzon, Magnus;

    2014-01-01

    , based on MANTRA-PAF (Medical Antiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation) study data, was developed to study long-term effects and costs of RFA compared with AADs as first-line treatment. Positive clinical effects were found in the overall population, a gain...... in older patients is uncertain, and in most of these AADs should be attempted before RFA (MANTRA-PAF ClinicalTrials.gov number; NCT00133211)....

  18. Remote magnetic with open-irrigated catheter vs. manual navigation for ablation of atrial fibrillation: a systematic review and meta-analysis.

    Science.gov (United States)

    Proietti, Riccardo; Pecoraro, Valentina; Di Biase, Luigi; Natale, Andrea; Santangeli, Pasquale; Viecca, Maurizio; Sagone, Antonio; Galli, Alessio; Moja, Lorenzo; Tagliabue, Ludovica

    2013-09-01

    The aim of this study was to determine the efficacy and safety of remote magnetic navigation (RMN) with open-irrigated catheter vs. manual catheter navigation (MCN) in performing atrial fibrillation (AF) ablation. We searched in PubMed (1948-2013) and EMBASE (1974-2013) studies comparing RMN with MCN. Outcomes considered were AF recurrence (primary outcome), pulmonary vein isolation (PVI), procedural complications, and data on procedure's performance. Odds ratios (OR) and mean difference (MD) were extracted and pooled using a random-effect model. Confidence in the estimates of the obtained effects (quality of evidence) was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. We identified seven controlled trials, six non-randomized and one randomized, including a total of 941 patients. Studies were at high risk of bias. No difference was observed between RMN and MCN on AF recurrence [OR 1.18, 95% confidence interval (CI) 0.85 to 1.65, P = 0.32] or PVI (OR 0.41, 95% CI 0.11-1.47, P = 0.17). Remote magnetic navigation was associated with less peri-procedural complications (Peto OR 0.41, 95% CI 0.19-0.88, P = 0.02). Mean fluoroscopy time was reduced in RMN group (-22.22 min; 95% CI -42.48 to -1.96, P = 0.03), although the overall duration of the procedure was longer (60.91 min; 95% CI 31.17 to 90.65, P RMN is not superior to MCN in achieving freedom from recurrent AF at mid-term follow-up or PVI. The procedure implies less peri-procedural complications, requires a shorter fluoroscopy time but a longer total procedural time. For the low quality of the available evidence, a proper designed randomized controlled trial could turn the direction and the effect of the dimensions explored.

  19. 经导管射频消融术治疗阵发性室上性心动过速269例分析%Analysis of 269 Paroxysmal Supraventricular Tachycardia Cases Treated with Radiofrequency Catheter Ablation

    Institute of Scientific and Technical Information of China (English)

    王朝亮; 曹佑德; 陈光瑞; 倪代梅; 吴永全

    2011-01-01

    目的:探讨射频消融术(RFCA)治疗阵发性室上性心动过速(PSVT)的有效性和安全性.方法:回顾分析RFCA治疗阵发性室上性心动过速269例结果,根据体表心电图和心内电生理检查进行RFCA.结果:房室折返性心动过速(AVRT)176例,总成功率97.7%,复发率3.4%,房室结折返性心动过速(AVNRT)93例,总成功率98.9%,复发率4.4%.术中出现短暂性脑缺血发作1例,术后出现Ⅲ度房室传导阻滞1例,无1例因为并发症死亡.结论:RFCA是治疗PSVT的有效方法.并发症和术者的熟练程度、消融靶点的位置、患者全身情况和解剖变异等有关.%Objective:To investigate the validity and security of radiofrequency catheter ablation(RFCA)in the treatment of paroxysmal superventricular tachycardia(PSVT).Methods:Review the results of 269 cases of PSVT patients treated with RFCA which is based on electrocardiogram and cardiac electrophysiologic study.Results:There were 176 cases of atrioventricular reentrant tachycardia(AVRT) with the success rate of 97.7% and the relapse rate of 3.4%.93 cases of atrioventricular nodal reentrant tachycardia(AVNRT)with the success rate of 98.9% and the relapse rate of 4.4%.Though we have 1 case of transient ischemic attack in the operation and 1 case of Ⅲ atrial ventricular block after the operation,we have no death case for the complication of the operation.Conclusion:RFCA is an effective method in the PSVT treatment.The complication depends on the operator's skill level,the position of ablation target,the general appearance of the patients and the anatomical variation.

  20. Image-based view-angle independent cardiorespiratory motion gating and coronary sinus catheter tracking for x-ray-guided cardiac electrophysiology procedures

    International Nuclear Information System (INIS)

    Determination of the cardiorespiratory phase of the heart has numerous applications during cardiac imaging. In this article we propose a novel view-angle independent near-real time cardiorespiratory motion gating and coronary sinus (CS) catheter tracking technique for x-ray fluoroscopy images that are used to guide cardiac electrophysiology procedures. The method is based on learning CS catheter motion using principal component analysis and then applying the derived motion model to unseen images taken at arbitrary projections, using the epipolar constraint. This method is also able to track the CS catheter throughout the x-ray images in any arbitrary subsequent view. We also demonstrate the clinical application of our model on rotational angiography sequences. We validated our technique in normal and very low dose phantom and clinical datasets. For the normal dose clinical images we established average systole, end-expiration and end-inspiration gating success rates of 100%, 85.7%, and 92.3%, respectively. For very low dose applications, the technique was able to track the CS catheter with median errors not exceeding 1 mm for all tracked electrodes. Average gating success rates of 80.3%, 71.4%, and 69.2% were established for the application of the technique on clinical datasets, even with a dose reduction of more than 10 times. In rotational sequences at normal dose, CS tracking median errors were within 1.2 mm for all electrodes, and the gating success rate was 100%, for view angles from RAO 90° to LAO 90°. This view-angle independent technique can extract clinically useful cardiorespiratory motion information using x-ray doses significantly lower than those currently used in clinical practice. (paper)

  1. Pulmonary Arterial Hypertension in Adults: Novel Drugs and Catheter Ablation Techniques Show Promise? Systematic Review on Pharmacotherapy and Interventional Strategies

    Directory of Open Access Journals (Sweden)

    Salvatore Rosanio

    2014-01-01

    Full Text Available This systematic review aims to provide an update on pharmacological and interventional strategies for the treatment of pulmonary arterial hypertension in adults. Currently US Food and Drug Administration approved drugs including prostanoids, endothelin-receptor antagonists, phosphodiesterase type-5 inhibitors, and soluble guanylate-cyclase stimulators. These agents have transformed the prognosis for pulmonary arterial hypertension patients from symptomatic improvements in exercise tolerance ten years ago to delayed disease progression today. On the other hand, percutaneous balloon atrioseptostomy by using radiofrequency perforation, cutting balloon dilatation, or insertion of butterfly stents and pulmonary artery catheter-based denervation, both associated with very low rate of major complications and death, should be considered in combination with specific drugs at an earlier stage rather than late in the progression of pulmonary arterial hypertension and before the occurrence of overt right-sided heart failure.

  2. Dedicated radial ventriculography pigtail catheter

    Energy Technology Data Exchange (ETDEWEB)

    Vidovich, Mladen I., E-mail: miv@uic.edu

    2013-05-15

    A new dedicated cardiac ventriculography catheter was specifically designed for radial and upper arm arterial access approach. Two catheter configurations have been developed to facilitate retrograde crossing of the aortic valve and to conform to various subclavian, ascending aortic and left ventricular anatomies. The “short” dedicated radial ventriculography catheter is suited for horizontal ascending aortas, obese body habitus, short stature and small ventricular cavities. The “long” dedicated radial ventriculography catheter is suited for vertical ascending aortas, thin body habitus, tall stature and larger ventricular cavities. This new design allows for improved performance, faster and simpler insertion in the left ventricle which can reduce procedure time, radiation exposure and propensity for radial artery spasm due to excessive catheter manipulation. Two different catheter configurations allow for optimal catheter selection in a broad range of patient anatomies. The catheter is exceptionally stable during contrast power injection and provides equivalent cavity opacification to traditional femoral ventriculography catheter designs.

  3. The Unique MediGuide Technology for CRT Lead Placement and Catheter Ablatio

    Directory of Open Access Journals (Sweden)

    Carlo Pappone; Martina Boscolo Berto; Vincenzo Santinelli

    2014-06-01

    Full Text Available Electrophysiologic procedures such as catheter ablation and/or cardiac resynchronization therapy are usually performed under fluoroscopic guidance alone. Currently, we are now witnessing the birth of a new era in which many patients can be safely and effectively treated without the use of fluoroscopy. Using MediGuide technology continuous fluoroscopy is no longer required to ascertain the position of the device/catheter, which minimizes the radiation exposure for both the physician and patient, with a further benefit by minimal need for contrast agent. This novel system provides real time tracking of devices projected into live fluoroscopy or pre-recorded cine-angiography. MediGuide technology is an important step forward facilitating complex ablation procedures such as AF ablation and CRT implantation.

  4. Design and rationale of the PRAGUE-12 trial: a large, prospective, randomized, multicenter trial that compares cardiac surgery with left atrial surgical ablation with cardiac surgery without ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation.

    Science.gov (United States)

    Straka, Zbyněk; Budera, Petr; Osmančík, Pavel; Vaněk, Tomáš; Hulman, Michal; Smíd, Michal; Malý, Marek; Widimský, Petr

    2013-01-01

    Surgical ablation procedure can restore sinus rhythm (SR) in patients with atrial fibrillation (AF) undergoing cardiac surgery. However, it is not known whether it has any impact on clinical outcomes. There is a need for a randomized trial with long-term follow-up to study the outcome of surgical ablation in patients with coronary and/or valve disease and AF. Patients are prospectively enrolled and randomized either to group A (cardiac surgery with left atrial ablation) or group B (cardiac surgery alone). The primary efficacy outcome is the SR presence (without any AF episode) during a 24-hour electrocardiogram after 1 year. The primary safety outcome is the combined end point of death, myocardial infarction, stroke, and renal failure at 30 days. Long-term outcomes are a composite of total mortality, stroke, bleeding, and heart failure at 1 and 5 years. We finished the enrollment with a total of 224 patients from 3 centers in 2 countries in December 2011. Currently, the incomplete 1-year data are available, and the patients who enrolled first will have their 5-year visits shortly. PRAGUE-12 is the largest study to be conducted so far comparing cardiac surgery with surgical ablation of AF to cardiac surgery without ablation in an unselected population of patients who are operated on for coronary and/or valve disease. Its long-term results will lead to a better recognition of ablation's potential clinical benefits.

  5. Tamponamento cardíaco em dois recém-nascidos causado por cateter umbilical Cardiac tamponade caused by central venous catheter in two newborns

    Directory of Open Access Journals (Sweden)

    Andrey José Monteiro

    2008-09-01

    Full Text Available Tamponamento cardíaco secundário ao uso de cateter venoso central é uma complicação rara, porém potencialmente tratável, quando identificada a tempo. Nós relatamos dois casos de tamponamento cardíaco, diagnosticados por ecocardiograma transtorácico, seguido de pericardiocentese de urgência e drenagem pericárdica cirúrgica como complicação de cateterização venosa umbilical. Em um caso, a ponta do cateter estava adequadamente localizada e, no outro caso, não. Em ambos os casos, solução hiperosmolar estava sendo infundida. Apesar de situação incomum, esta deve ser sempre considerada em neonato, evoluindo com choque cardiogênico sem causa aparente.Cardiac tamponade secondary to the use of central venous catheter is a rare complication; however, it is potentially reversible when it is caught in time. We report two cases of cardiac tamponade that was diagnosed using a transthoracic echocardiography, followed by urgent pericardiocentesis and surgical pericardial drainage as a complication from umbilical venous catheterization. In one case, the tip of the catheter was properly placed, and in the other case, it was not. In both cases, a hyperosmolar solution was being injected. Although it may be an uncommon situation, it should be always considered as a possibility in a newborn who develops cardiogenic shock without an apparent cause.

  6. Force control of flexible catheter robots for beating heart surgery

    OpenAIRE

    Kesner, Samuel Benjamin; Howe, Robert D.

    2011-01-01

    Recent developments in cardiac catheter technology promise to allow physicians to perform most cardiac interventions without stopping the heart or opening the chest. However, current cardiac devices, including newly developed catheter robots, are unable to accurately track and interact with the fast moving cardiac tissue without applying potentially damaging forces. This paper examines the challenges of implementing force control on a flexible robotic catheter. In particular, catheter frictio...

  7. Effect of catheter radiofrequency ablation on C-reactive protein, brain natriuretic peptide and echocardiograph in patients with persistent and permanent atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    Huang Qiong; Yuan Yiqiang; Qiu Chunguang; Zhao Yujie; Mao Youlin; Wang Ruimin; Wang Qian

    2014-01-01

    Background Radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has developed rapidly,and is a commonly performed ablation in many major hospitals throughout the world,due to its satisfactory results.The aim of this study was to detect the effect of RFCA on C-reactive protein (CRP),brain natriuretic peptide (BNP),and echocardiograph in patients with persistent and permanent AF.Methods A total of 120 patients (71 males,mean age (50.8±12.0) years) with persistent and permanent AF undergoing RFCA under guidance of the Carto merge technique were studied.Left atrial diameter (LAD),right atrial diameter (RAD),left ventricular ejection fraction (LVEF),CRP,and BNP were observed 3,6 and 12 months after RFCA and compared with results before RFCA.The recurrence of atrial arrhythmias was observed 3 and 12 months after the procedure.Results Compared with that before RFCA,LAD and RAD decreased and LVEF increased significantly after RFCA.Meanwhile,the levels of CRP and BNP were reduced significantly at 3,6,and 12 months after RFCA (P<0.05).In the non-recurrent patients,LVEF was increased significantly compared with the recurrent patients at 3,6,and 12 months after RFCA (P<0.05).CRP and BNP levels were decreased significantly in the non-recurrent patients compared with the recurrent patients at 3,6,and 12 months after RFCA (P<0.05).After one or two applications of RFCA,during a follow-up of 12 months,12 patients (10.0%) had AF,10 patients (8.3%) had atrial flutter,and 5 patients had atrial tachycardia (4.2%).Conclusions Conversion of AF to sinus rhythm by RFCA,has been shown to reduce LA size and improve LVEF.It can also significantly decrease the levels of CRP and BNP in patients with persistent and permanent AF and reduce the risk of inflammation and developing heart failure.

  8. 心房颤动导管消融相关无症状脑梗塞发生率Meta分析%Meta-analysis for the Incidence Rate of Asymptomatic Cerebral Embolism in Patients With Atrial Fibrillation After Catheter Ablation

    Institute of Scientific and Technical Information of China (English)

    韩全乐; 王桂苹; 刘书旺; 刘晓堃; 张琦; 张华; 王晓晓

    2015-01-01

      结论:房颤导管消融相关无症状脑梗塞发生率处在一个较高水平,是房颤导管消融以降低栓塞事件过程中必须面对的一个严峻问题,应得到更多关注,并采取相应的干预措施。%Objective: To generally assess the incidence rate of asymptomatic cerebral embolism in patients with atrial ifbrillation (AF) after catheter ablation by Meta-analysis in order to provide the basic information for cerebral embolism prevention. Methods: We systemically searched the publications of PubMed, Springer, Elsevier-SDOL, EMbase, SSCI, VIP, Chinese biomedical literature database (CBM), Chinese journal full-text database (CNKI), Wanfang data resource, Chinese outstanding master’s degree thesis database and Chinese important articles published in full-text database from 2006 to 2014 for the literatures regarding the asymptomatic cerebral embolism in AF patients after catheter ablation. The literature quality was evaluated by Loney criteria, Meta-analysis was conducted by R software to assess the incidence rate of asymptomatic cerebral embolism after ablation, the impact of type and quality for research were estimated by sensitivity analysis. Results: A total of 16 qualiifed literatures were enrolled in our research with 1258 patients. The incidence rate of asymptomatic cerebral embolism in AF patients after ablation was 17.46% (95% CI 13.13% - 22.84%). The sensitivity analysis indicated that excluding the literature at the lowest quality and the literature only with the part of age group, the Meta-analysis result had no obvious changes. Conclusion: The asymptomatic cerebral embolism in AF patients after ablation is at a relatively high prevalence condition, it should be seriously emphasized and with the active intervention in clinical practice.

  9. Prevention of ventricular fibrillation by percutaneous catheter alcohol ablation on posterior papillary muscle in swine%经皮导管乙醇消融猪左心室后乳头肌预防心室颤动的实验研究

    Institute of Scientific and Technical Information of China (English)

    周旭; 郭雷生; 蔡军; 隗冬梅; 石亮; 杨刚; 刘小青; 杨新春

    2011-01-01

    guide wire (supported by a transaortic guiding catheter) were punctured into the PPM.After the guide wire was withdrawn,chemical ablation was performed by injecting dehydrated alcohol ( ablation group,n =6) or saline ( control group,n =6) into the base of PPM through the central lumen of the micro-catheter.Results After PPM puncture,One animal was dead due to cardiac tamponade,twelve animals were performed percutaneous trans-catheter injection.In ablation group,no VF were induced by programmed RV stimulation in three animals (3/6) and two of them had no VF induced by further RV extra pacing either; two animals (2/6) had induced nonsustained VF and self terminated in several seconds; one animal (1/6) had induced sustained VF.In control group,all six animals (6/6) had induced sustained VF.The inducibility of sustained VF was significantly reduced by percutaneous catheter alcohol ablation on posterior papillary muscle (P<0.01 ).Conclusion Percutaneous catheter alcohol ablation of the left ventricular PPM could reduce VF inducibility in normal intact swine hearts.This suggests that the PPM may be involved in the generation and maintenance of VF.

  10. 儿童左心室特发性室性心动过速临床特点及射频消融治疗%Radiofrequency catheter ablation for idiopathic left ventricular tachycardia in children

    Institute of Scientific and Technical Information of China (English)

    林利; 袁越

    2012-01-01

    Objective: The purpose of this study was to analyze the clinical features and the effect of radiofrequency catheter ablation ( RFC A ) for idiopathic left ventricular tachycardia ( ILVT) in children. Methods : Eleetrophysiological study and radiofrequency catheter ablation were performed on 56 consecutive patients, and the target of ILVT was the site of earliest P potential on activation mapping in septal portion. Pacing and activation sequence mapping were used for LOT and VT originating from the left anterior fascicle in the ablation. The ablation target of LOT was where 12-lead pacing ECG was entirely consistent with IVT attacks. The successful target was that IVT could not be induced by repeated programmed stimulation while intravenous isoprena-Ime was administered. Results: The successful ablation rate was 98.2% (54 /55) in left IVT. 3 patients (5. 5% ) recurrenced during follow-up period and 2 were successfully reablated. Conclusion; RFCA has high success rate and few complications in treatment for ILVT.%目的:观察儿童左心室特发性室性心动过速(idiopathic left ventricular tachycardia ILVT)的临床特征和射频导管消融(radiofrequency catheter ablation RFCA)治疗的效果.方法:56例ILVT患儿行心内电生理检查和RFCA治疗,左心室特发性VT(ILVT)起自间隔部者以最早的P电位处为靶点,左心室流出道VT(LOT)和左前间隔来源的IVT,均以起搏与VT发作时12导联心电图QRS波,形态完全相同处或最早心室激动处为靶点.消融终点为程序刺激或静点异丙肾上腺素室速不被诱发.结果:RF-CA治疗ILVT的成功率为98.2%,复发率为5.5%.IVT起源部位分别位于左心室后间隔部47例,左前间隔3例,左心室流出道6例.结论:ILVT的RFCA成功率高,并发症少.

  11. Cardiac arrhythmia

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008032 Efficacy of integrated three-dimensional electroanatomic mapping with preacquired magnetic resonance images guide catheter atrial fibrillation ablation. YU Ronghui(喻荣辉), et al. Dept Cardiol, Beijing Anzhen Hosp, Capital Med Univ, Beijing 100029. Chin J Cardiol 2007;35(11):1029-1033. Objective To investigate the efficacy of integrated electroanatomic mapping with preacquired magnetic resonance (MR) images guided catheter at

  12. Direct cooling of the catheter tip increases safety for CMR-guided electrophysiological procedures

    Directory of Open Access Journals (Sweden)

    Reiter Theresa

    2012-02-01

    Full Text Available Abstract Background One of the safety concerns when performing electrophysiological (EP procedures under magnetic resonance (MR guidance is the risk of passive tissue heating due to the EP catheter being exposed to the radiofrequency (RF field of the RF transmitting body coil. Ablation procedures that use catheters with irrigated tips are well established therapeutic options for the treatment of cardiac arrhythmias and when used in a modified mode might offer an additional system for suppressing passive catheter heating. Methods A two-step approach was chosen. Firstly, tests on passive catheter heating were performed in a 1.5 T Avanto system (Siemens Healthcare Sector, Erlangen, Germany using a ASTM Phantom in order to determine a possible maximum temperature rise. Secondly, a phantom was designed for simulation of the interface between blood and the vascular wall. The MR-RF induced temperature rise was simulated by catheter tip heating via a standard ablation generator. Power levels from 1 to 6 W were selected. Ablation duration was 120 s with no tip irrigation during the first 60 s and irrigation at rates from 2 ml/min to 35 ml/min for the remaining 60 s (Biotronik Qiona Pump, Berlin, Germany. The temperature was measured with fluoroscopic sensors (Luxtron, Santa Barbara, CA, USA at a distance of 0 mm, 2 mm, 4 mm, and 6 mm from the catheter tip. Results A maximum temperature rise of 22.4°C at the catheter tip was documented in the MR scanner. This temperature rise is equivalent to the heating effect of an ablator's power output of 6 W at a contact force of the weight of 90 g (0.883 N. The catheter tip irrigation was able to limit the temperature rise to less than 2°C for the majority of examined power levels, and for all examined power levels the residual temperature rise was less than 8°C. Conclusion Up to a maximum of 22.4°C, the temperature rise at the tissue surface can be entirely suppressed by using the catheter's own irrigation

  13. Cardiac troponin I degradation in serum of patients with hypertrophic obstructive cardiomyopathy undergoing percutaneous septal ablation

    DEFF Research Database (Denmark)

    Madsen, Lene H; Lund, Terje; Grieg, Zanina;

    2009-01-01

    : percutaneous transluminal septal myocardial ablation (PTSMA) of hypertrophic obstructive cardiomyopathy (HOCM). Here the iatrogenic induction of myocardial necrosis occurs in vivo, allowing us to investigate degradation of cTnI by the second. METHODS: Blood samples were obtained from 8 patients with HOCM just...

  14. The role of Multidetector CT in the evaluation of the left atrium and pulmonary veins anatomy before and after radio-frequency catheter ablation for atrial fibrillation. Preliminary results and work in progress.Technical note

    International Nuclear Information System (INIS)

    Radio-frequency catheter ablation (RFCA) of the distal pulmonary veins is increasingly being used to treat recurrent or refractory atrial fibrillation that doesn't respond to pharmacologic therapy or cardioversion. Successful RFCA of atrial al fibrillation depends on the pre-procedural understanding of the complex anatomy of the distal pulmonary veins and the left atrium. Aim of this parer is to describe the technical main features that characterise the multidetector helical computed tomography in the evaluation of this anatomic region before and after RFCA procedure. The 3D post-processing techniques useful for pre-RFCA planning are straightforward

  15. Idiopathic ventricular tachycardia: transcatheter ablation or antiarrhythmic drugs?

    Directory of Open Access Journals (Sweden)

    Claudio Tondo; Corrado Carbucicchio; Antonio Dello Russo; Benedetta Majocchi; Martina Zucchetti; Francesca Pizzamiglio; Fabrizio Bologna; Fabio Cattaneo; Daniele Colombo; Eleonora Russo; Michela Casella

    2015-02-01

    Full Text Available Introduction Ventricular tachycardia or frequent premature ventricular contractions (PVCs can occur in the absence of any detectable structural heart disease. In this clinical setting, these arrhythmias are termed idiopathic. Usually, they carry a benign prognosis and any potential ablative intervention is carried out if patients are highly symptomatic or, more importantly, if frequent ventricular arrhythmias can lead to ventricular dysfunction. Methods In this paper, different forms of idiopathic ventricular tachycardia are reviewed. Outflow tract ventricular tachycardia from the right ventricle is the most frequent form of the so-called idiopathic ventricular tachycardia. Other forms of idiopathic ventricular arrhythmias include ventricular tachycardia/PVCs arising from tricuspid annulus, from the mitral annulus, inter-fascicular ventricular tachycardia and papillary muscle ventricular tachycardia. When interventional treatment is deemed necessary, detailed mapping ( earliest activation during VT/PVC, pace mapping is crucial as to identify the successful ablation site. Catheter ablation more than antiarrhythmic drug treatment is usually highly effective in eliminating idiopathic ventricular arrhythmias and providing prevention of recurrence. Conclusion Idiopathic VTs are not considered life-threatening arrhythmias and, prevention of recurrences is often achieved by means of catheter ablation that provides an improvement of quality of life. The overall acute success rate of catheter ablation is about 85-90% with a long–term prevention of arrhythmia recurrence of about 75-80%. It is advisable that the procedure is carried out by electrophysiologists with expertise in VT catheter ablation and extensive knowledge of cardiac anatomy as to ensure a high success rate and reduce the likelihood of major complications.

  16. 器质性心脏病室性心动过速导管消融治疗进展%Developments in Catheter Ablation of Ventricular Tachycardia in Patients with Organic Heart Disease

    Institute of Scientific and Technical Information of China (English)

    刘启明

    2011-01-01

    The mechanism of ventricular tachycardia ( VT) in organic heart disease is reentry within the scar and scar-border zone. Three dimensional mapping systems are often helpful for mapping, and irrigated ablation catheters are essential for linear ablation. Several mapping strategies are helpful in the scar-related VT. Activation mapping for hemodynamically tolerated VT, substrate mapping and voltage mapping for unstable VT, pace mapping and entrainment mapping determine putative VT exit sites and channels of slow conduction. We review the development of evidence-based medicine, indication, mapping, ablation and support methods for catheter ablation in scar-related VT.%器质性心脏病瘢痕相关性室性心动过速(室速)的发生主要是折返机制,目前多采用心脏三维标测系统指引下对耐受性好、血流动力学稳定的室速激动标测消融,对于血流动力学不稳定的室速,窦性心律下基质标测、电压图判断室速的解剖基质,结合起搏标测和拖带标测技术识别室速的折返环,盐水灌注导管消融治疗;近年来不断积累有关临床循证证据、适应证进一步拓展、新的标测消融和辅助技术临床上应用,取得了新的进展.

  17. Estudo eletrofisiológico e ablação por cateter: o que a Enfermagem precisa saber Estudio electrofisiológico y ablación por catéter: qué la enfermería precisa saber Electrophysiologic study and catheter ablation: what the nursing should know

    Directory of Open Access Journals (Sweden)

    Lutgarde Magda Suzanne Vanheusden

    2007-03-01

    Full Text Available A ablação por cateter é um procedimento invasivo eletrofisiológico que visa eliminar ou obstruir um circuito arritmogênico. Atualmente o Brasil conta com mais de 30 centros eletrofisiológicos nas regiões diversas que desenvolvem rotineiramente a técnica da ablação por radiofreqüência. Neste cenário específico, a presença da enfermeira vem se destacando desde a preparação do paciente até sua orientação para a alta. O objetivo deste artigo é revisar as indicações do estudo eletrofisiológico e da ablação por cateter para o diagnóstico e tratamento das arritmias cardíacas. O detalhamento técnico, as complicações e os cuidados de enfermagem são apresentados.La ablación por catéter es un procedimiento invasivo eletrofisiológico que tiene como objetivo eliminar o bloquear un circuito arritmogénico. Actualmente el Brasil cuenta con más de 30 centros eletrofisiológicos en las diversas regiones que desarrollan rutinariamente la técnica de ablación por radiofreqüência. En esta escena específica, la presencia de la enfermera viene destacándose desde la preparación del paciente hasta su orientación para el alta. El objetivo de este artículo es revisar las indicaciones del estudio eletrofisiológico y de la ablación por catéter para el diagnóstico y tratamiento de las arritmias cardiacas. El detallismo técnico, las complicaciones y los cuidados de de enfermería son presentados.The catheter ablation is an electro physiologic invasive procedure that aims at to eliminate or to block an arritmogenic circuit. Currently, Brazil has more than 30 electro physiologic centers in diverse regions that routinely develop the ablation technique by radiofrequency. In this specific scene, the presence of the nurse has been detaching since the preparation of the patient until the orientation for discharge. The objective of this article is to review the indications of the electro physiologic study and of the catheter ablation

  18. Clinical analysis of radiofrequency catheter ablation in 50 patients with ventricular arrhythmia%50例室性心律失常导管射频消融治疗临床分析

    Institute of Scientific and Technical Information of China (English)

    何鹏义; 木胡牙提; 马依彤; 汤宝鹏; 侯月梅; 张燕一; 姚焰

    2011-01-01

    目的:报道不同类型室性心律失常的射频导管消融(RFCA)体会.方法:50例室性心律失常患者中男20例、女30例,年龄14~70(43.21±13.31)岁.除1例为陈旧性心肌梗死冠状动脉旁路移植术(CABG)后持续性室性心动过速(VT)、5例为致心律失常性右室心肌病(ARVC)外,其余44例均为非器质性心脏病室性心律失常.43例非器质性心脏病室性心律失常采用传统的起搏与激动标测.6例器质性心脏病VT及1例多源室性期前收缩(PVC)在非接触标测系统EnSite3000指导下进行消融治疗.结果:①48例消融成功,2例失败,成功率96%,4例复发.②右室流出道(RVOT)起源的VT和PVC具有典型的心电图特征,表现为典型的左束支传导阻滞型伴电轴右偏.RVOT的起源点不同,其12导联心电图特征不同,Ⅰ、Ⅱ、Ⅲ和aVF导联呈RR'型,V1~3具有深S波是游离壁起源的特征.ARVC表现为典型的左束支传导阻滞型伴电轴右偏,窦性心律时V1~3 T波浅倒置,心脏核磁或心脏超声心动图见右室心肌运动减弱.③1例ARVC和1例陈旧性心肌梗死CABG术后病例在消融过程中出现心室颤动,经电除颤后继续消融成功.结论:RFCA是一种安全、有效的治疗方法.EnSite3000非接触标测系统定位快速准确,适用于ARVC、心肌梗死后VT等血流动力学不稳定的心律失常和多起源的复杂室性心律失常的标测.%To report the different experience in treating different types of ventricular arrhythmiaswith radiofrequency catheter ablation (RFCA). Method:The 50 cases of ventricular arrhythmias patients, consistedof 20 males and 30 females, aged (43. 21+13. 31) 14-70 years. Except l case of old myocardial infarction coro-nary artery bypass grafting (CABG) and the persistent VT, 5 cases of ARVC, the remaining 44 cases of ventricu-lar arrhythmias patients confirmed that no device such as the quality evidence of heart disease. The 43 non-organicventricular tachycardia and PVC

  19. Ablation of C/EBP homologous protein increases the acute phase mortality and doesn't attenuate cardiac remodeling in mice with myocardial infarction.

    Science.gov (United States)

    Luo, Guangjin; Li, Qingman; Zhang, Xiajun; Shen, Liang; Xie, Jiahe; Zhang, Jingwen; Kitakaze, Masafumi; Huang, Xiaobo; Liao, Yulin

    2015-08-14

    Endoplasmic reticulum stress is a proapoptotic and profibrotic stimulus. Ablation of C/EBP homologous protein (CHOP) is reported to reverse cardiac dysfunction by attenuating cardiac endoplasmic reticulum stress in mice with pressure overload or ischemia/reperfusion, but it is unclear whether loss of CHOP also inhibits cardiac remodeling induced by permanent-infarction. In mice with permanent ligation of left coronary artery, we found that ablation of CHOP increased the acute phase mortality. For the mice survived to 4 weeks, left ventricular anterior (LV) wall thickness was larger in CHOP knockout mice than in the wildtype littermates, while no difference was noted on posterior wall thickness, LV dimensions, LV fractional shortening and ejection fraction. Similarly, invasive assessment of LV hemodynamics, morphological analysis of heart and lung weight indexes, myocardial fibrosis and TUNEL-assessed apoptosis showed no significant differences between CHOP knockout mice and their wildtype ones, while in mice with ischemia for 45 min and reperfusion for 1 week, myocardial fibrosis and apoptosis in the infarct area were significantly attenuated in CHOP knockout mice. These findings indicate that ablation of CHOP doesn't ameliorate cardiac remodeling induced by permanent-myocardial infarction, which implicates that early reperfusion is a prerequisite for ischemic myocardium to benefit from CHOP inhibition.

  20. 特发性室性心律失常射频导管消融治疗828例分析%Catheter radiofrequency ablation of idiopathic ventricular arrhythmias-an analysis of 828 cases

    Institute of Scientific and Technical Information of China (English)

    林加锋; 林佳选; 李岳春; 季亢挺; 殷日鹏; 李嘉

    2015-01-01

    Objective To explore the efficacy and safety of catheter radiofrequency ablation (RF)for idiopathic premature ventricular contraction (PVC) and ventricular tachycardia (VT) from different origins. Methods RF was performed with a conventional catheter or an irrigated- tip catheter in 828 patients with PVC/VT under the guidance of X- ray image or three- dimensional mapping systems. The advantage and disadvantage of different mapping and ablation strategies for different PVC/VT were analyzed. Results 580 cases had PVC/VT originating from right ventricle (70.05%) and 248 from left ventricle (29.95%). Right ventricular outflow tract was the most common site (56.64%), fol owed by left ventricular septum, left ventricular outflow tract and tricuspid annulus. Success rate of ablation was 95.52% for right ventricular origin and 87.50% for left ventricular origin. Conventional catheter with temperature control was used in endocardial ablation, and irrigated- tip catheter was required in epicardial ablation via coronary sinus ostium. Conclusion RF is safety and efficacy for idiopathic PVC/VT with a higher success rate for those from right ventricle.%目的探讨不同起源特发性室性期前收缩(PVCs)和(或)室性心动过速(VT)的射频导管消融(下称消融)治疗疗效及安全性。方法828例PVCs/VT患者接受消融治疗,采用X线影像或三维标测系统进行标测,普通或冷盐水消融导管进行消融,分析不同标测与消融方法治疗不同起源PVCs/VT的优缺点。结果右心室起源580例(70.05%),左心室起源248例(29.95%),其中右心室流出道最常见(469例,占56.64%),其次为左心室间隔部、左心室流出道、邻近三尖瓣环。左、右心室起源分别消融成功率分别为87.50%和95.52%。心内膜起源者采用普通温控消融导管消融,经冠状窦的心外膜消融则需应用冷盐水灌注导管。结论特发性PVCs/VT消融治疗安全有效,右心室起源者成功率更高。

  1. Catheter Ablation of Ventricular Tachycardia

    Science.gov (United States)

    ... LIBRARY Hello, Guest! My alerts Sign In Join Facebook Twitter Home About this Journal Editorial Board General Statistics Circulation Cover Doodle → Blip the Doodle Go Red For Women's Issue Information for Advertisers Author Reprints Commercial Reprints Customer Service and Ordering ...

  2. Preparation of liposomal amiodarone and investigation of its cardiomyocyte-targeting ability in cardiac radiofrequency ablation rat model

    Directory of Open Access Journals (Sweden)

    Zhuge Y

    2016-05-01

    Full Text Available Ying Zhuge,1,* Zhi-Feng Zheng,1,* Mu-Qing Xie,2 Lin Li,2 Fang Wang,1 Feng Gao2,3 1Department of Cardiology, Shanghai First People’s Hospital of Nanjing Medical University, 2Department of Pharmaceutics, School of Pharmacy, 3Shanghai Key Laboratory of Functional Materials Chemistry, East China University of Science and Technology, Shanghai, People’s Republic of China*These authors contributed equally to this workAbstract: The objective of this study was to develop an amiodarone hydrochloride (ADHC-loaded liposome (ADHC-L formulation and investigate its potential for cardiomyocyte targeting after cardiac radiofrequency ablation (CA in vivo. The ADHC-L was prepared by thin-film method combined with ultrasonication and extrusion. The preparation process was optimized by Box–Behnken design with encapsulation efficiency as the main evaluation index. The optimum formulation was quantitatively obtained with a diameter of 99.9±0.4 nm, a zeta potential of 35.1±10.9 mV, and an encapsulation efficiency of 99.5%±13.3%. Transmission electron microscopy showed that the liposomes were spherical particles with integrated bilayers and well dispersed with high colloidal stability. Pharmacokinetic studies were investigated in rats after intravenous administration, which revealed that compared with free ADHC treatment, ADHC-L treatment showed a 5.1-fold increase in the area under the plasma drug concentration–time curve over a period of 24 hours (AUC0–24 h and an 8.5-fold increase in mean residence time, suggesting that ADHC-L could facilitate drug release in a more stable and sustained manner while increasing the circulation time of ADHC, especially in the blood. Biodistribution studies of ADHC-L demonstrated that ADHC concentration in the heart was 4.1 times higher after ADHC-L treatment in CA rat model compared with ADHC-L sham-operated treatment at 20 minutes postinjection. Fluorescence imaging studies further proved that the heart

  3. Impact of catheter ablation with remote magnetic navigation on procedural outcomes in patients with persistent and long-standing persistent atrial fibrillation

    DEFF Research Database (Denmark)

    Jin, Qi; Pehrson, Steen; Jacobsen, Peter Karl;

    2015-01-01

    BACKGROUND: The objectives of this study were to assess the procedural outcomes of persistent and long-standing persistent atrial fibrillation (PsAF and L-PsAF) ablation guided by remote magnetic navigation (RMN), and to detect factors predicting acute restoration of sinus rhythm (SR) by ablation...... with RMN. METHODS: A total of 313 patients (275 male, age 59 ± 9.5 years) with PsAF (187/313) or L-PsAF (126/313) undergoing ablation using RMN were included. Patients' disease history, pulmonary venous anatomy, left atrial (LA) volume, procedure time, mapping plus ablation time, radiofrequency (RF.......03). Stepwise regression analysis showed LA volume was the primary parameter affecting SR restoration (P = 0.01). The LA volume of patients without direct SR restoration by ablation was 24% greater than that of patients with SR restoration (P RMN is a safe...

  4. Electrophysiology Catheter Detection and Reconstruction From Two Views in Fluoroscopic Images.

    Science.gov (United States)

    Hoffmann, Matthias; Brost, Alexander; Koch, Martin; Bourier, Felix; Maier, Andreas; Kurzidim, Klaus; Strobel, Norbert; Hornegger, Joachim

    2016-02-01

    Electrophysiology (EP) studies and catheter ablation have become important treatment options for several types of cardiac arrhythmias. We present a novel image-based approach for automatic detection and 3-D reconstruction of EP catheters where the physician marks the catheter to be reconstructed by a single click in each image. The result can be used to provide 3-D information for enhanced navigation throughout EP procedures. Our approach involves two X-ray projections acquired from different angles, and it is based on two steps: First, we detect the catheter in each view after manual initialization using a graph-search method. Then, the detection results are used to reconstruct a full 3-D model of the catheter based on automatically determined point pairs for triangulation. An evaluation on 176 different clinical fluoroscopic images yielded a detection rate of 83.4%. For measuring the error, we used the coupling distance which is a more accurate quality measure than the average point-wise distance to a reference. For successful outcomes, the 2-D detection error was 1.7 mm ±1.2 mm. Using successfully detected catheters for reconstruction, we obtained a reconstruction error of 1.8 mm ±1.1 mm on phantom data. On clinical data, our method yielded a reconstruction error of 2.2 mm ±2.2 mm. PMID:26441411

  5. 儿童房性心动过速的电生理标测和射频导管消融%Radiofrequency catheter ablation of atrial tachycardia in children

    Institute of Scientific and Technical Information of China (English)

    高路; 袁越; 林利; 崔烺; 姚焰

    2010-01-01

    目的 报道儿童房性心动过速(房速)的电生理标测及射频导管消融的疗效.方法 43例患儿(男性23例,女性20例),年龄2~14(7.1±3.1)岁,其中33例为无休止房速,17例伴有明显的左心室扩大及慢性心力衰竭.所有患儿均进行电生理标测,在最早激动点进行导管射频消融.结果 39例自发或诱发房速,局灶起源36例(右心房26例,左心房10例),先天性心脏病后大折返房速3例.35例(89.7%)患儿消融术即刻成功,消融术中及术后无严重并发症发生.平均随访(25.2±13.5)个月,34例(87.2%)患儿不服药亦无房速发作,其余均获得明显改善.14例左心室重度扩大及射血分数减低患儿心脏大小及功能恢复正常.结论 儿童房速可经导管消融消除或获得明显改善.%Objective Atrial tachycardia (AT) is a common entity among children.This study was designed to investigate the effects of electrophysiological study (EPS) and radiofrequency (RF) catheter ablation of AT in children. Methods Forty-three children [ mean age: (7. 1 ± 3. 1 ) years ] with AT underwent EPS and catheter ablation. Thirty-three children had demonstrated incessant AT, and 17 children had severely dilated left ventricle (LV) and congestive heart failure before ablation. RF energy was delivered to the earliest activation site of the AT. Results Thirty-nine children have spontaneous or induced AT, 36 of them was verified as focal mechanism (26 foci in the right atrium and 10 in the left atrium),and 3 was macro-reentrant mechanism. The AT originated from right atrial appendage in 12 cases. RF ablation was acutely successful in 35 (89. 7% ) patients without any complications. During a follow-up period of ( 25.2 ± 13.5 ) months, 34/39 (87.2%) children had no recurrence of AT, and the 14 children with severe dilated LV before ablation had normal LV diameter. Conclusion RF catheter ablation is effective and safe for treatment of pediatric AT.

  6. The effect of integrated cardiac rehabilitation versus treatment as usual for atrial fibrillation patients treated with ablation: the randomised CopenHeartRFA trial protocol

    Science.gov (United States)

    Risom, Signe Stelling; Zwisler, Ann-Dorth Olsen; Rasmussen, Trine Bernholdt; Sibilitz, Kirstine Lærum; Svendsen, Jesper Hastrup; Gluud, Christian; Hansen, Jane Lindschou; Winkel, Per; Thygesen, Lau Caspar; Perhonen, Merja; Hansen, Jim; Dunbar, Sandra B; Berg, Selina Kikkenborg

    2013-01-01

    Introduction Atrial fibrillation affects almost 2% of the population in the Western world. To preserve sinus rhythm, ablation is undertaken in symptomatic patients. Observational studies show that patients with atrial fibrillation often report a low quality of life and are less prone to be physically active due to fear of triggering fibrillation. Small trials indicate that exercise training has a positive effect on exercise capacity and mental health, and both patients with recurrent atrial fibrillation and in sinus rhythm may benefit from rehabilitation in managing life after ablation. No randomised trials have been published on cardiac rehabilitation for atrial fibrillation patients treated with ablation that includes exercise and psychoeducational components. Aim To test the effects of an integrated cardiac rehabilitation programme versus treatment as usual for patients with atrial fibrillation treated with ablation. Methods and analysis design The trial is a multicentre parallel arm design with 1:1 randomisation to the intervention and control group with blinded outcome assessment. 210 patients treated for atrial fibrillation with radiofrequency ablation will be included. The intervention consists of a rehabilitation programme including four psychoeducative consultations with a specially trained nurse and 12 weeks of individualised exercise training, plus the standard medical follow-up. Patients in the control group will receive the standard medical follow-up. The primary outcome measure is exercise capacity measured by the VO2 peak. The secondary outcome measure is self-rated mental health measured by the Short Form 36 questionnaire. Postintervention, qualitative interviews will be conducted in 10% of the intervention group. Ethics and dissemination The protocol is approved by the regional research ethics committee (number H-1-2011-135), the Danish Data Protection Agency (reg. nr. 2007-58-0015) and follows the latest version of the Declaration of Helsinki

  7. Reprocessamento de cateteres cardíacos: uma revisão Reuse of cardiac catheters: a review

    Directory of Open Access Journals (Sweden)

    Silma Maria Cunha Pinheiro Ribeiro

    2006-09-01

    Full Text Available Os cateteres de hemodinâmica são amplamente reprocessados, principalmente em países em desenvolvimento, onde os custos da utilização desses insumos são altos. A literatura científica aponta a ausência de processos validados de limpeza e esterilização e é unânime a afirmação de que o reprocessamento provoca alterações na integridade física, química e funcional desses materiais. Dentro desse contexto, questionam-se quais as evidências publicadas sobre os danos provocados pelo reprocessamento dos cateteres de hemodinâmica? O objetivo é identificar as evidências científicas em relação aos efeitos do reprocessamento dos cateteres, do ponto de vista mecânico, físico, químico e biológico. Foi realizada uma pesquisa na base de dados Medline/Pubmed e LILACS, sem restrições de tempo, em inglês, português e espanhol, usando vocabulário controlado e não-controlado. Um total de 21 publicações foi analisado. Os artigos analisados apontam a ocorrência de alterações físicas, mecânicas e químicas. A limpeza e a esterilização dos cateteres não foi eficiente, tendo sido identificada a presença de debris e microrganismos ao final do processo. Vale ressaltar a importância dessas informações para a tomada de decisão em relação ao reprocessamento e reuso de cateteres de hemodinâmica.Hemodynamic catheters are widely reused mainly in developing countries where the cost of new devices is very high. Scientific publications point to an absence of validated cleaning and sterilization processes and there is a consensus that reusing these devices causes physical, chemical and funcional damage. So what is the evidence related to the use of this kind of catheter? The objective of this study is to identify the scientific evidence related to the effects of reprocessing. A search for publications in English, Portuguese and Spanish was performed in Medline/Pubmed and LILACS using Medical Subject Headings (MeSH terms and free

  8. Ablation of PGC-1beta results in defective mitochondrial activity, thermogenesis, hepatic function, and cardiac performance.

    Directory of Open Access Journals (Sweden)

    Christopher J Lelliott

    2006-11-01

    Full Text Available The transcriptional coactivator peroxisome proliferator-activated receptor-gamma coactivator-1beta (PGC-1beta has been implicated in important metabolic processes. A mouse lacking PGC-1beta (PGC1betaKO was generated and phenotyped using physiological, molecular, and bioinformatic approaches. PGC1betaKO mice are generally viable and metabolically healthy. Using systems biology, we identified a general defect in the expression of genes involved in mitochondrial function and, specifically, the electron transport chain. This defect correlated with reduced mitochondrial volume fraction in soleus muscle and heart, but not brown adipose tissue (BAT. Under ambient temperature conditions, PGC-1beta ablation was partially compensated by up-regulation of PGC-1alpha in BAT and white adipose tissue (WAT that lead to increased thermogenesis, reduced body weight, and reduced fat mass. Despite their decreased fat mass, PGC1betaKO mice had hypertrophic adipocytes in WAT. The thermogenic role of PGC-1beta was identified in thermoneutral and cold-adapted conditions by inadequate responses to norepinephrine injection. Furthermore, PGC1betaKO hearts showed a blunted chronotropic response to dobutamine stimulation, and isolated soleus muscle fibres from PGC1betaKO mice have impaired mitochondrial function. Lack of PGC-1beta also impaired hepatic lipid metabolism in response to acute high fat dietary loads, resulting in hepatic steatosis and reduced lipoprotein-associated triglyceride and cholesterol content. Altogether, our data suggest that PGC-1beta plays a general role in controlling basal mitochondrial function and also participates in tissue-specific adaptive responses during metabolic stress.

  9. The occurrence of new arrhythmias after catheter-ablation of accessory pathway: Delayed arrhythmic side-effect of curative radiofrequency lesion?

    Directory of Open Access Journals (Sweden)

    Mujović Nebojša

    2011-01-01

    Full Text Available Introduction. New arrhythmias (NA may appear late after accessory pathway (AP ablation, but their relation to curative radiofrequency (RF lesion is unknown. Objective. The aim of this study was to determine the prevalence and predictors for NA occurrence after AP ablation and to investigate pro-arrhythmic effect of RF. Methods. Total of 124 patients (88 males, mean age 43±14 years with Wolff-Parkinson-White syndrome and single AP have been followed after successful RF ablation. Post-ablation finding of arrhythmia, not recorded before the procedure, was considered a NA. The origin of NA was assessed by analysis of P-wave and/or QRS-complex morphology, and, thereafter, it was compared with locations of previously ablated APs. Results. Over the follow-up of 4.3±3.9 years, NA was registered in 20 patients (16%. The prevalence of specific NAs was as follows: atrioventricular (AV block 0.8%, atrial premature beats 1.6%, atrial fibrillation 5.4%, atrial flutter 0.8%, sinus tachycardia 4.8%, ventricular premature beats (VPBs 7.3%. Multivariate Cox-regression analysis identified (1 pre-ablation history of pathway-mediated tachyarrhythmias >10 years (HR=3.54, p=0.016 and (2 septal AP location (HR=4.25, p=0.003, as the independent predictors for NA occurrence. In four NA cases (two cases of septal VPBs, one of typical AFL and one of AV-block presumed NA origin was identified in the vicinity of previous ablation target. Conclusion. NAs were found in 16% of patients after AP elimination. In few of these cases, late on-site arrhythmic effect of initially curative RF lesion might be possible. While earlier intervention could prevent NA occurrence, closer follow-up is advised after ablation of septal AP.

  10. Clinical analysis of radiofrequency catheter ablation on paroxysmal supraventricular tachycardia%射频消融术治疗阵发性室上性心动过速382例临床分析

    Institute of Scientific and Technical Information of China (English)

    陈旸; 贺涛; 刘明江; 陶剑虹

    2012-01-01

    目的 谇估经导管射频消融术(RFCA)治疗阵发性室上性心动过速的临床疗效.方法 对心内科近两年382例伴不同阵发性室上性心动过速的患者采用射频消融治疗,对治疗结果进行回顾性分析,比较左侧旁道、右侧旁道及房室结双径路伴阵发性室上性心动过速患者术后成功率、复发率及并发症发生率等临床数据的差异.结果 房室折返性心动过速患者174例,其中左侧旁道113例,右侧旁道61例;房室结折返性心动过速208例.射频消融总成功率为97.4%,其中房室结双径路和左侧房室旁道介导的阵发性室上速射频消融成功率达98.4%.射频消融术后总复发率为2.6%,并发症发生率为1.8%.结论 射频消融治疗快速室上性心律失常安全、有效,成功率高,并发症发生率低.右侧旁道消融复发率高于左侧旁道及双径路.%Objective This study was to analyze the outcomes of patients with paroxysmal supravetricular tachycardia after therapeutic radiofrequency catheter ablation for further clinical operating works. Methods Clinical data of 382 patients with different supravetricular tachycardia received radiofrequency ablationtherapy were retrospectively analyzed. Results There were 174 patients with atrioventricular reentrant tachycardia. Among them, there were 113 cases with left accessory pathways, 61 cases with right accessory pathways. There were 208 patients with atrioventricular nodal reentrant tachycardia. The overallsuccess rate was 97.4%, in which radiofrequency catheter ablation of paroxysmal supraventricular tachycardia mediated by dual atrioventricular nodal and left accessory pathway had a higher success rate (98. 4%). The overall recurrence rate was 2. 6% and the incidence of complications was 1. 8% after radiofrequency catheter ablation. Conclusion Radiofrequency catheter ablation is an effective and safe therapeutic method with high successful rate, low incidence of complications for

  11. Preliminary Investigation: 2D-3D Registration of MR and X-ray Cardiac Images Using Catheter Constraints

    OpenAIRE

    Truong, Michael V.N.; Aslam, Abdullah; Rinaldi, Christopher Aldo; Razavi, Reza; Penney, Graeme P.; Rhode, Kawal

    2009-01-01

    Cardiac catheterization procedures are routinely guided by X-ray fluoroscopy but suffer from poor soft-tissue contrast and a lack of depth information. These procedures often employ pre-operative magnetic resonance or computed tomography imaging for treatment planning due to their excellent soft-tissue contrast and 3D imaging capabilities. We developed a 2D-3D image registration method to consolidate the advantages of both modalities by overlaying the 3D images onto the X-ray. Our method uses...

  12. A questionable indication for ICD extraction after successful VT ablation

    Directory of Open Access Journals (Sweden)

    Luca Segreti, MD; Andrea Di Cori, MD; Giulio Zucchelli, MD, PhD; Ezio Soldati, MD; Giovanni Coluccia, MD; Stefano Viani, MD; Luca Paperini, MD; Maria Grazia Bongiorni, MD, FESC

    2015-04-01

    Full Text Available Sustained ventricular tachyarrhythmias represent a kind of complication shared by a number of clinical presentations of heart disease, sometimes leading to sudden cardiac death. Many efforts have been made in the fight against such a complication, mainly being represented by the implantable cardioverter defibrillator (ICD. In recent years, catheter ablation has grown as a means to effectively treat patients with sustained ventricular arrhythmias, in the contest of different cardiac substrates. Since carrying an ICD is associated with a potential risk deriving from its possible infective or malfunctioning complications, and given the current effectiveness of lead extraction procedures, it has been thought not to be unreasonable to ask ourselves about how to deal with ICD patients who have been successfully treated by means of ablation of their ventricular arrhythmias. In this paper we will review the current evidence about ICD therapy, catheter ablation of ventricular arrhythmias and lead extraction, trying to outline some considerations about how to face this new clinical issue.

  13. 脑电双频指数监测在小儿射频消融术中的应用%The application of Bispectrai index in pediatric radio frequency catheter ablation

    Institute of Scientific and Technical Information of China (English)

    王嵘; 卿恩明; 丁雪峰; 李秋霞; 董秀华

    2009-01-01

    我院心脏儿科2005至2008年择期行心导管射频消融术患儿106例,随机分为脑电双频指数(BIS)监测组(A组,50例)和改良警觉镇静(OAA/S)评分组(B组,56例),按需以靶控输注丙泊酚维持麻醉.A组维持BIS值55~65;B组以改良OAA/S评分1分控制麻醉深度.分别于麻醉诱导前、诱导后1 min、术中、术毕时,测定心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO2),记录丙泊酚用量、辅助呼吸时间、清醒时间及术后有无恶心呕吐和呼吸抑制.结果 示两组心率、MAP、SpO2差异无统计学意义(P>0.05),术中辅助呼吸时间、丙泊酚用量及清醒时间较短(P<0.05),两组术后均无恶心呕吐及呼吸抑制.提示应用脑电双频指数监测在小儿射频消融术中能正确判断麻醉深度,可保持患儿呼吸循环平稳,减少麻醉药用量,缩短术后清醒时间,提高麻醉质量.%The aim of the study is to evaluate the feasibility and safety of Bispectral index (BIS) monitoring in pediatric radio frequency catheter ablation. One hundred and six children aged 0. 6-12 years, scheduled for radio frequency catheter ablation, were randomly divided into two groups. In group A patients received BIS monitoring during the operation (n = 50), and the group B received modified Observer's Assessment of Alertness/Sedation (OAA/S) scaling (n = 56). The anesthesia was maintained with propofol target-controlled infusion. The intraoperative propefol target concentration was adjusted to maintain the BIS values between 55-65 in group A and OAA/S scale about 1 in group B respectively, The heart rate (HR), mean arterial pressure (MAP) and pulse oximetric saturation (SpO2) were measured before anesthetic induction, 1 min after induction, catheter puncturing and the end of operation respectively. The requirements of propofol, the times of supporting ventilation and recovery, the respiratory depression, nausea and vomiting postoperatively were also recorded. The intraoperative

  14. Repeat Catheter Ablation of Long-standing Persistent Atrial Fibrillation in Patients with a Total Atrial Fibrillation Duration of More Than 2 Years: Effects of the CHA2DS2-VASc Score and Estimated Glomerular Filtration Rate on the Outcomes.

    Science.gov (United States)

    Wang, Qian; Jiang, Shi-Li; Liu, Xu; Yang, Yi-Qing

    2016-01-01

    Objective Little is known about the outcome of repeat catheter ablation of long-standing persistent atrial fibrillation (AF) in patients with a total AF duration of more than 2 years. The main objective of this study was to explore the results and factors affecting the clinical success rate of these repeat procedures. Methods We enrolled 99 patients with a total AF duration of more than 2 years and recurrent atrial arrhythmias after the initial catheter ablation of long-standing persistent AF. The enrolled patients were divided into two groups named the AF-recurrence group (50 patients) and the atrial tachycardia (AT)-recurrence group (49 patients) and all underwent a strict follow-up. The quality of life (QOL) and AF-related symptom classification were assessed at baseline and at 24 months post re-ablation. Results After a mean follow-up of 31 months, 30 (30.3%) patients were free from arrhythmia recurrence, and the success rate in the AT-recurrence group was higher than that in the AF-recurrence group (32.7% vs. 28.0%, p=0.614). A Cox regression analysis revealed a CHA2DS2-VASc score ≥3 to be a predictor of recurrence. AF recurrent patients with an abnormal renal function were more prone to undergo a failed procedure. However, an abnormal renal function had no effect on the outcome of the repeat procedure for patients with AT recurrence. At the 24-month follow-up, patients maintaining sinus rhythm (SR) had a significantly improved QOL and AF-related symptoms. Conclusion The success rate of repeat procedures for long-standing persistent AF and a total AF duration of more than 2 years is poor for patients with a CHA2DS2-VASc score ≥3. An impaired renal function has an unfavorable effect on the outcome for patients with AF recurrence. For patients maintaining SR, both the QOL and AF symptomatology improve significantly. PMID:27629945

  15. Dilemma with the route of venous access for hemodialysis catheter insertion in a patient with dilated ischemic cardiomyopathy treated by cardiac resynchronization therapy

    Directory of Open Access Journals (Sweden)

    Devanahalli Ashokananda

    2016-01-01

    Full Text Available A 68 year old patient requiring urgent dialysis due to raising potassium was referred to our center. He had 3 indwelling catheters in his heart via right subclavian vein. His left subclavian and interngal jugular veins were thrombosed possibly due to earlier indwelling catheters. The dilemma was if right internal jugular venous route could be used for insertion of dialysis catheter. Under fluoroscopic guidance, right internal jugular vein was cannulated with the dialysis catheter without problems. This case is being presented to highlight the need for imaging both by ultrasound and radiography during the procedure.

  16. 射频消融治疗心房颤动并发急性心脏压塞行心包穿刺引流治疗的临床分析%Clinical Analysis of Radiofrequency Ablation for Atrial Fibrillation Concurrent Acute Cardiac Tamponade Line the Pericardiocentesis Treatment

    Institute of Scientific and Technical Information of China (English)

    张大鹏; 王祖禄

    2012-01-01

      Objective To analyze the diagnosis,cause and experience during the treatment of acute cardiac Tamponade (ACT) in radiofrequency catheter ablation in atrial fibrillation. Methods In a retrospective analysis,we investigated the cause and summarized the process of diagnosis and treatment of ACT in 178 consecutive patients with radiofrequency ablation in atrial fibrillation from March 2005 to June 2010.Results There were 9 cases complicated with ACT in 294 patients with incidence. All were performed emergency pericardiocentesis. None of them died. Conclusion Incidence of ACT is low in RFCA in AF. Earlier discovery and appropriate management can stabilize hemodynamics and avoid operation.%  目的分析和探讨经导管射频消融(Radiofrequency Catheter Ablation,RFCA)治疗心房颤动(Atrial Fibrillation,AF)并发急性心脏压塞(Acute Cardiac Tamponade,ACT)的原因、诊断及处理方法.方法回顾性分析309例AF患者行RFCA术中急性心脏压塞ACT的诊断、发生的原因及处理方法.结果在309例行RFCA术的AF患者中,根据临床表现及超声心动图检查,证实有11例并发ACT,发生率为3.06%.其中2例经快速补液和多巴胺治疗血压难以维持及纠正,经用阿托品后心率无明显提升,9例全部行急诊心包穿刺引流,无一例死亡.结论在AF的RFCA中应尽早期发现发ACT,并及时行心包穿刺及持续引流,可以稳定患者的血液动力学,并避免开胸手术治疗.

  17. 小儿心脏术后中心静脉导管相关性感染与导管留置时间关系的探讨%Probe into relationship between central venous catheter related infection and catheter indwelling time in children af-ter pediatric cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    陈桂花; 陈付萍; 吴兰华

    2015-01-01

    [目的]探讨小儿心脏术后中心静脉导管相关性感染与导管留置时间的关系,期望能够找到置管最安全的留置时间,指导临床合理拔管,降低置管相关性感染的发生率。[方法]进行心脏直视手术的334例先心病患儿的临床资料进行回顾性分析,并对中心静脉导管相关性感染与导管留置时间的关系进行总结。[结果]334例先心病患儿均按实际病情拔除导管,其中3 d 内拔除219例,占65.56%,导管感染率为7.76%(17/219);99例在4 d~6 d 内拔出,占29.64%,导管感染率为20.20%(20/99);7 d~10 d 内拔除16例,占4.79%,导管感染率为31.25%(5/16)。[结论]随着导管留置时间的延长,导管相关性感染发生率逐渐升高,并且多组之间的比较差异有统计学意义(P <0.01)。小儿心脏外科术后适宜的置管时间应在3 d 内,可以显著减少导管相关性感染的发生。%Objective:To probe into the relationship between central venous catheter related infection and cathe-ter indwelling time in patients after pediatric cardiac surgery,in order to find the most safe indwelling time,to guide clinical rational extubation and reduce the incidence of the catheter related infections.Methods:The clinical data of 334 cases with congenital heart disease were retrospectively analyzed.And the relationship between cen-tral venous catheter related infection and catheter indwelling time was summarized.Results:The catheter in all 334 cases with congenital heart disease was removed based on the actual condition.The catheter in 21 9 cases was removed in 3 days,accounting for 65.56%,the infection rate was 7.76% (17/21 9).The catheter in 99 cases was pulled out in 4 6 days,accounting for 29.64% and the infection rate was 20.20% (20/99).1 6 cases were extracted from 7 to 10 days,accounting for 4.79%.The infection rate was 31.25% (5/1 6).Conclusion:With the prolonging of indwelling time,the incidence of catheter related infection

  18. 抗凝管理服务在心房颤动导管消融术后患者中的应用评价%Evaluation of anticoagulation management service in patients who underwent catheter ablation for atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    田颖; 刘兴鹏; 齐淑媛; 卢晓英; 陈汝明; 尹先东; 周旭; 石亮; 王彦江; 杨新春

    2012-01-01

    Objective To evaluate the effectiveness of anticoagulation management service (AMS) in patients who underwent catheter ablation for atrial fibrillation (AF).Methods Two hundreds and forty-five consecutive patients [134 males; age (64 ± 11) years] with AF were enrolled.All patients received warfarin therapy for 3 ~ 6 months after catheter ablation for AF.Patients adjusted their warfarin doses either by visiting the outpatient clinic (the former 116 patients,non-AMS group) or under the guidance of one well-trained nurse (the latter 129 patients,AMS group).The percentage of patients in whom the international normalized ratio (INR) value achieved therapeutic anticoagulation range (2.0 ~ 3.0),the effective anticoagulation rate that defined as more than 70% of INR values were between 2.0 ~ 3.0 after titration period,and the INR fluctuation index after titration period were compared between the 2 groups.Results Warfarin therapy rendered 119 patients (92.2%) in AMS group and 93 patients (80.2%) in non-AMS group achieved therapeutic anticoagulation range (P=0.008).The effective anticoagulation rate in AMS group (59.8%) was significantly higher than that in non-AMS group (42.7%,P =0.027),while the INR fluctuation index in AMS group were significantly less than that in non-AMS group(0.64±0.74 vs 1.01±1.03,P=0.004).Conclusion This study demonstrates that the application of AMS in patients who underwent catheter ablation of AF is helpful in achieving higher effective anticoagulation rate while keeping therapeutic INR value more stable.%目的 评价抗凝管理服务(AMS)在心房颤动(房颤)导管消融术后患者中的应用价值.方法 连续245例[男134例,年龄(64±11)岁]接受导管消融治疗的房颤患者,所有患者术后均接受口服华法林抗凝治疗3~6个月.其中,前116例随机就诊于心内科门诊并接受华法林剂量调整(非AMS组),后129例接受经过培训的专业护士指导下的华法林剂量调整(AMS组).

  19. Atrioventricular Junction Ablation in Atrial Fibrillation: Choosing The Right Patient and Pacing Device

    Directory of Open Access Journals (Sweden)

    Finn Akerstr�m; Mois�s Rodr�guez-Ma�ero; Marta Pach�n; Alberto Puchol; X. Alberte Fern�ndez-L�pez; Luis Mart�nez-Sande; Miguel Valderr�bano MD; Miguel A. Arias.

    2015-08-01

    Full Text Available Atrial fibrillation (AF is the most common cardiac arrhythmia and despite advancements in rhythm control through direct catheter ablation, maintaining sinus rhythm is currently not possible in a large proportion of AF patients. Furthermore, in some instances pharmacological rate control may be insufficient, resulting in a highly symptomatic patient at risk of developing tachycardia-induced cardiomyopathy and heart failure (HF. Catheter ablation of the atrioventricular junction (AVJ with subsequent permanent pacemaker implantation provides definite rate control and represents an attractive therapeutic option when pharmacological rate control is not achieved. In those with reduced ventricular function, cardiac resynchronization therapy (CRT should be considered over right ventricular apical (RVA pacing in order to avoid the deleterious effects associated with a high amount of chronic RVA pacing. Another group of patients that may also benefit from AVJ ablation are HF patients with concomitant AF receiving CRT. In this patient cohort AVJ ablation ensures near 100% biventricular pacing, thus allowing optimization of the therapeutic effects of CRT.

  20. Ablação por cateter com radiofreqüência de vias acessórias esquerdas por abordagem transeptal Radiofrequency catheter ablation of left accessory pathways by transeptal approach

    Directory of Open Access Journals (Sweden)

    Márcio Augusto Silva

    2006-05-01

    Full Text Available OBJETIVO: Estudar uma série de pacientes submetidos a ablação por cateter, com radiofreqüência (RF de vias acessórias (VA esquerdas mediante abordagem transeptal (TS, comparando-os aos pacientes submetidos ao mesmo tipo de procedimento por abordagem arterial retrógrada (AR convencional. MÉTODOS: Cem pacientes consecutivos (56 masculinos; 34,3 ± 11 anos de idade, portadores de 100 VA esquerdas (62 manifestas e 38 ocultas foram submetidos a ablação por cateter por via TS (50 pacientes e por via AR (50 pacientes, de forma alternada. A análise foi baseada na intenção de tratar. RESULTADOS: A punção transeptal foi realizada com sucesso em 48 (96% pacientes. Por esse acesso foi obtido sucesso primário na ablação em todos os pacientes e nenhuma complicação foi observada. Ao compararmos com o grupo AR não verificamos diferença em relação ao sucesso primário (p = 0,2, taxa de recorrências (p = 1,0, tempos de fluoroscopia (p = 0,63 e total (p = 0,47. No grupo AR um paciente apresentou complicação vascular. A abordagem TS proporcionou um menor tempo de ablação (p = 0,01 e número de aplicações de RF (p = 0,003 em relação à abordagem AR convencional. As recorrências e insucessos da primeira sessão de cada grupo foram submetidos a novo procedimento pela técnica oposta (cross-over, obtendo-se assim um sucesso final na ablação de 100%. CONCLUSÃO: As abordagens TS e AR apresentam eficácia e segurança semelhantes para ablação de vias acessórias esquerdas. O tempo de ablação e o número de aplicações de RF foram menores com a abordagem TS. Quando as técnicas foram utilizadas de forma complementar, aumentaram a eficácia final da ablação.OBJECTIVE: To study a series of patients submitted to radiofrequency catheter ablation (RFA of left accessory pathways (AP using the transeptal approach (TSA as compared to the conventional retrograde arterial approach (RAA. METHODS: One hundred consecutive patients (56 male

  1. 左房容积指数对导管射频消融术后房颤复发的预测价值%Value of left atrial volume index in predicting recurrence of atrial fibrillation after catheter ablation

    Institute of Scientific and Technical Information of China (English)

    张国茹; 胡喜田; 刘金波; 吕新湖; 李燕; 王永贤

    2011-01-01

    Objective To investigate the the value of left atrial volume index in predicting late recurrence of atrial fibrillation (AF) after catheter ablation.Methods 52 patients who had undergone RFCA were followed up for 12 months.Clinical variables which could affect recurrence of atrial fibrillation after catheter ablation were analyzed.Results All of the 52 patients had completed the CPVA procedure ( 1 patient was lost).At the end of one year follow-up, 39 patients were successfully treated without AF recurrence.12 patients ( 23.53% ) suffered from atrial fibrillation recurrence.Compared with that of unrecurrence group, left atrial diameter (LAD) and left atrial volume index (LAVI) of recurrence group decreased significantly.There was no significant difference between the recurrence group and unrecurrence group in age, sex, EF and heart disease ( P < 0.05 or < 0.01 ).Logistic regression analysis revealed that the only indepedent predictor for the recurrence of atrial fibrillation was LAVI (P <0.01 ).Conclusions Compared with LAD, LAVI is a better parameter for predicting recurrence of atrial fibrillation.%目的 探讨左房容积指数(LAVI)对导管射频消融术(RFCA)后房颤(AF)复发的预测价值.方法 对52例行RFCA的AF患者随访12个月,分析RFCA后AF复发的影响因素.结果 52例患者均完成CPVA,达到消融终点;随访12个月时未复发39例,复发12例(23.53%),1例失访.复发与未复发者比较,其年龄、性别、左室射血分数、是否合并器质性心脏病无统计学差异,左房直径及LAVI有统计学差异(P<0.05或<0.01);Logistic多元回归分析显示,LAVI为AF复发的独立危险因素(P<0.01).结论 与左房直径比较,LAVI是更好的预测RFCA后AF复发的因素.

  2. The Second Grade National Prize for Science and Technology Progress——Clinical Research and Technology Dissemination of Catheter Ablation of Atrial Fibrillation%心房颤动导管消融的临床研究与推广应用——2010年度国家科学技术进步二等奖

    Institute of Scientific and Technical Information of China (English)

    岳花兰; 李晓璐; 汤日波

    2011-01-01

    心房颤动(房颤)是一种严重危害人群健康的常见心血管疾病,导管消融是近年发展起来的治疗房颤的新方法.项目组针对房颤导管消融尚缺乏科学、规范的技术方法这一难题,对房颤导管消融的方法与技术策略系统地进行了研究:①建立了右前斜位45°透视指导下房间隔穿刺方法;②国际首创单导管标测、消融隔离肺静脉的方法;③首次证明应在环肺静脉消融线上补点隔离肺静脉;④首次证明瓣膜病房颤行导管消融是安全有效的;⑤总结、建立了我国三维标测系统指导下房颤导管消融的方法.项目组总结创新的方法大幅度提高了我国房颤导管消融的治疗和研究水平.%Atrial fibrillation(AF) is a common cardiovascular disease associated with increased mortality and morbility. Catheter ablation of AF has emerged as a developing therapy to cure AF. However, scientific and normative strategy and technology of AF ablation were limited at the beginning of this century. With regard to this issue, the strategy and technology of AF ablation were systemic explored and some achievements were obtained in this project. ① A method of transseptal catheterization guided by fluoroscopy in right anterior oblique 45。was originally established; ② A method of pulmonary vein isolation and pulmonary vein mapping with single catheter was built; ③ This project provided the first evidence that circumferential pulmonary vein isolation was superior to segmental isolation; ④ It was proved that catheter ablation of valvular AF was safe and effective; ⑤ Some methods of catheter ablation of AF guided with 3 D mapping system in China were systemic established. This project deeply improved and facilitated the therapeutic and research level in the field of catheter ablation of AF.

  3. Postnatal ablation of Foxm1 from cardiomyocytes causes late onset cardiac hypertrophy and fibrosis without exacerbating pressure overload-induced cardiac remodeling.

    Directory of Open Access Journals (Sweden)

    Craig Bolte

    Full Text Available Heart disease remains a leading cause of morbidity and mortality in the industrialized world. Hypertrophic cardiomyopathy is the most common genetic cardiovascular disorder and the most common cause of sudden cardiac death. Foxm1 transcription factor (also known as HFH-11B, Trident, Win or MPP2 plays an important role in the pathogenesis of various cancers and is a critical mediator of post-injury repair in multiple organs. Foxm1 has been previously shown to be essential for heart development and proliferation of embryonic cardiomyocytes. However, the role of Foxm1 in postnatal heart development and in cardiac injury has not been evaluated. To delete Foxm1 in postnatal cardiomyocytes, αMHC-Cre/Foxm1(fl/fl mice were generated. Surprisingly, αMHC-Cre/Foxm1(fl/fl mice exhibited normal cardiomyocyte proliferation at postnatal day seven and had no defects in cardiac structure or function but developed cardiac hypertrophy and fibrosis late in life. The development of cardiomyocyte hypertrophy and cardiac fibrosis in aged Foxm1-deficient mice was associated with reduced expression of Hey2, an important regulator of cardiac homeostasis, and increased expression of genes critical for cardiac remodeling, including MMP9, αSMA, fibronectin and vimentin. We also found that following aortic constriction Foxm1 mRNA and protein were induced in cardiomyocytes. However, Foxm1 deletion did not exacerbate cardiac hypertrophy or fibrosis following chronic pressure overload. Our results demonstrate that Foxm1 regulates genes critical for age-induced cardiomyocyte hypertrophy and cardiac fibrosis.

  4. Postnatal ablation of Foxm1 from cardiomyocytes causes late onset cardiac hypertrophy and fibrosis without exacerbating pressure overload-induced cardiac remodeling.

    Science.gov (United States)

    Bolte, Craig; Zhang, Yufang; York, Allen; Kalin, Tanya V; Schultz, Jo El J; Molkentin, Jeffery D; Kalinichenko, Vladimir V

    2012-01-01

    Heart disease remains a leading cause of morbidity and mortality in the industrialized world. Hypertrophic cardiomyopathy is the most common genetic cardiovascular disorder and the most common cause of sudden cardiac death. Foxm1 transcription factor (also known as HFH-11B, Trident, Win or MPP2) plays an important role in the pathogenesis of various cancers and is a critical mediator of post-injury repair in multiple organs. Foxm1 has been previously shown to be essential for heart development and proliferation of embryonic cardiomyocytes. However, the role of Foxm1 in postnatal heart development and in cardiac injury has not been evaluated. To delete Foxm1 in postnatal cardiomyocytes, αMHC-Cre/Foxm1(fl/fl) mice were generated. Surprisingly, αMHC-Cre/Foxm1(fl/fl) mice exhibited normal cardiomyocyte proliferation at postnatal day seven and had no defects in cardiac structure or function but developed cardiac hypertrophy and fibrosis late in life. The development of cardiomyocyte hypertrophy and cardiac fibrosis in aged Foxm1-deficient mice was associated with reduced expression of Hey2, an important regulator of cardiac homeostasis, and increased expression of genes critical for cardiac remodeling, including MMP9, αSMA, fibronectin and vimentin. We also found that following aortic constriction Foxm1 mRNA and protein were induced in cardiomyocytes. However, Foxm1 deletion did not exacerbate cardiac hypertrophy or fibrosis following chronic pressure overload. Our results demonstrate that Foxm1 regulates genes critical for age-induced cardiomyocyte hypertrophy and cardiac fibrosis.

  5. 球囊漂浮电极导管床旁心脏临时起搏术40例临床分析%Clinical analysis of floating catheter in bedside temporary cardiac pacing in 40 patients

    Institute of Scientific and Technical Information of China (English)

    叶剑飞; 刘晓凯; 郑林; 茅焕豪; 郑伟峰; 张茗茗

    2012-01-01

    Objectives To observe the clinical effect of floating catheter in bedside temporary cardiac pacing. Methods Forty patients with severe bradyarrhythmia were included in this study and floating catheter for temporary cardiac pacing was propelled into right ventricle by Seldinger technique without fluoroscopy, under the guidance of bedside electrocardiography monitoring. The location of electrods were confirmed by QRS wave. The duration of placing floating catheter and the average time of pacing were recorded, and the complications of pacing were observed. Results Forty patients were successfully punctured, with an average duration of placing floating catheter of(9.1±2.1) min, pacing time of 1-15 days (median time of 5.5 days). Two cases were on loosen electrode, but no other complications were found. Conclusions Bedside floating electrode catheter can be used without fluoroscopy and replacement of critical patients in emergent pacing, with characters of easy performing, rapid pacing, definite effects and relative safety, and it is suitable for promotion in primary hospitals.%目的 观察漂浮电极导管床旁临时心脏起搏的临床应用效果.方法 对40例严重缓慢型心律失常患者在床旁体表心电图临护指导下,通过Seldinger穿刺技术,在无X线透视条件下将临时起搏漂浮电极导管送人右心室,通过体表心电图QRS波群确定电极位置.记录放置电极导管所花费的时间与平均起搏时间,观察临时起搏操作并发症.结果 40例患者穿刺均获成功,安置球囊漂浮电极导管平均操作时间(9.1±2.1) min,起搏时间1-15 d,中位时间5.5d.电极脱位2例,无其他并发症.结论 床旁漂浮电极导管可在没有X线设备下紧急起搏而不需搬动危重患者,具有操作简单、起搏迅速、疗效肯定及相对安全的特点,适合在基层医院推广应用.

  6. Efficacy of radiofrequency catheter ablation reversing frequent premature ventricular complexes%射频消融术对频发室性早搏患者左心室功能的影响

    Institute of Scientific and Technical Information of China (English)

    聂建明; 韩智红; 张烨; 王云龙; 汪烨; 李腾飞; 任学军

    2013-01-01

    目的 探讨射频消融术能否纠正左心室功能失调.方法 将符合入组标准的患者49例分成射频消融组(35例)和对照组(14例).射频消融组患者行射频消融治疗,对照组患者接受药物干预.患者均随访3~6个月,评估2组患者室性期前收缩负荷(PVC)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)及左心室收缩末期内径(LVESD)等情况.结果 治疗前射频消融组与对照组PVC、LVEF、LVEDD、LVESD差异均无统计学意义[(24±11)%比(21±7)%;(63±9)%比(60±6)%;(50±4) mm比(49±5)mm; (32±5)mm比(34 ±3) mm;均P>0.05].治疗后射频消融组PVC明显减低[(8±11)%比(24±11)%,t =6.149,P<0.01],LVEF明显增高[(68±5)%比(63±9)%,t=3.426,P<0.01],LVEDD明显减小[(48±3)mm比(50±4)mm,t=3.539,P<0.01],LVESD明显减小[(3l±3)mm比(32±5)mm,t=2.665,P <0.05].对照组治疗后PVC增高[(22±5)%比(21±7)%,t=3.180,P<0.05],LVEF减低[(59±5)%比(60±6)%,t=2.754,P<0.05],LVEDD增加[(50±5)mm比(49 ±5)mm,t =5.551,P<0.01],LVESD增加[(35 ±3)mm比(34±3)mm,t=2.599,P<0.05].射频消融组治疗后PVC、LVEF、LVESD与对照组治疗后比较差异均有统计学意义(均P<0.01).结论 频发室性早搏的患者更易发生左心室扩大和收缩功能失调.对药物治疗不满意的频发室性早搏患者通过射频导管消融治疗可以获得满意的疗效.对有适应证者应尽早行射频消融术根治.%Objective To explore whether radiofrequency catheter ablation can reverse left ventricular dysfunction.Methods Totally 35 patients for radiofrequency catheter ablation (RFCA) and 14 patients who took antiarrhythmic drugs but did not accept radiofrequency catheter ablation were enrolled.All patients were evaluated at baseline and 3-6 months followed up in terms of premature ventricular complexes (PVC),left ventricular ejection fraction (LVEF),left ventricular end-diastolic dimension (LVEDD) and left ventricular end systolic

  7. Alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy

    DEFF Research Database (Denmark)

    Jensen, Morten K; Prinz, Christian; Horstkotte, Dieter;

    2013-01-01

    The infarction induced by alcohol septal ablation (ASA) may predispose to arrhythmia and sudden cardiac death (SCD).......The infarction induced by alcohol septal ablation (ASA) may predispose to arrhythmia and sudden cardiac death (SCD)....

  8. A cooled water-irrigated intraesophageal balloon to prevent thermal injury during cardiac ablation: experimental study based on an agar phantom

    Energy Technology Data Exchange (ETDEWEB)

    Lequerica, Juan L [Cardiac Research Laboratory, Instituto de Biomedicina, Spanish Council for Scientific Research (CSIC), Valencia (Spain); Berjano, Enrique J [Institute for Research and Innovation on Bioengineering, Valencia Polytechnic University, Valencia (Spain); Herrero, Maria [Cardiac Research Laboratory, Instituto de Biomedicina, Spanish Council for Scientific Research (CSIC), Valencia (Spain); Melecio, Lemuel [Cardiac Research Laboratory, Instituto de Biomedicina, Spanish Council for Scientific Research (CSIC), Valencia (Spain); Hornero, Fernando [Department of Cardiac Surgery, Consorcio Hospital General Universitario, Valencia (Spain)

    2008-02-21

    A great deal of current research is directed to finding a way to minimize thermal injury in the esophagus during radiofrequency catheter ablation of the atrium. A recent clinical study employing a cooling intraesophageal balloon reported a reduction of the temperature in the esophageal lumen. However, it could not be determined whether the deeper muscular layer of the esophagus was cooled enough to prevent injury. We built a model based on an agar phantom in order to experimentally study the thermal behavior of this balloon by measuring the temperature not only on the balloon, but also at a hypothetical point between the esophageal lumen and myocardium (2 mm distant). Controlled temperature (55 {sup 0}C) ablations were conducted for 120 s. The results showed that (1) the cooling balloon provides a reduction in the final temperature reached, both on the balloon surface and at a distance of 2 mm; (2) coolant temperature has a significant effect on the temperature measured at 2 mm from the esophageal lumen (it has a less effect on the temperature measured on the balloon surface) and (3) the pre-cooling period has a significant effect on the temperature measured on the balloon surface (the effect on the temperature measured 2 mm away is small). The results were in good agreement with those obtained in a previous clinical study. The study suggests that the cooling balloon gives thermal protection to the esophagus when a minimum pre-cooling period of 2 min is programmed at a coolant temperature of 5 deg. C or less. (note)

  9. Hemodynamic Change in Pulmonary Vein Stenosis after Radiofrequency Ablation: Assessment with Magnetic Resonance Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Yun, Doyoung; Jung, Jung Im; Oh, Yong Seog; Youn, Ho Joong [Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2012-11-15

    We present a case of pulmonary vein (PV) stenosis after radio-frequency (RF) ablation, in which a hemodynamic change in the pulmonary artery was similar to that of congenital PV atresia on time-resolved contrast-enhanced magnetic resonance angiography (TR-MRA). A 48-year-old man underwent RF ablation due to atrial fibrillation. The patient subsequently complained of hemoptysis, dyspnea on exertion, and right chest pain. Right PV stenosis after catheter ablation was diagnosed through chest computed tomography and lung perfusion scan. Pulmonary TR-MRA revealed the pulmonary artery via systemic arterial collaterals and draining systemic collateral veins. On a velocity-encoded cine image, the flow direction of the right pulmonary artery was reversed in the diastolic phase and the left pulmonary artery demonstrated continuous forward flow throughout the cardiac cycle. These hemodynamic changes were similar to those seen in congenital unilateral PV atresia.

  10. The effect of integrated cardiac rehabilitation versus treatment as usual for atrial fibrillation patients treated with ablation

    DEFF Research Database (Denmark)

    Risom, Signe Stelling; Zwisler, Ann-Dorth Olsen; Rasmussen, Trine Bernholdt;

    2013-01-01

    INTRODUCTION: Atrial fibrillation affects almost 2% of the population in the Western world. To preserve sinus rhythm, ablation is undertaken in symptomatic patients. Observational studies show that patients with atrial fibrillation often report a low quality of life and are less prone to be physi...

  11. Visualization of cardiac wavefronts using data fusion

    Science.gov (United States)

    Kynor, David B.; Dietz, Anthony; Friets, Eric; Peterson, Jon; Bergstrom, Ursula; Triedman, John; Hammer, Peter

    2002-05-01

    Catheter ablation has emerged as a highly effective treatment for arrhythmias that are constrained by known, easily located, anatomic landmarks. However, this treatment has enjoyed limited success for arrhythmias that are characterized by complex activation patterns or are not anatomically constrained. This class of arrhythmias, which includes atrial fibrillation and ventricular tachycardia resulting from ischemic heart disease, demands improved mapping tools. Current technology forces the cardiologist to view cardiac anatomy independently from the functional information contained in the electrical activation patterns. This leads to difficulties in interpreting the large volumes of data provided by high-density recording catheters and in mapping patients with abnormal anatomy (e.g., patients with congenital heart disease). The goal of this is work is development of new data processing and display algorithms that will permit the clinician to view activation sequences superimposed onto existing fluoroscopic images depicting the location of recording catheters within the heart. In cases where biplane fluoroscopic images and x-ray camera position data are available, the position of the catheters can be reconstructed in three-dimensions.

  12. Esophageal papilloma: Flexible endoscopic ablation byradiofrequency

    Institute of Scientific and Technical Information of China (English)

    Gianmattia del Genio; Federica del Genio; Pietro Schettino; Paolo Limongelli; Salvatore Tolone; Luigi Brusciano; Manuela Avellino; Chiara Vitiello; Giovanni Docimo; Angelo Pezzullo; Ludovico Docimo

    2015-01-01

    Squamous papilloma of the esophagus is a rare benignlesion of the esophagus. Radiofrequency ablation is anestablished endoscopic technique for the eradication ofBarrett esophagus. No cases of endoscopic ablation ofesophageal papilloma by radiofrequency ablation (RFA)have been reported. We report a case of esophagealpapilloma successfully treated with a single sessionof radiofrequency ablation. Endoscopic ablation ofthe lesion was achieved by radiofrequency using anew catheter inserted through the working channelof endoscope. The esophageal ablated tissue wasremoved by a specifically designed cup. Completeablation was confirmed at 3 mo by endoscopy withbiopsies. This case supports feasibility and safety of asa new potential indication for BarrxTM RFA in patientswith esophageal papilloma.

  13. Radiofrequency catheter ablation of atrial tachycardia after repairing of the ventricular septal defect in pediatrics%儿童室间隔修补术后远期心房内折返性心动过速的消融

    Institute of Scientific and Technical Information of China (English)

    高路; 袁越; 林利; 崔烺; 姚焰

    2011-01-01

    目的 报道儿童先天性心脏病室间隔缺损(VSD)术后远期出现的心房内折返性心动过速(IART)的电生理标测及导管消融疗效.方法 8例患儿(男、女各4例),平均年龄(7.1±4.1)岁,VSD术后1~5年发生持续性IART,8例均有左心室扩大,其中5例合并慢性心力衰竭.行心房电生理标测,部分应用三维标测( EnSite NavX)技术,标测折返环的关键峡部并行导管消融.结果 8例均自发IART,折返环关键部位分布:6例位于三尖瓣环峡部,1例于右心房界嵴至下腔静脉间,1例于三尖瓣环9点位置至界嵴间.所有(100%)患儿手术即刻成功,无并发症.平均随访(25.2±16.5)个月,2例复发,其中1例再次消融成功,总成功率7/8( 87.5%).左心室大小及射血分数均明显好转.结论 儿童VSD术后IART机制多为三尖瓣环-下腔静脉峡部依赖型心房扑动,可经导管消融治愈或明显改善.三维标测技术能准确快速定位折返环的电生理峡部并指导消融,显著减少曝光时间.%Objective This study aimed to investigate the effects of electrophysiological study(EPS) and radiofrequency (RF) catheter ablation of intra-atrial reentrant tachycardia (IART) after repairing the congenital ventricular septal defect (VSD) in pediatrics.Methods Eight children (4 boys,and 4 girls,mean age 7.1 ± 4.1 years),who experienced incessant IART 1-5 years after VSD surgery,underwent EPS and RF ablation.All children had dilated left ventricle ( LV),and 5 of 8 demonstrated severely LV dilation and congestive heart failure before ablation.RF energy was delivered to the critical isthmus of the reentry circuit of IART.Results All children have spontaneous AT at the beginning of the procedure.All of the IARTs was macro-reentrant mechanism.The critical isthmus was located at the isthmus between inferior vena cava(IVC)-tricuspid valve annulus (TVA)in 6,between the crista teminalis(CT)and IVC in 1,and between CT and 9 o' clock of TVA in 1.RF ablation was

  14. Radiofrequency catheter ablation of ventricular arrhythmia arising from the left aortic sinus of Valsalva%Valsalva窦内起源室性心律失常的射频消融

    Institute of Scientific and Technical Information of China (English)

    鲍中华; 郭俊芳; 张国辉; 真亚; 李卫东; 孙琴芳; 张凤琴

    2009-01-01

    Objective To investigate the electrocardiographic characteristics and assess the efficiency of ra-diofrequency catheter ablation(RFCA) in ventricular arrhythmia arising from the aortic sinus of Valsalva. Methods Eighteen patients(6 males and 12 females)were selected to undergo RFCA for ventficular arrhythmia originating from the left aortic sinus of Valsava. All of them were symptomatic,but without evidence of structural heart disease. Activation mapping was performed in the endocardium of the aortic sinus of Valsalva,then ablation was performed at the site with the earliest ventricular wave in endocardium electrograms. At the same time, coronary and aortic angiog-raphy were performed to assess the anatomic relationship between the ventricular tachycardia (VT)/ventricular pre-mature contraction (VPC) origin and coronary arteries and aortic valve before the RF energy delivery. Results Eighteen patients were successfully managed, with no major complications related to the procedure. VT eliminated and VPC counts on 24-hour ECG monitoring decreased significantly after the ablation[18 474(12 399,26 812)/24h vs 4 (1,7)/24 h, Wilcoxon signed-rank test, P<0.05]. During a follow-up period of 6 monthes, there was no recur-rence. Conclusions Ventricular arrhythmia arising from the aortic sinus of Valsalva has specific electrocardiograph-ic characteristics, and it can be successfully and safely treated under the guidance of activation mapping.%目的 评价主动脉Valsalva窦内起源室性心律失常的心电生理特征和射频消融疗效.方法 18例起源于主动脉Valsalva窦内频发室性期前收缩或室性心动过速患者,其中男6例,女12例,均伴有明显的症状,但排除器质性心脏病.采用Valsalva窦内激动标测法,在局部心内电图室波最早处放电消融,同时行冠状动脉造影以评价室性心律失常起源点与冠状动脉开口以及主动脉瓣的解剖学关系.结果 18例患者均消融成功,无严重并发症发生.

  15. Atrial Tachycardias Occurring After Atrial Fibrillation Ablation: Strategies for Mapping and Ablation

    Directory of Open Access Journals (Sweden)

    Stavros Mountantonakis, MD

    2010-10-01

    Full Text Available The occurrence of left atrial tachycardias (AT after catheter ablation for atrial fibrillation (AF is common, especially after more extensive ablation of persistent AF. These AT are invariably symptomatic and often do not respond to medical therapy. The initial strategy involves ventricular rate control, cardioversion, and observation as some tachycardias may resolve with time. For persistent ATs, effective management frequently requires catheter intervention. Careful characterization of the tachycardia mechanism is essential in designing an effective ablation strategy that would also avoid further creation of pro-arrhythmic substrate. With this review, we summarize the incidence, mechanism, diagnosis and treatment of ATs occurring after AF ablation.

  16. Ablação do flutter atrial típico: estudo prospectivo e randomizado do cateter irrigado fechado versus cateter com eletrodo distal de 8 mm Ablation of typical atrial flutter: a prospective randomized study of cooled-tip versus 8-mm-tip catheters

    Directory of Open Access Journals (Sweden)

    Sissy L. Melo

    2007-03-01

    Full Text Available OBJETIVOS: Trabalho prospectivo, randomizado para comparar a eficácia e a segurança do cateter irrigado em relação ao cateter com eletrodo distal de 8 mm para ablação com radiofreqüência (RF do flutter atrial. MÉTODOS: Em 52 pacientes consecutivos referidos para tratamento do flutter atrial típico, a ablação do istmo cavotricuspídeo (Ist-CT foi realizada com cateter de irrigação fechada (n=26 ou com cateter de eletrodo distal de 8 mm (n=26. Os pulsos de RF foram aplicados ponto a ponto por 60 segundos com potência limitada a 50 w com o cateter irrigado e por controle de temperatura (60ºC, 70 w com cateter de 8 mm. O critério de fim do procedimento foi a obtenção de bloqueio bidirecional do Ist-CT. RESULTADOS: O bloqueio Ist-CT foi obtido em 98,1% dos pacientes. O "crossover" ocorreu em quatro pacientes do grupo com cateter irrigado. Não se encontrou diferença estatística significante em relação aos parâmetros da ablação, tais como tempo total de aplicação de RF (591,1±309,0s vs 486,2±250,8s, duração do procedimento (86,4 ± 23,6 vs 78,1±22,5min e tempo de fluoroscopia (17,0±6,7 vs 15,4±4,6min entre os dois grupos. Durante seguimento médio de 10,6 meses, um paciente do grupo irrigado apresentou recorrência do flutter atrial típico. CONCLUSÃO: A ablação do Ist-CT resultou ser efetiva e segura para o controle do flutter atrial com ambas as técnicas empregadas (cateter com eletrodo distal de 8 mm e cateter irrigado. A complexidade técnica do cateter irrigado proporciona menor competitividade.OBJECTIVES: Both ablation catheters with closed irrigated system and 8mm tip-catheters have been shown to be more effective for typical atrial flutter radiofrequency (RF ablation when compared to conventional 4 mm tip catheter. Considering the differences in complexity and costs of both systems, a prospective study was designed to compare the efficacy and safety of cooled-tip and 8mm-tip catheters for atrial flutter

  17. A unique case of pulmonary artery catheter bleeding from the oximetry connection port

    Directory of Open Access Journals (Sweden)

    Suman Rajagopalan

    2014-12-01

    Full Text Available Pulmonary artery catheter is an invasive monitor usually placed in high-risk cardiac surgical patients to optimize the cardiac functions. We present this case of blood oozing from the oximetry connection port of the pulmonary artery catheter that resulted in the inability to monitor continuous cardiac output requiring replacement of the catheter. The cause of this abnormal bleeding was later confirmed to be due to a manufacturing defect.

  18. Unusual migration of pulmonary artery catheter

    Directory of Open Access Journals (Sweden)

    Sanjay Kuravinakop

    2007-01-01

    Full Text Available Pulmonary artery catheter is widely used in intensive care. Distal migration of the catheter is a know complication. Diagnosis of such a migration is made by both clinical criteria and radiographs. A 55 year old septic lady was admitted to the intensive care unit. Pulmonary artery catheter introduced for cardiac output monitoring migrated from right lung to left lung. Diagnosis was made following a chest radiograph the following day of insertion with the clinical criteria remaining unaltered. Migration of pulmonary artery catheter can occur not only distally but from one lung to another. Clinical criteria alone cannot rule out migration. Chest radiographs form an important part in monitoring the position of the pulmonary artery catheter.

  19. Possible role for cryoballoon ablation of right atrial appendage tachycardia when conventional ablation fails.

    Science.gov (United States)

    Amasyali, Basri; Kilic, Ayhan

    2015-06-01

    Focal atrial tachycardia arising from the right atrial appendage usually responds well to radiofrequency ablation; however, successful ablation in this anatomic region can be challenging. Surgical excision of the right atrial appendage has sometimes been necessary to eliminate the tachycardia and prevent or reverse the resultant cardiomyopathy. We report the case of a 48-year-old man who had right atrial appendage tachycardia resistant to multiple attempts at ablation with use of conventional radiofrequency energy guided by means of a 3-dimensional mapping system. The condition led to cardiomyopathy in 3 months. The arrhythmia was successfully ablated with use of a 28-mm cryoballoon catheter that had originally been developed for catheter ablation of paroxysmal atrial fibrillation. To our knowledge, this is the first report of cryoballoon ablation without isolation of the right atrial appendage. It might also be an alternative to epicardial ablation or surgery when refractory atrial tachycardia originates from the right atrial appendage.

  20. Therapeutic efficiency of catheter ablation in treatment of premature ventricular complexes originating from the right ventricular outflow tract accompanied with left ventricular enlargement: a 5-year follow-up investigation of 30 cases%导管法消融右室流出道室性早搏伴左心室增大30例5年随访观察

    Institute of Scientific and Technical Information of China (English)

    胡立禄; 刘世玉; 雷挺; 高全清; 唐力; 唐成玥; 苏代泉; 帅锋利

    2012-01-01

    目的 探讨导管法消融右室流出道室性早搏伴左心室增大患者的疗效.方法 对30例右室流出道室性早搏伴左心室增大的患者进行导管法射频消融(Radiofrequency cathter ablation,RFCA)治疗.术前常规完成心脏超声检查,成功消融术后5年每年随访超声心动图(ultrasound echocardiography,UCG)及动态心电图(Dynamic Electrocardiogram,DCG,又称Hol-ter).结果 30例患者即刻成功者20例,远期成功8例,无效者2例.术后1年随访20例即刻成功者,UCG结果提示18例患者左室舒张末期内径已在正常值范围内,与自身相比缩小值在3~7 mm以上;随访至第2、3、4、5年,UCG结果无明显变化.另2例患者心脏大小虽未达到正常值范围,但与自身相比较亦有相应缩小.8例远期成功者临床症状也有明显改善.结论 导管法消融治疗右室流出道室早伴左心室增大具有良好临床疗效.%Objective To investigate the therapeutic efficacy of catheter ablation in treatment of patients with premature ven-tricular complexes originating from the right venlricular outftow tract accompanied with left venlricular enlargement Methods The catheler ablalion was performed to 30 patients selected. The rouline cardiac ultrasound examination was carried out before operation. Af-ter surgery, the patients were followed-up for 5 years. During the period of follow-up, echocardiography and dynamic electrocardiogram DCG(Holter)monitoring were performed every year. Results In the 30 patients,20 were acute success,8 were effective,and 2 were in-effeclive. At the first year foltow-up, the UCG resulls showed that 18 of 20 acule success patients presenled a normal left venlricular end-diastolic diameler,and at least reduced 3 ~7 mm compared to pre-operation. During the periods of 2 ~ 5 years foltow-up, no further changes were observed. The heart size of another 2 acule success patients was also reduced although not reach to the normal range. The clinical symptoms of

  1. 室性心动过速及顽固性室性早搏的导管消融治疗%Catheter Ablation of Ven tricular Tachycardia and Symptomatic Ventricular Premature Beats.

    Institute of Scientific and Technical Information of China (English)

    郑强荪; 薛玉生; 赵玉; 张录兴; 王毅; 柳荫; 史俊忠; 杨欣国; 杜日映

    2001-01-01

    Clinical results of ventricular tachycardia(VT) and symptomatic ventricula rpremature beats(VPBs) in 67 patients were reviewed retrospectively.Twenty-fou rand forty-three patients received this treatment in the periods from March 1991 to October 1993 and from November 1993 to October 1999,which were termed early stage and late stage,respectively.Direct current catheter ablation (DCCA) and radiofrequency catheter ablation(RFCA) were performed on all patients guided by endocardial activation mapping combined with pace mapping.The success rate in the patients treated by RFCA was significantly lower in the early stage than th at in the late stage(40% vs 95%,P<0.05).The recurrence rate,the incidence of complications and the mean peak CPK concentration were higher in the patients tr eated by DCCA in the early stage than those by RFCA in the late stage(10% vs 2%, P<0.05; 20% vs 5%,P<0.05;1 032±369 U/L vs 163±82 U/L,P<0.05).Among 67 patients,there were 52 patients with idiopathic ventricular tachycardi a(IVT).Right IVT was found in 22 patients,which originated from the right vent ricular outflow tract in 19 (79%).The earliest endocardial activation in the su ccessful target points was 25.3±5.6 ms before the onset of the QRS complex in 21patients during those IVT.Left IVT was found in 26 patients,which originated from the left posterior septum in 21(75%).The earliest endocardial activation was 29.1±6.0 ms before the onset of the QRS complex in 25patients.The isolate dpurkinje potential was recorded in only one patient.The success rate was 94%( 17/18) for IVT by DCCA in the early stage,while 100%(30/30) by RFCA in the late stage.There were 10 patients with VT combined with structural heart disease.Of them,2 received DCCA in the early stage,whose VT was successfully eliminated in 1.The other 8 patients received RFCA in the late stage,whose VT was elimin ated in 6.There were 5 patients with the refractory symptomatic VPBs,which ori ginated from the right outflow tract in 4

  2. Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants versus Vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Radiofrequency Catheter Ablation of Atrial Fibrillation: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Giuseppe Santarpia

    Full Text Available Use of the non-vitamin K antagonist oral anticoagulants (NOACs is endorsed by current guidelines for stroke prevention in patients with atrial fibrillation (AF. However efficacy and safety of NOACs in patients undergoing catheter ablation (RFCA of AF has not been well established yet.To perform a meta-analysis of all studies comparing NOACs and vitamin K antagonist oral anticoagulants (VKAs in patients undergoing RFCA.Studies were searched for in PubMed and Google Scholar databases.Studies were considered eligible if: they evaluated the clinical impact of NOACs versus VKAs; they specifically analyzed the use of anticoagulants during periprocedural phase of RFCA; they reported clinical outcome data.25 studies were selected, including 9881 cases. The summary measure used was the risk ratio (RR with 95% confidence interval (CI. The random-effects or the fixed effect model were used to synthesize results from the selected studies.There was no significant difference in thromboembolic complications (RR 1.39; p=0.13. Bleeding complications were significantly lower in the NOACs-treated arm as compared to VKAs (RR=0.67, p<0.001. Interestingly, a larger number of thromboembolic events was found in the VKAs-treated arm in those studies where VKAs had been interrupted during the periprocedural phase (RR=0.68; p=ns. In this same subgroup a significantly higher incidence of both minor (RR=0.54; p=0.002 and major bleeding (RR=0.41; p=0.01 events was recorded. Conversely, the incidence of thromboembolic events in the VKAs-treated arm was significantly lower in those studies with uninterrupted periprocedural anticoagulation treatment (RR=1.89; p=0.02.As with every meta-analysis, no patients-level data were available.The use of NOACs in patients undergoing RFCA is safe, given the lower incidence of bleedings observed with NOACs. On the other side, periprocedural interruption of VKAs and bridging with heparin is associated with a higher bleeding rate with no

  3. 磁导航系统遥控导管消融治疗右心室流出道室性心动过速/室性早搏%Remote radiofrequency catheter ablation of right ventricular outflow tract ventricular tachycardia/pre-mature ventricular complexes using the magnetic navigation system combined with non-contact map-ping system

    Institute of Scientific and Technical Information of China (English)

    翟立上; 顾凯; 陈明龙; 曹克将; 杨兵; 孙建辉; 徐东杰; 张凤祥; 居维竹; 陈红武; 郦明芳; 杨刚

    2014-01-01

    Objective To evaluate the safety and efficacy of remote radiofrequency catheter ablation of right ventricular outflow tract ventricular tachycardia/premature ventricular complexes ( RVOT-VT/PVCs ) using the magnetic navigation system combined with the non-contact mapping system. Methods Totally 16 pa-tients with RVOT-VT/PVCs [12 women and 4 men,mean aged (44±15) years] were enrolled. The original site of arrhythmias was determined by non-contact activation mapping and conventional pace mapping. Ablation was performed using HeliosⅡmagnetic temperature-controled catheter manipulated by NiobeⅡmagnetic navi-gation system. If failed with magnetic system,the procedure would be transferred to manually controlled session. Results Among 10 of 16 subjects,documented RVOT-VT/PVCs were successfully abolished by remote abla-tion controlled by magnetic navigation system. In the other 6 patients,RVOT VT/PVCs were eliminated by man-ually controlled catheter ablation. The total procedure time was (190±42) min,and the mean ablation time was (240±33) s,and the average times of energy application were 3. 9±1. 6. The total X-ray exposure time was (4. 8±2. 6) min,which including (3. 2±2. 0) min for operators,and (1. 6±1. 0) min for remote ablation,respec-tively. No other complications were observed except one patient developed postoperative arteriovenous fistula. Conclusion Magnetic navigation system combined with non-contact mapping system was safe and effective for remote radiofrequency catheter ablation of RVOT-VT/PVCs. It may potentially reduce X-ray exposure time for both patients and operators.%目的:探讨应用磁导航遥控导管消融治疗右心室流出道起源的室性心动过速/室性早搏( RVOT-VT/PVCs)的安全性和有效性。方法2008年11月至2009年11月,在南京医科大学第一附属医院心血管内科行体表心电图检查,诊断为RVOT-VT/PVCs的患者共16例[女12例,男4例,平均年龄(44±15)岁],结合应用非接触标测系

  4. EM-navigated catheter placement for gynecologic brachytherapy: an accuracy study

    Science.gov (United States)

    Mehrtash, Alireza; Damato, Antonio; Pernelle, Guillaume; Barber, Lauren; Farhat, Nabgha; Viswanathan, Akila; Cormack, Robert; Kapur, Tina

    2014-03-01

    Gynecologic malignancies, including cervical, endometrial, ovarian, vaginal and vulvar cancers, cause significant mortality in women worldwide. The standard care for many primary and recurrent gynecologic cancers consists of chemoradiation followed by brachytherapy. In high dose rate (HDR) brachytherapy, intracavitary applicators and /or interstitial needles are placed directly inside the cancerous tissue so as to provide catheters to deliver high doses of radiation. Although technology for the navigation of catheters and needles is well developed for procedures such as prostate biopsy, brain biopsy, and cardiac ablation, it is notably lacking for gynecologic HDR brachytherapy. Using a benchtop study that closely mimics the clinical interstitial gynecologic brachytherapy procedure, we developed a method for evaluating the accuracy of image-guided catheter placement. Future bedside translation of this technology offers the potential benefit of maximizing tumor coverage during catheter placement while avoiding damage to the adjacent organs, for example bladder, rectum and bowel. In the study, two independent experiments were performed on a phantom model to evaluate the targeting accuracy of an electromagnetic (EM) tracking system. The procedure was carried out using a laptop computer (2.1GHz Intel Core i7 computer, 8GB RAM, Windows 7 64-bit), an EM Aurora tracking system with a 1.3mm diameter 6 DOF sensor, and 6F (2 mm) brachytherapy catheters inserted through a Syed-Neblett applicator. The 3D Slicer and PLUS open source software were used to develop the system. The mean of the targeting error was less than 2.9mm, which is comparable to the targeting errors in commercial clinical navigation systems.

  5. 起源于乳头肌特发性室性心律失常的电生理特点及射频导管消融%Electrophysiologic characteristics and radiofrequency catheter ablation of idiopathic ventricular arrhythmias originating from the papillary muscles

    Institute of Scientific and Technical Information of China (English)

    李世倍; 王祖禄; 梁延春; 梁明; 韩雅玲; 金志清; 张虹; 时书音

    2011-01-01

    目的 报道特发性左心室乳头肌起源室性心律失常(VA)的电生理特点及射频导管消融结果.方法 连续8例接受射频消融治疗、术中经电生理检查及心室造影证实起源于左/右心室乳头肌的VA患者,包括室性心动过速(VT)6例、频发室性早搏(PVCs)2例,男7例,女1例,年龄4~66岁,均无器质性心脏病.结果 8例患者中,6例VA起源于左心室后组乳头肌,余2例分别起源于左心室前组乳头肌和右心室间隔部乳头肌.与特发性左心室分支性VT相比,左心室乳头肌起源VA的QRS时限较宽,VT或PVCs时可有QRS波改变.所有8例患者消融均较困难,4例应用普通头端4 mm射频导管消融后复发,其中3例在第2次或第3次应用盐水灌注导管消融成功,1例4岁患者再次应用普通4 mm导管消融成功;4例首次消融即应用盐水灌注导管,即刻消融成功,随访中1例复发.所有患者均未出现严重并发症.结论 特发性心室乳头肌起源VA并非少见,其体表心电图具有一定特征,消融多较困难,复发率较高,应用盐水灌注导管可能有助于提高消融成功率.%Objective To investigate the electrocardiographic and electrophysiological characteristics and the effect of radiofrequency catheter ablation of idiopathic ventricular arrhythmias(VA)originating from the papillary muscles(PAM)in the left or right ventricle.Methods Eight patients(7 men,aged from 4 to 66years)underwent catheter ablation of idiopathic VA originating from the papillary muscles judged by electrophysiological study and ventriculography.Six patients had ventricular tachycardia(VI)and 2 patients had frequent premature ventricular contractions(PVCs).All patients had no evidence of structural heart disease.Results In the 8 patients,there were 6 patients whose VA originated from the posterior PAM of the left ventricle,and there were 2 patients whose VA originated separately from the anterior PAM of the left ventricle and the sepal PAM of the

  6. Effect of Perioperation Psychological Nursing and Health Education on Patients with Paroxysmal Supraventricular Heartbeat Tachycardia Radiofrequency Catheter Ablation%围手术期心理护理及健康教育对射频消融治疗室上性心动过速患者的影响

    Institute of Scientific and Technical Information of China (English)

    王永春; 肖平; 张晓兰; 董晓芳; 青燕; 张大勇

    2014-01-01

    目的:探讨围手术期心理护理及健康教育对阵发性室上性心动过速(PSVT)射频消融(RFCA)患者的影响。方法接受 RFCA 患者800例随机分成两组。对照组(400例)由医师进行术前谈话,护士进行术前准备。护理组(400例)除医师进行术前谈话,护士进行术前准备外,在围手术期由医师及病房护士对患者进行健康教育,由病房护士及导管室护士对患者进行心理护理。结果护理组较对照组心率、血压、并发症等两组差异有统计学意义(P <0.05)。结论围手术期对接受 RFCA 的患者进行心理护理及健康教育能改善患者的生理指标、减少对手术的恐惧及不适感、降低并发症、增加手术成功率。%Objective To investigate the effect of peri operation period of psychological nursing and health education for patients with Paroxysmal supraventricular heartbeat tachycardia radiofrequency catheter ablation. Methods 800 patients were ran-domly divided into two groups of patients with Paroxysmal supraventricular heartbeat tachycardia radiofrequency catheter ablation. The control group (400 cases) preoperative conversation by physicians, nurses were preoperative preparation. Nursing group (400 cases) in addition to physicians of conversation before operation, nursing of preoperative preparation, during operation period by the nurse physician and ward patients for health education, the patients psychological nursing by nurses in ward nurses and cathe-ter room;Results Heart rate, blood pressure, operation time, complications between the two groups was statistically significant (P < 0. 05). Conclusion During operation period of patients undergoing Paroxysmal supraventricular heartbeat tachycardia radio-frequency catheter ablation in psychological nursing and health education can improve the physiological index of operation, reduced in patients with fear and discomfort, reduce complications, increase the success rate of operation.

  7. Dose-Escalation Study for Cardiac Radiosurgery in a Porcine Model

    Energy Technology Data Exchange (ETDEWEB)

    Blanck, Oliver, E-mail: oliver.blanck@uksh.de [Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); CyberKnife Center Northern Germany, Guestrow (Germany); Bode, Frank [Medical Department II, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Gebhard, Maximilian [Institute of Pathology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Hunold, Peter [Department of Radiology and Nuclear Medicine, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Brandt, Sebastian [Department of Anaesthesiology and Intensive Care Medicine, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Bruder, Ralf [Institute for Robotics and Cognitive Systems, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Grossherr, Martin [Department of Anaesthesiology and Intensive Care Medicine, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Vonthein, Reinhard [Institute of Medical Biometry and Statistics, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Rades, Dirk [Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); Dunst, Juergen [Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck (Germany); University Copenhagen (Denmark)

    2014-07-01

    Purpose: To perform a proof-of-principle dose-escalation study to radiosurgically induce scarring in cardiac muscle tissue to block veno-atrial electrical connections at the pulmonary vein antrum, similar to catheter ablation. Methods and Materials: Nine mini-pigs underwent pretreatment magnetic resonance imaging (MRI) evaluation of heart function and electrophysiology assessment by catheter measurements in the right superior pulmonary vein (RSPV). Immediately after examination, radiosurgery with randomized single-fraction doses of 0 and 17.5-35 Gy in 2.5-Gy steps were delivered to the RSPV antrum (target volume 5-8 cm{sup 3}). MRI and electrophysiology were repeated 6 months after therapy, followed by histopathologic examination. Results: Transmural scarring of cardiac muscle tissue was noted with doses ≥32.5 Gy. However, complete circumferential scarring of the RSPV was not achieved. Logistic regressions showed that extent and intensity of fibrosis significantly increased with dose. The 50% effective dose for intense fibrosis was 31.3 Gy (odds ratio 2.47/Gy, P<.01). Heart function was not affected, as verified by MRI and electrocardiogram evaluation. Adjacent critical structures were not damaged, as verified by pathology, demonstrating the short-term safety of small-volume cardiac radiosurgery with doses up to 35 Gy. Conclusions: Radiosurgery with doses >32.5 Gy in the healthy pig heart can induce circumscribed scars at the RSPV antrum noninvasively, mimicking the effect of catheter ablation. In our study we established a significant dose-response relationship for cardiac radiosurgery. The long-term effects and toxicity of such high radiation doses need further investigation in the pursuit of cardiac radiosurgery for noninvasive treatment of atrial fibrillation.

  8. The bowed catheter sign: a risk for pericardial tamponade

    Energy Technology Data Exchange (ETDEWEB)

    Towbin, Richard [Phoenix Children' s Hospital, Department of Radiology, Phoenix, AZ (United States)

    2008-03-15

    The use of a central venous catheter (CVC) has become commonplace in the care of children with a wide variety of medical and surgical problems. Complications resulting from the insertion of these catheters are well recognized and can be life-threatening. When a temporary CVC or other catheter is inserted into the central venous system it is secured to the skin with a combination of sutures and sterile dressing. This fixes the catheter in place and does not allow it to retract, thereby putting pressure on the right atrial wall via the catheter tip if it is too long. The probability of wall penetration is increased if a catheter or device is tapered at the point of contact. The purpose of this case report is to present the bowed catheter sign and to review the anatomy of the cavotricuspid isthmus, a possible predisposing factor to cardiac perforation and tamponade. (orig.)

  9. Faster, safer and better catheter ablation?

    NARCIS (Netherlands)

    B. Schwagten (Bruno)

    2012-01-01

    textabstractUndoubtedly the pace at which we are living increases step by step on a daily basis. Since this is a gradual process in general, this may go unnoticed to some, but the implications on healthcare are not to be taken too lightly. Interventional electrophysiology as a distinct entity is a r

  10. Percutaneous transhepatic bipolar radiofrequency catheter ablation for the treatment of malignant obstructive jaundice:preliminary experience in 20 c ases%经皮经肝双极射频消融导管恶性梗阻性黄疸20例

    Institute of Scientific and Technical Information of China (English)

    崔宁; 李晓群

    2014-01-01

    Objective To investigate the feasibility, safety and clinical effect of percutaneous transhepatic bipolar radiofrequency catheter ablation in treating malignant obstructive jaundice. Methods Twenty patients with inoperable malignant biliary obstruction were enrolled in this study. Of the 20 cases , 2 had biliary stent re-occlusion. Percutaneous transhepatic bipolar radiofrequency catheter ablation was carried out in all patients. The ablation power was 5 - 12 W, single ablation time was 60 - 120 s, the average duration of ablation was 4.66 min (1.5 - 8.5 min), and the mean effective ablation extent was 5.76 cm (4 -10 cm). After ablation, balloon catheter was inserted to dilate the occluded segment, which was followed by implantation of biliary metal stent. The clinical efficacy , safety and complications were recorded. Results Percutaneous transhepatic bipolar radiofrequency catheter ablation was successfully completed in all the 20 patients. Implantation of biliary metal stent was performed in 17 patients , among them balloon dilatation was employed in 11 patients before stent implantation , simple balloon dilatation with no stent implantation was employed in one patient, and ablation was adopted after biliary stent re-occlusion occurred in two patients. After the ablation, no complications such as biliary fistula, biliary tract infections, liver penetrating injuries, peritonitis, etc. occurred. Biliary drainage was successfully completed in all patients. The median follow-up period was three months(0.5-10 months); the stent patency rate at the end of one and three months was 100% (19/19) and 79% (11/14) respectively. The one-month and 3-month survival rate was 95% (19/20) and 93% (14/15) respectively. During the follow-up period, 8 of the 20 patients were alive and 12 died. The median survival time was 144 days (13 - 330 days) and the median time of stent patency was 60 days (30-210 days). Of the 12 fatal patients, 8 died of cachexia with multi- system failure

  11. 儿童流出道室性心律失常射频消融疗效探讨%Efficacy of radiofrequency catheter ablation of outflow tract ventricular arrhythmias in children

    Institute of Scientific and Technical Information of China (English)

    江河; 李小梅; 李延辉; 刘海菊; 张仪; 戈海延

    2016-01-01

    目的 探讨儿童流出道室性心律失常特点以及射频消融疗效及策略.方法 回顾性分析2012年1月至2015年7月因流出道室性心律失常在清华大学第一附属医院住院的53例患儿射频消融手术资料,其中男34例、女19例,年龄(8±3)岁,体重(33±13)kg.患儿均符合射频消融手术适应证而接受手术治疗,结合手术资料分析该类室性心律失常发病年龄、表现形式、好发部位以及消融疗效及策略.结果 53例流出道室性心律失常患儿平均发病年龄(8±4)岁.频发室性期前收缩为主要表现形式,占68%(36例).流出道室性心律失常主要起源于右室流出道,占66%(35例),以肺动脉瓣下1 cm区域(89%,31/35)及间隔(77%,27/35)多见.射频消融即时成功率为98%(52/53),远期复发率10% (5/52),手术并发症发生率2%(1/53).X线曝光量(743±323)mGay·cm2.6例患儿术中需要实施双侧标测消融.结论 儿童流出道室性心律失常以右室流出道起源最多见,射频消融治疗安全有效,部分病例术中需要实施双侧标测消融.%Objective To explore the features of outflow tract ventricular arrhythmias (OTVA) in children and evaluate the efficacy and experiences of radiofrequency catheter ablation (RFCA).Method Data were collected and analyzed on 53 consecutive pediatric patients who underwent RFCA for OTVA from January 2012 to July 2015 in the First Hospital of Tsinghua University.These children included 34 male and 19 female,whose average age was (8 ±3) years and body weight was (33 ± 13) kg.All the children met the indication criteria for RFCA of OTVA in children.Data were analyzed about the onset age,the forms and ablation efficacy and strategies of OTVA.Result The average age of onset was (8 ± 4) years.Of these children,68% (36/53) had frequent premature ventricular complex which was the main arrhythmia pattern.The proportion of 66% (35/53) were of right ventricular outflow tract (RVOT).The vast

  12. Robotic Catheters for Beating Heart Surgery

    OpenAIRE

    Kesner, Samuel Benjamin

    2011-01-01

    Compliant and flexible cardiac catheters provide direct access to the inside of the heart via the vascular system without requiring clinicians to stop the heart or open the chest. However, the fast motion of the intracardiac structures makes it difficult to modify and repair the cardiac tissue in a controlled and safe manner. In addition, rigid robotic tools for beating heart surgery require the chest to be opened and the heart exposed, making the procedures highly invasive. The novel robot...

  13. Radiotherapy beyond cancer: Target localization in real-time MRI and treatment planning for cardiac radiosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Ipsen, S. [Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006, Australia and Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck 23562 (Germany); Blanck, O.; Rades, D. [Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck 23562 (Germany); Oborn, B. [Illawarra Cancer Care Centre (ICCC), Wollongong, New South Wales 2500, Australia and Centre for Medical Radiation Physics (CMRP), University of Wollongong, Wollongong, New South Wales 2500 (Australia); Bode, F. [Medical Department II, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck 23562 (Germany); Liney, G. [Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, New South Wales 2170 (Australia); Hunold, P. [Department of Radiology and Nuclear Medicine, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck 23562 (Germany); Schweikard, A. [Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck 23562 (Germany); Keall, P. J., E-mail: paul.keall@sydney.edu.au [Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006 (Australia)

    2014-12-15

    Purpose: Atrial fibrillation (AFib) is the most common cardiac arrhythmia that affects millions of patients world-wide. AFib is usually treated with minimally invasive, time consuming catheter ablation techniques. While recently noninvasive radiosurgery to the pulmonary vein antrum (PVA) in the left atrium has been proposed for AFib treatment, precise target location during treatment is challenging due to complex respiratory and cardiac motion. A MRI linear accelerator (MRI-Linac) could solve the problems of motion tracking and compensation using real-time image guidance. In this study, the authors quantified target motion ranges on cardiac magnetic resonance imaging (MRI) and analyzed the dosimetric benefits of margin reduction assuming real-time motion compensation was applied. Methods: For the imaging study, six human subjects underwent real-time cardiac MRI under free breathing. The target motion was analyzed retrospectively using a template matching algorithm. The planning study was conducted on a CT of an AFib patient with a centrally located esophagus undergoing catheter ablation, representing an ideal case for cardiac radiosurgery. The target definition was similar to the ablation lesions at the PVA created during catheter treatment. Safety margins of 0 mm (perfect tracking) to 8 mm (untracked respiratory motion) were added to the target, defining the planning target volume (PTV). For each margin, a 30 Gy single fraction IMRT plan was generated. Additionally, the influence of 1 and 3 T magnetic fields on the treatment beam delivery was simulated using Monte Carlo calculations to determine the dosimetric impact of MRI guidance for two different Linac positions. Results: Real-time cardiac MRI showed mean respiratory target motion of 10.2 mm (superior–inferior), 2.4 mm (anterior–posterior), and 2 mm (left–right). The planning study showed that increasing safety margins to encompass untracked respiratory motion leads to overlapping structures even in the

  14. Diagnosis and treatment of cardiac sarcoidosis.

    Science.gov (United States)

    Kusano, Kengo F; Satomi, Kazuhiro

    2016-02-01

    Sarcoidosis is a systemic granulomatous disease of unknown aetiology. The frequency of cardiac involvement (cardiac sarcoidosis (CS)) varies in the different geographical regions, but it has been reported that it is an absolutely important prognostic factor in this disease. Complete atrioventricular block is the most common, and ventricular tachycardia/ventricular fibrillation the second most common arrhythmia in this disease, both of which are associated with cardiac sudden death. Diagnosing CS is sometimes difficult because of the non-specific ECG and echocardiographic findings, and CS is sometimes misdiagnosed as dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy or an idiopathic ventricular aneurysm, and therefore, endomyocardial biopsy is important, but has a low sensitivity. Another problem is the recognition of isolated types of CS. Recently, MRI and (18)F-fluorodeoxyglucose positron emission tomography have been demonstrated to be useful tools for the non-invasive diagnosis of CS as well as therapeutic evaluation tools, but are still unsatisfactory. Treatment of CS is usually done by corticosteroid therapy to control inflammation, prevent fibrosis and protect from any deterioration of the cardiac function, but the long-term outcome is still in debate. Despite the advancement of non-pharmacological approaches for CS (pacing, defibrillators and catheter ablation) to improve the prognosis, there are still many issues remaining to resolve diagnosing and managing CS. Here, we attempt a review of the clinical evidence, with special focus on the current understanding of this disease and showing the current strategies and remaining problems of diagnosing and managing CS. PMID:26643814

  15. Temperature-controlled radiofrequency ablation of cardiac tissue: an in vitro study of the impact of electrode orientation, electrode tissue contact pressure and external convective cooling

    DEFF Research Database (Denmark)

    Petersen, H H; Chen, X; Pietersen, A;

    1999-01-01

    A variety of basic factors such as electrode tip pressure, flow around the electrode and electrode orientation influence lesion size during radiofrequency ablation, but importantly is dependent on the chosen mode of ablation. However, only little information is available for the frequently used...... temperature-controlled mode. The purpose of the present experimental study was to evaluate the impact during temperature-controlled radiofrequency ablation of three basic factors regarding electrode-tissue contact and convective cooling on lesion size....

  16. The Impact of Radiofrequency Catheter Ablation on Coagulation Function and the Preventive Effect of Heparin in Related Patients%射频消融术对凝血功能的影响及肝素的干预作用

    Institute of Scientific and Technical Information of China (English)

    吴再涛; 李玲; 单其俊

    2013-01-01

    目的:了解射频消融(Radiofrequency catheter ablation,RFCA)术对患者凝血功能的影响及肝素的干预作用.方法:连续入选接受RFCA治疗的快速性心律失常患者31例,根据手术不同路径分为经右心导管组16例,经左心导管组15例.经左心导管组术中经血管鞘注射肝素钠50 U/kg,经右心导管组未注射肝素钠.分别于术前及术后20 h抽取静脉血测定血浆D-二聚体水平,采用自身对照的方法进行统计学处理,了解手术前后患者血浆D-二聚体水平的变化及肝素的干预作用.结果:①RFCA术后患者血浆D-二聚体水平明显升高.②经左心导管组术中虽应用了肝素钠,但其术后血浆D-二聚体水平仍会升高.③经右心导管组手术也会引起血浆D-二聚体升高,其升高的程度与经左心导管组手术术中应用肝素钠者无显著差异.④血浆D-二聚体升高的程度与放电时间、累计放电能量、消融温度及手术时间无相关性.结论:①RFCA术可引起机体呈高凝状态和继发性纤溶亢进,血凝状态改变,有血栓形成风险.②肝素钠还不足以对RFCA术所致的血凝状态改变产生保护作用.③经右心导管行RFCA的患者也应考虑给予适当的抗凝及抗血小板活化药物,以减少RFCA术后潜在的血栓危险.%Objective:To explore the impact of radiofrequency catheter ablalion( RFCA) on coagulation function and the preventive effect of heparin in relaled patients. Methods: A total of 31 conseculive patients with Lachyarrhythmia who received RFCA treatment were recruited and divided into 2 groups according Lo their surgical pathways. Via right heart catheterization (Right group) ,n=16,and via left heart calheter-ization (Left group) ,n= 15. The patients in Left group received heparin 50 U/kg via vascular sheath injection in surgery,while Right group had no heparin. Blood samples were collected before surgery and 20 hours after surgery lo examine plasma D-dimer levels and to

  17. Catheter-based endomyocardial delivery of mesenchymal precursor cells using 3D echo guidance improves cardiac function in a chronic myocardial injury ovine model.

    Science.gov (United States)

    Cheng, Yanping; Yi, Genghua; Conditt, Gerard B; Sheehy, Alexander; Kolodgie, Frank D; Tellez, Armando; Polyakov, Igor; Gu, Anguo; Aboodi, Michael S; Wallace-Bradley, David; Schuster, Michael; Martens, Timothy; Itescu, Silviu; Kaluza, Greg L; Basu, Shubhayu; Virmani, Renu; Granada, Juan F; Sherman, Warren

    2013-01-01

    The administration of bone marrow-derived stem cells may provide a new treatment option for patients with heart failure. Transcatheter cell injection may require multi-imaging modalities to optimize delivery. This study sought to evaluate whether endomyocardial injection of mesenchymal precursor cells (MPCs) could be guided by real-time 3D echocardiography (RT3DE) in treating chronic, postinfarction (MI) left ventricular (LV) dysfunction in sheep. Four weeks after induction of an anterior wall myocardial infarction in 39 sheep, allogeneic MPCs in doses of either 25 × 10(6) (n = 10), 75 × 10(6) (n = 9), or 225 × 10(6) (n = 10) cells or nonconditioned control media (n = 10) were administered intramyocardially into infarct and border zone areas using a catheter designed for combined fluoroscopic and RT3DE-guided injections. LV function was assessed before and after injection. Infarct dimension and vascular density were evaluated histologically. RT3DE-guided injection procedures were safe. Compared to controls, the highest dose MPC treatment led to increments in ejection fraction (3 ventricula 3% in 225M MPCs vs. -5 ± 4% in the control group, p logistical obstacles. Significant increases in LV performance (ejection fraction and wall thickening) and neovascularization resulted from this technique, and so this technique has important implications for treating patients with postischemic LV dysfunction. PMID:23107489

  18. Integration of cardiac computed tomography into pulmonary vein isolation in patients with paroxysmal atrial fibrillation

    International Nuclear Information System (INIS)

    Purpose: Detailed anatomic information of the left atrium is necessary for securely performing radiofrequency ablation of atrial fibrillation-triggering ectopies in the pulmonary vein ostia. In this study the impact of a preinterventionally acquired cardiac computed tomography (CT) on pulmonary vein isolation (PVI) was assessed. Materials and methods: Examinations of 54 patients with paroxysmal atrial fibrillation undergoing PVI were analyzed. In 27 patients a supplementary cardiac CT was obtained prior to PVI (CT group, 12 women, 15 men, 59.7 ± 9.9 years of age): 16 x 1.5 mm collimation, 0.2 pitch, 120 kV tube voltage, 400 effective mAs. The fluoroscopy time, effective dose and quantity of radiofrequency (RF) pulses of the following catheter ablation were compared to 27 patients undergoing stand-alone PVI (11 women, 16 men, 62.0 ± 9.9 years of age). Mann-Whitney tests served for statistical comparison. Results: CT datasets were successfully integrated into the ablation procedure of each patient in the CT group. The mean quantity of RF pulses was significantly lower in the CT group (22.1 ± 8.0 vs. 29.1 ± 11.9, p = 0.030), and a significant reduction of fluoroscopy time was found (41.8 ± 12.0 min vs. 51.2 ± 16.0 min, p = 0.005). Effective doses of the catheter ablation differed in an equivalent dimension but altogether not significantly (14.9 ± 10.0 mSv vs. 20.0 ± 16.0 mSv, p = 0.203). The mean additive effective dose of the cardiac CT was 85 ± 0.3 mSv. (orig.)

  19. Ablation of a therapy-resistant posteroseptal accessory atrioventricular pathway: going for gold.

    Science.gov (United States)

    McCann, Conor J; Gal, Benjamin; Geelen, Peter

    2010-04-01

    Posteroseptal accessory pathways are sometimes resistant to ablation because of the complex anatomy of this region. Ex-vivo experiments have demonstrated that gold-tip radiofrequency ablation catheters create deeper lesions than conventional platinum-iridium tip catheters. This case of a 62-year-old man with Wolf-Parkinson-White syndrome illustrates that the ability to create such lesions can be a very useful option when previous attempts with platinum-iridium tip catheters have failed.

  20. Presternal peritoneal catheter.

    Science.gov (United States)

    Twardowski, Zbylut J

    2002-04-01

    The swan neck presternal catheter is composed of 2 flexible (silicon rubber) tubes joined by a titanium connector at the time of implantation. The exit site is located in the parasternal area. The catheter located on the chest was designed to reduce the incidence of exit site infections compared to peritoneal dialysis catheters with abdominal exits. From August 1991 to September 30, 2001, 974 swan neck presternal catheters were implanted worldwide. At the university of Missouri, 150 of these catheters were implanted and followed for over 130 patient years. Presternal catheters tended to perform better than swan neck abdominal catheters regarding exit and tunnel infections, even though they were implanted in several patients in whom regular catheters with the exit on the abdomen would be difficult or impossible to implant. Two-year survival probability of presternal catheters was 0.95. Recurrent/refractory peritonitis was the only reason for catheter failure. The catheter is particularly useful in obese patients (body mass index >35), patients with ostomies, children with diapers and fecal incontinence, and patients who want to take baths without the risk of exit contamination. Many patients prefer presternal catheter because of better body image. Disadvantages of the presternal catheter are minimal. Compared with abdominal catheters, dialysis-solution flow is slightly slower because of the increased catheter length; however, slower flow is insignificant clinically. There is a possibility of catheter disconnection in the tunnel, but this complication is extremely rare in adults and easily corrected. Finally, the implantation technique is more challenging compared with that of single-piece, abdominal catheters. PMID:12085389

  1. Central venous catheters and catheter locks in children with cancer

    DEFF Research Database (Denmark)

    Handrup, Mette Møller; Møller, Jens Kjølseth; Schrøder, Henrik

    2013-01-01

    To determine if the catheter lock taurolidine can reduce the number of catheter-related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC).......To determine if the catheter lock taurolidine can reduce the number of catheter-related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC)....

  2. Importance of Delayed Enhanced Cardiac MRI Imaging in Idiopathic RVOT-VT: Differentiating Mimics Including Early Stage ARVC and Cardiac Sarcoidosis

    Directory of Open Access Journals (Sweden)

    Carlos Macias, MD; Keijiro Nakamura, MD; Roderick Tung, MD; Noel G. Boyle, MD PhD; Kalyanam Shivkumar, MD, PhD and Jason S. Bradfield, MD.

    2014-12-01

    Full Text Available Abstract: A detailed understanding of cardiac anatomy and pathophysiology is necessary to optimize catheter ablation procedural success for patients with symptomatic ventricular tachycardia (VT/premature ventricular contractions (PVCs of outflow tract origin. Comprehensive imaging with cardiac magnetic resonance imaging (cMRI is now at the forefront of procedural planning for complex ventricular arrhythmia ablation for patients with structural heart disease, but is increasingly used in patients with presumed “idiopathic” outflow VT/PVCs as well. cMRI with late gadolinium enhancement (LGE can localize small regions of myocardial scar from previous myocardial infarction, fibrosis from non-ischemic cardiomyopathy, or edema/fibrosis from inflammatory disorders and help define targets for ablation. LGE, in combination with structural assessment, can help differentiate true idiopathic outflow VT/PVCs from those caused by early stage disease secondary to more significant pathology, such as arrhythmogenic right ventricular cardiomyopathy or cardiac sarcoidosis. We review the benefits of cMRI with LGE for patients with VT/PVCs of outflow origin.

  3. Suprapubic catheter care

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000145.htm Suprapubic catheter care To use the sharing features on this page, please enable JavaScript. A suprapubic catheter (tube) drains urine from your bladder. It is ...

  4. Surgical Ablation of Atrial Fibrillation.

    Science.gov (United States)

    Ramlawi, Basel; Abu Saleh, Walid K

    2015-01-01

    The Cox-maze procedure for the restoration of normal sinus rhythm, initially developed by Dr. James Cox, underwent several iterations over the years. The main concept consists of creating a series of transmural lesions in the right and left atria that disrupt re-entrant circuits responsible for propagating the abnormal atrial fibrillation rhythm. The left atrial appendage is excluded as a component of the Maze procedure. For the first three iterations of the Cox- maze procedure, these lesions were performed using a surgical cut-and-sew approach that ensured transmurality. The Cox-Maze IV is the most currently accepted iteration. It achieves the same lesion set of the Cox- maze III but uses alternative energy sources to create the transmural lesions, potentially in a minimally invasive approach on the beating heart. High-frequency ultrasound, microwave, and laser energy have all been used with varying success in the past. Today, bipolar radiofrequency heat or cryotherapy cooling are the most accepted sources for creating linear lesions with consistent safety and transmurality. The robust and reliable nature of these energy delivery methods has yielded a success rate reaching 90% freedom from atrial fibrillation at 12 months. Such approaches offer a significant long-term advantage over catheter-based ablation, especially in patients having longstanding, persistent atrial fibrillation with characteristics such as dilated left atrial dimensions, poor ejection fraction, and failed catheter ablation. Based on these improved results, there currently is significant interest in developing a hybrid ablation strategy that incorporates the superior transmural robust lesions of surgical ablation, the reliable stroke prevention potential of epicardial left atrial appendage exclusion, and sophisticated mapping and confirmatory catheter-based ablation technology. Such a minimally invasive hybrid strategy for ablation may lead to the development of multidisciplinary "Afib teams" to

  5. Feasibility and safety of remote-controlled magnetic navigation for ablation of atrial fibrillation.

    Science.gov (United States)

    Katsiyiannis, William T; Melby, Daniel P; Matelski, Jayme L; Ervin, Vanessa L; Laverence, Kerri L; Gornick, Charles C

    2008-12-15

    Radiofrequency ablation for atrial fibrillation (AF) involves complex catheter manipulation resulting in prolonged procedure time and fluoroscopy exposure. Remote magnetic navigation (RMN) represents a novel approach toward improving the ability to perform complex ablation. Forty patients underwent ablation for AF, 20 using RMN (NIOBE II, Stereotaxis, Inc) with a 4-mm-tip magnetic catheter (Celsius, Biosense Webster) and 20 using a conventional 8-mm-tip bidirectional ablation catheter (Blazer, Boston Scientific). All patients underwent a combined wide area circumferential ablation and segmental pulmonary vein (PV) isolation using a circular mapping catheter and cavotricuspid isthmus ablation for right atrial flutter. The procedural end point was PV entrance block. There was no difference in atrial size, left ventricular systolic function, or type of AF between groups. PV entrance block was achieved in all patients. Mean procedure time was 279 +/- 60 minutes in the conventional group versus 209 +/- 56 minutes in the RMN group (p RMN group (p RMN group free from clinical AF and off antiarrhythmic drugs (p = NS). There were 2 additional ablations performed for atypical atrial flutter in the conventional group and 3 in the RMN group (p = ns). Ablation catheter char formation was not observed. There were no procedural complications. In conclusion, radiofrequency ablation of AF performed with RMN is safe and feasible. Compared with conventional hand-navigated ablation, RMN ablation results in similar clinical outcomes with decreased fluoroscopy and procedure times.

  6. Causes of central venous catheter-related infections after cardiac surgery and intervention measures%心脏术后中心静脉导管感染的原因分析及干预措施的研究

    Institute of Scientific and Technical Information of China (English)

    郭舒婕; 王晓敏; 张瑜; 张艳丽

    2012-01-01

    OBJECTIVE To analyze the causes of central venous catheter-related infections after the cardiac surgery and to explore the intervention countermeasures. METHODS A total of 100 patients who underwent cardiac surgery were selected, and all the patients underwent the central venous catheterization. RESULTS Of the 100 patients investigated, the central venous catheter-related infections occurred in 22 patients with the infection rate of 22. 0% , including 6 cases of Staphylococcus epidermidis infections, 5 cases of S. aureus infections, 4 cases of Klebsiella pneumoniae infections, 3 cases of Enterococcus faecalis infections, 1 case of Acinetobacter baumannii infection, 1 case of Enterobacter cloacae infection, 1 case of Candida albicans infection, and 1 case of Pseudomonas aeruginosa infection. The infections disappeared after being given appropriate antibiotics on the basis of drug susceptibility testing. The incidence rate of the central venous catheter-related infections in the patients with less than 50 years of age was 12. 5%, and 26. 5% of the patients with more than 50 years, the difference was statistically significant (P<0. 05). The infection rate of the patients without complications was 9. 1 % , and 28. 3% of the patients with complications, the difference was statistically significant (P<0. 05). The infection rate of the patients with the subclavian vein as puncture site was 17. 8%. and 21. 8% of the patients with internal jugular vein as the puncture site, the difference was not statistically significant. The infection rate of the patients with the joints and sealing solution optimized was 17. 6%, the conventional 37. 5%, the difference was statistically significantP<0. 05). The infection rate of the patients with dual-chamber was 21. 4% , 27. 3% of the patients with three-cavity, the difference was not statistically significant. The infection rate of the patients with the catheterization duration less than 7 days was 9. 1% , 20. 1% of the patient with the

  7. The transponder system: a new method of precise catheter placement in the right atrium under echocardiographic guidance.

    Science.gov (United States)

    Landzberg, J S; Franklin, J O; Langberg, J J; Herre, J M; Scheinman, M M; Schiller, N B

    1988-09-01

    The ability to localize catheters within the heart has gained importance with the use of percutaneous catheter ablation and the transseptal approach for valvuloplasty. A prototype interactive transponder catheter system, specifically designed to mark the catheter tip for echocardiographic visualization, was used to place catheters at the tricuspid anulus and the fossa ovalis in anesthetized dogs. Catheter tip location was marked by lesions produced by radiofrequency energy delivered at the distal catheter electrode. At autopsy, the center of the radiofrequency-induced lesion was located 2.8 +/- 0.7 mm from the edge of the lateral tricuspid anulus and 3.5 +/- 3.1 mm from the center of the fossa ovalis. The transponder catheter system offers the ability to precisely position catheters in the right atrium under echocardiographic guidance.

  8. Radiation dose is significantly reduced by use of contact force sensing catheter during circumferential pulmonary vein isolation

    Directory of Open Access Journals (Sweden)

    Giuseppe Stabile; Antonio De Simone; Francesco Solimene; Assunta Iuliano, Vincenzo La Rocca; Vincenzo Schillaci; Alfonso Panella; Gergana Shopova; Felice Nappi; Francesco Urraro; Giovanni Russo; Giovanni Napolitano; Paola Chiariello

    2015-04-01

    Full Text Available The creation of a durable radiofrequency (RF lesion depends on several parameters, including catheter tip electrode size and composition, tip orientation, temperature, RF pulse duration, power, blood flow, and catheter to tissue contact. The development of new contact force (CF sensor catheters has allowed the measurement of the tip to tissue CF during the RF ablation procedure. Here, we describe the clinical experience obtained using CF catheters for atrial fibrillation ablation, with a specific focus on the impact of CF technology on acute procedural data (procedure and fluoroscopy time.

  9. 达比加群酯应用于非瓣膜病心房颤动患者导管射频消融围术期的有效性和安全性%Effectiveness and safety of dabigatran on non-valvular atrial fibrillation patients during perioperative period of radiofrequency catheter ablation

    Institute of Scientific and Technical Information of China (English)

    李松南; 董建增; 王璐; 杨汪洋; 闻松男; 刘念; 白融; 冯莉; 汤日波

    2016-01-01

    Objective To investigate the effectiveness and safety of dabigatran on non-valvular atrial fibrillation(AF) patients during perioperative period of radiofrequency catheter ablation(RFCA).Methods Totally 292 patients with non-valvular AF who had RFCA from January 2013 to September 2014 were retrospectively analyzed and divided into 2 groups according to use of anticoagulants:dabigatran group (146 cases) and warfarin group(146 cases).All patients were treated with regular anticoagulant therapies for 3 months after RFCA.The effectiveness and safety of drugs were compared between groups.Results There was no death during hospitalization and follow-up period in both groups.In dabigatran group,ischemic stroke occurred in 1 case and severe hemorrhage occurred in 2 cases(1 case of cardiac tamponade,1 case of gastrointestinal hemorrhage).In warfarin group,severe hemorrhage occurred in 3 cases(1 case of cardiac tamponade,1 case of hemothorax,1 case of puncture site hematoma).The dabigatran group and warfarin group had 8 and 7 cases of minor bleeding respectively.Incidences of total bleeding,severe hemorrhage and minor bleeding had no significant difference between groups(all P <0.05).The incidence of gastrointestinal irritative symptom in dabigatran group was significantly higher than that in warfarin group [11.0%(16/146) vs 4.1% (6/146),P =0.022].Conclusions Dabigatran used for anticoagulant therapy in non-valvular AF patients during RFCA is safe and effective.Dabigatran can be the replacement therapy of warfarin.%目的 探讨达比加群酯应用于非瓣膜病心房颤动患者导管射频消融围术期的有效性及安全性.方法 收集2013年1月至2014年9月在首都医科大学附属北京安贞医院接受导管射频消融治疗的292例非瓣膜病心房颤动患者的病历资料进行回顾性分析,将所有患者按照术后应用抗凝药物不同分为达比加群酯组和华法林组,各146例.所有患者术后规律抗凝治疗3个月,比较2

  10. Radiologic interventional retrieval of retained central venous catheter fragment in prematurity: case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jee Won; Jo, Jung Hyun; Park, Byeong Ho [College of Medicine, Dong-A University, Busan (Korea, Republic of)

    2007-12-15

    The fracture of a central venous catheter is a rare but potentially serious complication. Moreover, removal of the broken catheter pieces is considerably challenging, especially for premature infants. We report 3 case studies of the percutaneous transcatheter retrieval of broken catheter parts in 3 premature infants. We confirmed the location of the catheter fragments via a DSA venogram with diluted contrast media. Using the minimum amount of contrast, and extreme caution, we made certain no contrast-induced nephrotoxicity of air embolism occurred during catheter manipulation. In addition, when the broken fragment was curled or attached to the cardiac wall, we used a hook-shaped catheter to facilitate the capturing of the catheter with a loopsnare. This report demonstrates the feasibility of removing a retained catheter fragment in a premature infant using a percutaneous transcatheter approach.

  11. Investigation of central venous catheter-related infections in patients undergoing cardiac surgery%心脏术后患者中心静脉置管感染调查分析

    Institute of Scientific and Technical Information of China (English)

    马海英; 张志强; 段长虹; 李岩; 杨艳荣; 臧树志

    2013-01-01

    目的 对心脏术后患者行中心静脉置管(CVC)感染情况进行调查,为其临床的防治提供参考.方法 共纳入558例心外科行心脏手术的患者,所有患者根据病情均给予CVC,观察患者是否发生感染,并应用非条件logistic回归分析进行多因素分析.结果 558例行CVC患者中发生感染85例,感染率为15.3%;CVC尖端培养阳性28例,分离的16株病原菌中革兰阳性菌8株占50.0%,革兰阴性菌6株占37.5%,真菌2株占12.5%;85例感染患者中,65例为局部定植,12例为局部感染,8例为菌血症;单因素分析结果表明,感染患者年龄≥60岁、留置时间≥7d、导管管径≥16 G、导管管腔(多腔)、糖尿病史所占例数明显高于未发生感染患者,且感染患者白蛋白更低,差异有统计学意义(P<0.05);进一步行多因素分析结果表明,年龄≥60岁、留置时间≥7d、导管管腔(多腔)、糖尿病史及低白蛋白是CVC患者发生感染的独立危险因素(P<0.05).结论 年龄≥60岁、留置时间≥7d、导管管腔(多腔)、糖尿病史及低白蛋白是CVC患者发生感染的独立危险因素,对该类危险因素进行必要的干预具有重要的意义.%OBJECTIVE To investigate the status of the central venous catheter (CVC)-related infections in the patients undergoing cardiac surgery so as to provide reference for the clinical prevention and treatment. METHODS A total pf 558 patients who underwent the cardiac surgery were enrolled in the study, all patients were given the CVC according to the illness, the status of the infections was observed, and multivariate non-conditional logistic regression analysis was performed. RESULTS There were 85 of 558 CVC patients in whom the infections occurred. There were 28 cases with the culture of CVC positive. Of 16 strains of pathogens isolated, there were 8 (50.0%) strains of gram-positive bacteria, 6 (37. 5%) strains of gram-negative bacteria,and 2 (12. 5%) strains of fungi. Of

  12. Ablação por cateter do flutter atrial. Caracterização eletrofisiológica da interrupção da condução pelos istmos posterior e septal Catheter ablation of atrial flutter. Electrophysiological characterization of posterior and septal isthmus block

    Directory of Open Access Journals (Sweden)

    José Marcos Moreira

    1998-07-01

    Full Text Available OBJETIVO: Avaliar os tipos de bloqueio obtidos nos istmos posterior (entre o anel tricuspídeo e veia cava inferior e septal (entre o anel tricuspídeo e óstio do seio coronário, após ablação do flutter atrial (FLA. MÉTODOS: Foram submetidos à ablação por radiofreqüência (RF 14 pacientes com FLA tipo I (9 homens em 16 procedimentos. A ativação atrial ao redor do anel tricuspídeo foi avaliada em ritmo sinusal utilizando-se cateter "Halo" com 10 pares de eletrodos (H1-2 a H19-20, durante estimulação do seio coronário proximal (SCP e região póstero-lateral do átrio direito (H1-2, antes e após ablações lineares. De acordo com a frente de programação do impulso definiu-se: ausência de bloqueio (condução bidirecional, bloqueio incompleto (condução bidirecional com retardo num dos sentidos e bloqueio completo (ausência de condução pelo istmo. O intervalo desta ativação (deltaSCP/H1-2 foi analisado. RESULTADOS: Bloqueio completo foi obtido em 7 procedimentos (44% e incompleto em 4 (25%. O deltaSCP/H1-2 foi de 74 ± 26ms no primeiro grupo e de 30,5 ± 7,5ms no segundo (pPURPOSE: Evaluate the different types of conduction blocks obtained between inferior vena cava-tricuspid annulus (posterior isthmus and between tricuspid annulus-coronary sinus ostium (septal isthmus after radiofrequency (RF catheter ablation of atrial flutter (AFL METHODS: In 16 procedures, 14 patients (pts, 9 male, with type I AFL underwent RF ablation. Atrial activation around tricuspid annulus was performed with a 10-bipole "Halo" catheter (H1-2; H19-20. In sinus rhythm, isthmus conduction was evaluated during proximal coronary sinus (PCS and low lateral right atrium (H1-2 pacing, before and after linear ablation. According to the wave front of impulse propagation we assessed absence of block (bidirectional conduction; incomplete block (bidirectional conduction with delay in one front of impulse propagation and complete block (absence of conduction

  13. The Atrial Fibrillation Ablation Pilot Study

    DEFF Research Database (Denmark)

    Arbelo, Elena; Brugada, Josep; Hindricks, Gerhard;

    2014-01-01

    was achieved in 40.7% of patients (43.7% in paroxysmal AF; 30.2% in persistent AF; 36.7% in long-lasting persistent AF). A second ablation was required in 18% of the cases and 43.4% were under antiarrhythmic treatment. Thirty-three patients (2.5%) suffered an adverse event, 272 (21%) experienced a left atrial...... tachycardia, and 4 patients died (1 haemorrhagic stroke, 1 ventricular fibrillation in a patient with ischaemic heart disease, 1 cancer, and 1 of unknown cause). CONCLUSION: The AFib Ablation Pilot Study provided crucial information on the epidemiology, management, and outcomes of catheter ablation of AFib...

  14. Ultrasound Current Source Density Imaging in live rabbit hearts using clinical intracardiac catheter

    Science.gov (United States)

    Li, Qian

    Ultrasound Current Source Density Imaging (UCSDI) is a noninvasive modality for mapping electrical activities in the body (brain and heart) in 4-dimensions (space + time). Conventional cardiac mapping technologies for guiding the radiofrequency ablation procedure for treatment of cardiac arrhythmias have certain limitations. UCSDI can potentially overcome these limitations and enhance the electrophysiology mapping of the heart. UCSDI exploits the acoustoelectric (AE) effect, an interaction between ultrasound pressure and electrical resistivity. When an ultrasound beam intersects a current path in a material, the local resistivity of the material is modulated by the ultrasonic pressure, and a change in voltage signal can be detected based on Ohm's Law. The degree of modulation is determined by the AE interaction constant K. K is a fundamental property of any type of material, and directly affects the amplitude of the AE signal detected in UCSDI. UCSDI requires detecting a small AE signal associated with electrocardiogram. So sensitivity becomes a major challenge for transferring UCSDI to the clinic. This dissertation will determine the limits of sensitivity and resolution for UCSDI, balancing the tradeoff between them by finding the optimal parameters for electrical cardiac mapping, and finally test the optimized system in a realistic setting. This work begins by describing a technique for measuring K, the AE interaction constant, in ionic solution and biological tissue, and reporting the value of K in excised rabbit cardiac tissue for the first time. K was found to be strongly dependent on concentration for the divalent salt CuSO4, but not for the monovalent salt NaCl, consistent with their different chemical properties. In the rabbit heart tissue, K was determined to be 0.041 +/- 0.012 %/MPa, similar to the measurement of K in physiologic saline: 0.034 +/- 0.003 %/MPa. Next, this dissertation investigates the sensitivity limit of UCSDI by quantifying the relation

  15. Ablação com radiofreqüência de extra-sístoles da via de saída do ventrículo direito Radiofrequency catheter ablation of premature ventricular contractions originating in the right ventricular outflow tract

    Directory of Open Access Journals (Sweden)

    Francisco C. C. Darrieux

    2007-03-01

    Full Text Available OBJETIVOS: Avaliar se a ablação com radiofreqüência é um procedimento eficiente para o tratamento das extra-sístoles da via de saída do ventrículo direito (EVSVD, e se resulta em melhora dos sintomas. MÉTODOS: Estudo prospectivo, com 30 pacientes consecutivos (idade média de 40±13 anos, 25 do sexo feminino, sem cardiopatia estrutural aparente, com EVSVD, muito freqüentes (densidade média de 1.263±593/h, sintomáticos por mais de 1 ano (média =74 meses e refratários aos fármacos antiarrítmicos (3±1,7, incluindo os beta-bloqueadores, que foram submetidos à ablação com radiofreqüência. RESULTADOS: Após o primeiro procedimento, houve 23 sucessos iniciais (76,6% e 7 iniciais insucessos (23,4%. Quatro pacientes tiveram recorrências, sendo que dois desses não se submeteram ao segundo procedimento. O segundo procedimento foi realizado em 9 pacientes (7 insucessos iniciais e 2 recorrências, e o sucesso ocorreu em 5 pacientes adicionais, sendo 1 caso por acesso epicárdico. A taxa de sucesso final foi de 80% (24/30, e nenhuma complicação maior ocorreu. Após um seguimento médio de 14±6 meses, no grupo de sucesso final houve uma redução de mais de 90% na densidade das extra-sístoles(24/24; pOBJECTIVES: To evaluate if radiofrequency catheter ablation is an effective procedure for the treatment of right ventricular outflow tract premature ventricular contractions (RVOT-PVC and ascertain if it results in an improvement of symptoms. METHODS: A prospective study with 30 consecutive patients (mean age 40 ± 13 years, 25 females, with no apparent structural cardiopathy, with very frequent (mean density of 1,263 ± 593/h RVOT-PVC, symptomatic for more than one year (mean = 74 months and resistant to antiarrhythmic drugs (3 ± 1.7, including beta-blockers, who underwent radiofrequency catheter ablation. RESULTS: After the first procedure, there were 23 initial successful cases (76.6% and 7 initial failures (23.4%. Four patients

  16. Contact Force and Atrial Fibrillation Ablation

    Directory of Open Access Journals (Sweden)

    Waqas Ullah; Richard Schilling; Tom Wong

    2016-02-01

    Full Text Available Catheters able to measure the force and vector of contact between the catheter tip and myocardium are now available. Pre-clinical work has established that the degree of contact between the radiofrequency ablation catheter and myocardium correlates with the size of the delivered lesion. Excess contact is associated with steam pops and perforation. Catheter contact varies within the left atrium secondary to factors including respiration, location, atrial rhythm and the trans-septal catheter delivery technology used. Compared with procedures performed without contact force (CF-sensing, the use of this technology has, in some studies, been found to improve complication rates, procedure and fluoroscopy times, and success rates. However, for each of these parameters there are also studies suggesting a lack of difference from the availability of CF data. Nevertheless, CF-sensing technology has been adopted as a standard of care in many institutions. It is likely that use of CF-sensing technology will allow for the optimization of each individual radiofrequency application to maximize efficacy and procedural safety. Recent work has attempted to define what these optimal targets should be, and approaches to do this include assessing for sites of pulmonary vein reconnection after ablation, or comparing the impedance response to ablation. Based on such work, it is apparent that factors including mean CF, force time integral (the area under the force-time curve and contact stability are important determinants of ablation efficacy. Multicenter prospective randomized data are lacking in this field and required to define the CF parameters required to produce optimal ablation.

  17. Application of Cardiac Magnetic Resonance Imaging in Radiofrequency Ablation of Atrial Fibrilla-tion%心脏磁共振成像在心房颤动消融手术前后的应用

    Institute of Scientific and Technical Information of China (English)

    陈明鲜(综述); 周胜华(审校)

    2015-01-01

    随着科学的进步、技术的发展,射频消融已成为治疗心房颤动的重要手段,其在心房颤动的治疗中起举足轻重作用,但仍有部分患者消融术无效,其中一个主要原因系无法正确评估肺静脉和左心房结构。心脏磁共振成像( cMRI)具有高分辨率的优点,能准确地评估软组织结构,cMRI近年来运用于心房颤动评估逐渐增多,有助于提高心房颤动射频消融成功率和减少手术并发症。%With the development of current technology, radiofrequency ablation has become a critical treatment method for atrial fibrillation .Radiofrequency ablation plays a pivotal role in atrial fibrillation thera-py,however,it still remains ineffective to a few patients .One of the main shortcoming is its inability to cor-rectly assess the structure of pulmonary vein and left atrium .The major advantages of cardiac magnetic reso-nance imaging(cMRI) are is the high temporal and spatial resolution and the ability to characterize the com-position of soft tissues,therefore,cMRI has been gradually used to assess atrial fibrillation in order to improve ablation outcome and reduce complications .

  18. 三维标测系统指导下希氏束旁室性期前收缩的射频消融及心电图分析%Catheter ablation of para-Hisian ventricular premature guided by 3-dimensional mapping system and ECG analysis

    Institute of Scientific and Technical Information of China (English)

    王洪; 洪浪; 周元凤; 赖珩莉; 陈再华; 欧阳长生; 邱赟

    2012-01-01

    目的:探讨三维标测系统指导下经导管射频消融起源于希氏束旁室性期前收缩(室早)的疗效及安全性.方法:对7例起源于希氏束旁频发室早的患者在三维标测系统指导下行射频消融治疗,其中5例采用Carto标测系统,2例采用Ensite Array系统.采用Carto标测系统者经股静脉送入消融大头至右室,在室早发作时采点建模,建立右室解剖结构及电激动顺序三维图像;采用Ensite Array标测系统者经股静脉送人Array球囊电极至右室流出道,利用消融大头采点,建立右室三维图,并对室早激动起源及出口进行实时标测.在右室三维解剖图上标示出希氏束位置,观察最早激动点与希氏束的距离,对心律失常的最早激动部位消融.冷盐水大头消融功率为25 W,温度为43℃,0.9%氯化钠溶液流量消融时17~20 ml/min,放电间隙2 ml/min.结果:7例患者室早体表心电图呈左束支传导阻滞图形,Ⅰ、Ⅱ、aVL、aVF导联为直立的R波,Ⅲ导联为R、rs、rS、rsR,均为RⅡ>RaVF>RaⅢ,V1导联为QS型.7例患者均在希氏束旁标测到最早激动点,位于希氏束上方(11.29士2.98)mm处,在最早激动点及附近消融成功,室早消失,与术前同样条件静脉滴注异丙肾上腺素不能诱发室早.2例患者术中出现右束支传导阻滞,1例经术中推注地塞米松10 mg后转复正常,另1例术后4d心电图转复正常.随访12~28个月,无复发.结论:三维标测系统指导下经导管射频消融起源于希氏束旁室早安全有效.%Objective:To investigate the safety and efficacy of catheter ablation for para-Hisian ventricular premature (VP) guided by 3-dimensional mapping system ( Carto/Ensite Array). Method: Seven patients suffered from para-Hisian region VP were treated with radiofrequency catheter ablationg guided by 3rdimensional mapping system, in which 5 guided by Carto and 2 by Ensite Array. With the Carto Array, the large—tip electrode catheter was

  19. Atrioventricular Junction Ablation for Atrial Fibrillation.

    Science.gov (United States)

    Patel, Dilesh; Daoud, Emile G

    2016-04-01

    Atrioventricular junction (AVJ) ablation is an effective therapy in patients with symptomatic atrial fibrillation who are intolerant to or unsuccessfully managed with rhythm control or medical rate control strategies. A drawback is that the procedure mandates a pacing system. Overall, the safety and efficacy of AVJ ablation is high with a majority of the patients reporting significant improvement in symptoms and quality-of-life measures. Risk of sudden cardiac death after device implantation is low, especially with an appropriate postprocedure pacing rate. Mortality benefit with AVJ ablation has been shown in patients with heart failure and cardiac resynchronization therapy devices. PMID:26968669

  20. [Suprapubic catheter insertion].

    Science.gov (United States)

    Neumann, Eva; Schwentner, Christian

    2016-01-01

    The suprapubic catheter enables a percutaneous drainage of urine. The insertion is made superior of the pubic bone through the abdominal wall into the bladder. It allows a permanent drainage of urine bypassing the urethra. The insertion of a suprapubic catheter requires knowledge and expertise. This paper summarizes the basic background and allows to follow the practical application step by step. PMID:26800072

  1. 射频消融治疗室上速162例临床疗效观察%Clinical Observation of Radiofrequency Catheter Ablation for 162 Cases with Supraventricular tachycardia

    Institute of Scientific and Technical Information of China (English)

    陈进业; 刘发俊

    2013-01-01

    Objective: To discuss and analyses the clinical effects of radiofrequency ablation in supraventricular tachycardia treatment. Method: 162 paroxysmal supraventricular tachycardia cases were selected as the object of study, patients were treated with radiofrequency ablation, retrospectively analyzed the clinical efficacy of patients. Result: ①162 paroxysmal supraventricular tachycardia patients with successful ablation in 157 cases, accounting for 96. 91 % . Total atrioventricular accessory pathway was 83 cases, and 79 cases were success, successful rate was 95.18%. All 79 atrioventricular node reentrant tachycardia patients with success heartbeat, the successful rate was 100%. ②cTnI postoperative concentrations compared with before operation,the results has statistical significance ( P<0. 05 ). ③patients' GH, RP, PF, SF, RE, MH, VT and BP after radiofrequency ablation therapy were significantly different with before operation( P< 0. 05 ). ④7 cases of complications, accounting for 4. 32% , 2 cases of recurrence, about 1. 23%. Conclusion: Radiofrequency ablation is a safe and effective method for the supraventricular tachycardia treatment, complications and recurrence rate are related with physiological, anatomical characteristics, types of the ablation target position.%目的:探讨与分析射频消融治疗室上速的临床疗效.方法:选择2009年7月至2011年7月来我院就诊的阵发性室上性心动过速患者162例为研究对象,对其予以射频消融治疗,将临床疗效进行回顾性分析.结果:①162例阵发性室上性心动过速患者,成功消融157例,占96.91%.房室旁道共83例,成功79例,占95.18%.房室结折返性心动过速79例,均成功消融,成功率为100%.②cTnI术后的浓度与术前相比,P<0.05.③射频消融治疗后患者的GH、RP、PF、SF、RE、MH、VT及BP等各方面与术前相比,P<0.05.④本组共发生7例并发症,占4.32%,复发2例,占1.23%.结论:射频消融是治疗室上速的安全有

  2. Initial exeperience of catheter ablation of right atrial rapid arrhythmia in children using CARTO system.%应用CARTO系统射频消融儿童快速右房房性心律失常的初步体会

    Institute of Scientific and Technical Information of China (English)

    曾少颖; 杨平珍; 李渝芬; 王慧深; 石继军; 区曦区曦

    2001-01-01

    目的 初步总结应用CARTO系统指导射频消融儿童快速右房房性心律失常的经验。方法 右房房速(AT)3例,典型房扑(AF)l例,心动周期(277±31)ms,在心动过速时应用CARTO系统标测右房,重建三维电解剖图并指导射频消融靶点;房扑消融后分别在低位右房和冠状窦以500 ms起搏作电解剖图,判断完全双向传导阻滞。结果 2例为局灶性房速,起源点分别在希氏束旁(Koch三角)和高位右旁;1例为右房壁疤痕介导的折返性房性心动过速(IART)。4例成功消融,放电次数(10.6±5.5)次,透视时间(18±9)min,术程(110±38)min。结论 (1)CARTO系统容易寻找最佳靶点;(2)房扑消融后在低位右房和冠状窦起搏作电解剖图,判断完全双向传导阻滞,大幅度减小X线透视时间,提高成功率,降低复发率。%Objective To make a initial summary of CARTO system for electroanatomical mapping and ablation of right atrial rapid arrhythmia in children. Methods We treated four children, included three cases with right atrial tachycardia (AT), one case with typical atrial flutter (AF). The cycle length was (277±31)ms. The CARTO system was used to provide a real-time-dimensimal image of the right atrial and guide catheter mapping ablation. After AF ablated, electroanatomical map was created during coronary sinus and lower right atrium pacing with 500 ms respectively to assess the bidirectional conduction block. Results Among three cases with AT, one case was scar-related AT in right atrium, Two cases were focal AT (papahisial foci and accessory wall in right atrium), All four cases were successfully ablated with (10.6±5.5)RF pulses. The fluoroscopic time was (18±9)min. The procedure time was (110±38)min. Conclusion Not only be easily maked and ablated successfully the optimal taget under less fluoroscopic exposure, but also it could significantly decrease recurrent events during typical AF

  3. Engineering Considerations Of Catheters For Intravascular Ultrasonic Measurements

    Science.gov (United States)

    Martin, Roy W.; Johnson, Christopher C.

    1989-08-01

    The mechanical properties of commonly used fluid transfusion or pressure monitoring catheters are similar to the properties required of catheters which include sensing devices. Consequently, bending and torsional stiffness of commercial catheters and tubes were measured at both room and body temperature. Five of these usually placed with the aid of fluoroscopy had an average Young's modulus of 5714x101 dyne/cm at 21°C which decreased 29% at body temperature; a shear modulus of 70.5x101 dyne/cm 4 at 21°C which decreased 13% at body temperature, and plastic deformation of 8% when loaded for 1 minute at 37°. Four of these were composed of a composite material. Catheters which are balloon directed during insertion had moduli values approximately 1/3 of these or less. The drag forces produced on balloons used on such catheters were measured for fluid velocities ranging from 10-50 cm/sec. Using this information the average force applied to a balloon throughout a cardiac cycle was calculated; values of 1280 dynes for a .6 ml balloon and 2490 dynes for a 1 ml balloon were found. The maximum wall thicknesses to catheter radii for single lumen catheters were determined for various material moduli which would allow the catheter tip to be directed by a balloon during its passage into the right heart.

  4. 经导管射频消融治疗阵发性室上性心动过速1106例临床分析%Catheter ablation of paroxysmal supraventricular tachycardia:a single-center prospective study of 1106 cases

    Institute of Scientific and Technical Information of China (English)

    周法光; 黄卫斌; 陈超; 万发银; 郭晋村; 王焱; 洪江

    2012-01-01

    目的 探讨经导管射频消融治疗阵发性室上性心动过速的效果及安全性.方法 2003年7月至2011年1月在厦门市心脏中心行心内电生理检查及射频消融术治疗的心动过速患者1106例,分析各型心动过速的构成比,评价术中成功率及其相关因素,长期随访观察复发率及并发症发生率.结果 共纳入阵发性室上性心动过速患者1106例,男女比例为1∶1,其中房室旁道型心动过速588例,房室结折返型心动过速477例,房性心动过速41例.术中即刻消融成功1087例(98.3%,1087/1106),复发43例(3.9%,43/1106),其中房室结折返型心动过速复发7例(1.5%,7/477);房室旁道复发33例(5.6%,33/588),左侧旁道复发16例(3.9%,16/302),右侧旁道17例(9.1%,17/186);房性心动过速复发3例(8.1%,3/41).并发症发生率为1.5%(17/1106),主要为气胸6例,血气胸1例,肺栓塞1例,左颈皮下气肿1例,术中一过性Ⅲ度房室传导阻滞2例,术中I度房室传导阻滞3例,术后持续性Ⅲ度房室传导阻滞需植入永久性心脏起搏器2例(0.2%),术后5d心源性猝死1例,为长期中风卧床者,为手术非相关死亡.结论 经导管射频消融为阵发性室上性心动过速安全有效的治疗方法.%Objective To investigate the efficacy and safety of catheter radiofrequency ablation of paroxysmal supraventricular tachycardia.Methods From Jul 2003 to Jan 2011,1106 cases with narrow QRS complex tachycardia who were treated by catheter radiofrequency ablation were recruited from our center and followed up for the rates of successful treatment,rcurrence and complications.Results There were in total 1106 patients (atrioventricular reentrant tachycardia:588 ; atrioventricular nodal reentrant tachycardia:477; atrial tachycardia:41 ),with a sex proportion of 1∶1.Successful ablation rate was 98.3 % (1087/1106).Of the 1087 successful ablation cases,43 (3.9% )were warranted repeated ablation.The recurrent rates for

  5. Percutaneous thermal ablation of renal neoplasms

    International Nuclear Information System (INIS)

    Due to modern examination techniques such as multidetector computed tomography and high-field magnetic resonance imaging, the detection rate of renal neoplasms is continually increasing. Even though tumors exceeding 4 cm in diameter rarely metastasize, all renal lesions that are possible neoplasms should be treated. Traditional treatment techniques include radical nephrectomy or nephron-sparing resection, which are increasingly performed laparoscopically. Modern thermal ablation techniques such as hyperthermal techniques like radiofrequency ablation RFA, laser induced thermal ablation LITT, focused ultrasound FUS and microwave therapy MW, as well as hypothermal techniques (cryotherapy) may be a useful treatment option for patients who are unfit for or refuse surgical resection. Cryotherapy is the oldest and best known thermal ablation technique and can be performed laparoscopically or percutaneously. Since subzero temperatures have no antistyptic effect, additional maneuvers must be performed to control bleeding. Percutaneous cryotherapy of renal tumors is a new and interesting method, but experience with it is still limited. Radiofrequency ablation is the most frequently used method. Modern probe design allows volumes between 2 and 5 cm in diameter to be ablated. Due to hyperthermal tract ablation, the procedure is deemed to be safe and has a low complication rate. Although there are no randomized comparative studies to open resection, the preliminary results for renal RFA are promising and show RFA to be superior to other thermal ablation techniques. Clinical success rates are over 90% for both, cryo- and radiofrequency ablation. Whereas laser induced thermal therapy is established in hepatic ablation, experience is minimal with respect to renal application. For lesions of more than 2 cm in diameter, additional cooling catheters are required. MR thermometry offers temperature control during ablation. Microwave ablation is characterized by small ablation volumes

  6. Automatic classification of scar tissue in late gadolinium enhancement cardiac MRI for the assessment of left-atrial wall injury after radiofrequency ablation

    Science.gov (United States)

    Perry, Daniel; Morris, Alan; Burgon, Nathan; McGann, Christopher; MacLeod, Robert; Cates, Joshua

    2012-03-01

    Radiofrequency ablation is a promising procedure for treating atrial fibrillation (AF) that relies on accurate lesion delivery in the left atrial (LA) wall for success. Late Gadolinium Enhancement MRI (LGE MRI) at three months post-ablation has proven effective for noninvasive assessment of the location and extent of scar formation, which are important factors for predicting patient outcome and planning of redo ablation procedures. We have developed an algorithm for automatic classification in LGE MRI of scar tissue in the LA wall and have evaluated accuracy and consistency compared to manual scar classifications by expert observers. Our approach clusters voxels based on normalized intensity and was chosen through a systematic comparison of the performance of multivariate clustering on many combinations of image texture. Algorithm performance was determined by overlap with ground truth, using multiple overlap measures, and the accuracy of the estimation of the total amount of scar in the LA. Ground truth was determined using the STAPLE algorithm, which produces a probabilistic estimate of the true scar classification from multiple expert manual segmentations. Evaluation of the ground truth data set was based on both inter- and intra-observer agreement, with variation among expert classifiers indicating the difficulty of scar classification for a given a dataset. Our proposed automatic scar classification algorithm performs well for both scar localization and estimation of scar volume: for ground truth datasets considered easy, variability from the ground truth was low; for those considered difficult, variability from ground truth was on par with the variability across experts.

  7. Electrocardiographic characteristics and radiofrequency catheter ablation of ventricular tachycardia and frequent ventricular premature contractions originating from left ventricular outflow tract%射频消融治疗起源于左室流出道的室性心动过速和频发室性期前收缩

    Institute of Scientific and Technical Information of China (English)

    陈宏; 张薇薇; 李荣琴; 李占全; 崔然

    2008-01-01

    目的 探讨源自左室流出道部位的室性心动过速(室速)和室性期前收缩(室早)的心电图特点和射频消融的安全性.方法 对9例于左室流出道部位消融的室速/室早病例的心电图和射频消融情况进行归纳总结.结果 消融成功部位6例在左冠窦内,3例在主动脉瓣下.心电图特点:(1)Ⅱ、Ⅲ、avF导联均呈高R波;(2)aVR和aVL导联均呈QS型,且aVL振幅多大于aVR;(3)Ⅰ导联多呈QS型;(4)V1导联R波偏高:R/S>0.62;(5)胸前导联R波移行不规则;(6)V5、V6多呈R型.9例均消融成功,无复发病例,无左主干及主动脉瓣损伤.结论 源自左室流出道的室速/室早具有独特的心电图表现,射频消融能安全有效地根治此类心律失常.%Objective To investigate the electrocardiographic(ECG) characteristics and assess the safety of radiofrequency catheter ablation (RFCA) of ventricular tachyeardia (VT), and frequent ventricular premature con- tractious(VPCs) originating from left ventricular outflow tract(LVOT). Methods Twelve-lead ECG analysis and RFCA were performed in 9 patient with VT or VPCs originating from LVOT. Results The sites to be successfully ablated were in left valsalva sinus in 6 patients,and subaortic valve in 3 patient. ECG revealed tall R wave in leads Ⅱ, Ⅲ ,aVF, V5 and V6. QS morphology in both leads aVR and aVL,QS morphology in lead Ⅰ in most cases. R wave in lead Ⅰ was relative tall, the R/S wave amplitude in lead V1 was over 0.62 ,and precordia R wave transition was irregular. All 9 patients were successfully ablated. No death or recurrenced case during follow-up. Conclusion Ventricular taehycardia and frequent ventricular premature rcontractions originating from left ventricutar outflow tract could be known by some specific ECG characteristics and could be radically treated safely by RFCA.

  8. Electrocardiophysiological characteristics and radiofrequency catheter ablation of frequent premature ventricular contractions originating from aortic sinus of Valsalva%起源于主动脉窦频发室性期前收缩的心电生理特征及射频消融治疗

    Institute of Scientific and Technical Information of China (English)

    陈丽华; 卫展扬; 黄虔; 李大强; 熊斌

    2012-01-01

    Objectives To report the electrocardiophysiological characteristics of frequent premature ventricular contractions (PVCs) originating from the aortic sinus of Valsalva in 11 patients, radiofrequency catheter ablation (RFCA) and its effect. Methods Morphologic characteristics of PVCs in electrocardiography (ECG) and Holter of 11 patients were observed before ablation. Duration and amplitude of r wave in lead V1 were measured. Duration ratio of r/ QRS and amplitude ratio of r/S were calculated respectively. The origin of PVC was determined by pace mapping and activation mapping at the aortic sinus of Valsalva during the operation with coronary arteriography to assist mapping. RFCA was performed afterwards. Results All of the 11 patients had frequent PVCs and 5 of them had recurrent paroxysmal ventricular tachycardias. QRS in leads Ⅱ ,Ⅲ and aVF showed tall R waves. QRS in lead V1 presented in the shape of rs and precordial leads transferred before lead V3. QRS complex in lead V6 presented more in the shape of Rs or a non-S wave. Duration of r wave in lead V1 was (84.6±9.8) ms, which exceeded 50% of the QRS complex. Amplitude ratio of r/S was 0.72±0.31. The local ventricular electrogram at effective target ablation was recorded(35.6± 8.9) ms prior to QRS on electrocardiogram. PVCs were decreased and eliminated after delivering radiofrequency energy for 2-8 seconds at the target site. Conclusions QRS in leads II , III and aVF of PVCs originating from aortic sinus of Valsalva showed tall R waves with a wide duration (>50% of QRS complex) and tall amplitude (>30% of S wave) of r waves in lead V1. Radiofrequency catheter ablation of PVCs at aortic sinus of Valsalva is safe and effective.%目的 报道11例起源于主动脉窦的频发室性期前收缩(premature ventricular contraction,PVC)患者的心电生理特征、射频消融(radiofrequency catheter ablation,RFCA)方法及疗效.方法 分析患者术前体表心电图和动态心电图PVC的特点,测量V1

  9. Auditing urinary catheter care.

    Science.gov (United States)

    Dailly, Sue

    Urinary catheters are the main cause of hospital-acquired urinary tract infections among inpatients. Healthcare staff can reduce the risk of patients developing an infection by ensuring they give evidence-based care and by removing the catheter as soon as it is no longer necessary. An audit conducted in a Hampshire hospital demonstrated there was poor documented evidence that best practice was being carried out. Therefore a urinary catheter assessment and monitoring tool was designed to promote best practice and produce clear evidence that care had been provided. PMID:22375340

  10. Comparison of Standard Catheters Versus Radial Artery-Specific Catheter in Patients Who Underwent Coronary Angiography Through Transradial Access.

    Science.gov (United States)

    Chen, On; Goel, Sunny; Acholonu, Michael; Kulbak, Guy; Verma, Shivani; Travlos, Efstratios; Casazza, Richard; Borgen, Elliot; Malik, Bilal; Friedman, Michael; Moskovits, Norbert; Frankel, Robert; Shani, Jacob; Ayzenberg, Sergey

    2016-08-01

    In this prospective, randomized controlled study, we aim to compare the performance outcomes of standard catheters with the radial artery-specific catheter. Over the past decade, transradial cardiac catheterization has gained widespread popularity because of its low complication rates compared with transfemoral access. Operators have the choice of using either standard catheters (used for both transfemoral and transradial approach, with need for separate catheter use for either right or left coronary artery engagement) or a dedicated radial artery catheter, which is specifically designed to engage both coronary arteries through radial artery access. A total of 110 consecutive patients who underwent coronary angiography at our institution from March 2015 to April 2015 were prospectively randomized to either radial artery-specific Tiger catheter (5Fr; Terumo Interventional Systems, Somerset, New Jersey) versus standard Judkins left and right catheters (5Fr R4, L4; Cordis Corporation, Miami, Florida). The end points of the study included fluoroscopy time, dose-area product, contrast volume used, and total procedure time for the coronary angiography. A total of 57 patients (52%) were randomized to radial artery-specific catheter and 53 (48%) to the standard catheter. Tiger catheter was associated with significantly lower fluoroscopy time (184 ± 91 vs 238 ± 131 seconds, p = 0.015), which was statistically significant. Other outcome measures such as dose-area product (2,882.4 ± 1,471.2 vs 3,524.6 ± 2,111.7 Gy·cm(2), p = 0.07), total contrast volume (48.1 ± 16.1 vs 53.4 ± 18.5 ml, p = 0.114), and total procedure time (337 ± 382 vs 434 ± 137 seconds, p = 0.085) were also lower in single-catheter group, but it did not reach statistical significance. A total of 8 patients (14%) were crossed over from radial-specific catheter arm to standard catheter arm because of substandard image quality and difficulty in coronary engagement. Six patients had to be

  11. Durable Pulmonary Vein Isolation: The Holy Grail of Atrial Fibrillation Ablation

    Directory of Open Access Journals (Sweden)

    Darrat Y; Morales G; Shah J; Di Biase L; Natale A; Elayi CS

    2014-04-01

    Full Text Available The inability to achieve durable pulmonary vein isolation (PVI remains a major limitation to catheter ablation for the treatment of atrial fibrillation (AF, potentially resulting in AF recurrence. In this review, we discuss the research performed investigating methods to improve lesion permanence for the goal of durable PVI. Investigations evaluating procedural techniques, various catheters utilized, adjunctive pharmacologic therapy, and novel energy sources designed to improve ablation lesion permanence are discussed.

  12. Assessment of left atrial function in patients with paroxysmal atrial fibrillation after different strategy of radiofrequency catheter ablation%左房线性消融治疗阵发性心房颤动患者术后的左房功能心超评价

    Institute of Scientific and Technical Information of China (English)

    李莹; 朱彩霞; 顾宇英; 罗轶玮; 马岚; 张代富; 陈明; 刘怡; 郑建华

    2011-01-01

    patients for a long-term follow-up, we examined the LA diameters by M-mode and 2-dimensional echocardiography, mitral inllow by Doppler echocardiography before and after ablation. And we measured the velocity of mirral annulus motion (Va) in late diastolic phase by tissue Doppler image. Results: ① Twenty patients (64. 52 % ) out of thirty-one in control group mainain sinus thythm. Twenty-six (70. 27 % ) patients out of thirty-seven in CPVA group were successfully treated, and nine patients failed; ②After long-term maintenance of sinus thythm, the left atrial volume has become smaller. No statistical significance in different periods after treatment compared with before treatment in control group. Six months after ablation. the left atrial volume was significantly smaller in patients who hadsinus conversion by the RF procedure, no further reduction 12 months after the treatment. The left atrial diametcr was significantly smaller in patients who remained in sinus thythm. In contrast, in patients with recurrences of AF, LA dimension and left atrial volume were not changed;③One month after ablation, the LAAEF, A-VTl, VA and AFF decreased and recovered 12 months later. The Va significantly decrease after RF ablation. Conclusion:Circumferential radiofrequencypulmonary vein ablation for PAF is effective. This study demonstrates reverse morphological remodeling of the LA after restoration ot sinus thythm by ablation and no difference in patients with AF recurrence. LA catheter ablation results in decreased LA local systolic function.

  13. Robotics in invasive cardiac electrophysiology.

    Science.gov (United States)

    Shurrab, Mohammed; Schilling, Richard; Gang, Eli; Khan, Ejaz M; Crystal, Eugene

    2014-07-01

    Robotic systems allow for mapping and ablation of different arrhythmia substrates replacing hand maneuvering of intracardiac catheters with machine steering. Currently there are four commercially available robotic systems. Niobe magnetic navigation system (Stereotaxis Inc., St Louis, MO) and Sensei robotic navigation system (Hansen Medical Inc., Mountain View, CA) have an established platform with at least 10 years of clinical studies looking at their efficacy and safety. AMIGO Remote Catheter System (Catheter Robotics, Inc., Mount Olive, NJ) and Catheter Guidance Control and Imaging (Magnetecs, Inglewood, CA) are in the earlier phases of implementations with ongoing feasibility and some limited clinical studies. This review discusses the advantages and limitations related to each existing system and highlights the ideal futuristic robotic system that may include the most promising features of the current ones.

  14. 右心室间隔部室性早搏/室性心动过速的心电图特征及射频消融治疗%Electrocardiographic characteristics and radiofrequency catheter ablation of premature ventricular complexes/ventricular tachycardia originating from right ventricular septum

    Institute of Scientific and Technical Information of China (English)

    王永光; 林加锋; 李岳春; 季亢挺; 殷日鹏

    2015-01-01

    Objective To observe the curative efficacy and safety of radiofrequency catheter ablation and the electrocardiographic characteristics of idiopathic premature ventricular complexes/ventricular tachycardia(PVC/VT) originating from right ventricular septum.Methods Electrocardiographic characteristics and variation of PVC/VT originating from right ventricular septum were analyzed in 62 patients [32 males,average age of (57.0 ± 18.8) years old] undergoing radiofrequency catheter ablation.Results Forty-nine patients (79.0%) were successfully ablated without related complications.Its electrocardiographic characteristics and change rulewere as follows:①QRS morphology was mainly R in lead Ⅰ;②most was R,a few was r,m or qr in lead aVL;③QS,qs or r in lead aVR;④The position of the origin was positively associated with R wave amplitude in inferior leads,but negatively correlated with the amplitude of S wave;⑤PVC/VT originating from right ventricular outflow tract always manifested as R wave in the inferior leads,while the majority of PVC/VT originating from right ventricular septum showed S wave in at least one or more inferior leads;⑥In addition to PVC/ VT originating from right ventricular septum adjacent to tricuspid annulus and the middle upper septum was rS in lead V1,most PVC/IVT originating from other parts was QS in lead V1,and with the origin point moving down to the middle and apical segments,the amplitude and distribution of precordial R wave becomes less,while QS wave was deeper and distributed more widely.Conclusion Radiofrequency catheter ablation is safe and effective for treating PVC/VT originating from the right ventricular septum,the electrocardiographic characteristics of different origins have certain change rules,grasping these characteristics will be benefit to determine its origin,shorten the operation time.%目的 探讨右心室间隔部起源特发性室性早搏/室性心动过速(PVC/VT)的体表心电图特点及射频消融治

  15. Utilidade do Ultrassom intracardíaco no isolamento de veias pulmonares usando cateter-balão a laser Utilidad del ultrasonido intracardíaco en el aislamiento de venas pulmonares usando catéter-balón láser Utility of intracardiac ultrasound imaging to guide pulmonary vein ablation using laser balloon catheter

    Directory of Open Access Journals (Sweden)

    Luiz Leite

    2009-12-01

    . Se obtuvo el aislamiento completo en 38/59 (64%, y fue significantemente más común sin derrame: [30/38 (79% versus 8/23 (35%, pBACKGROUND: Pulmonary vein isolation (PVI with balloon catheter has been used as the endpoint for AF ablation. OBJECTIVE: To determine the usefulness of intracardiac ultrasound (ICUS to guide PVI using laser balloon catheter. METHODS: 59 PVs were ablated in 27 dogs. Doppler imaging was used to identify blood flow leaks between PV and balloon. After each energy delivery, the circular mapping catheter was repositioned to check if isolation had been achieved. The leak position was then correlated with the gap position at the pathological study. Multivariate logistic regression analysis was undertaken. RESULTS: 59 PV were ablated. Mean burn time was 279±177 sec, mean balloon diameter was 23±3 mm, and mean balloon length was 25±4 mm. Complete isolation was achieved in 38/59 (64% cases, and it was significantly more common when there was no leak: [30/38 (79% versus 8/23 (35%, p<0.001]. This occurred regardless of time of laser application (302±223 sec. vs. 266±148 sec., p=ns, laser power (3.5 W/cm, 4.5 W/cm, and 5.5 W/cm, balloon diameter (24± 3 mm vs. 22± 3 mm, p=ns and length (27±4 mm vs. 24±4mm, p=ns. The positive predictive value for predicting incomplete isolation was 65% and the negative predictive value was 83%. CONCLUSION: An identifiable leak between PV and the LBA device seen at the ICUS is predictive of lower PV isolation rates. ICUS may be useful for leak detection to avoid ineffective energy application during circumferential PV ablation. This could also be helpful when other types of energy are used.

  16. 心脏直视手术同期双极射频消融迷宫术治疗心房颤动%Intraoperative radiofrequency ablation to treat atrial fibrillation during concomitant cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    石开虎; 曹炜; 龚文辉; 张飞; 吴君旭; 徐盛松; 宣海洋; 赵旭东

    2011-01-01

    Objective:To observe the effect of bipolar ablation system for intraoperative treatment of atrial fibrillation (AF). Methods:From December 2008 to February 2010, the bipolar radiofrequency ablation CardioblateTM washing machine was used to treat 21 patients with organic heart disease ( 19 cases with rheumatic valve disease, 2 patients with congenital heart disease) and AF who underwent combined intraoperative RFA. The ablation lesion pattern was modified Cox mini-maze, including 17 case of persistent/permanent AF and 4 paroxysmal AF cases. Results: All operations were successfully completed, with a mean RF ablation time of (15.4 ± 6. 8) min, of which 16 cases had restoration ofsinus rhythm after operation, 5 had paroxysmal AF 1 to 4 days after operation, and were converted to sinus rhythm after intravenous injection of amiodarone hydrochloride, with oral amiodarone maintained.No complete atrioventricular block occurred. Neither cardiac perforation nor operative mortality was observed. Average time of stay was (10.2 ± 2.5) days. During a mean follow-up time of (11.2 ± 1.4)months, 85.71% (18/21) had sinus rhythm, while 14.29% (3/21) had the AF rhythm. Conclusion:In patients with organic heart disease concomitant with AF, during open heart surgery the bipolar radiofrequency ablation for AF under the same washing line CardioblateTM is a simple, safe and effective method.%目的:探讨心内直视下同期双极射频消融治疗器质性心脏病合并心房颤动的经验及疗效.方法:2008年12月至2010年2月间采用Cardioblate冲洗式双极射频消融机为21例器质性心脏病(19例为风湿性瓣膜病、2例为先天性心脏病)合并心房颤动患者施行消融术,其中持续性/永久性房颤17例,阵发性房颤4例,消融经线为改良Cox Mini-maze手术.结果:21例手术均顺利完成,平均消融时间为(15.4±6.8)min,术后当天有16例恢复为窦性心律;5例分别于术后1~4 d发生阵发性房颤,经静脉注射盐酸胺

  17. Automated planning of ablation targets in atrial fibrillation treatment

    Science.gov (United States)

    Keustermans, Johannes; De Buck, Stijn; Heidbüchel, Hein; Suetens, Paul

    2011-03-01

    Catheter based radio-frequency ablation is used as an invasive treatment of atrial fibrillation. This procedure is often guided by the use of 3D anatomical models obtained from CT, MRI or rotational angiography. During the intervention the operator accurately guides the catheter to prespecified target ablation lines. The planning stage, however, can be time consuming and operator dependent which is suboptimal both from a cost and health perspective. Therefore, we present a novel statistical model-based algorithm for locating ablation targets from 3D rotational angiography images. Based on a training data set of 20 patients, consisting of 3D rotational angiography images with 30 manually indicated ablation points, a statistical local appearance and shape model is built. The local appearance model is based on local image descriptors to capture the intensity patterns around each ablation point. The local shape model is constructed by embedding the ablation points in an undirected graph and imposing that each ablation point only interacts with its neighbors. Identifying the ablation points on a new 3D rotational angiography image is performed by proposing a set of possible candidate locations for each ablation point, as such, converting the problem into a labeling problem. The algorithm is validated using a leave-one-out-approach on the training data set, by computing the distance between the ablation lines obtained by the algorithm and the manually identified ablation points. The distance error is equal to 3.8+/-2.9 mm. As ablation lesion size is around 5-7 mm, automated planning of ablation targets by the presented approach is sufficiently accurate.

  18. AF Termination: the Holy Grail of Persistent AF Ablation?

    Directory of Open Access Journals (Sweden)

    Dennis H. Lau, MBBS

    2010-06-01

    Full Text Available The optimal catheter ablation approach for longstanding persistent atrial fibrillation (AF remains elusive despite significant advances made in our understanding of this arrhythmia. A recent systematic review highlighted the significant variation in procedural success rate both within and between techniques, necessitating repeat ablation procedures and anti-arrhythmic drugs to achieve improved outcomes in those with long-standing persistent AF.1 Indeed, current expert consensus statement recommended ablation beyond ostial pulmonary vein isolation for these patients.2 Despite incorporating various substrate modification techniques which commonly include linear lesions and targeting of complex fractionated electrograms, the reported success rates from various laboratories are still below par to those in paroxysmal AF patients.1 Perhaps the often dilated and chronically remodeled atria in longstanding persistent AF patients harbor complex structural substrates capable of maintaining the arrhythmia beyond amelioration even with extensive catheter ablation in some. Certainly, this reflects our incomplete understanding of the complex mechanisms underlying this arrhythmia.

  19. Integration of cardiac computed tomography into pulmonary vein isolation in patients with paroxysmal atrial fibrillation; Integration einer praeinterventionellen Computertomografie des Herzens in die therapeutische Pulmonalvenenisolation bei Patienten mit paroxysmalem Vorhofflimmern

    Energy Technology Data Exchange (ETDEWEB)

    Weber, T.F. [Abt. Radiologie, Deutsches Krebsforschungszentrum, Heidelberg (Germany); Klemm, H.; Willems, S. [Klinik und Poliklinik fuer Kardiologie und Angiologie, Universitaetsklinikum Hamburg-Eppendorf (Germany); Koops, A.; Adam, G.; Begemann, P.G. [Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Universitaetsklinikum Hamburg-Eppendorf (Germany); Nagel, H.D. [Philips Medizin Systeme GmbH, Hamburg (Germany)

    2007-12-15

    Purpose: Detailed anatomic information of the left atrium is necessary for securely performing radiofrequency ablation of atrial fibrillation-triggering ectopies in the pulmonary vein ostia. In this study the impact of a preinterventionally acquired cardiac computed tomography (CT) on pulmonary vein isolation (PVI) was assessed. Materials and methods: Examinations of 54 patients with paroxysmal atrial fibrillation undergoing PVI were analyzed. In 27 patients a supplementary cardiac CT was obtained prior to PVI (CT group, 12 women, 15 men, 59.7 {+-} 9.9 years of age): 16 x 1.5 mm collimation, 0.2 pitch, 120 kV tube voltage, 400 effective mAs. The fluoroscopy time, effective dose and quantity of radiofrequency (RF) pulses of the following catheter ablation were compared to 27 patients undergoing stand-alone PVI (11 women, 16 men, 62.0 {+-} 9.9 years of age). Mann-Whitney tests served for statistical comparison. Results: CT datasets were successfully integrated into the ablation procedure of each patient in the CT group. The mean quantity of RF pulses was significantly lower in the CT group (22.1 {+-} 8.0 vs. 29.1 {+-} 11.9, p = 0.030), and a significant reduction of fluoroscopy time was found (41.8 {+-} 12.0 min vs. 51.2 {+-} 16.0 min, p = 0.005). Effective doses of the catheter ablation differed in an equivalent dimension but altogether not significantly (14.9 {+-} 10.0 mSv vs. 20.0 {+-} 16.0 mSv, p = 0.203). The mean additive effective dose of the cardiac CT was 85 {+-} 0.3 mSv. (orig.)

  20. Frequent Premature Ventricular Complexes Originating from the Left Ventricular Summit Successfully Ablated from the Proximal Great Cardiac Vein Using an Impedance-based Electroanatomical Mapping System.

    Science.gov (United States)

    Nagata, Yoshihisa; Ogawa, Masahiro; Goto, Shunichiro; Morii, Joji; Imaizumi, Satoshi; Yasuda, Tomoo; Matsumoto, Naomichi; Saku, Keijiro

    2016-01-01

    We herein report a 58-year-old woman with frequent premature ventricular complexes (PVCs) originating from the left ventricular summit. The earliest ventricular activation of spontaneous PVCs was recorded in the proximal site of the great cardiac vein, which was simultaneously mapped and conducted using an impedance-based electroanatomical mapping system. Irrigated radiofrequency with a starting power output of 20 W and maximal temperature set at 40°C was applied with 10 Ω impedance fall, resulting in total disappearance of the frequent PVCs. The patient has remained free from PVCs for 18 months without requiring antiarrhythmic drug therapy. PMID:27374677

  1. SU-C-303-06: Treatment Planning Study for Non-Invasive Cardiac Arrhythmia Ablation with Scanned Carbon Ions in An Animal Model

    Energy Technology Data Exchange (ETDEWEB)

    Eichhorn, A; Constantinescu, A; Prall, M; Kaderka, R; Durante, M; Graeff, C [GSI Helmholtz Center, Darmstadt, DE (Germany); Lehmann, H I; Takami, M; Packer, D L [Mayo Clinic, Rochester, Minnesota (United States); Lugenbiel, P; Thomas, D [University of Heidelberg, Heidelberg, DE (Germany); Richter, D; Bert, C [University Clinic Erlangen, Erlagen, DE (Germany)

    2015-06-15

    Purpose: Scanned carbon ion beams might offer a non-invasive alternative treatment for cardiac arrhythmia, which are a major health-burden. We studied the feasibility of this procedure in an animal model. The underlying treatment planning and motion mitigation strategies will be presented. Methods: The study was carried out in 15 pigs, randomly distributed to 3 target groups: atrioventricular node (AVN, 8 animals with 25, 40, and 55 Gy target dose), left ventricular free-wall (LV, 4 animals with 40 Gy) and superior pulmonary vein (SPV, 3 animals with 40 Gy). Breathing motion was suppressed by repeated enforced breathholds at end exhale. Cardiac motion was mitigated by an inhomogeneous rescanning scheme with up to 15 rescans. The treatment planning was performed using the GSI in-house software TRiP4D on cardiac-gated 4DCTs, applying a range-considering ITV based on an extended CTV. For AVN and SPV isotropic 5 mm margins were applied to the CTV, while for the LV 2mm+2% range margins were used. The opposing fields for AVN and LV targets were optimized independently (SFUD), while SPV treatments were optimized as IMPT deliveries, including dose restrictions to the radiosensitive AVN. Results: Median value of D{sub 95} over all rescanning simulations was 99.1% (AVN), 98.0% (SPV) and 98.3% (LV) for the CTV and 94.7% (AVN) and 92.7% (SPV) for the PTV, respectively. The median D{sub 5}-D{sub 95} was improved with rescanning compared to unmitigated delivery from 13.3 to 6.5% (CTV) and from 23.4 to 11.6% (PTV). ICRP dose limits for aorta, trachea, esophagus and skin were respected. The maximal dose in the coronary arteries was limited to 30 Gy. Conclusion: We demonstrated the feasibility of a homogeneous dose delivery to different cardiac structures in a porcine model using a time-optimized inhomogeneous rescanning scheme. The presented treatment planning strategies were applied in a pig study with the analysis ongoing. Funding: This work was supported in part by the

  2. Effects of exercise training and coronary ablation on swimming performance, heart size, and cardiac enzymes in rainbow trout, Oncorhynchus mykiss

    DEFF Research Database (Denmark)

    FARRELL, AP; JOHANSEN, JA; STEFFENSEN, JF;

    1990-01-01

    % increase in the levels of the aerobic enzymes citrate synthase and ß-hydroxyacyl CoA dehydrogenase and a 32% increase in the mass of spongy myocardium. As a result of these compensations and coronary regrowth, chronic coronary ligation did not affect maximum prolonged swimming speed. These experiments......Rainbow trout, Oncorhynchus mykiss, were exercise trained for 28-52 days. Trained fish were 13% larger and swam 12% faster in an aerobic swimming test. Training induced cardiac growth that was isometric with body growth, since ventricle mass relative to body mass was constant. The proportions...

  3. SU-C-303-06: Treatment Planning Study for Non-Invasive Cardiac Arrhythmia Ablation with Scanned Carbon Ions in An Animal Model

    International Nuclear Information System (INIS)

    Purpose: Scanned carbon ion beams might offer a non-invasive alternative treatment for cardiac arrhythmia, which are a major health-burden. We studied the feasibility of this procedure in an animal model. The underlying treatment planning and motion mitigation strategies will be presented. Methods: The study was carried out in 15 pigs, randomly distributed to 3 target groups: atrioventricular node (AVN, 8 animals with 25, 40, and 55 Gy target dose), left ventricular free-wall (LV, 4 animals with 40 Gy) and superior pulmonary vein (SPV, 3 animals with 40 Gy). Breathing motion was suppressed by repeated enforced breathholds at end exhale. Cardiac motion was mitigated by an inhomogeneous rescanning scheme with up to 15 rescans. The treatment planning was performed using the GSI in-house software TRiP4D on cardiac-gated 4DCTs, applying a range-considering ITV based on an extended CTV. For AVN and SPV isotropic 5 mm margins were applied to the CTV, while for the LV 2mm+2% range margins were used. The opposing fields for AVN and LV targets were optimized independently (SFUD), while SPV treatments were optimized as IMPT deliveries, including dose restrictions to the radiosensitive AVN. Results: Median value of D95 over all rescanning simulations was 99.1% (AVN), 98.0% (SPV) and 98.3% (LV) for the CTV and 94.7% (AVN) and 92.7% (SPV) for the PTV, respectively. The median D5-D95 was improved with rescanning compared to unmitigated delivery from 13.3 to 6.5% (CTV) and from 23.4 to 11.6% (PTV). ICRP dose limits for aorta, trachea, esophagus and skin were respected. The maximal dose in the coronary arteries was limited to 30 Gy. Conclusion: We demonstrated the feasibility of a homogeneous dose delivery to different cardiac structures in a porcine model using a time-optimized inhomogeneous rescanning scheme. The presented treatment planning strategies were applied in a pig study with the analysis ongoing. Funding: This work was supported in part by the Helmholtz Association, the

  4. Catheter ablation and medical treatment for atrial fibrillation in patients with heart failure:a meta-analysis%心力衰竭合并心房颤动患者心率控制与消融节律控制疗效比较的荟萃分析

    Institute of Scientific and Technical Information of China (English)

    耿金; 戴望亮; 胡婷婷; 马树人; 徐伟

    2015-01-01

    目的:比较心率控制和射频消融节律控制治疗心力衰竭(心衰)合并心房颤动(房颤)患者的疗效。方法在Pubmed、EMBASE、中国知网及万方数据库中检索1990年1月至2014年3月发表的比较心率控制与节律控制治疗心衰合并房颤患者的随机对照研究,并应用Revman 5.1及Stata 12.0对其进行分析,分析的主要事件为随访结束时的左心室射血分数( LVEF )、左心室收缩末期容积(LVESV)、6 min步行试验(6-MWT)及生活质量评分(QoL)。结果4项研究最终入组,包括224例合并房颤的心衰患者。荟萃( meta)分析提示与心率控制相比,射频消融节律控制可以显著改善 LVEF (WMD 6.61,95% CI 4.49~8.74)、LVESV(WMD -16.26,95% CI -30.26~-2.26)、6-MWT(WMD 36.88,95% CI 12.72~61.04)及QoL(WMD -14.05,95% CI -22.03~-6.07),差异有统计学意义。结论心衰合并房颤患者选择射频消融节律控制治疗可以提高左心室功能、逆转心肌重构、提高运动耐量并且改善生活质量。%Objective To evaluate the efficiency of rhythm control ( RhC) using catheter ablation and rate control ( RaC) for atrial fibrillation in patients with heart failure. Methods The Pubmed,EMBASE,CNKI and Wanfang Data were searched for randomized controlled trials published from January,1990 to March 2014. Revman 5. 1and Stata 12. 0 were used to perform this meta-analysis and the main outcomes were left ventricular ejection fraction (LVEF),left ventricular end-systolic volume (LVESV),6 min walking test (6-MWT) and quality of life (QoL). Results Four studies were included,and we got 224 patients for the final analyses. Meta-analysis demonstrated that RhC can improve LVEF (WMD 6. 61,95% CI 4. 49~8. 74),LVESV (WMD-16. 26,95% CI -30. 26~-2. 26),6-MWT (WMD 36. 88,95% CI 12. 72~61. 04) and QoL (WMD-14. 05, 95% CI-22. 03~-6. 07) when compared with RaC. Conclusions Catheter ablation for RhC is better than RaC for the improvement of LVEF,LVESV,6

  5. Ablation of atrial fibrillation using CT image integration

    International Nuclear Information System (INIS)

    In our case report we describe a catheter ablation in a patient with symptomatic, drug-refractory atrial fibrillation using the new CT image integrating mapping technology. Using image integration an arrhythmogenic right inferior pulmonary vein was revealed which was not found during conventional 3-dimensional mapping. Thereby we want to demonstrate potential impacts on safety and effectiveness of ablation strategies using an image integration technology, especially in cases of difficult anatomic variations. (author)

  6. Habib VesOpen消融导管治疗小型猪模拟门静脉癌栓的安全性研究%The safety of Habib VesOpen bipolar radiofrequency ablation catheter used in the treatment of portal vein tumor thrombus:an experimental study in miniature pig models

    Institute of Scientific and Technical Information of China (English)

    张林; 付金鑫; 宋鹏; 袁凯; 阎洁羽; 段峰; 王茂强; 刘凤永

    2015-01-01

    目的:探索射频消融(RFA)导管治疗门静脉癌栓(PVTT)的安全性。方法将10头实验小型猪分为3组:A组(n=6)直接行正常门静脉RFA治疗;B组(n=2)先行门静脉球囊封堵,然后行门静脉新鲜血栓RFA治疗;C组(n=2)先建立PVTT模型,待门静脉血栓机化后行门静脉RFA治疗。术后1、3、4周作MRI检查,4周后处死动物作病理学检查。结果 A组动物在功率5 W条件下接受RFA治疗0.6~3.6 min,MRI检查及1个月后病理学检查均未发现明确异常。 B组动物RFA后MRI检查提示门静脉区损伤较A组明显,术后1、3、4周内膜MRI检查提示门静脉水肿逐渐减轻;术后1个月病理学检查证实邻近肝组织损伤严重。C组在功率7 W条件下接受RFA治疗1.5 min,术后MRI检查未见消融区明显水肿,病理学检查可见机化的血栓坏死、血管内皮细胞受损。结论采用Habib VesOpen双极RFA导管治疗PVTT,应根据PVTT严重程度选择合适的RFA功率与时间。PVTT较轻时采用大功率、短时间RFA可能较安全,PVTT较重时改用小功率、长时间RFA更为安全可靠。%Objective To explore the safety of Habib VesOpen bipolar radiofrequency ablation (RFA) catheter used in the treatment of portal vein tumor thrombus (PVTT). Methods A total of 10 miniature pigs were randomly divided into 3 groups. Group A(n=6):RFA of normal portal vein was directly performed;group B (n=2): balloon obstruction of the portal vein was performed first, which was followed by RFA for the fresh thrombus in the portal vein; group C (n=2): PVTT model was established first, and RFA of the portal vein was carried out when the portal thrombus became organized. MRI examination was employed at one, 3 and 4 weeks after RFA; the animals were sacrificed 4 weeks after RFA and pathological examination of portal vein was performed. Results Pigs of group A received portal vein RFA under the condition of 5 W power for 0

  7. Central venous catheter insertion problem solving using intravenous catheter: technical communication

    Directory of Open Access Journals (Sweden)

    Alemohammad M

    2013-02-01

    Full Text Available Insertion of central venous catheter is an accepted method for hemodynamic monitor-ring, drug and fluid administration, intravenous access, hemodialysis and applying cardiac pace-maker in hospitalized patients. This procedure can be associated with severe complications. The aim of this article is to provide a practical approach to prevent catheter malposition in states that the guide wire will not pass freely.During central venous insertion in internal jugular vein using modified seldinger technique, when after venous insertion, the passage of the guide wire shows difficulties and don’t pass freely, insertion of an intravenous cannula over the wire and re-insertion of the wire can help to prevent malposition of the wire and the catheter. Use of an intravenous cannula over the guide, in situations that the guide wire cannot pass freely among the needle inserted in internal jugular vein, and re-insertion of the guide can probably prevent or reduce the tissue or vascular trauma and the associated complica-tions. This simple maneuver can be helpful in difficult cases especially in cardiac surgery patients who receive high dose heparin and it is necessary to avoid traumatize-tion of carotid artery.

  8. Mitral valve perforation appearing years after radiofrequency ablation

    DEFF Research Database (Denmark)

    Fisch-Thomsen, Marie; Jensen, Jesper K; Egeblad, Henrik;

    2011-01-01

    The case is reported of a young adult with Wolff-Parkinson-White (WPW) syndrome who, three years after a complicated radiofrequency (RF) catheter ablation procedure, developed dyspnea on exertion. Echocardiography revealed severe mitral valve regurgitation caused by a perforation of the posterior...

  9. Laser Ablation for Small Hepatocellular Carcinoma

    Science.gov (United States)

    Pacella, Claudio Maurizio; Francica, Giampiero; Di Costanzo, Giovanni Giuseppe

    2011-01-01

    Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and is increasingly detected at small size (liver transplantation, or percutaneous ablation have been proposed. When surgical options are precluded, image-guided tumor ablation is recommended as the most appropriate therapeutic choice in terms of tumor local control, safety, and improvement in survival. Laser ablation (LA) represents one of currently available loco-ablative techniques: light is delivered via flexible quartz fibers of diameter from 300 to 600 μm inserted into tumor lesion through either fine needles (21g Chiba needles) or large-bore catheters. The thermal destruction of tissue is achieved through conversion of absorbed light (usually infrared) into heat. A range of different imaging modalities have been used to guide percutaneous laser ablation, but ultrasound and magnetic resonance imaging are most widely employed, according to local experience and resource availability. Available clinical data suggest that LA is highly effective in terms of tumoricidal capability with an excellent safety profile; the best results in terms of long-term survival are obtained in early HCC so that LA can be proposed not only in unresectable cases but, not differently from radiofrequency ablation, also as the first-line treatment. PMID:22191028

  10. Efficacy and safety of radiofrequency catheter ablation of premature ventricular contractions origina ting from the right ventricular outflow tract%右心室流出道室性早搏射频消融治疗的有效性和安全性评价

    Institute of Scientific and Technical Information of China (English)

    朱文青; 王张生; 巫慧钧; 周一泉; 许澎; 孙万峰; 冯凯; 谷慧敏; 葛均波

    2009-01-01

    目的 评价应用Carto系统射频消融治疗右心室流出道起源性室性早搏(室早)有效性和安全性.方法 选择2005年5月至2007年12月临床治疗的47例室早患者,其中男性21例,女性26例,平均年龄(34.5±19.2)岁,病程3~38个月.射频所用能量为40 W,时间为120~240 s,温度设定为60℃.分别在消融术前和术后1、3和12个月进行动态心电图检查.结果 47例中成功45例,有效率为95.8%.2例1年后复发新的早搏,未发现任何并发症.结论 应用Carto系统对右心室流出道起源性室早经射频消融治疗是有效和安全的.%Objective To assess efficacy and safety in patients with right ventricular outflow tract (RVOT) arrhythmias treated with radiofrequency catheter ablation (RFCA) combined with electro-anatomical mapping system (Carto). Methods The study group consisted of 47 consecutive patients (mean age 34. 5 ± 19.2 years,range 18~61 years,21 males,26 females) with symptomatic arrhythmias originating from RVOT, who underwent RFCA between Oct. 2005 and Dec. 2007. RFCA was performed with the use of the Carto system. The power of RF current was set at 40 Watts,duration 120~240 seconds,and maximal temperature 60 degrees C. In order to assess RFCA efficacy,a 24-hour Holter ECG monitoring was performed before RFCA and shortly after the procedure as well as one, three and twelve months afterwards. Results Holter ECG monitoring after RFCA showed that the procedure was successful in 45 (95. 8%) patients. In the remaining two patients no sig nificant reduction in the frequency of ventricular ectopy was noted,however,no complex ventricular arrhythmias were observed. None of the complications were observed. Conclusion RFCA with the use of the Carto system is effective and safe in the treatment of arrhythmias originating from RVOT.

  11. Clinical analysis on radiofrequency catheter ablation in 112 cases of paroxysmal supraventricular tachycardia in young people%经导管射频消融治疗青年人阵发性室上性心动过速112例临床分析

    Institute of Scientific and Technical Information of China (English)

    孙丽芳; 梁锦军; 石少波; 阮兵; 吴冰; 杨波

    2013-01-01

    目的 探讨经导管射频消融术(radiofrequency catheter ablation,RFCA)治疗青年人中阵发性室上性心动过速(paroxysmal supraventricular tachycardia,PSVT)的有效性和安全性.方法 回顾分析2007年1月-2012年1月在武汉大学人民医院心内科行心内电生理检查及RFCA治疗的青年PSVT的患者112例,分析各型PSVT的构成比,评价各型PSVT术中成功率,门诊随访观察,复发者行第2次RFCA术.结果 112例患者中,男性61例,占54.5%;女性51例,占45.5%.年龄14 ~44岁,平均(27.0±10.7)岁.112例患者中各型PSVT的构成比:房室折返性心动过速(atrioventricular reentrant tachycardia,AVRT) 60例,占53.4%;房室结折返性心动过速(atrioventricular nodal reentrant tachycardia,AVNRT) 50例,占44.6%;房性心动过速(atrial tachycardia,AT)2例,占1.8%.术中即刻消融成功109例,占97.3%.复发2例,占1.79%,其中隐匿性右侧旁道(C RAP)复发1例(0.89%),隐匿性左侧旁道(CLAP)复发1例(0.89%),再次消融后均获成功.结论 射频消融治疗青年人PSVT是有效且安全的.

  12. Comparison Between Cryoablation and Radiofrequency Catheter Ablation for Treating the Patients With Atrio-ventricular Nodal Reentrant Tachycardia by Meta-analysis%对比冷冻消融和射频消融治疗房室结折返性心动过速的荟萃分析

    Institute of Scientific and Technical Information of China (English)

    程小成; 张国中; 杨佳; 邹红钰; 刘增长

    2014-01-01

    目的:本研究旨在对比冷冻消融和射频消融治疗房室结折返性心动过速(AVNRT)的有效性和安全性。  方法:对Medline、The Cochrane Library、Embase数据库进行系统性检索,检索截止时间为2014-05,纳入满足选择标准的研究。  结果:最终5篇随机对照研究和14篇回顾性研究入选。研究总人群2900例,其中1384例分布在冷冻组,1516例分布在射频组。总体结果显示,与射频消融相比,尽管冷冻消融减少永久性房室传导阻滞(AVB)的风险(OR:0.27;95%CI 0.11~0.62,P  结论:虽然冷冻消融治疗AVNRT减少房室阻滞的风险,但有效性低于射频消融。%Objective: The compare the safety and efficacy between cryoablation (CRYO) and radiofrequency catheter ablation (RFCA) for treating the patients with atrio-ventricular nodal reentrant tachycardia (AVNRT) by meta-analysis. Methods: We systemically searched the Medline, Cochrane library and Embase database to fulifll our pre-deifned criteria until the publication of May 2014. Results: There were 5 randomized controlled trials (RCTs) and 14 retrospective trials enrolled in our study with 2900 patients. The patients were allocated into 2 groups:CRYO group, n=1384 and RFCA group, n=1516. The overall pool-analysis demonstrated that compared with RFCA group, CRYO group had the lower risk of permanent atrio-ventricular nodal block (OR:0.27, 95%CI 0.11 to 0.62, P Conclusion: Although CRYO could decrease the risk of permanent atrio-ventricular nodal block, while its effectiveness was lower than RFCA for AVNRT treatment in relevant patients.

  13. Biopsy catheter (image)

    Science.gov (United States)

    ... are removed. The test is performed routinely after heart transplantation to detect potential rejection. It may also be performed when cardiomyopathy, myocarditis, cardiac amyloidosis, or other disorders are suspected.

  14. Percutaneous thermal ablation of renal neoplasms; Perkutane Thermoablation von Nierentumoren

    Energy Technology Data Exchange (ETDEWEB)

    Tacke, J. [Inst. fuer Diagnostische und Interventionelle Radiologie/Neuroradiologie, Klinikum Passau (Germany); Mahnken, A.H.; Guenther, R.W. [Klinik fuer Radiologische Diagnostik, Universitaetsklinikum Aachen (Germany)

    2005-12-15

    Due to modern examination techniques such as multidetector computed tomography and high-field magnetic resonance imaging, the detection rate of renal neoplasms is continually increasing. Even though tumors exceeding 4 cm in diameter rarely metastasize, all renal lesions that are possible neoplasms should be treated. Traditional treatment techniques include radical nephrectomy or nephron-sparing resection, which are increasingly performed laparoscopically. Modern thermal ablation techniques such as hyperthermal techniques like radiofrequency ablation RFA, laser induced thermal ablation LITT, focused ultrasound FUS and microwave therapy MW, as well as hypothermal techniques (cryotherapy) may be a useful treatment option for patients who are unfit for or refuse surgical resection. Cryotherapy is the oldest and best known thermal ablation technique and can be performed laparoscopically or percutaneously. Since subzero temperatures have no antistyptic effect, additional maneuvers must be performed to control bleeding. Percutaneous cryotherapy of renal tumors is a new and interesting method, but experience with it is still limited. Radiofrequency ablation is the most frequently used method. Modern probe design allows volumes between 2 and 5 cm in diameter to be ablated. Due to hyperthermal tract ablation, the procedure is deemed to be safe and has a low complication rate. Although there are no randomized comparative studies to open resection, the preliminary results for renal RFA are promising and show RFA to be superior to other thermal ablation techniques. Clinical success rates are over 90% for both, cryo- and radiofrequency ablation. Whereas laser induced thermal therapy is established in hepatic ablation, experience is minimal with respect to renal application. For lesions of more than 2 cm in diameter, additional cooling catheters are required. MR thermometry offers temperature control during ablation. Microwave ablation is characterized by small ablation volumes

  15. Initial experience with circumferential pulmonary vein ablation guided by fusion of magnetic resonance imaging with three-dimensional electroanatomic mapping

    Institute of Scientific and Technical Information of China (English)

    TANG Kai; MA Jian; MA Fu-sheng; JlA Yu-he; ZHANG Shu

    2006-01-01

    @@ Catheter ablation for the treatment of atrial fibrillation (AF) has been a focal target of electrophysiological study in recent years. Up to date,circumferential pulmonary vein ablation (CPVA)guided by three-dimensional (3-D) electroanatomic mapping (Carto, USA) has been one of the most favourable procedures for the treatment of AF.

  16. Meta-Analysis of Risk of Stroke or Transient Ischemic Attack With Dabigatran for Atrial Fibrillation Ablation

    DEFF Research Database (Denmark)

    Sardar, Partha; Nairooz, Ramez; Chatterjee, Saurav;

    2014-01-01

    with warfarin for AF ablation. A total of 5,513 patients undergoing catheter ablation were included in 17 observational studies and 1 randomized trial. Fourteen events of stroke or transient ischemic attacks were reported in the dabigatran group and 4 in the warfarin group (Peto's odds ratio 3.94, 95...... complications including stroke and transient ischemic attack....

  17. Photoacoustic characterization of radiofrequency ablation lesions

    Science.gov (United States)

    Bouchard, Richard; Dana, Nicholas; Di Biase, Luigi; Natale, Andrea; Emelianov, Stanislav

    2012-02-01

    Radiofrequency ablation (RFA) procedures are used to destroy abnormal electrical pathways in the heart that can cause cardiac arrhythmias. Current methods relying on fluoroscopy, echocardiography and electrical conduction mapping are unable to accurately assess ablation lesion size. In an effort to better visualize RFA lesions, photoacoustic (PA) and ultrasonic (US) imaging were utilized to obtain co-registered images of ablated porcine cardiac tissue. The left ventricular free wall of fresh (i.e., never frozen) porcine hearts was harvested within 24 hours of the animals' sacrifice. A THERMOCOOLR Ablation System (Biosense Webster, Inc.) operating at 40 W for 30-60 s was used to induce lesions through the endocardial and epicardial walls of the cardiac samples. Following lesion creation, the ablated tissue samples were placed in 25 °C saline to allow for multi-wavelength PA imaging. Samples were imaged with a VevoR 2100 ultrasound system (VisualSonics, Inc.) using a modified 20-MHz array that could provide laser irradiation to the sample from a pulsed tunable laser (Newport Corp.) to allow for co-registered photoacoustic-ultrasound (PAUS) imaging. PA imaging was conducted from 750-1064 nm, with a surface fluence of approximately 15 mJ/cm2 maintained during imaging. In this preliminary study with PA imaging, the ablated region could be well visualized on the surface of the sample, with contrasts of 6-10 dB achieved at 750 nm. Although imaging penetration depth is a concern, PA imaging shows promise in being able to reliably visualize RF ablation lesions.

  18. Eventos adversos e motivos de descarte relacionados ao reuso de produtos médicos hospitalares em angioplastia coronária Adverse events and reasons for discard related to the reuse of cardiac catheters in percutaneous transluminal coronary angioplasty

    Directory of Open Access Journals (Sweden)

    Margarete Ártico Batista

    2006-09-01

    the brand-new and reuse of medical equipment. METHOD: Sixty patients were studied (48.3% with unstable angina, 45% with acute myocardial infarction and 6.7% with other diagnoses. During the procedure and stay in the Intensive Coronary Unit, the occurrence of fever, hypotension or hypertension, chills, sudoresis, bleeding, nausea and vomits were observed. Seven products were evaluated: catheter introducer, catheter guides (0.35 and 0.014, catheter balloons for angioplasty, indeflators and manifolds. In total, 76 brand-new and 410 reused apparatuses were studied to verify the occurrence of discard, whether this happened before or during the procedure and for what reasons. P-values < 0.05 were considered signicant. RESULTS: Twenty-six patients presented adverse effects. Hypotension was the most common seen in 11(18.3% cases. There was no significant association between this adverse effect and reuse or not of the equipment. Three brand-new products and 55 of the reused products were discarded as they were incomplete. CONCLUSION: The adverse effects presented by patients submitted to coronary vessel angioplasty were not associated to the reuse of the medical equipment. The integrity and functionality were the main reasons of discard.

  19. Catheter Ablation of Tachyarrhythmias in Koch’s Triangle

    NARCIS (Netherlands)

    G-J.P. Kimman (Geert-Jan)

    2005-01-01

    textabstractKoch’s triangle is an intruiging area. On the atrial aspect, the triangular area itself is delineated by the tendon of Todaro, which inserts in the atrial aspect of the central fibrous body to mark the apex of Koch´s triangle. The ventricular border is formed by the septal leaflet of th

  20. The comparison of catheter ablation and permanent pacing on patients with paroxysmal atrial fibrillation related tachycardia-bradycardia syndrome%阵发性心房颤动合并长R-R间期导管消融和起搏治疗的对比

    Institute of Scientific and Technical Information of China (English)

    陈英伟; 董建增; 马长生

    2014-01-01

    Objective To evaluate the outcome of AF ablation in patients with paroxysmal atrial fibrillation (AF) related tachycardia-bradycardia syndrome. Methods Fifty consecutive patients with paroxysmal AF and prolonged symptomatic sinus pauses on termination of AF referred to our hospital for ablation were evaluated (ABL group). In another 61 patients, paroxysmal AF was treated with anti-arrhythmic drug and a pacemaker was implanted due to AF related tachycardia-bradycardia syndrome. These patients were used as control (PM group). Results A total of 50 patients in the ABL group fulfilled Class I indication for pacemaker implantation at baseline but they actually underwent AF ablation. Re-evaluation at the end of follow-up showed that 47 (94%) patients no longer needed a pacemaker (Class III indication) because of free from AF with no recurrences of pre-syncopal or syncopal events or documented sinus pauses after the last procedure. More patients in the PM group were on AADs (PM 42.6%, ABL 6.0%, P < 0.001) while sinus rhythm maintenance at the end of follow-up was remarkably higher in the ABL group (82.0%vs. 21.3%in PM group, P < 0.001). The total rates of cardiac related re-hospitalization was not significantly different between the two groups, but hospitalizations caused by tachyarrhythmia was significantly higher in the PM group (PM group 14.8%, ABL group 2.0%, P=0.020).The embolic events, heart failure and death rate were not significantly different between the two groups. Conclusions In patients with paroxysmal AF related tachycardia-bradycardia syndrome, AF ablation seems to be superior to a strategy of pacing plus AAD. Pacemaker implantation can be waived in the majority of patients after a successful ablation.%目的:评估导管消融对阵发性心房颤动(房颤)相关快-慢综合征的疗效。方法连续入选2010年1月至2012年9月在北京安贞医院房颤中心接受导管消融的50例阵发性房颤合并房颤终止后症状性长间歇的

  1. Imaging in percutaneous ablation for atrial fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Maksimovic, Ruzica [Erasmus Medical Center, Department of Radiology, GD Rotterdam (Netherlands); Institute for Cardiovascular Diseases of the University Medical Center, Belgrade (Czechoslovakia); Dill, Thorsten [Kerckhoff-Heart Center, Department of Cardiology, Bad Nauheim (Germany); Ristic, Arsen D.; Seferovic, Petar M. [Institute for Cardiovascular Diseases of the University Medical Center, Belgrade (Czechoslovakia)

    2006-11-15

    Percutaneous ablation for electrical disconnection of the arrhythmogenic foci using various forms of energy has become a well-established technique for treating atrial fibrillation (AF). Success rate in preventing recurrence of AF episodes is high although associated with a significant incidence of pulmonary vein (PV) stenosis and other rare complications. Clinical workup of AF patients includes imaging before and after ablative treatment using different noninvasive and invasive techniques such as conventional angiography, transoesophageal and intracardiac echocardiography, computed tomography (CT) and magnetic resonance imaging (MRI), which offer different information with variable diagnostic accuracy. Evaluation before percutaneous ablation involves assessment of PVs (PV pattern, branching pattern, orientation and ostial size) to facilitate position and size of catheters and reduce procedure time as well as examining the left atrium (presence of thrombi, dimensions and volumes). Imaging after the percutaneous ablation is important for assessment of overall success of the procedure and revealing potential complications. Therefore, imaging methods enable depiction of PVs and the anatomy of surrounding structures essential for preprocedural management and early detection of PV stenosis and other ablation-related procedures, as well as long-term follow-up of these patients. (orig.)

  2. Imaging in percutaneous ablation for atrial fibrillation

    International Nuclear Information System (INIS)

    Percutaneous ablation for electrical disconnection of the arrhythmogenic foci using various forms of energy has become a well-established technique for treating atrial fibrillation (AF). Success rate in preventing recurrence of AF episodes is high although associated with a significant incidence of pulmonary vein (PV) stenosis and other rare complications. Clinical workup of AF patients includes imaging before and after ablative treatment using different noninvasive and invasive techniques such as conventional angiography, transoesophageal and intracardiac echocardiography, computed tomography (CT) and magnetic resonance imaging (MRI), which offer different information with variable diagnostic accuracy. Evaluation before percutaneous ablation involves assessment of PVs (PV pattern, branching pattern, orientation and ostial size) to facilitate position and size of catheters and reduce procedure time as well as examining the left atrium (presence of thrombi, dimensions and volumes). Imaging after the percutaneous ablation is important for assessment of overall success of the procedure and revealing potential complications. Therefore, imaging methods enable depiction of PVs and the anatomy of surrounding structures essential for preprocedural management and early detection of PV stenosis and other ablation-related procedures, as well as long-term follow-up of these patients. (orig.)

  3. Indication of the radiofrequency induced lesion size by pre-ablation measurements

    DEFF Research Database (Denmark)

    Stagegaard, Niels; Petersen, Helen Høgh; Chen, Xu;

    2005-01-01

    for assessing these factors prior to ablation may indicate the lesion size which will be obtained for any given catheter position. METHODS AND RESULTS: Radiofrequency ablation was performed in vitro on strips of left ventricular porcine myocardium during two different levels of convective cooling (0 or 0.1 m......, during unchanged conditions, radiofrequency ablation was performed as either temperature-controlled, power-controlled or irrigated tip ablation and lesion size was determined. DeltaIMP increased significantly (P convective cooling. Delta......T was significantly increased by increasing contact pressure (P correlation between the obtained lesion size and power output...

  4. The role of Multidetector CT in the evaluation of the left atrium and pulmonary veins anatomy before and after radio-frequency catheter ablation for atrial fibrillation. Preliminary results and work in progress.Technical note; Il ruolo della TC Multidetettore nella valutazione anatomica dell'atrio sinistro e delle vene polmonari prima e dopo ablazione percutanea con radiofrequenza della fibrillazione atriale. Risultati preliminari e work in progress

    Energy Technology Data Exchange (ETDEWEB)

    Centoze, Maurizio; Della Sala, Sabino Walter; Dalla Palma, Francesco [Azienda Provinciale per i servizi sanitari, Trento (Italy). Dipartimento di radiodiagnostica; Del Greco, Maurizio; Marini, Massimiliano [Ospedale S. Chiara, Trento (Italy). U.O. di cardiologia; Nollo, Giandomenico; Ravelli, Flavia [Trento Univ., Trento (Italy). Dipartimento di fisica

    2005-07-15

    Radio-frequency catheter ablation (RFCA) of the distal pulmonary veins is increasingly being used to treat recurrent or refractory atrial fibrillation that doesn't respond to pharmacologic therapy or cardioversion. Successful RFCA of atrial al fibrillation depends on the pre-procedural understanding of the complex anatomy of the distal pulmonary veins and the left atrium. Aim of this parer is to describe the technical main features that characterise the multidetector helical computed tomography in the evaluation of this anatomic region before and after RFCA procedure. The 3D post-processing techniques useful for pre-RFCA planning are straightforward. [Italian] La ablazione percutanea con radiofrequenza (RFCA) del tratto distale delle vene polmonari nella fibrillazione atriale, che non risponde al trattamento farmacologico e alla cardioversione elettrica, e una procedura in grande sviluppo. Il successo del trattamento dipende dalla comprensione della complessa anatomia delle vene polmonari e dell'atrio sinistro. Lo scopo di questo articolo e illustrare gli aspetti tecnici fondamentali che caratterizzano lo studio di questa regione anatomica con TC spirale multidetettore prima e dopo RFCA. Particolare risalto e stato rivolto alle tecniche di post-processing 3D estremamente utili nella pianificazione della procedura di ablazione.

  5. MO-A-BRD-08: Radiosurgery Beyond Cancer: Real-Time Target Localization and Treatment Planning for Cardiac Radiosurgery Under MRI Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Ipsen, S [University of Luebeck, Luebeck, SH (Germany); University of Sydney, Camperdown (Australia); Blanck, O [CyberKnife Zentrum Norddeutschland, Guestrow, MV (Germany); Oborn, B [Illawarra Cancer Care Centre, Wollongong, NSW (Australia); Bode, F [Medical Clinic II, Section for Electrophysiology, UKSH, Luebeck, SH (Germany); Liney, G [Ingham Institute for Applied Medical Research, Liverpool, NSW (United Kingdom); Keall, P [University of Sydney, Camperdown (Australia)

    2014-06-15

    Purpose: Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting >2.5M Americans and >4.5M Europeans. AF is usually treated with minimally-invasive, time consuming catheter ablation techniques. Radiosurgery of the pulmonary veins (PV) has been proposed for AF treatment, however is challenging due to the complex respiratory and cardiac motion patterns. We hypothesize that an MRI-linac could solve the difficult real-time targeting and adaptation problem. In this study we quantified target motion ranges on cardiac MRI and analyzed the dosimetric benefits of margin reduction assuming real-time MRI tracking was applied. Methods: For the motion study, four human subjects underwent real-time cardiac MRI under free breathing. The target motion on coronal and axial cine planes was analyzed using a template matching algorithm. For the planning study, an ablation line at each PV antrum was defined as target on an AF patient scheduled for catheter ablation. Various safety margins ranging from 0mm (perfect tracking) to 8mm (untracked motion) were added to the target defining the PTV. 30Gy single fraction IMRT plans were then generated. Finally, the influence of a 1T magnetic field on treatment beam delivery was calculated using the Geant4 Monte Carlo algorithm to simulate the dosimetric impact of MRI guidance. Results: The motion study showed the mean respiratory motion of the target area on MRI was 8.4mm (SI), 1.7mm (AP) and 0.3mm (LR). Cardiac motion was small (<2mm). The planning study showed that with increasing safety margins to encompass untracked motion, dose tolerances for OARs such as the esophagus and airways were exceeded by >100%. The magnetic field had little impact on the dose distribution. Conclusion: Our results indicate that real-time MRI tracking of the PVs seems feasible. Accurate image guidance for high-dose AF radiosurgery is essential since safety margins covering untracked target motion will result in unacceptable treatment plans.

  6. A review of the safety aspects of radio frequency ablation

    Directory of Open Access Journals (Sweden)

    Abhishek Bhaskaran

    2015-09-01

    Full Text Available In light of recent reports showing high incidence of silent cerebral infarcts and organized atrial arrhythmias following radiofrequency (RF atrial fibrillation (AF ablation, a review of its safety aspects is timely. Serious complications do occur during supraventricular tachycardia (SVT ablations and knowledge of their incidence is important when deciding whether to proceed with ablation. Evidence is emerging for the probable role of prophylactic ischemic scar ablation to prevent VT. This might increase the number of procedures performed. Here we look at the various complications of RF ablation and also the methods to minimize them. Electronic database was searched for relevant articles from 1990 to 2015. With better awareness and technological advancements in RF ablation the incidence of complications has improved considerably. In AF ablation it has decreased from 6% to less than 4% comprising of vascular complications, cardiac tamponade, stroke, phrenic nerve injury, pulmonary vein stenosis, atrio-esophageal fistula (AEF and death. Safety of SVT ablation has also improved with less than 1% incidence of AV node injury in AVNRT ablation. In VT ablation the incidence of major complications was 5–11%, up to 3.4%, up to 1.8% and 4.1–8.8% in patients with structural heart disease, without structural heart disease, prophylactic ablations and epicardial ablations respectively. Vascular and pericardial complications dominated endocardial and epicardial VT ablations respectively. Up to 3% mortality and similar rates of tamponade were reported in endocardial VT ablation. Recent reports about the high incidence of asymptomatic cerebral embolism during AF ablation are concerning, warranting more research into its etiology and prevention.

  7. 小儿左主动脉窦起源的室性心律失常心电生理特点和射频消融治疗%Electrophysiological characteristics and radiofrequency catheter ablation of ventricular arrhythmia originating from the left coronary aortic sinus in children

    Institute of Scientific and Technical Information of China (English)

    林利; 高路; 崔烺; 于霞; 马洪山; 袁越

    2014-01-01

    目的 报道7例左主动脉窦(LCAS)起源的室性心律失常患儿的心电生理特征和射频导管消融(RFCA)疗效.评价体表心电图对鉴别LCAS及右心室流出道(RVOT)起源的室性心律失常的价值.方法 分析2006年1月至2013年5月在首都医科大学附属北京儿童医院心脏中心内科17例无器质性心脏病的室性心律失常患儿体表心电图(ECG)和动态心电图室性早搏(室早)或室性心动过速(室速)的形态特点.其中7例LCAS来源,10例RVOT来源.结果 两组室性心律失常在Ⅱ、Ⅲ、aVF导联均为高大R波.LCAS组移行在V1、V2导联(85.7%).RVOT组多在V3导联以后(90%).RVOT组的R波时限指数及R/S波幅指数小于LCAS组(0.50±0.14对0.74±0.13,P<0.01;0.32±0.21对3.25±2.45,P<0.01),差异有统计学意义.LCAS组7例中,6例治愈,1例复发.结论 特异性的心电图表现有利于明确LCAS的病灶来源.RFCA治疗LCAS起源的室性心律失常疗效显著.%Objective This study sought to evaluate the electrocardiogram (ECG) characteristics on differentiating ventricular arrhythmia originating from the left coronary aortic sinus (LCAS) and from right ventricular outflow tract (RVOT) and to assess the results of radiofrequency catheter ablation (RFCA) of ventricular arrhythmia from the LCAS.Methods Twelve-lead and Holter ECG analysis,electrophysiological study and RFCA were performed in 17 pediatric patients with ventricular arrhythmia without organic heart disease,including originating from LCAS in 7 patients and originating from RVOT in 10 patients.Results When arrhythmia originating from LCAS,the surface ECG revealed tall R wave on lead Ⅱ,Ⅲ and aVF.Precordial R wave transition occurred on lead V1,V2.For arrhythmia originating from RVOT,the surface ECG had same characteristics on lead Ⅱ,Ⅲ and aVF.Precordial R wave transition occurred ≥ lead V3 during arrhythmia.The index of R wave duration and R/S amplitude on lead V1 and V2 in RVOT group were

  8. Studies of ablation pressure, ablative acceleration and ablative implosions

    International Nuclear Information System (INIS)

    Time and space resolved X-ray spectroscopy have been used to measure ablation rate and ablation pressure on plane targets irradiated by the first and second harmonics of Nd glass laser light. Streaked X-ray shadowgraphy has been applied to the study of ablatively imploded spherical shell targets uniformly irradiated by six 1.05 μm laser beams. The results give a direct measurement of shell acceleration and thus of ablation pressure and show evidence of fluid instability increasing as the shell ratio is varied from 10 to 100. A direct determination of implosion core density is also obtained. (author)

  9. The Hunter Pulmonary Angiography Catheter for a Brachiocephalic Vein Approach

    International Nuclear Information System (INIS)

    The purpose of this work was to describe our experience in performing pulmonary angiography using the Hunter pulmonary catheter, manufactured by Cook, Inc., which is a modified 6F pigtail catheter with a 'C-shaped' curve, designed for a brachiocephalic vein approach. One hundred twenty-three patients underwent pulmonary angiograms using the Hunter catheter between August 1997 and January 2002. Operator comments were gathered in 86 (70%) of the cases. The operator was, if possible, the most junior resident on the service. Thirty-nine operators participated in the survey. Efficacy, safety, and ease of use of the catheter were determined by operators' comments and ECG observations during the procedure. Corroborating clinical data were gathered from medical records. In 68 (79%) of the procedures that were commented upon, the operator described insertion into the pulmonary artery (PA) as easy; only 2 (2%) indicated difficulty in accessing the PA. In 41 (63%) of the bilateral angiograms that were commented upon, the operator described accessing the left PA from the right PA as easy; only 6 (9%) rated it as difficult and all were with an older technique in which the catheter was withdrawn to the pulmonary bifurcation without a wire or with only the soft tip of the wire in the pigtail and then rotated to the left main pulmonary artery. Thirty-one of the 41 patients who demonstrated premature ventricular contractions (PVCs) had a previous history of heart disease. Nineteen of the 39 patients who did not have PVCs had a history of heart disease (p = 0.018). The maneuverability and shape of the Hunter catheter make pulmonary angiography an easy procedure, even for operators with minimal experience and limited technical proficiency. PVCs demonstrated a statistically significant correlation with a positive patient history for cardiac disease, rather than being a universal risk

  10. 应用Swan-Ganz导管测定肺动脉高压犬模型肺循环阻力及心输出量的实验研究%Application of Swan-Ganz catheter to measure pulmonary vascular resistance and cardiac output of canine model with pulmonary arterial hypertension

    Institute of Scientific and Technical Information of China (English)

    林约瑟; 李淑娟; 李轩狄; 李运泉; 王慧深

    2015-01-01

    ObjectiveTo explore the value of Swan-Ganz catheter to measure pulmonary vascular resistance (PVR) and cardiac output (CO) of canine model with pulmonary arterial hypertension (PAH).MethodsSixteen Beagle dogs were randomly divided into two groups, the control group(n=8) and the pulmonary arterial hypertension group (n=8). Arterial blood was obtained to test arterial oxygen saturation. A Swan-Ganz catheter was advanced through the the right jugular vein way to the pulmonary artery and the pulmonary arterial pressure (PAP) were measured. Blood was obtained to test the pulmonary arterial oxygen saturation and plasma concentration of brain natriuretic peptide (BNP). Cardiac output and pulmonary vascular resistance were then calculated according to formula. The pulmonary arterial hypertension group were injected dehydromonocrataline 2.5 mg/kgto set up pulmonary arterial hypertension model. Hemodynamic measure was repeated after eight weeks.ResultsEight weeks after injection of dehydromonocrotaline, the pulmonary arterial systolic pressure, mean pulmonary arterial pressure of the pulmonary arterial hypertension group were significantly increased from (20.33±1.86) mmHg to (50.10±3.72) mmHg, (10.42±1.48) mmHg to (34.30±2.35) mmHg, the pulmonary arterial resistance, pulmonary vascular resistance were significantly increased from (1.10±0.24) Wood to (12.60±0.29) Wood, (2.34±0.33) Wood to (15.68±0.68) Wood, respectively, cardiac output was significantly decreased from (4.60±0.64) L/min to (2.30±0.35) L/min (P<0.05).ConclusionIt is an accurate, stable and repeatable method to apply Swan-Ganz catheter for measuring pulmonary vascular resistance and cardiac output in Beagle models with pulmonary arterial hypertension.%目的:探讨Swan-Ganz导管在肺动脉高压犬模型肺循环阻力及心输出量测定中的应用价值。方法16只比格犬随机分为2组,正常对照组(n=8)、肺动脉高压组(n=8)。穿刺动脉取血检测血氧饱和度。

  11. 41例频发室性早搏的心电图特点及射频消融治疗临床疗效评价%Analysis of electrocardiogram characteristics and evaluation of clinical efifcacy of radiofrequency catheter ablation in 41 patients with frequent premature centricular contractions

    Institute of Scientific and Technical Information of China (English)

    林楚容; 范景如; 陈墅; 梁嘉; 郭舜奇

    2015-01-01

    Objective To explore the electrocardiogram (ECG) characteristics and clinical efifcacy of radiofrequency catheter ablation (RFCA) in 41 patients with frequent premature centricular contractions (PVCS). Methods 41 patients undergoing ECG examination and RFCA treatment were retrospectively analyzed. Their ECG, dynamic electrocardiogram (DCG) characteristics and the clinical efifcacy of RFCA were analyzed.Results The DCG indicated frequent PVCS (frequency>10 000 beats/24 h), among which many were bigeminy or trigeminy. And three cases complicated with paroxysmal ventricular tachycardia. The effective target sites: 28 within right ventriclular outlfow tract, 8 left ventricular outlfow tract, 1 left ventricular apex, 1 mitral annulus, and 2 tricuspid annulus. Besides, the right spot for ablation of one case could not be identiifed. Immediate success of RFCA occurred in 39 cases, and failed in two cases; the rate of immediate success was 95.1% and the failure rate 4.9%. One week after RFCA, PVCS of DCG of 37 successful cases did not appear again, two cases had occasional PVC, and all patients had no obvious clinical symptoms such as palpitation, chest tightness, etc. or complications. After successful surgery, the symptoms caused by PVCS did not occur anymore. 3 to 12 months’ follow-up showed that no recurrence occurred.ConclusionsAnalyzing the ECG characteristics of PVCS before RFCA can preliminarily identify the origin site of PVCs and increase the successful rate and safety. RFCA for PVCS without organic heart diseases is effective and safe.%目的:探讨41例频发室性早搏的常规心电图特点及射频消融治疗的临床疗效。方法回顾性分析41例进行常规心电图检查及射频消融治疗的频发室性早搏患者,分析其常规心电图、动态心电图特点和射频消融治疗的临床疗效。结果动态心电图示为频发室性早搏,频率>1万次/24 h,多为二、三联律,并有3例合并有阵发性室性心动过

  12. Effectiveness and safety of anticoagulant therapy with dabigatran etexilate in patients after radiofrequency catheter ablation of atrial fibrillation%达比加群酯用于心房颤动射频导管消融术后抗凝治疗有效性及安全性研究

    Institute of Scientific and Technical Information of China (English)

    王璇; 王祖禄; 杨桂棠; 金志清; 梁明; 梁延春; 韩雅玲

    2015-01-01

    Objective To evaluate the effectiveness and safety of anticoagulant therapy with dabigatran etexilate in patient after radiofrequency catheter ablation(RFCA) of atrial fibrillation(AF).Methods A cohort of 120 patients who underwent RFCA of AF was enrolled.The 120 patients were divided into dabigatran group (60 patients) and warfarin Group (60 patients).In dabigatran etexilate group,dabigatran etexilate (110 mg or 150 mg,bid)was given for at least 2 month.In warfarin group,standard medication of warfarin was given for at least 2 months by adjusting the INR in the range between 2.0 and 3.0.All the patients took the same anticoagulant during the whole period of anticoagulation therapy.Results ①There were no significant differences in baseline characteristics between two groups except the systolic blood pressure.②There were no significant differences between 2 groups in the death and thromboembolism events,including cerebral,systemic and pulmonary emboli(none in both groups).There were no TIMI major bleeding events in both groups.There were no significant differences in minor bleeding events between two groups (2/60 vs 4/60) (P> 0.05).The length of hospital stay (including both total and post-ablation hospital stay)was significantly shorter in dabigatran etexilate group than in warfarin group.Conclusion Compared with oral warfarin,the effectiveness and safety of oral dabigatran etexilate had similar effect in the patients after RFCA of AF.Dabigatran etexilate could be safely and effectively used in AF patients with low or middle risk of thromboembolism after RFCA,and could significantly decrease the length of hospital stay.%目的 评估达比加群酯用于心房颤动(房颤)导管消融术后抗凝治疗的有效性及安全性.方法 自2013年3月11日至2014年4月16日在沈阳军区总医院将接受房颤射频导管消融的患者分为达比加群酯组60例和华法林组60例.达比加群酯组:房颤导管消融术后给予110 mg或150mg,每日2

  13. Delayed bowel perforation following suprapubic catheter insertion

    OpenAIRE

    Mehta Ajay; Ahmed Shwan J; Rimington Peter

    2004-01-01

    Abstract Background Complications of suprapubic catheter insertion are rare but can be significant. We describe an unusual complication of a delayed bowel perforation following suprapubic catheter insertion. Case presentation A gentleman presented with features of peritonitis and feculent discharge along a suprapubic catheter two months after insertion of the catheter. Conclusion Bowel perforation is the most feared complication of suprapubic catheter insertion especially in patients with low...

  14. Hydrodynamics of catheter biofilm formation

    CERN Document Server

    Sotolongo-Costa, Oscar; Rodriguez-Perez, Daniel; Martinez-Escobar, Sergio; Fernandez-Barbero, Antonio

    2009-01-01

    A hydrodynamic model is proposed to describe one of the most critical problems in intensive medical care units: the formation of biofilms inside central venous catheters. The incorporation of approximate solutions for the flow-limited diffusion equation leads to the conclusion that biofilms grow on the internal catheter wall due to the counter-stream diffusion of blood through a very thin layer close to the wall. This biological deposition is the first necessary step for the subsequent bacteria colonization.

  15. Durable Pulmonary Vein Isolation: The Holy Grail of Atrial Fibrillation Ablation

    Directory of Open Access Journals (Sweden)

    Duy Thai Nguyen; William H. Sauer

    2010-10-01

    Full Text Available The inability to achieve durable pulmonary vein isolation remains a major limitation to catheter ablation for the treatment of atrial fibrillation (AF. In this review, we discuss the research performed over the past decade investigating methods to improve lesion permanence for the goal of durable pulmonary vein isolation (PVI. Investigations evaluating procedural techniques, adjunctive pharmacologic therapy, and newer energy sources designed to improve ablation lesion permanence are discussed.

  16. Intermittently “Pre-Excited” ECG after Accessory Pathway Ablation: Unsuccessful Procedure or a Complication?

    Directory of Open Access Journals (Sweden)

    Evgeny Mikhaylov

    2012-01-01

    Full Text Available A 52-year-old woman with previously unsuccessful posteroseptal pathway ablation using radiofrequency energy presented with intermittently occurring short PR followed by a wide QRS complex, and complaining of palpitations with characteristics different from previous history. During a second electrophysiological procedure no signs of preexcitation were found. Ventricular discharges with fusion with sinus beats were revealed, and catheter ablation of premature contractions originating from the proximity to previous accessory pathway was carried out.

  17. A system for visualization and automatic placement of the endoclamp balloon catheter

    NARCIS (Netherlands)

    Furtado, H.; Stüdeli, T.; Sette, M.; Samset, E.; Gersak, B.

    2010-01-01

    The European research network "Augmented Reality in Surgery" (ARIS*ER) developed a system that supports minimally invasive cardiac surgery based on augmented reality (AR) technology. The system supports the surgical team during aortic endoclamping where a balloon catheter has to be positioned and ke

  18. Catheter-related right atrial thrombus and pulmonary embolism: A case report and systematic review of the literature

    OpenAIRE

    Karen EA Burns; Andrew McLaren

    2009-01-01

    Central venous catheters (CVCs) are commonly used in clinical practice. One of the foremost complications associated with their use is the potential for symptomatic or asymptomatic thrombosis. CVC thrombosis, in turn, may not only result in vascular and catheter occlusion but also infection, pulmonary embolism, and formation of right heart thromboemboli. Thrombi within cardiac chambers are associated with an increased risk of mortality due to their potential for embolization to the pulmonary ...

  19. Fetal cardiac interventions: clinical and experimental research.

    Science.gov (United States)

    Yuan, Shi-Min; Humuruola, Gulimila

    2016-01-01

    Fetal cardiac interventions for congenital heart diseases may alleviate heart dysfunction, prevent them evolving into hypoplastic left heart syndrome, achieve biventricular outcome and improve fetal survival. Candidates for clinical fetal cardiac interventions are now restricted to cases of critical aortic valve stenosis with evolving hypoplastic left heart syndrome, pulmonary atresia with an intact ventricular septum and evolving hypoplastic right heart syndrome, and hypoplastic left heart syndrome with an intact or highly restrictive atrial septum as well as fetal heart block. The therapeutic options are advocated as prenatal aortic valvuloplasty, pulmonary valvuloplasty, creation of interatrial communication and fetal cardiac pacing. Experimental research on fetal cardiac intervention involves technical modifications of catheter-based cardiac clinical interventions and open fetal cardiac bypass that cannot be applied in human fetuses for the time being. Clinical fetal cardiac interventions are plausible for midgestation fetuses with the above-mentioned congenital heart defects. The technical success, biventricular outcome and fetal survival are continuously being improved in the conditions of the sophisticated multidisciplinary team, equipment, techniques and postnatal care. Experimental research is laying the foundations and may open new fields for catheter-based clinical techniques. In the present article, the clinical therapeutic options and experimental fetal cardiac interventions are described. PMID:27279868

  20. Epidural catheterization in cardiac surgery: The 2012 risk assessment

    Directory of Open Access Journals (Sweden)

    Thomas M Hemmerling

    2013-01-01

    Full Text Available Aims and Objectives: The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the literature up to September 2012. Materials and Methods: We included all reported cases of epidural catheter placement for cardiac surgery in web and in literature from 1966 to September 2012. Risks of other medical and non-medical activities were retrieved from recent reviews or national statistical reports. Results: Based on our analysis the risk of catheter-related epidural hematoma is 1 in 5493 with a 95% confidence interval (CI of 1/970-1/31114. The risk of catheter-related epidural hematoma in cardiac surgery is similar to the risk in the general surgery population at 1 in 6,628 (95% CI 1/1,170-1/37,552. Conclusions: The present risk calculation does not justify not offering epidural analgesia as part of a multimodal analgesia protocol in cardiac surgery.

  1. SvO2 Trigger in Transfusion Strategy After Cardiac Surgery

    Science.gov (United States)

    2016-05-18

    Undergoing Nonemergent Cardiac Surgery; Central Venous Catheter on the Superior Vena Cava (to Perform ScVO2 Measure); Anemia (Transfusion; Hemodynamic and Respiratory Stability; Bleeding Graded as Insignificant, Mild, Moderate of Universal Definition of Perioperative Bleeding

  2. Lack of agreement and trending ability of the endotracheal cardiac output monitor compared with thermodilution

    DEFF Research Database (Denmark)

    Møller-Sørensen, H; Hansen, K L; Ostergaard, M;

    2012-01-01

    BACKGROUND: Minimally invasive monitoring systems of central haemodynamics are gaining increasing popularity. The present study investigated the precision of the endotracheal cardiac output monitor (ECOM) system and its agreement with pulmonary artery catheter thermodilution (PAC TD) for measuring...

  3. 30例房颤射频消融术的临床研究%Clinical study of 30 cases of atrial fibrillation ablation

    Institute of Scientific and Technical Information of China (English)

    郑元喜; 辜和平; 程静芳

    2014-01-01

    目的:探讨导管射频消融术治疗房颤的临床效果。方法回顾性分析2010年11月~2013年1月我院应用导管射频消融术治疗30例房颤患者的临床资料。房颤类型:阵发性心房颤动26例,持续性/长时间持续性心房颤动4例。结果本组共行40次消融术,30例患者术中均达到消融终点,平均能量25 W。30例房颤患者消融术全部成功。仅环形隔离右上下肺静脉者1例,同时环形隔离左、右上下肺静脉者12例。随访期间所有患者均未发生肺静脉狭窄、心肌穿孔、血气胸、心脏停搏和食管穿孔等并发症。3例房颤患者术中发生迷走反射,注射阿托品后恢复正常。其中26例阵发性房颤患者消融术中转为窦性心律16例,所有患者术后3个月停用胺碘酮或心律平等抗心律失常药物。结论经导管射频消融术治疗房颤可以降低心力衰竭和血栓栓塞等并发症的发生率,具有微创、时间短、手术效果好等优点,值得临床推广和应用。%Objective To investigate the clinical therapeutic effect of radiofrequency catheter ablation in treatment of atrial fibrillation. Methods The clinical data of 30 cases of patients with atrial fibrillation that had application of ra-diofrequency catheter ablation from November 2010 to January 2013 in our hospital were analyzed. Type of atrial fib-rillation: 26 patients with paroxysmal atrial fibrillation, 4 patients with persistent atrial fibrillation. Results There were 40 times of ablation, 30 patients reached the endpoint of ablation, average power of 25 W. Atrial fibrillation ablation in 30 patients were all successful, 1 cases only annular isolated right inferior pulmonary vein, and both of right and left inferior pulmonary vein isolation ring in 12 cases. In the follow-up period, there were no cases of pulmonary vein stenosis, cardiac perforation, pneumothorax, cardiac arrest and esophageal perforation. Vagal reflex occurred in 3

  4. The supraclavicular fossa ultrasound view for central venous catheter placement and catheter change over guidewire.

    Science.gov (United States)

    Kim, Se-Chan; Klebach, Christian; Heinze, Ingo; Hoeft, Andreas; Baumgarten, Georg; Weber, Stefan

    2014-12-23

    The supraclavicular fossa ultrasound view can be useful for central venous catheter (CVC) placement. Venipuncture of the internal jugular veins (IJV) or subclavian veins is performed with a micro-convex ultrasound probe, using a neonatal abdominal preset with a probe frequency of 10 Mhz at a depth of 10-12 cm. Following insertion of the guidewire into the vein, the probe is shifted to the right supraclavicular fossa to obtain a view of the superior vena cava (SVC), right pulmonary artery and ascending aorta. Under real-time ultrasound view, the guidewire and its J-tip is visualized and pushed forward to the lower SVC. Insertion depth is read from guidewire marks using central venous catheter. CVC is then inserted following skin and venous dilation. The supraclavicular fossa view is most suitable for right IJV CVC insertion. If other insertion sites are chosen the right supraclavicular fossa should be within the sterile field. Scanning of the IJVs, brachiocephalic veins and SVC can reveal significant thrombosis before venipuncture. Misplaced CVCs can be corrected with a change over guidewire technique under real-time ultrasound guidance. In conjunction with a diagnostic lung ultrasound scan, this technique has a potential to replace chest radiograph for confirmation of CVC tip position and exclusion of pneumothorax. Moreover, this view is of advantage in patients with a non-p-wave cardiac rhythm were an intra-cardiac electrocardiography (ECG) is not feasible for CVC tip position confirmation. Limitations of the method are lack of availability of a micro-convex probe and the need for training.

  5. Bacteriological Profile of Epidural Catheters

    Directory of Open Access Journals (Sweden)

    B. M. Sahay, Sanjot Dahake, D. K Mendiratta*,Vijayshree Deotale*,B. Premendran, P.S.Dhande, Pratibha Narang*

    2010-01-01

    Full Text Available The bacteriological profile of epidural catheters was studied in 88 patients. Skin swabs before catheterizationand before removal of catheter with their controls were cultured in TSB Medium. The catheter hub, theportion at the skin puncture site and at the tip were cultured in TSB Medium. The 1cm of the catheter bitjust before the tip was cultured in TGB medium for anaerobes.Both, the skin controls swabs and theanaerobic culture, were negative. From the remaining, 56 positive cultures were obtained. Staphylococcusepidermidis was the predominant organism in 52% followed by staphylococcus aureus 25%. The remaining23% was shared by Acinetobacter, Pseudomonas, Klebsiella, and E. coli. All the positive cultures fromskin prior to epidural catheterization had turned sterile by 48 hours, indicating continued bactericidal actionof the disinfectant. The likely source of positive skin cultures at 48 hours is hair follicles.The catheter tipculture was positive in 9 specimen, none of which resulted in the formation of epidural abscess. In 3 casesthe cultures of skin puncture site and the tip were identical indicating tracking-in of the organisms.

  6. 达比加群酯在心房颤动患者经导管射频消融术围术期抗凝治疗中的安全性和有效性研究%Safety and Efficacy of Dabigatran in Anticoagulation Therapy in the Perioperative Period of Radiofrequency Catheter Ablation for Patients With Atrial Fibrillation

    Institute of Scientific and Technical Information of China (English)

    徐晓薇; 陈步星; 魏欣; 郭晓彬; 林涛

    2016-01-01

    目的:探讨达比加群酯在心房颤动(房颤)患者经导管射频消融术( RFCA)围术期抗凝治疗中的安全性和有效性。方法选取2014年6月—2015年9月,在首都医科大学附属北京天坛医院接受RFCA的房颤患者80例。采用随机数字表法,将其分为对照组38例和观察组42例。两组患者均行RFCA,对照组围术期采用华法林抗凝治疗,观察组采用达比加群酯抗凝治疗。术后随访3个月,记录并比较两组围术期并发症发生情况。结果两组性别、平均年龄、房颤类型、存在外周血管动脉粥样斑块比例、左心房前后径、左心室射血分数( LVEF)、内生肌酐清除率(CCr)、房颤患者卒中发生评分系统(CHA2DS2-Vasc)得分、合并症、既往有卒中史比例比较,差异无统计学意义(P﹥0.05)。随访至3个月时,两组均无卒中等血栓栓塞事件发生;两组联合终点事件发生率比较,差异无统计学意义(P﹥0.05)。结论达比加群酯在房颤患者RFCA围术期抗凝治疗中的有效性和安全性均不低于华法林,可作为安全、稳定的RFCA围术期抗凝治疗策略。%Objective To explore the safety and efficacy of dabigatran in anticoagulation therapy in the perioperative period of radiofrequency catheter ablation(RFCA)for patients with atrial fibrillation(AF). Methods From June 2014 to September 2015,we enrolled 80 AF patients who received RFCA in Beijing Tian Tan Hospital affiliated to Capital Medical University. By random number table method,the patients were divided into control group(n =38)and observation group(n=42). The two groups were administrated by RFCA,control group was administrated by warfarin in anticoagulation therapy in the perioperative period, and observation group was administrated by dabigatran in anticoagulation therapy. After 3 - month postoperative follow-up,the occurrence of complications in the perioperative period was recorded

  7. Adrenergic innervation of the developing chick heart: neural crest ablations to produce sympathetically aneural hearts

    International Nuclear Information System (INIS)

    Ablation of various regions of premigratory trunk neural crest which gives rise to the sympathetic trunks was used to remove sympathetic cardiac innervation. Neuronal uptake of [3H]-norepinephrine was used as an index of neuronal development in the chick atrium. Following ablation of neural crest over somites 10-15 or 15-20, uptake was significantly decreased in the atrium at 16 and 17 days of development. Ablation of neural crest over somites 5-10 and 20-25 caused no decrease in [3H]-norepinephrine uptake. Removal of neural crest over somites 5-25 or 10-20 caused approximately equal depletions of [3H]-norepinephrine uptake in the atrium. Cardiac norepinephrine concentration was significantly depressed following ablation of neural crest over somites 5-25 but not over somites 10-20. Light-microscopic and histofluorescent preparations confirmed the absence of sympathetic trunks in the region of the normal origin of the sympathetic cardiac nerves following neural crest ablation over somites 10-20. The neural tube and dorsal root ganglia were damaged in the area of the neural-crest ablation; however, all of these structures were normal cranial and caudal to the lesioned area. Development of most of the embryos as well as the morphology of all of the hearts was normal following the lesion. These results indicate that it is possible to produce sympathetically aneural hearts by neural-crest ablation; however, sympathetic cardiac nerves account for an insignificant amount of cardiac norepinephrine

  8. Cerebral embolization during AF ablation �Pathophysiology, Prevention and Management

    Directory of Open Access Journals (Sweden)

    Nasir Shariff, MD

    2013-04-01

    Full Text Available Catheter based ablation therapy has evolved as an invaluable tool in the management of symptomatic patients with atrial fibrillation (AF. The procedure of AF ablation requires instrumentation in the systemic circulation predisposing to various concerns that can result in systemic embolization. We will describe the reported incidence of these events and refer to the various pathophysiologic explanations for their occurrence. Details on the risk factors and the relevant studies will also be reviewed. Preventive and treatment strategies in patients undergoing the ablation procedure will be discussed.

  9. Ablation of incessant ventricular tachycardia by epicardial approach. A case report

    International Nuclear Information System (INIS)

    A ventricular tachycardia (VT) is relentless when it persists longer than 24 hours despite completing treatment with at least two antiarrhythmic drugs, electrical cardioversion (CEV) or overstimulation. It is a dramatic clinical situation, with high mortality. Catheter ablation endocardial using radio frequency is the treatment of choice, although it is a highly complex and procedure with a success rate of between 45% and 75% in different publications. One reason for these results, sometimes discouraging of endocardial ablation, is that circuits of re-entry, basic mechanism of this arrhythmia, often are subepicardicos. We present a case of incessant TV referred to our service in which an epicardial ablation was performed

  10. Thermistor guided radiofrequency ablation of atrial insertion sites in patients with accessory pathways.

    Science.gov (United States)

    Tracy, C M; Moore, H J; Solomon, A J; Rodak, D J; Fletcher, R D

    1995-11-01

    Radiofrequency ablation has gained acceptance in the treatment of patients with symptomatic Wolff-Parkinson-White syndrome. The purpose of this study was to characterize the relation between temperature and other electroconductive parameters in patients undergoing atrial insertion accessory pathway ablation utilizing a thermistor equipped catheter. The mean temperature and power at sites of atrial insertion ablation are lower than has been previously associated with creation of radiofrequency lesions in the ventricle. While high cavitary blood flow in the atrium may result in cooling, the thinner atrial tissue may require less energy to achieve adequate heating than ventricular myocardium.

  11. Catheter-based photoacoustic endoscope

    Science.gov (United States)

    Yang, Joon-Mo; Li, Chiye; Chen, Ruimin; Zhou, Qifa; Shung, K. Kirk; Wang, Lihong V.

    2014-06-01

    We report a flexible shaft-based mechanical scanning photoacoustic endoscopy (PAE) system that can be potentially used for imaging the human gastrointestinal tract via the instrument channel of a clinical video endoscope. The development of such a catheter endoscope has been an important challenge to realize the technique's benefits in clinical settings. We successfully implemented a prototype PAE system that has a 3.2-mm diameter and 2.5-m long catheter section. As the instrument's flexible shaft and scanning tip are fully encapsulated in a plastic catheter, it easily fits within the 3.7-mm diameter instrument channel of a clinical video endoscope. Here, we demonstrate the intra-instrument channel workability and in vivo animal imaging capability of the PAE system.

  12. AF Termination: the Holy Grail of Persistent AF Ablation?

    Directory of Open Access Journals (Sweden)

    Dennis H. Lau

    2010-05-01

    Full Text Available The optimal catheter ablation approach for long-standing persistent atrial fibrillation (AF remains elusive despite significant advances made in our understanding of this arrhythmia. A recent systematic review highlighted the significant variation in procedural success rate both within and between techniques, necessitating repeat ablation procedures and anti-arrhythmic drugs to achieve improved outcomes in those with long-standing persistent AF . Indeed, current expert consensus statement recommended ablation beyond ostial pulmonary vein isolation for these patients . Despite incorporating various substrate modification techniques which commonly include linear lesions and targeting of complex fractionated electrograms, the reported success rates from various laboratories are still below par to those in paroxysmal AF patients.

  13. 21 CFR 882.4100 - Ventricular catheter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ventricular catheter. 882.4100 Section 882.4100...) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4100 Ventricular catheter. (a) Identification. A ventricular catheter is a device used to gain access to the cavities of the brain for...

  14. Effectiveness of different central venous catheters for catheter-related infections: a network meta-analysis.

    Science.gov (United States)

    Wang, H; Huang, T; Jing, J; Jin, J; Wang, P; Yang, M; Cui, W; Zheng, Y; Shen, H

    2010-09-01

    We aimed to compare the effectiveness of various catheters for prevention of catheter-related infection and to evaluate whether specific catheters are superior to others for reducing catheter-related infections. We identified randomised, controlled trials that compared different types of central venous catheter (CVC), evaluating catheter-related infections in a systematic search of articles published from January 1996 to November 2009 via Medline, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. Network meta-analysis with a mixed treatment comparison method using Bayesian Markov Chain Monte Carlo simulation was used to combine direct within-trial, between-treatment comparisons with indirect trial evidence. Forty-eight clinical trials (12 828 CVCs) investigating 10 intervention catheters contributed to the analyses. For prevention of CVC colonisation, adjusted silver iontophoretic catheters (odds ratio: 0.58; 95% confidence interval: 0.33-0.95), chlorhexidine and silver sulfadiazine catheters (0.49; 0.36-0.64), chlorhexidine and silver sulfadiazine blue plus catheters (0.37; 0.17-0.69), minocycline-rifampicin catheters (0.28; 0.17-0.43) and miconazole-rifampicin catheters (0.11; 0.02-0.33) were associated with a significantly lower rate of catheter colonisation compared with standard catheters. For prevention of CRBSI, adjusted heparin-bonded catheters (0.20; 0.06-0.44) and minocycline-rifampicin catheters (0.18; 0.08-0.34) were associated with a significantly lower rate of CRBSI with standard catheters. Rifampicin-based impregnated catheters seem to be better for prevention of catheter-related infection compared with the other catheters.

  15. Which is the appropriate arrhythmia burden to offer RF ablation for RVOT tachycardias?

    Directory of Open Access Journals (Sweden)

    Andreas Rillig; Tina Lin; Feifan Ouyang; Karl-Heinz Kuck; Roland Richard Tilz

    2014-12-01

    Full Text Available Premature ventricular complexes (PVCs and ventricular tachycardia (VT in patients with structurally normal hearts originate from the right ventricular outflow tract (RVOT in the majority of cases. In the last few decades catheter ablation of these arrhythmias has been proven to be effective. RVOT VT/PVCs may cause disabling symptoms or arrhythmia induced cardiomyopathy. However, the PVC burden at which catheter ablation should be recommended is still controversial. What adds to the controversy is why some patients with only a low number of PVCs can be highly symptomatic and may even develop arrhythmia induced cardiomyopathy, whilst others may have a higher PVC/VT burden and remain asymptomatic and do not develop cardiomyopathy for a long period of time. Therefore, although catheter ablation of RVOT PVCs has high success and low complication rates, the time point of when ablation should be recommended is currently still under debate. This review discusses the treatment strategies and prognosis for RVOT tachycardias and focuses on the question of which arrhythmia burden is appropriate to offer RF ablation.

  16. A statistical method for retrospective cardiac and respiratory motion gating of interventional cardiac x-ray images

    Energy Technology Data Exchange (ETDEWEB)

    Panayiotou, Maria, E-mail: maria.panayiotou@kcl.ac.uk; King, Andrew P.; Housden, R. James; Ma, YingLiang; Rhode, Kawal S. [Division of Imaging Sciences and Biomedical Engineering, King' s College London, London SE1 7EH (United Kingdom); Cooklin, Michael; O' Neill, Mark; Gill, Jaswinder; Rinaldi, C. Aldo [Department of Cardiology, Guy' s and St. Thomas' Hospitals NHS Foundation Trust, London SE1 7EH (United Kingdom)

    2014-07-15

    Purpose: Image-guided cardiac interventions involve the use of fluoroscopic images to guide the insertion and movement of interventional devices. Cardiorespiratory gating can be useful for 3D reconstruction from multiple x-ray views and for reducing misalignments between 3D anatomical models overlaid onto fluoroscopy. Methods: The authors propose a novel and potentially clinically useful retrospective cardiorespiratory gating technique. The principal component analysis (PCA) statistical method is used in combination with other image processing operations to make our proposed masked-PCA technique suitable for cardiorespiratory gating. Unlike many previously proposed techniques, our technique is robust to varying image-content, thus it does not require specific catheters or any other optically opaque structures to be visible. Therefore, it works without any knowledge of catheter geometry. The authors demonstrate the application of our technique for the purposes of retrospective cardiorespiratory gating of normal and very low dose x-ray fluoroscopy images. Results: For normal dose x-ray images, the algorithm was validated using 28 clinical electrophysiology x-ray fluoroscopy sequences (2168 frames), from patients who underwent radiofrequency ablation (RFA) procedures for the treatment of atrial fibrillation and cardiac resynchronization therapy procedures for heart failure. The authors established end-systole, end-expiration, and end-inspiration success rates of 97.0%, 97.9%, and 97.0%, respectively. For very low dose applications, the technique was tested on ten x-ray sequences from the RFA procedures with added noise at signal to noise ratio (SNR) values of√(5)0, √(1)0, √(8), √(6), √(5), √(2), and √(1) to simulate the image quality of increasingly lower dose x-ray images. Even at the low SNR value of √(2), representing a dose reduction of more than 25 times, gating success rates of 89.1%, 88.8%, and 86.8% were established. Conclusions: The proposed

  17. A statistical method for retrospective cardiac and respiratory motion gating of interventional cardiac x-ray images

    International Nuclear Information System (INIS)

    Purpose: Image-guided cardiac interventions involve the use of fluoroscopic images to guide the insertion and movement of interventional devices. Cardiorespiratory gating can be useful for 3D reconstruction from multiple x-ray views and for reducing misalignments between 3D anatomical models overlaid onto fluoroscopy. Methods: The authors propose a novel and potentially clinically useful retrospective cardiorespiratory gating technique. The principal component analysis (PCA) statistical method is used in combination with other image processing operations to make our proposed masked-PCA technique suitable for cardiorespiratory gating. Unlike many previously proposed techniques, our technique is robust to varying image-content, thus it does not require specific catheters or any other optically opaque structures to be visible. Therefore, it works without any knowledge of catheter geometry. The authors demonstrate the application of our technique for the purposes of retrospective cardiorespiratory gating of normal and very low dose x-ray fluoroscopy images. Results: For normal dose x-ray images, the algorithm was validated using 28 clinical electrophysiology x-ray fluoroscopy sequences (2168 frames), from patients who underwent radiofrequency ablation (RFA) procedures for the treatment of atrial fibrillation and cardiac resynchronization therapy procedures for heart failure. The authors established end-systole, end-expiration, and end-inspiration success rates of 97.0%, 97.9%, and 97.0%, respectively. For very low dose applications, the technique was tested on ten x-ray sequences from the RFA procedures with added noise at signal to noise ratio (SNR) values of√(5)0, √(1)0, √(8), √(6), √(5), √(2), and √(1) to simulate the image quality of increasingly lower dose x-ray images. Even at the low SNR value of √(2), representing a dose reduction of more than 25 times, gating success rates of 89.1%, 88.8%, and 86.8% were established. Conclusions: The proposed

  18. Cytometric Catheter for Neurosurgical Applications

    Energy Technology Data Exchange (ETDEWEB)

    Evans III, Boyd Mccutchen [ORNL; Allison, Stephen W [ORNL; Fillmore, Helen [ORNL; Broaddus, William C [ORNL; Dyer, Rachel L [ORNL; Gillies, George [ORNL

    2010-01-01

    Implantation of neural progenitor cells into the central nervous system has attracted strong interest for treatment of a variety of pathologies. For example, the replacement of dopamine-producing (DA) neural cells in the brain appears promising for the treatment of patients affected by Parkinson's disease. Previous studies of cell-replacement strategies have shown that less than 90% of implanted cells survive longer than 24 - 48 hours following the implantation procedure. However, it is unknown if these cells were viable upon delivery, or if they were affected by other factors such as brain pathology or an immune response. An instrumented cell-delivery catheter has been developed to assist in answering these questions by facilitating quantification and monitoring of the viability of the cells delivered. The catheter uses a fiber optic probe to perform flourescence-based cytometric measurments on cells exiting the port at the catheter tip. The current implementation of this design is on a 3.2 mm diameter catheter with 245 micrometer diameter optical fibers. Results of fluorescence testing data are presented and show that the device can characterize the quantity of cell densities ranging from 60,000 cells/ml to 600,000 cells/ml with a coefficient of determination of 0.93.

  19. Transhepatic venous catheters for hemodialysis

    Directory of Open Access Journals (Sweden)

    Mohamed El Gharib

    2014-06-01

    Conclusion: Based on our findings, transhepatic hemodialysis catheters have proven to achieve good long-term functionality. A high level of maintenance is required to preserve patency, although this approach provides remarkably durable access for patients who have otherwise exhausted access options.

  20. Delayed bowel perforation following suprapubic catheter insertion

    Directory of Open Access Journals (Sweden)

    Mehta Ajay

    2004-12-01

    Full Text Available Abstract Background Complications of suprapubic catheter insertion are rare but can be significant. We describe an unusual complication of a delayed bowel perforation following suprapubic catheter insertion. Case presentation A gentleman presented with features of peritonitis and feculent discharge along a suprapubic catheter two months after insertion of the catheter. Conclusion Bowel perforation is the most feared complication of suprapubic catheter insertion especially in patients with lower abdominal scar. The risk may be reduced with the use of ultrasound scan guidance.

  1. Lung Ablation: Whats New?

    Science.gov (United States)

    Xiong, Lillian; Dupuy, Damian E

    2016-07-01

    Lung cancer had an estimated incidence of 221,200 in 2015, making up 13% of all cancer diagnoses. Tumor ablation is an important treatment option for nonsurgical lung cancer and pulmonary metastatic patients. Radiofrequency ablation has been used for over a decade with newer modalities, microwave ablation, cryoablation, and irreversible electroporation presenting as additional and possibly improved treatment options for patients. This minimally invasive therapy is best for small primary lesions or favorably located metastatic tumors. These technologies can offer palliation and sometimes cure of thoracic malignancies. This article discusses the current available technologies and techniques available for tumor ablation. PMID:27050331

  2. A cost effectiveness based safety and efficacy study of resterilized intra-parenchymal catheter based intracranial pressure monitoring in developing world

    Science.gov (United States)

    Gupta, Deepak Kumar; Bisht, Ajay; Batra, Priyam; Mathur, Purva; Mahapatra, Ashok Kumar

    2016-01-01

    Background: The management of traumatic brain injury (TBI) aims to maintain the normal cerebral perfusion in spite of the mass lesions that may occur (haematoma, contusion, and oedema). The monitoring of the intracranial pressure (ICP) is a step in that direction. The intra-parenchymal catheters have the lowest incidence of infection compared to intra-ventricular/subdural catheters with reliable and accurate pressure recordings. The major disadvantage of the intra-parenchymal catheters is the cost, especially in developing nations. Hypothesis: Resterilized intra-parenchymal strain gauge catheters can be used safely for ICP monitoring without any added risk of meningitis. The reusage of catheters can bring down the costs. Resterilized catheters/equipment have been approved for usage in cardiac usage, but such study on ICP catheters has not been carried out so far in any part of the world. Methodology: A total of 100 consecutive cases of severe TBI receiving ICP monitoring at a level 1 trauma center of a developing nation were prospectively studied (34 cases had fresh catheters, and 66 had resterilized [using ethylene oxide] catheters). Observations: The use of reused resterilized catheters was not associated with increased incidence of meningitis or fever (the surrogate marker for infection in this study). Also, there was concordance between the pressure recording of reused catheters and operative finding/subsequent computed tomography scans. These catheters after sterilization could be reused 2–4 times and reliably recorded the ICP (insignificant drift) with no increase in the incidence of meningitis. Conclusions: Usage of resterilized intra-parenchymal ICP catheters is feasible, safe, efficacious, and cost effective and brings down the cost of monitoring significantly.

  3. A cost effectiveness based safety and efficacy study of resterilized intra-parenchymal catheter based intracranial pressure monitoring in developing world

    Science.gov (United States)

    Gupta, Deepak Kumar; Bisht, Ajay; Batra, Priyam; Mathur, Purva; Mahapatra, Ashok Kumar

    2016-01-01

    Background: The management of traumatic brain injury (TBI) aims to maintain the normal cerebral perfusion in spite of the mass lesions that may occur (haematoma, contusion, and oedema). The monitoring of the intracranial pressure (ICP) is a step in that direction. The intra-parenchymal catheters have the lowest incidence of infection compared to intra-ventricular/subdural catheters with reliable and accurate pressure recordings. The major disadvantage of the intra-parenchymal catheters is the cost, especially in developing nations. Hypothesis: Resterilized intra-parenchymal strain gauge catheters can be used safely for ICP monitoring without any added risk of meningitis. The reusage of catheters can bring down the costs. Resterilized catheters/equipment have been approved for usage in cardiac usage, but such study on ICP catheters has not been carried out so far in any part of the world. Methodology: A total of 100 consecutive cases of severe TBI receiving ICP monitoring at a level 1 trauma center of a developing nation were prospectively studied (34 cases had fresh catheters, and 66 had resterilized [using ethylene oxide] catheters). Observations: The use of reused resterilized catheters was not associated with increased incidence of meningitis or fever (the surrogate marker for infection in this study). Also, there was concordance between the pressure recording of reused catheters and operative finding/subsequent computed tomography scans. These catheters after sterilization could be reused 2–4 times and reliably recorded the ICP (insignificant drift) with no increase in the incidence of meningitis. Conclusions: Usage of resterilized intra-parenchymal ICP catheters is feasible, safe, efficacious, and cost effective and brings down the cost of monitoring significantly. PMID:27695548

  4. Catheter-Based Ultrasound for 3D Control of Thermal Therapy

    Science.gov (United States)

    Diederich, Chris; Chen, Xin; Wootton, Jeffery; Juang, Titania; Nau, Will H.; Kinsey, Adam; Hsu, I.-Chow; Rieke, Viola; Pauly, Kim Butts; Sommer, Graham; Bouley, Donna

    2009-04-01

    Catheter-based ultrasound applicators have been investigated for delivering hyperthermia and thermal ablation for the treatment of cancer and benign diseases. Technology includes an intrauterine applicator integrated with an HDR ring applicator, interstitial applicators for hyperthermia delivery during brachytherapy, interstitial applicators for tumor ablation, and transurethral devices for conformal prostate ablation. Arrays of multiple sectored tubular transducers have been fabricated for interstitial and intrauterine hyperthermia applicators. High-power interstitial versions have been evaluated for percutaneous implantation with directional or dynamic angular control of thermal ablation. Transurethral applicators include curvilinear transducers with rotational sweeping of narrow heating patterns, and multi-sectored tubular devices capable of dynamic angular control without applicator movement. Performance was evaluated in phantom, excised tissue, in vivo experiments in canine prostate under MR temperature monitoring, clinical hyperthermia, and 3D-biothermal simulations with patient anatomy. Interstitial and intrauterine devices can tailor hyperthermia to large treatment volumes, with multisectored control useful to limit exposure to rectum and bladder. Curvilinear transurethral devices with sequential rotation produce target conforming coagulation zones that can cover either the whole gland or defined focal regions. Multi-sectored transurethral applicators can dynamically control the angular heating profile and target large regions of the prostate without applicator manipulation. High-power interstitial implants with directional devices can be used to effectively ablate defined target regions while avoiding sensitive tissues. MR temperature monitoring can effectively define the extent of thermal damage and provided a means for real-time control of the applicators. In summary, these catheter-based ultrasound devices allow for dynamic control of heating profiles

  5. Influencing factors of life qualities of children and adolescents with congenital heart disease received cardiac catheter interventional treatment%儿童和青少年先天性心脏病患者介入治疗后生存质量的影响因素研究

    Institute of Scientific and Technical Information of China (English)

    林平; 李玲; 高学琴

    2012-01-01

    Objective To explore the ifluencing factors of life qualities of children and adolescents with congenital heart disease received cardiac catheter interventional treatment and to provide theoretical guidance for formulating targeted nursing strategies,so as to improve their quality of life.Methods Totals of 96children and adolescences who underwent cardiac catheter interventional treatment were recruited from a hospital' s department of cardiology in Harbin city,Heilongjiang province.Pediatric quality of life inventory Generic Core Scales Version 4.0 and self-designed questionnaire including demographic data and possible influencing factors were used to investigated,respectively in 24 hours pre - treatment,1 month and 6 months post - treatment.Results The total score of PedsQLTM4.0 was ( 67.38 ± 15.31 ) before treatment,and (76.55 ±11.37 ),(80.47 ± 9.69 )after received treatment one months and six months later,respectively.The statistical data showed that patients' age,state of the household economy,social assistance influenced with total score of life quality (t =-3.26,2.58,2.73,2.54,2.37,respectively,P < 0.05 ) and state of the household economy,family relationship,parenting style were influenced factors for physiology function of patients ( t =2.92,3.40,-1.51,-2.86,-3.66,respectively; P<0.05 ).Patients age,self-care ability,parents cognition had effect on psychosocial functioning of quality of life for children and adolescences with congenital heart disease ( t =- 2.31,1.80,-1.40,2.64,respectively; P<0.05 ).Conclusions Patients' age,self-care ability,state of the household economy,parenting style,family relationship,parents' cognitive and social assistance have effect on quality of life of children and adolescences with congenital heart disease.So we should pay attention to conduct targeted nursing interventions for both patients and their families to improve their quality of life.%目的 探讨儿童和青少年先天性心脏病患者介入治疗后

  6. Optimization of the generator settings for endobiliary radiofrequency ablation

    Institute of Scientific and Technical Information of China (English)

    Maximilien; Barret; Sarah; Leblanc; Ariane; Vienne; Alexandre; Rouquette; Frederic; Beuvon; Stanislas; Chaussade; Frederic; Prat

    2015-01-01

    AIM:To determine the optimal generator settings for endobiliary radiofrequency ablation. METHODS:Endobiliary radiofrequency ablation was performed in live swine on the ampulla of Vater,the common bile duct and in the hepatic parenchyma. Radiofrequency ablation time,"effect",and power were allowed to vary. The animals were sacrificed two hours after the procedure. Histopathological assessment of the depth of the thermal lesions was performed. RESULTS:Twenty-five radiofrequency bursts were applied in three swine. In the ampulla of Vater(n = 3),necrosis of the duodenal wall was observed starting with an effect set at 8,power output set at 10 W,and a 30 s shot duration,whereas superficial mucosal damage of up to 350 μm in depth was recorded for an effect set at 8,power output set at 6 W and a 30 s shot duration. In the common bile duct(n = 4),a 1070 μm,safe and efficient ablation was obtained for an effect set at 8,a power output of 8 W,and an ablation time of 30 s. Within the hepatic parenchyma(n = 18),the depth of tissue damage varied from 1620 μm(effect = 8,power = 10 W,ablation time = 15 s) to 4480 μm(effect = 8,power = 8 W,ablation time = 90 s). CONCLUSION:The duration of the catheter application appeared to be the most important parameter influencing the depth of the thermal injury during endobiliary radiofrequency ablation. In healthy swine,the currently recommended settings of the generator may induce severe,supratherapeutic tissue damage in the biliary tree,especially in the high-risk area of the ampulla of Vater.

  7. Cardiac arrest

    Science.gov (United States)

    ... Article.jsp. Accessed June 16, 2014. Myerburg RJ, Castellanos A. Approach to cardiac arrest and life-threatening ... PA: Elsevier Saunders; 2011:chap 63. Myerburg RJ, Castellanos A. Cardiac arrest and audden aardiac death. In: ...

  8. Comparison of the Outcomes of Monopolar and Bipolar Radiofrequency Ablation in Surgical Treatment of Atrial Fibrillation

    Institute of Scientific and Technical Information of China (English)

    Wei-zhao Huang; Ying-meng Wu; Hong-yu Ye; Hai-ming Jiang

    2014-01-01

    Objective To compare the therapeutic effects and safety of monopolar and bipolar radiofrequency (RF) ablation used during cardiac surgery to treat atrial fibrillation. Methods We retrospectively studied a total of 81 patients with chronic atrial fibrillation who underwent open cardiac surgery with concomitant RF ablation between January 2007 and March 2011. Fifty-eight patients received bipolar RF ablation and 23 received monopolar RF ablation, respectively. The sinus rhythm restoration rate, the procedural duration, the frequency of severe perioperative complications, and mortality were compared between the two groups. Results The sinus rhythm restoration rate did not differ significantly between the two groups after follow-up of 15.1 ± 12.6 months (P=0.199). The frequencies of severe perioperative complications and mortality were also similar in the two groups. The total procedural time using bipolar RF ablation was significantly shorter than that using monopolar ablation (19.7±4.6 minutes vs. 28.1±8.5 minutes, P Conclusions Both monopolar and bipolar RF ablation are safe and effective in treating chronic atrial fibrillation patients during open cardiac surgery, but bipolar RF ablation is more convenient in practice.

  9. Laser ablation principles and applications

    CERN Document Server

    1994-01-01

    Laser Ablation provides a broad picture of the current understanding of laser ablation and its many applications, from the views of key contributors to the field. Discussed are in detail the electronic processes in laser ablation of semiconductors and insulators, the post-ionization of laser-desorbed biomolecules, Fourier-transform mass spectroscopy, the interaction of laser radiation with organic polymers, laser ablation and optical surface damage, laser desorption/ablation with laser detection, and laser ablation of superconducting thin films.

  10. The Role of Contact Force in Atrial Fibrillation Ablation

    Directory of Open Access Journals (Sweden)

    Hiroshi Nakagawa; Warren M. Jackman

    2014-06-01

    Full Text Available During radiofrequency (RF ablation, low electrode-tissue contact force (CF is associated with ineffective RF lesion formation, whereas excessive CF may increase the risk of steam pop and perforation. Recently, ablation catheters using two technologies have been developed to measure real-time catheter-tissue CF. One catheter uses three optical fibers to measure microdeformation of a deformable body in the catheter tip. The other catheter uses a small spring connecting the ablation tip electrode to the catheter shaft with a magnetic transmitter and sensors to measure microdeflection of the spring. Pre-clinical experimental studies have shown that 1 at constant RF power and application time, RF lesion size significantly increases with increasing CF; 2 the incidence of steam pop and thrombus also increase with increasing CF; 3 modulating RF power based on CF (i.e, high RF power at low CF and lower RF power at high CF results in a similar and predictable RF lesion size. In clinical studies in patients undergoing pulmonary vein (PV isolation, CF during mapping in the left atrium and PVs showed a wide range of CF and transient high CF. The most common high CF site was located at the anterior/rightward left atrial roof, directly beneath the ascending aorta. There was a poor relationship between CF and previously used surrogate parameters for CF (unipolar or bipolar atrial potential amplitude and impedance. Patients who underwent PV isolation with an average CF of 20g had lower AF recurrence. AF recurred within 12 months in 6 of 8 patients (75% who had a mean Force-Time Integral (FTI, area under the curve for contact force vs. time 1000 gs. In another study, controlling RF power based on CF prevented steam pop and impedance rise without loss of lesion effectiveness. These studies confirm that CF is a major determinant of RF lesion size and future systems combining CF, RF power and application time may provide real-time assessment of lesion formation

  11. 3D model-based catheter tracking for motion compensation in EP procedures

    Science.gov (United States)

    Brost, Alexander; Liao, Rui; Hornegger, Joachim; Strobel, Norbert

    2010-02-01

    Atrial fibrillation is the most common sustained heart arrhythmia and a leading cause of stroke. Its treatment by radio-frequency catheter ablation, performed using fluoroscopic image guidance, is gaining increasingly more importance. Two-dimensional fluoroscopic navigation can take advantage of overlay images derived from pre-operative 3-D data to add anatomical details otherwise not visible under X-ray. Unfortunately, respiratory motion may impair the utility of these static overlay images for catheter navigation. We developed an approach for image-based 3-D motion compensation as a solution to this problem. A bi-plane C-arm system is used to take X-ray images of a special circumferential mapping catheter from two directions. In the first step of the method, a 3-D model of the device is reconstructed. Three-dimensional respiratory motion at the site of ablation is then estimated by tracking the reconstructed catheter model in 3-D. This step involves bi-plane fluoroscopy and 2-D/3-D registration. Phantom data and clinical data were used to assess our model-based catheter tracking method. Experiments involving a moving heart phantom yielded an average 2-D tracking error of 1.4 mm and an average 3-D tracking error of 1.1 mm. Our evaluation of clinical data sets comprised 469 bi-plane fluoroscopy frames (938 monoplane fluoroscopy frames). We observed an average 2-D tracking error of 1.0 mm +/- 0.4 mm and an average 3-D tracking error of 0.8 mm +/- 0.5 mm. These results demonstrate that model-based motion-compensation based on 2-D/3-D registration is both feasible and accurate.

  12. Ablation of Myocardial Tissue With Nanosecond Pulsed Electric Fields.

    Directory of Open Access Journals (Sweden)

    Fei Xie

    Full Text Available Ablation of cardiac tissue is an essential tool for the treatment of arrhythmias, particularly of atrial fibrillation, atrial flutter, and ventricular tachycardia. Current ablation technologies suffer from substantial recurrence rates, thermal side effects, and long procedure times. We demonstrate that ablation with nanosecond pulsed electric fields (nsPEFs can potentially overcome these limitations.We used optical mapping to monitor electrical activity in Langendorff-perfused New Zealand rabbit hearts (n = 12. We repeatedly inserted two shock electrodes, spaced 2-4 mm apart, into the ventricles (through the entire wall and applied nanosecond pulsed electric fields (nsPEF (5-20 kV/cm, 350 ns duration, at varying pulse numbers and frequencies to create linear lesions of 12-18 mm length. Hearts were stained either with tetrazolium chloride (TTC or propidium iodide (PI to determine the extent of ablation. Some stained lesions were sectioned to obtain the three-dimensional geometry of the ablated volume.In all animals (12/12, we were able to create nonconducting lesions with less than 2 seconds of nsPEF application per site and minimal heating (< 0.2°C of the tissue. The geometry of the ablated volume was smoother and more uniform throughout the wall than typical for RF ablation. The width of the lesions could be controlled up to 6 mm via the electrode spacing and the shock parameters.Ablation with nsPEFs is a promising alternative to radiofrequency (RF ablation of AF. It may dramatically reduce procedure times and produce more consistent lesion thickness than RF ablation.

  13. Ablation of Myocardial Tissue With Nanosecond Pulsed Electric Fields

    Science.gov (United States)

    Xie, Fei; Varghese, Frency; Pakhomov, Andrei G.; Semenov, Iurii; Xiao, Shu; Philpott, Jonathan; Zemlin, Christian

    2015-01-01

    Background Ablation of cardiac tissue is an essential tool for the treatment of arrhythmias, particularly of atrial fibrillation, atrial flutter, and ventricular tachycardia. Current ablation technologies suffer from substantial recurrence rates, thermal side effects, and long procedure times. We demonstrate that ablation with nanosecond pulsed electric fields (nsPEFs) can potentially overcome these limitations. Methods We used optical mapping to monitor electrical activity in Langendorff-perfused New Zealand rabbit hearts (n = 12). We repeatedly inserted two shock electrodes, spaced 2–4 mm apart, into the ventricles (through the entire wall) and applied nanosecond pulsed electric fields (nsPEF) (5–20 kV/cm, 350 ns duration, at varying pulse numbers and frequencies) to create linear lesions of 12–18 mm length. Hearts were stained either with tetrazolium chloride (TTC) or propidium iodide (PI) to determine the extent of ablation. Some stained lesions were sectioned to obtain the three-dimensional geometry of the ablated volume. Results In all animals (12/12), we were able to create nonconducting lesions with less than 2 seconds of nsPEF application per site and minimal heating (< 0.2°C) of the tissue. The geometry of the ablated volume was smoother and more uniform throughout the wall than typical for RF ablation. The width of the lesions could be controlled up to 6 mm via the electrode spacing and the shock parameters. Conclusions Ablation with nsPEFs is a promising alternative to radiofrequency (RF) ablation of AF. It may dramatically reduce procedure times and produce more consistent lesion thickness than RF ablation. PMID:26658139

  14. Transhepatic venous catheters for hemodialysis

    OpenAIRE

    Mohamed El Gharib; Gamal Niazi; Waleed Hetta; Yahya Makkeyah

    2014-01-01

    Purpose: To describe our experience with the technique of transhepatic venous access for hemodialysis and to evaluate its functionality and complications. Patients and methods: From March 2012 till October 2012, 23 patients with age ranging from 12 to 71 years old having end-stage renal disease (ESRD) were included in our study and were subjected to transhepatic venous catheter insertion. In 21 patients there were not any remaining patent peripheral venous accesses. In 2 patients there wer...

  15. Advantages of a workbench reshaped AR1 mod catheter for right coronary angiography by right radial approach.

    Science.gov (United States)

    Baldi, Cesare; Mirra, Marco; Di Maio, Marco; Attisano, Tiziana; Di Muro, Michele Roberto; Vigorito, Francesco; Farina, Rosario; Polito, Maria Vincenza; Giudice, Pietro; Piscione, Federico

    2014-03-01

    Transradial approach in cardiac catheterization is increasing. In daily practice, coronary angiography via radial artery is usually performed by using catheters designed for femoral approach. The aim of this study was to evaluate advantages in the use of a workbench reshaped AR1 mod catheter, in terms of procedural duration time, number of catheters per procedure, fluoroscopy time, contrast agent administered volume, images quality and costs. Two hundred patients, submitted to coronary angiography via right radial artery in our institution, have been retrospectively reviewed. Patients have been divided in two groups, depending on whether a workbench reshaped Cordis Amplatz AR1 mod catheter (rAR1 mod), or catheters in their original shape (OC) have been employed. In the rAR1 mod group (100 patients) a lower number of catheters per procedure (1.07 ± 0.25 vs. 1.47 ± 1.65; p right coronary selective engagement (76.76% vs. 53.12%; p right coronary angiography via right radial approach is performed, the utilization of rAR1 mod catheter correlates with multiple advantages in terms of procedural parameters.

  16. [RADIOFREQUENCY ABLATION FOR THE TREATMENT OF VARICOSE VEINS].

    Science.gov (United States)

    Sugiyama, Satoru; Miyade, Yoshio; Inaki, Yasuhiko

    2015-05-01

    Significant advances in the endovenous technique for treating incompetent saphenous veins could change the surgical strategy in patients with varicose veins. Radiofrequency ablation (RFA) was approved as a new technique for the treatment of varicose veins in Japan in June 2014. In RFA, the ablation temperature is controlled by a sensor at the upper end of the catheter. The vein wall is heated with stable conductive power of 120 degrees C, resulting in endothelial denudation. The RFA method was approved in 1998 in Europe and in 1999 in the USA. The ClosurePLUS catheter was developed in 2003 and ClosureFAST in 2006. High occlusion rates and lower postoperative complication rates were reported with ClosureFAST than with ClosurePLUS. It is expected that this new ablation technique will control saphenous vein reflux with less pain and less ecchymosis after surgery. The treatment of varicose veins is less invasive with RFA devices and will become widely accepted as an alternative to conventional surgery for varicose veins in Japan.

  17. Epicardial Ventricular Tachycardia Ablation: Clinical Practice and Recent Developments

    Directory of Open Access Journals (Sweden)

    Michalis Efremidis MD

    2011-08-01

    Full Text Available Mapping and radiofrequency (RF catheter ablation of ventricular tachycardia (VT is a demanding procedure, with variable success rates (1. The presence of deep subendocardial or epicardial re-entry circuits is regarded as one of the reasons of failure of endocardial ablation, and these circuits have been acknowledged in ischemic and non-ischemic dilated cardiomyopathy (CMP, other types of CMP and especially in arrhythmogenic right ventricular cardiomyopathy (ARVC.The significance of epicardial VT circuits was brought to light in Chagas’ disease, which characteristically results in epicardial involvement in approximately 70% of patients (2. A recent study found one third of VTs to be epicardial in origin among patients with nonischemic CMP, about double the incidence among those with ischemic heart disease(3. Mapping and ablation of these epicardial circuits is quite exigent. Although coronary veins can be used to perform epicardial mapping, the manipulation of the catheter is strictly limited to the anatomical distribution of these vessels. Thus, the subxiphoid percutaneous approach to the pericardial space is the only technique that allows extensive, unhampered mapping of the epicardial surface of both ventricles.

  18. Cardiac factors in orthostatic hypotension

    Science.gov (United States)

    Löllgen, H.; Dirschedl, P.; Koppenhagen, K.; Klein, K. E.

    Cardiac function is determined by preload, afterload, heart rate and contractility. During orthostatic stress, the footward blood shift is compensated for by an increase of afterload. LBNP is widely used to analyze effects of volume displacement during orthostatic stress. Comparisons of invasive ( right heart catheterization) and non-invasive approach (echocardiography) yielded similar changes. Preload and afterload change with graded LBNP, heart rate increases, and stroke volume and cardiac output decrease. Thus, the working point on the left ventricular function curve is shifted to the left and downward, similar to hypovolemia. However, position on the Frank-Starling curve, the unchanged ejection fraction, and the constant Vcf indicate a normal contractile state during LBNP. A decrease of arterial oxygen partial pressure during LBNP shwos impaired ventilation/perfusion ratio. Finally, LBNP induced cardiac and hemodynamic changes can be effectively countermeasured by dihydroergotamine, a potent venoconstrictor. Comparison of floating catheter data with that of echocardiography resulted in close correlation for cardiac output and stroke volume. In addition, cardiac dimensions changed in a similar way during LBNP. From our findings, echocardiography as a non-invasive procedure can reliably used in LBNP and orthostatic stress tests. Some informations can be obtained on borderline values indicating collaps or orthostatic syncope. Early fainters can be differentiated from late fainters by stroke volume changes.

  19. Kredsløbsmonitorering af kritisk syge patienter med "pulse contour cardiac output"-systemet

    DEFF Research Database (Denmark)

    Afshari, Arash; Perner, Anders; Bonde, Jan

    2006-01-01

    The Pulse Contour Cardiac Output (PiCCO) monitoring system measures cardiac output with high precision and accuracy. The system may replace the pulmonary artery catheter in most critically ill patients because the rate of serious complications may be lower. Whether the use of dynamic or static...

  20. Electrophysiological Cardiac Modeling: A Review.

    Science.gov (United States)

    Beheshti, Mohammadali; Umapathy, Karthikeyan; Krishnan, Sridhar

    2016-01-01

    Cardiac electrophysiological modeling in conjunction with experimental and clinical findings has contributed to better understanding of electrophysiological phenomena in various species. As our knowledge on underlying electrical, mechanical, and chemical processes has improved over time, mathematical models of the cardiac electrophysiology have become more realistic and detailed. These models have provided a testbed for various hypotheses and conditions that may not be easy to implement experimentally. In addition to the limitations in experimentally validating various scenarios implemented by the models, one of the major obstacles for these models is computational complexity. However, the ever-increasing computational power of supercomputers facilitates the clinical application of cardiac electrophysiological models. The potential clinical applications include testing and predicting effects of pharmaceutical agents and performing patient-specific ablation and defibrillation. A review of studies involving these models and their major findings are provided.

  1. Infections associated with the central venous catheters.

    Science.gov (United States)

    Drasković, Biljana; Fabri, Izabella; Benka, Anna Uram; Rakić, Goran

    2014-01-01

    Central venous catheters are of an essential importance to critically ill patients who require long-term venous access for various purposes. Their use made the treatment much easier, but still they are not harmless and are prone to numerous complications. Catheter infections represent the most significant complication in their use. The frequency of infections varies in different patient care settings, but their appearance mostly depends on the patient's health condition, catheter insertion time, localization of the catheter and type of the used catheter. Since they are one of the leading causes of nosocomial infections and related to significant number of morbidity and mortality in intensive care units, it is very important that maximal aseptic precautions are taken during the insertion and the maintenance period. Prevention of infection of the central venous catheters demands several measures that should be applied routinely.

  2. A Numerical Investigation of Heat Transfer Cardiac Output Measurements

    OpenAIRE

    Fotheringham, P.; A R Gourlay; McKee, S.; Andrews, S

    2005-01-01

    Measurement of cardiac output is often investigated using a technique based on hot-film anemometry. Here, we discuss a modification to hot-film anemometry, which involves a cylindrical heating element mounted flush on the surface of a typical Swan-Ganz catheter. In contrast to traditional thermodilution, the method discussed here has the potential to allow continuous monitoring of cardiac output.This paper demonstrates that there is a simple approximate relationship between the power input to...

  3. Flush Foley's catheter: The most easy way

    OpenAIRE

    Vijay P. Agrawal

    2013-01-01

    Introduction: Foley catheters are used for monitoring urine output in anesthetized patients, comatose patients, incontinent patients, acute urinary retention, paralysed patients, trauma patients, urethral surgeries, ureterectomy, kidney disease, before and after cesarean sections etc. When a Foley catheter becomes clogged, it can cause various complications. For which it is flushed or replaced.Objectives: To find a simple way to flush a Foleys catheter.Material & Methods: Patient was expl...

  4. A case of misplaced permacath dialysis catheter

    Directory of Open Access Journals (Sweden)

    Mohammed Arshad Ali

    2015-01-01

    Full Text Available Central venous placement using ultrasound has significantly reduced the complications associated with blind puncture. The central venous catheter can still get misplaced if it follows an anomalous route after appropriate puncture of desired vessel. We report a case of misplaced dialysis catheter into the accessory hemiazygos vein which resulted in a large hemothorax, and we recommend the routine use of a fluoroscope for placement of dialysis catheters so as to avoid serious complications.

  5. Guide Wire Induced Cardiac Tamponade: The Soft J Tip Is Not So Benign

    Directory of Open Access Journals (Sweden)

    Sankalp Dwivedi

    2016-01-01

    Full Text Available Central venous catheter (CVC insertion rarely causes cardiac tamponade due to perforation. Although it is a rare complication, it can be lethal if not identified early. We report a case of cardiac tamponade caused by internal jugular (IJ central venous catheter (CVC insertion using a soft J-tipped guide wire which is considered safe and rarely implicated with cardiac tamponade. A bedside transthoracic echocardiogram (TTE revealed a pericardial effusion with tamponade. An emergent bedside pericardiocentesis was done revealing bloody fluid and resulted in clinical stabilization.

  6. Impact of different catheter lock strategies on bacterial colonization of permanent central venous hemodialysis catheters.

    Science.gov (United States)

    Erb, Stefan; Widmer, Andreas F; Tschudin-Sutter, Sarah; Neff, Ursula; Fischer, Manuela; Dickenmann, Michael; Grosse, Philipp

    2013-12-01

    Thirty-nine hemodialysis patients with permanent central venous catheters were analyzed for bacterial catheter colonization comparing different catheter-lock strategies. The closed needleless Tego connector with sodium chloride lock solution was significantly more frequently colonized with bacteria than the standard catheter caps with antimicrobially active citrate lock solution (odds ratio, 0.22 [95% confidence interval, 0.07-0.71]; P = .011).

  7. Investigation and analysis of postoperative cardiac venous catheter-related bloodstream infections in children with congenital heart disease%先天性心脏病患儿术后中心静脉导管相关性血流感染的调查分析

    Institute of Scientific and Technical Information of China (English)

    贾鹏; 黄睿; 李刚; 刘斌

    2015-01-01

    OBJECTIVE To investigate postoperative central venous catheter‐related bloodstream infections in children with congenital heart disease as well as the distribution of pathogenic bacteria ,so as to provide the basis for reducing infection rates .METHODS A total of 617 children with congenital heart disease who underwent surgical treatment in the cardiology center during May 2011 to Mar .2013 were enrolled .The targeted monitoring of central venous catheter‐related bloodstream infections was performed , and the infection incidence and the pathogen distribution were investigated .RESULTS Among the 617 children who underwent cardiac surgery and had indwelling central venous catheters ,12 cases of related bloodstream infections occurred ,the incidence was 1 .94% .Three cases (25 .00% ) had related bloodstream infections occurring in 7 days ,7 cases (58 .33% ) in 8 - 15 days and 2 cases (16 .67% ) after 15 days .Totally 21 pathogens were detected ,including 12 gram‐negative bacteria accounting for 57 .14% and 9 gram‐positive bacteria accounting for 42 .86% ,among which Acinetobacter baumannii ,Pseudomonas aeruginosa ,Staphylococcus aureus accounted for the top three .CONCLUSION The rate of postoperative central venous catheter‐related bloodstream infections in children with congenital heart disease is relatively high .In the course of treatment ,health care workers should be strictly in accordance with the instruc‐tion manual ,implement proactive measures to prevent infection in children ,reduce central venous catheter‐related bloodstream infections ,shorten hospital stay in children and reduce mortality .%目的:探讨先天性心脏病患儿术后中心静脉导管(CVC)相关性血流感染以及病原菌分布,为临床降低其感染率提供依据。方法选取2011年5月-2013年3月心脏病治疗中心收治的617例实施手术治疗的先天性心脏病患儿,进行中心静脉导管相关血流感染目标性监测,调查研究感

  8. Conduction recovery in patients with recurrent atrial fibrillation after pulmonary vein isolation using multi-electrode duty cycled radiofrequency ablation

    NARCIS (Netherlands)

    Balt, J.C.; Karadavut, S.; Mulder, A.A.W.; Luermans, J.G.; Wijffels, M.C.; Boersma, L.V.

    2013-01-01

    INTRODUCTION: The pulmonary vein ablation catheter (PVAC) is designed for pulmonary vein isolation (PVI). Electrical reconnection of pulmonary veins is believed to result in AF recurrence. The purpose of this study was to establish the location and extent of PV reconnection after PVI with the PVAC c

  9. Completely thoracoscopic pulmonary vein isolation with ganglionic plexus ablation and left atrial appendage amputation for treatment of atrial fibrillation

    NARCIS (Netherlands)

    A. Yilmaz; G.S.C. Geuzebroek; B.P. van Putte; L.V.A. Boersma; U. Sonker; J.M.T. de Bakker; W.J. van Boven

    2010-01-01

    Objective: Percutaneous catheter pulmonary vein isolation (PVI) has been the preferred choice for invasive treatment of symptomatic, drug-refractory lone atrial fibrillation (AF). Incomplete ablation lines, procedure-related morbidity and long-term success remain, however, a problem. A minimally inv

  10. Cardiac arrythmias

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    950269 Radiofrequency ablation of atrioventricularaccessory pathways in treating supraventricular tachy-cardia.LI Zhongcheng(李忠诚),et al.Dept Cardiol,2nd Affili Hosp,Tianjin Med Univ.Tianjin,300000.Tianjin Med J 1994;22(12):707-709Twenty-nine atrioventricular accessory pathwaysin 27 patients with WPW syndrome were ablated withradiofrequency current.It included 15 males and 12fameles,aged 19~63(37.8±17.8) years old,13 cases

  11. Emergency bypass post percutaneous atrial ablation: a case report.

    LENUS (Irish Health Repository)

    Hargrove, M

    2010-11-01

    A 34-year-old male undergoing percutaneous atrial ablation procedure for paroxysmal fibrillation required emergency sternotomy for cardiac tamponade. The patient had been anticoagulated and had received plavix and aspirin prior to and during the ablation procedure. Seven units of red cell concentrate had been transfused in the cardiac catherisation laboratory. On arrival in theatre, the patient was hypotensive, but was awake on induction of anaesthesia. No recordable blood pressure with non-invasive monitoring was observed. A sternotomy was immediately performed and, on evacuation of the pericardium, a bleeding site was not visible. The patient was commenced on cardiopulmonary bypass. Bleeding site was identified and the defect closed. The patient was weaned from cardiopulmonary bypass with minimal inotropic support and made an uneventful recovery. Bypass time was 38 minutes. A literature review showed a 1% incidence of post-ablation bleeding(1). The incidence of reverting to bypass for such an event has not been reported previously. During these procedures, it might be wise to have the cardiothoracic team notified while atrial ablation procedures are being performed in the cardiac catheterization laboratory.

  12. Cryo-Balloon Catheter Localization Based on a Support-Vector-Machine Approach.

    Science.gov (United States)

    Kurzendorfer, Tanja; Mewes, Philip W; Maier, Andreas; Strobel, Norbert; Brost, Alexander

    2016-08-01

    Cryo-balloon catheters have attracted an increasing amount of interest in the medical community as they can reduce patient risk during left atrial pulmonary vein ablation procedures. As cryo-balloon catheters are not equipped with electrodes, they cannot be localized automatically by electro-anatomical mapping systems. As a consequence, X-ray fluoroscopy has remained an important means for guidance during the procedure. Most recently, image guidance methods for fluoroscopy-based procedures have been proposed, but they provide only limited support for cryo-balloon catheters and require significant user interaction. To improve this situation, we propose a novel method for automatic cryo-balloon catheter detection in fluoroscopic images by detecting the cryo-balloon catheter's built-in X-ray marker. Our approach is based on a blob detection algorithm to find possible X-ray marker candidates. Several of these candidates are then excluded using prior knowledge. For the remaining candidates, several catheter specific features are introduced. They are processed using a machine learning approach to arrive at the final X-ray marker position. Our method was evaluated on 75 biplane fluoroscopy images from 40 patients, from two sites, acquired with a biplane angiography system. The method yielded a success rate of 99.0% in plane A and 90.6% in plane B, respectively. The detection achieved an accuracy of 1.00 mm±0.82 mm in plane A and 1.13 mm±0.24 mm in plane B. The localization in 3-D was associated with an average error of 0.36 mm±0.86 mm. PMID:26978663

  13. Radiofrequency ablation in dermatology

    Directory of Open Access Journals (Sweden)

    Sachdeva Silonie

    2007-01-01

    Full Text Available Radiofreqeuency ablation is a versatile dermatosurgical procedure used for surgical management of skin lesions by using various forms of alternating current at an ultra high frequency. The major modalities in radiofrequency are electrosection, electrocoagulation, electrodessication and fulguration. The use of radiofrequency ablation in dermatosurgical practice has gained importance in recent years as it can be used to treat most of the skin lesions with ease in less time with clean surgical field due to adequate hemostasis and with minimal side effects and complications. This article focuses on the major tissue effects and factors influencing radiofrequency ablation and its application for various dermatological conditions.

  14. In situ treatment of liver using catheter based therapeutic ultrasound with combined imaging and GPS tracking

    Science.gov (United States)

    Ghoshal, Goutam; Heffter, Tamas; Williams, Emery; Bromfield, Corinne; Salgaonkar, Vasant; Rund, Laurie; Ehrhardt, John M.; Diederich, Chris J.; Burdette, E. Clif

    2013-02-01

    Extensive surgical procedure or liver transplant still remains the gold standard for treating slow-growing tumors in liver. But only few candidates are suitable for such procedure due to poor liver function, tumors in unresectable locations or presence of other liver diseases. In such situations, minimally invasive surgery may be the best therapeutic procedure. The use of RF, laser and ultrasound ablation techniques has gained considerable interest over the past several years to treat liver diseases. The success of such minimally invasive procedure depends on accurately targeting the desired region and guiding the entire procedure. The purpose of this study is to use ultrasound imaging and GPS tracking system to accurately place a steerable acoustic ablator and multiple temperature sensors in porcine liver in situ. Temperature sensors were place at eight different locations to estimate thermal distribution in the three-dimensional treated volume. Acoustic ablator of center frequency of 7 MHz was used for the experiments. During therapy a maximum temperature of 60-65 °C was observed at a distance 8-10 mm from the center of the ablation transducer. The dose distribution was analyzed and compared with the gross pathology of the treated region. Accurate placement of the acoustic applicator and temperature sensors were achieved using the combined image-guidance and the tracking system. By combining ultrasound imaging and GPS tracking system accurate placement of catheter based acoustic ablation applicator can be achieved in livers in situ.

  15. Interventional cardiac catheterization.

    Science.gov (United States)

    Pihkala, J; Nykanen, D; Freedom, R M; Benson, L N

    1999-04-01

    Over the past decade, transcatheter interventions have become increasingly important in the treatment of patients with congenital heart lesions. These procedures may be broadly grouped as dilations (e.g., septostomy, valvuloplasty, angioplasty, and endovascular stenting) or as closures (e.g., vascular embolization and device closure of defects). Balloon valvuloplasty has become the treatment of choice for patients in all age groups with simple valvar pulmonic stenosis and, although not curative, seems at least comparable to surgery for congenital aortic stenosis in newborns to young adults. Balloon angioplasty is successfully applied to a wide range of aortic, pulmonary artery, and venous stenoses. Stents are useful in dilating lesions of which the intrinsic elasticity results in vessel recoil after balloon dilation alone. Catheter-delivered coils are used to embolize a wide range of arterial, venous, and prosthetic vascular connections. Although some devices remain investigational, they have been successfully used for closure of many arterial ducts and atrial and ventricular septal defects. In the therapy for patients with complex CHD, best results may be achieved by combining cardiac surgery with interventional catheterization. The cooperation among interventional cardiologists and cardiac surgeons was highlighted in a report of an algorithm to manage patients with tetralogy of Fallot or pulmonary atresia with diminutive pulmonary arteries, involving balloon dilation, coil embolization of collaterals, and intraoperative stent placement. In this setting, well-planned catheterization procedures have an important role in reducing the overall number of procedures that patients may require over a lifetime, with improved outcomes.

  16. Pulse contour-derived cardiac output in hemodialysis patients

    DEFF Research Database (Denmark)

    Cordtz, Joakim; Ladefoged, Soeren D

    2010-01-01

    analysis, namely the Finometer monitor (FNM) for further use on patients dialyzing on a central vascular catheter. Fifty simultaneous cardiac output measurements were obtained during hemodialysis sessions in 25 patients. The internal variability of the FNM measurements was assessed by comparing 24 pairs...

  17. Microwave Ablation of Hepatic Malignancy

    OpenAIRE

    Lubner, Meghan G.; Brace, Christopher L.; Ziemlewicz, Tim J.; Hinshaw, J. Louis; Lee, Fred. T.

    2013-01-01

    Microwave ablation is an extremely promising heat-based thermal ablation modality that has particular applicability in treating hepatic malignancies. Microwaves can generate very high temperatures in very short time periods, potentially leading to improved treatment efficiency and larger ablation zones. As the available technology continues to improve, microwave ablation is emerging as a valuable alternative to radiofrequency ablation in the treatment of hepatic malignancies. This article rev...

  18. Moldable cork ablation material

    Science.gov (United States)

    1977-01-01

    A successful thermal ablative material was manufactured. Moldable cork sheets were tested for density, tensile strength, tensile elongation, thermal conductivity, compression set, and specific heat. A moldable cork sheet, therefore, was established as a realistic product.

  19. The Use of Cardiac Magnetic Resonance Imaging in the Diagnostic Workup and Treatment of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Peter Haemers

    2012-01-01

    Full Text Available Atrial fibrillation (AF is the most common cardiac arrhythmia and imposes a huge clinical and economic burden. AF is correlated with an increased morbidity and mortality, mainly due to stroke and heart failure. Cardiovascular imaging modalities, including echocardiography, computed tomography (CT, and cardiovascular magnetic resonance (CMR, play a central role in the workup and treatment of AF. One of the major advantages of CMR is the high contrast to noise ratio combined with good spatial and temporal resolution, without any radiation burden. This allows a detailed assessment of the structure and function of the left atrium (LA. Of particular interest is the ability to visualize the extent of LA wall injury. We provide a focused review of the value of CMR in identifying the underlying pathophysiological mechanisms of AF, its role in stroke prevention and in the guidance of radiofrequency catheter ablation. CMR is a promising technique that could add valuable information for therapeutic decision making in specific subpopulations with AF.

  20. Alternatives to Indwelling Catheters Cause Unintended Complications.

    Science.gov (United States)

    Nguyen, Jessica; Harvey, Ellen M; Lollar, Daniel I; Bradburn, Eric H; Hamill, Mark E; Collier, Bryan R; Love, Katie M

    2016-08-01

    To reduce the risk of catheter-associated urinary tract infection (CAUTI), limiting use of indwelling catheters is encouraged with alternative collection methods and early removal. Adverse effects associated with such practices have not been described. We also determined if CAUTI preventative measures increase the risk of catheter-related complications. We hypothesized that there are complications associated with early removal of indwelling catheters. We described complications associated with indwelling catheterization and intermittent catheterization, and compared complication rates before and after policy updates changed catheterization practices. We performed retrospective cohort analysis of trauma patients admitted between August 1, 2009, and December 31, 2013 who required indwelling catheter. Associations between catheter days and adverse outcomes such as infection, bladder overdistention injury, recatheterization, urinary retention, and patients discharged with indwelling catheter were evaluated. The incidence of CAUTI and the total number of catheter days pre and post policy change were similar. The incidence rate of urinary retention and associated complications has increased since the policy changed. Practices intended to reduce the CAUTI rate are associated with unintended complications, such as urinary retention. Patient safety and quality improvement programs should monitor all complications associated with urinary catheterization practices, not just those that represent financial penalties. PMID:27657581

  1. Pulmonary vein triggers, focal sources, rotors and atrial cardiomyopathy: implications for the choice of the most effective ablation therapy.

    Science.gov (United States)

    Pison, L; Tilz, R; Jalife, J; Haïssaguerre, M

    2016-05-01

    Understanding of the pathophysiological mechanism(s) underlying atrial fibrillation (AF) is the foundation on which current ablation strategies are built. In the vast majority of patients with paroxysmal AF, the ablation procedure should target the pulmonary veins. In patients with nonparoxysmal AF, however, pulmonary vein isolation alone seems to be insufficient to prevent the arrhythmia. Several recent clinical trials have investigated the concept that rotors (re-entry based on a meandering central core from which spiral waves emanate) might be the mechanism responsible for sustaining AF. Ablation of these localized AF sources is an important step towards substrate-driven procedures in persistent AF. Hybrid AF ablation procedures, based on the integration of endocardial transcatheter and epicardial off-pump surgical techniques, have been introduced to overcome their mutual shortcomings. The long-term results are encouraging, especially in currently challenging settings such as nonparoxysmal AF and failed endocardial catheter ablation procedures. PMID:26991806

  2. 心脏自主神经节消融治疗睡眠呼吸暂停并发心房颤动的实验研究%Effects of cardiac autonomic ganglia ablation on atrial fibrillation associated with sleep apnea

    Institute of Scientific and Technical Information of China (English)

    余小梅; 鲁志兵; 何文博; 何勃; 黄兵; 赵劲波; 江洪

    2013-01-01

    Objective To investigate the effects of cardiac autonomic ganglionated plexus (GP)ablation on atrial fibrillation(AF) associated with sleep apnea(SA).Methods Thirteen dogs were randomly divided into two groups.GP ablation was performed after SA in the first group(n=7) and before SA in the second group (n =6).Surface electrocardiograms and blood were collected.Effective refractory period (ERP) and window of vulnerability(WOV) of the atrium,pulmonary veins and superior vena cava were measured in the baseline state,at the end of SA which was lasted for 1 hour and after GP ablation,respectively.Changes of heart rate,blood pressure,arterial blood gas analysis,heart rate viability (HRV),ERP and WOV were compared between the two groups before and after GP ablation.Results In the first group,during the process of SA,the heart rate and blood pressure increased and then decreased.At the end of 1 h SA,the HRV analysis revealed that the ratio of low frequency/high frequency(LF/HF) reduced compare to the level of baseline state [(0.6±0.2)vs.(O.8± 0.2),P<0.05] ; ERP was significantly shortened,and ∑WOV was significantly increased(P<0.05).After GP ablation,LF/HF was significantly increased[(1.1±0.3)vs(0.8±0.2),P<0.05],ERP was significantly prolonged,and ∑WOV was decreased (P<0.05).In the second group,during SA process following GP ablation,the heart rate and blood pressure were increased and then decreased.ERP was shortened at several sites.However,there were no significant changes of LF/HF and ∑WOV.In both groups,hypoxemia,hypercapnia and acidosis were observed after 1 h SA.Conclusion The autonomic nervous system plays an important role in the occurrence of AF associated with SA.GP ablation may reverse and prevent AF caused by SA.%目的 研究心脏自主神经节(GP)消融对睡眠呼吸暂停(SA)并发心房颤动(房颤)的影响.方法 成年杂种犬13只,采用随机数字法分为2组.第1组先制作SA模型再行GP消融(n=7),

  3. Cardiac Malpositions

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Shi Joon; Im, Chung Gie; Yeon, Kyung Mo; Hasn, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1979-06-15

    Cardiac Malposition refers to any position of the heart other than a left-sided heart in a situs solitus individual. Associated cardiac malformations are so complex that even angiocardiographic and autopsy studies may not afford an accurate information. Although the terms and classifications used to describe the internal cardiac anatomy and their arterial connections in cardiac malpositions differ and tend to be confusing, common agreement exists on the need for a segmental approach to diagnosis. Authors present 18 cases of cardiac malpositions in which cardiac catheterization and angiocardiography were done at the Department of Radiology, Seoul National University Hospital between 1971 and 1979. Authors analyzed the clinical, radiographic, operative and autopsy findings with the emphasis on the angiocardiographic findings. The results are as follows: 1. Among 18 cases with cardiac malpositions, 6 cases had dextrocardia with situs inversus, 9 cases had dextrocardia with situs solitus and 3 cases had levocardia with situs inversus. 2. There was no genuine exception to visceroatrial concordance rule. 3. Associated cardiac malpositions were variable and complex with a tendency of high association of transposition and double outlet varieties with dextrocardia in situs solitus and levocardia in situs inversus. Only one in 6 cases of dextrocardia with situs inversus had pure transposition. 4. In two cases associated pulmonary atresia was found at surgery which was not predicted by angiocardiography. 5. Because many of the associated complex lesions can be corrected surgically provided the diagnosis is accurate, the selective biplane angiocardiography with or without cineradiography is essential.

  4. Central venous catheters: detection of catheter complications and therapeutical options; Zentralvenoese Katheter: Diagnostik von Komplikationen und therapeutische Optionen

    Energy Technology Data Exchange (ETDEWEB)

    Gebauer, B.; Beck, A. [Universitaetsmedizin Charite, Berlin (Germany). Klinik fuer Strahlenheilkunde; Wagner, H.J. [Vivantes-Kliniken, Friedrichshain und Am Urban, Berlin (Germany). Radiologie; Vivantes-Kliniken, Hellersdorf und Prenzlauer Berg (Germany). Radiologie

    2008-06-15

    For modern medicine central venous catheters play an important role for diagnostic and therapeutic options. Catheter implantation, complication detection and therapy of catheter complications are an increasing demand for the radiologist. The review article provides an overview of different catheter types, their indications, advantages and disadvantages. Catheter malpositions are usually detectable in conventional X-ray. Most malpositions are correctable using interventional-radiological techniques. In addition therapeutical options for thrombotic complications (venous thrombosis, catheter occlusion, fibrin sheath) are discussed. In case of an infectious catheter complication, usually a catheter extraction and re-implantation is necessary.

  5. Historical highlights in cardiac pacing.

    Science.gov (United States)

    Geddes, L A

    1990-01-01

    The benchmarks in cardiac pacing are identified, beginning with F. Steiner (1871), who rhythmically stimulated the chloroform-arrested hearts of 3 horses, 1 donkey, 10 dogs, 14 cats, and 8 rabbits. The chloroform-arrested heart in human subjects was paced by T. Greene in the following year (1872) in the UK. In 1882, H. Ziemssen in Germany applied cardiac pacing to a 42-year old woman who had a large defect in the anterior left chest wall subsequent to resection of an enchondroma. Intentional cardiac pacing did not occur until 1932, when A.A. Hyman in the US demonstrated that cardiac pacing could be clinically practical. Hyman made a batteryless pacemaker for delivery in induction shock stimuli (60-120/min) to the atria. His pacemaker was powered by a hand-wound, spring-driven generator which provided 6 min of pacemaking without rewinding. Closed-chest ventricular pacing was introduced in the US in 1952 by P.M. Zoll et al. Zoll (1956) also introduced closed-chest ventricular defibrillation. W.L. Weirich et al. (1958) demonstrated that direct-heart stimulation in closed-chest patients could be achieved with slender wire electrodes. S. Furman and J.B. Schwedel (1959) developed a monopolar catheter electrode for ventricular pacing in man. In the same year, W. Greatbatch and W.M. Chardack developed the implantable pacemaker. PMID:18238328

  6. Cardiac MR Elastography: Comparison with left ventricular pressure measurement

    OpenAIRE

    Samani Abbas; Hamm Bernd; Schnorr Jörg; Kaufels Nikola; Laule Michael; Elgeti Thomas; Braun Jürgen; Sack Ingolf

    2009-01-01

    Abstract Purpose of study To compare magnetic resonance elastography (MRE) with ventricular pressure changes in an animal model. Methods Three pigs of different cardiac physiology (weight, 25 to 53 kg; heart rate, 61 to 93 bpm; left ventricular [LV] end-diastolic volume, 35 to 70 ml) were subjected to invasive LV pressure measurement by catheter and noninvasive cardiac MRE. Cardiac MRE was performed in a short-axis view of the heart and applying a 48.3-Hz shear-wave stimulus. Relative changes...

  7. From cell to bedside: some pathophysiologic considerations about the cardiac stimulation

    International Nuclear Information System (INIS)

    Myocardial cell pathophysiology is presented as related to possible modification by electrical stimulation of the myocardium. The objective is a diagnostic and therapeutic clinical application such as is seen with bradyarrhythmias and tachyarrhythmias. In addition, the E C is an essential tool during catheter ablation procedures

  8. Clinical effect of radiofrequency catheter ablation combined with ozone injection in the treatment of lumbar disc herniation of cervical spine%射频消融加臭氧注射微创技术治疗腰椎间盘突出症的临床效果观察

    Institute of Scientific and Technical Information of China (English)

    杨劲松; 刘衡; 佟言

    2015-01-01

    Objective: To observe the clinical effect of radiofrequency ablation combined with ozone injection in the treat-ment of cervical intervertebral disc herniation.Methods: selected in our hospital in 2013 from August in August were 60 cases of cervical lumbar disc herniation patients, through the double chromosphere randomly divided into observation group (n = 30) and control group (n = 30), the clinical therapeutic effect of two groups of patients were compared and analyzed.Results: after treatment, the VAS score of the observation group was lower than that of the control group, the effective rate was 90%, higher than that of the control group 70% (P<0.05).Conclusion: in the treatment of cervical inter-vertebral disc herniation, the minimally invasive technique of radiofrequency ablation combined with improve the quality of life of patients. It is worthy of clinical application.%目的:观察分析腰椎间盘突出症患者采用射频消融加臭氧注射微创技术治疗的临床效果。方法:选取我院2013年8月-2014年8月收治的60例腰椎间盘突出症患者,通过双色球随机分组法分为观察组(n=30)及对照组(n=30),对照组患者采用常规治疗,观察组患者采用射频消融加臭氧注射微创技术治疗,对两组患者临床治疗效果进行比较和分析。结果:治疗后观察组患者VAS评分较对照组更低,治疗有效率90.00%,高于对照组70.00%(P<0.05)。结论:在腰椎间盘突出症治疗中,射频消融加臭氧注射微创技术可明显缓解腰椎间盘突出症状,减轻患者身心疼痛,提高临床治疗效果,进而改善患者生活质量,值得临床推广应用。

  9. Laser Ablation Of Atrial Fibrillation: Mid-term Clinical Experience

    Directory of Open Access Journals (Sweden)

    Li Poa, MD

    2009-08-01

    Full Text Available Background: Atrial Fibrillation is known to account for one third of all the strokes caused in the US in the population above the age of 70. Patients treated with the surgical Cox MAZE operation have been shown to have a 150 fold decrease in the incidence of stroke over an 18 year period. However, the original Cox MAZE although extremely successful in treating atrial fibrillation and decreasing the incidence of strokes was not performed widely because of complexity and invasiveness of the procedure. A variety of alternative energy based curative ablation strategies are now available for more minimally invasive therapeutic management of atrial fibrillation (AF. In this communication, we report our clinical experience in AF therapy utilizing laser energy ablation technology. Methods: Fifty two consecutive AF patients underwent concomitant or isolated ablation prior to any coexisting cardiac procedures that included CABG (coronary artery bypass surgery, MV (mitral valve or AV (aortic valve repairs. All patients had an epicardially based ablation pattern with basic lesions being en bloc box type pulmonary vein isolation which included the antral surface of the left atrium, directed ganglionectomies of the the right anterior and inferior ganglions, posteriomedial ablation of the IVC ( inferior vena cava, and a right isthmus ablation. Twenty seven patients had ligation of their left atrial appendage, 14 patients had resection of the ligament of Marshall, and three patients had endocardial placed lesions of a mitral annular connecting type lesion. In order to maintain the patients in normal sinus rhythm (NSR, electrical cardioversion and anti-arrhythmic drugs were employed as required. Results: At a median follow-up of 250 days, 44 of the total 52 patients (84.6% exhibited NSR.. No complications or mortality were reported due to the laser procedure. Conclusion: Laser ablation was successfully and safely used for endocardial and epicardial AF ablation

  10. Transient Ablation of Teflon Hemispheres

    Science.gov (United States)

    Arai, Norio; Karashima, Kei-ichi; Sato, Kiyoshi

    1997-01-01

    For high-speed entry of space vehicles into atmospheric environments, ablation is a practical method for alleviating severe aerodynamic heating. Several studies have been undertaken on steady or quasi-steady ablation. However, ablation is a very complicated phenomenon in which a nonequilibrium chemical process is associated with an aerodynamic process that involves changes in body shape with time. Therefore, it seems realistic to consider that ablation is an unsteady phenomenon. In the design of an ablative heat-shield system, since the ultimate purpose of the heat shield is to keep the internal temperature of the space vehicle at a safe level during entry, the transient heat conduction characteristics of the ablator may be critical in the selection of the material and its thickness. This note presents an experimental study of transient ablation of Teflon, with particular emphasis on the change in body shape, the instantaneous internal temperature distribution, and the effect of thermal expansion on ablation rate.

  11. Power Laser Ablation Symposia

    CERN Document Server

    Phipps, Claude

    2007-01-01

    Laser ablation describes the interaction of intense optical fields with matter, in which atoms are selectively driven off by thermal or nonthermal mechanisms. The field of laser ablation physics is advancing so rapidly that its principal results are seen only in specialized journals and conferences. This is the first book that combines the most recent results in this rapidly advancing field with authoritative treatment of laser ablation and its applications, including the physics of high-power laser-matter interaction. Many practical applications exist, ranging from inertial confinement fusion to propulsion of aerostats for pollution monitoring to laser ignition of hypersonic engines to laser cleaning nanoscale contaminants in high-volume computer hard drive manufacture to direct observation of the electronic or dissociative states in atoms and molecules, to studying the properties of materials during 200kbar shocks developed in 200fs. Selecting topics which are representative of such a broad field is difficu...

  12. Psychological situation in military patients before cardiac radiofrequency ablation%心脏射频消融术前军队患者的心理状况分析

    Institute of Scientific and Technical Information of China (English)

    王娟; 易蕊; 谭琛; 郭娟; 门爱民; 王敏; 李俊峡

    2013-01-01

    目的了解军队患者拟行心脏射频消融术前的心理健康状况,为探索心律失常的“双心”整合治疗模式提供心理学的依据。方法纳入拟行心脏射频消融术的军队患者169例,采用症状自评量表(SCL-90)对其进行术前心理测评,并将其测评结果与军人常模进行比较;同时采用Logistic回归分析人口学信息、所属部队(分为边防部队、作战部队、驻京部队及干休所)、心律失常类型、对疾病认知度等资料与SCL-90的躯体化、焦虑、抑郁、恐怖因子的关系。结果拟行心脏射频消融术的军队患者术前SCL-90的躯体化、焦虑、抑郁、强迫、恐怖等因子得分均显著高于国内军人的常模,其中预激综合征、阵发性室上性心动过速患者的躯体化较其他病种更加显著,对疾病认知度中等或差的患者发生躯体化、焦虑的概率较高,来自边防部队的患者更易出现焦虑、强迫、恐怖等情绪;(17~30)岁患者以恐怖情绪为主,(31~50)岁患者以强迫情绪为主。结论心脏射频消融术前军队患者普遍存在心理障碍,尤其是对疾病缺乏认知、来自边防部队的患者更易出现焦虑等情绪障碍,同时不同年龄的患者出现的情绪化障碍特点有所不同。%Objective To understand the psychological situation in military patients before radiofrequency ablation (RFA), and provide the psychological evidence for the integrated therapeutic mode for arrhythmia. Methods The military patients (n=169) with planned radiofrequency ablation were chosen, and given pre-operation psychological assessment by applying SCL-90 and the outcomes were compared with military norm. The relationship among demographic information, troops (frontier forces, combat forces, Beijing forces and sanitarium for retired cadres), types of arrhythmia and disease awareness and factors of somatization, anxiety, depression and phobia in SCL-90 was

  13. Navigation for fluoroscopy-guided cryo-balloon ablation procedures of atrial fibrillation

    Science.gov (United States)

    Bourier, Felix; Brost, Alexander; Kleinoeder, Andreas; Kurzendorfer, Tanja; Koch, Martin; Kiraly, Attila; Schneider, Hans-Juergen; Hornegger, Joachim; Strobel, Norbert; Kurzidim, Klaus

    2012-02-01

    Atrial fibrillation (AFib), the most common arrhythmia, has been identified as a major cause of stroke. The current standard in interventional treatment of AFib is the pulmonary vein isolation (PVI). PVI is guided by fluoroscopy or non-fluoroscopic electro-anatomic mapping systems (EAMS). Either classic point-to-point radio-frequency (RF)- catheter ablation or so-called single-shot-devices like cryo-balloons are used to achieve electrically isolation of the pulmonary veins and the left atrium (LA). Fluoroscopy-based systems render overlay images from pre-operative 3-D data sets which are then merged with fluoroscopic imaging, thereby adding detailed 3-D information to conventional fluoroscopy. EAMS provide tracking and visualization of RF catheters by means of electro-magnetic tracking. Unfortunately, current navigation systems, fluoroscopy-based or EAMS, do not provide tools to localize and visualize single shot devices like cryo-balloon catheters in 3-D. We present a prototype software for fluoroscopy-guided ablation procedures that is capable of superimposing 3-D datasets as well as reconstructing cyro-balloon catheters in 3-D. The 3-D cyro-balloon reconstruction was evaluated on 9 clinical data sets, yielded a reprojected 2-D error of 1.72 mm +/- 1.02 mm.

  14. Catheter-directed Thrombolysis in Acute Superior Vena Cava Syndrome Caused by Central Venous Catheters.

    Science.gov (United States)

    Cui, Jie; Kawai, Tasuo; Irani, Zubin

    2015-01-01

    Indwelling central venous catheters have been reported to increase the risk of superior venous cava (SVC) syndrome. This case report describes the development of acute SVC syndrome in a 28-year-old woman with end-stage renal disease implanted with a left-side hemodialysis reliable outflow graft and a right-side double lumen hemodialysis catheter via internal jugular veins. Her symptoms were not alleviated after catheter removal and systemic anticoagulation therapy. She was eventually treated with catheter-directed thrombolysis and a predischarge computer tomographic venogram on postthrombolytic procedure day 7 showed patent central veins and patient remained asymptomatic. This case demonstrates that catheter-directed thrombolysis can be safely employed to treat refractory catheter-induced acute SVC syndrome in end-stage renal disease patients.

  15. Retained Urethral Catheter Secondary to Placement in Proximal Ureter

    Directory of Open Access Journals (Sweden)

    Thomas B. McGregor

    2016-01-01

    Full Text Available We present an unusual complication secondary to indwelling urethral catheter placement. Routine catheter placement by the obstetrics team in a postpartum female leads to retention of the catheter and inability of its removal by both the obstetrics and urology teams. Although a retained urinary catheter is relatively common, inability to remove a catheter secondary to placement inadvertently into a ureter is extremely rare. In this paper we will discuss the options in removing a retained catheter and present our case of a retained catheter secondary to placement within the right proximal ureter.

  16. Retained Urethral Catheter Secondary to Placement in Proximal Ureter.

    Science.gov (United States)

    McGregor, Thomas B; Sharda, Rajan

    2016-01-01

    We present an unusual complication secondary to indwelling urethral catheter placement. Routine catheter placement by the obstetrics team in a postpartum female leads to retention of the catheter and inability of its removal by both the obstetrics and urology teams. Although a retained urinary catheter is relatively common, inability to remove a catheter secondary to placement inadvertently into a ureter is extremely rare. In this paper we will discuss the options in removing a retained catheter and present our case of a retained catheter secondary to placement within the right proximal ureter.

  17. Cardiac rehabilitation

    Science.gov (United States)

    ... attack or other heart problem. You might consider cardiac rehab if you have had: Heart attack Coronary heart disease (CHD) Heart failure Angina (chest pain) Heart or heart valve surgery Heart transplant Procedures such as angioplasty and stenting In some ...

  18. Optical-vortex laser ablation

    OpenAIRE

    Hamazaki, Junichi; Morita, Ryuji; Chujo, Keisuke; Kobayashi, Yusuke; Tanda, Satoshi; Omatsu, Takashige

    2010-01-01

    Laser ablation of Ta plates using nanosecond optical vortex pulses was carried out, for the first time. It was suggested that owing to orbital angular momentum of optical vortex, clearer and smoother processed surfaces were obtained with less ablation threshold fluence, in comparison with the ablation by a nonvortex annular beam modified from a spatially Gaussian beam.

  19. THE KISSING BALLOON TECHNIQUE WITH 2 OVER-THE-WIRE BALLOON CATHETERS THROUGH A SINGLE 8-FRENCH GUIDING CATHETER

    NARCIS (Netherlands)

    DENHEIJER, P; BERNINK, PJLM; VANDIJK, RB; TWISK, SPM; LIE, KI

    1991-01-01

    Some of the newer over-the-wire coronary angioplasty catheters have shaft sizes of 3.0 French (F) or less. The inner diameter of modern 8-F guiding catheters is large enough to accommodate two of such balloon catheters. We report a kissing balloon procedure with two over-the-wire catheters through a

  20. Double Ring Array Catheter for In Vivo Real-Time 3D Ultrasound.

    Science.gov (United States)

    Smith, Stephen W; Gardea, Paul; Patel, Vivek; Douglas, Stephen J; Wolf, Patrick D

    2014-03-12

    We developed new forward-viewing matrix transducers consisting of double ring arrays of 118 total PZT elements integrated into catheters used to deploy medical interventional devices. Our goal is 3D ultrasound guidance of medical device implantation to reduce x-ray fluoroscopy exposure. The double ring arrays were fabricated on inner and outer custom polyimide flexible circuits with inter-element spacing of 0.20 mm and then wrapped around an 11 French (Fr) catheter to produce a 15 Fr catheter (outer diameter [O.D.]). We used a braided cabling technology to connect the elements to the Volumetrics Medical Imaging (VMI) real-time 3D ultrasound scanner. Transducer performance yielded an average -6 dB fractional bandwidth of 49% ± 11% centered at 4.4 MHz for 118 elements. Real-time 3D cardiac scans of the in vivo pig model yielded good image quality including en face views of the tricuspid valve and real-time 3D guidance of an endo-myocardial biopsy catheter introduced into the left ventricle. PMID:24626564

  1. Using urokinase to restore patency in double lumen catheters.

    Science.gov (United States)

    Northsea, C

    1994-08-01

    All hemodialysis patients with temporary or permanent double lumen catheters are at risk for catheter occlusion. Clinical outcomes and cost-effectiveness of using urokinase, a thrombolytic agent, to declot occluded double lumen dialysis catheters were evaluated for 2 years. Patency was restored in 95 of 102 catheters. These data support the use of urokinase to safely and effectively restore patency, thereby extending the length of time a catheter can be used for dialysis.

  2. Venous port catheter dislocation as an unusual cause of pneumonia

    Directory of Open Access Journals (Sweden)

    Umut Serhat Sanrı

    2014-06-01

    Full Text Available The use of central venous port catheter is a very useful method for long-term therapy in patients with malignancy. Catheter insertion technique and maintenance of equipment is very important to the prevention of catheter-related complications. The most frequent complications are deep venous thrombosis, port infection, catheter obstruction. İn this article, pneumonia occurrence after chemotherapy infusion in a patient who has a completely extravasated central venous port catheter discussed.

  3. Atrial Fibrillation Ablation Using Magnetic Navigation Comparison With Conventional Approach During Long-Term Follow-Up

    Directory of Open Access Journals (Sweden)

    Tolga AKSU; Serdar BOZYEL; Ebru GOLCUK; K�vanc YALIN; Tumer Erdem Guler

    2015-10-01

    Full Text Available trial fibrillation (AF ablation targeting the circumferential isolation of pulmonary veins (PVI is an established therapeutic alternative in symptomatic AF patients resistant to anti-arrhythmic medications. The procedure technically challenging and multiple difficulties must be overcome in order to achieve a successful outcome. The magnetic navigation system (MNS is a remote catheter control technology that has an advantages such as an atraumatic catheter design that improves the procedural safety, a reduced amount of radiation exposure to both the patient and physician, unrestricted and reproducible catheter manoeuvrability that allows the access to difficult anatomical situations, and an improved catheter stability lead to better energy delivery. Due to these advantages, MNS is increasingly being used for AF ablation and both acute and chronic success rates are comparable with the conventional technique. However, MNS is related to longer radiofrequency (RF application duration and procedure time. But, the new developments in navigation systems, catheters and sheaths used, combination of MNS and a new three-dimensional mapping systems are very promising to obviate these concerns.

  4. Advanced Imaging Catheter: Final Project Report

    Energy Technology Data Exchange (ETDEWEB)

    Krulevitch, P; Colston, B; DaSilva, L; Hilken, D; Kluiwstra, J U; Lee, A P; London, R; Miles, R; Schumann, D; Seward, K; Wang, A

    2001-07-20

    Minimally invasive surgery (MIS) is an approach whereby procedures conventionally performed with large and potentially traumatic incisions are replaced by several tiny incisions through which specialized instruments are inserted. Early MIS, often called laparoscopic surgery, used video cameras and laparoscopes to visualize and control the medical devices, which were typically cutting or stapling tools. More recently, catheter-based procedures have become a fast growing sector of all surgeries. In these procedures, small incisions are made into one of the main arteries (e.g. femoral artery in the thigh), and a long thin hollow tube is inserted and positioned near the target area. The key advantage of this technique is that recovery time can be reduced from months to a matter of days. In the United States, over 700,000 catheter procedures are performed annually representing a market of over $350 million. Further growth in this area will require significant improvements in the current catheter technology. In order to effectively navigate a catheter through the tortuous vessels of the body, two capabilities must exist: imaging and positioning. In most cases, catheter procedures rely on radiography for visualization and manual manipulation for positioning of the device. Radiography provides two-dimensional, global images of the vasculature and cannot be used continuously due to radiation exposure to both the patient and physician. Intravascular ultrasound devices are available for continuous local imaging at the catheter tip, but these devices cannot be used simultaneously with therapeutic devices. Catheters are highly compliant devices, and manipulating the catheter is similar to pushing on a string. Often, a guide wire is used to help position the catheter, but this procedure has its own set of problems. Three characteristics are used to describe catheter maneuverability: (1) pushability -- the amount of linear displacement of the distal end (inside body) relative to

  5. An Unusual Complication of Suprapubic Catheter Insertion

    Directory of Open Access Journals (Sweden)

    Krishnan Ananthakrishnan

    2006-01-01

    Full Text Available A patient who had a small bowel mesentery perforation following insertion of a suprapubic catheter (SPC is described. He had no bowel complaints immediately following the procedure, but presented 10 weeks later with insidious onset bowel obstruction due to the kink caused by the catheter. This complication occurred despite cystoscopy control and adequate bladder distension prior to the procedure. This isolated case illustrates the fact that regardless of the ease and frequency of SPC insertion, complications do occur.

  6. Tumor ablations in IMRI

    Institute of Scientific and Technical Information of China (English)

    Roberto Blanco Sequeiros

    2002-01-01

    @@ IntroductionMagnetic resonance imaging based guidance control and monitoring of minimally invasive intervention has developed from a hypothetical concept to a practical possibility. Magnetic-resonance-guided interstitial therapy in principle is defined as a treatment technique for ablating deepseated tumors in the human body.

  7. Spark ablation device

    NARCIS (Netherlands)

    Schmidt-Ott, A.; Pfeiffer, T.V.

    2013-01-01

    A spark ablation device for generating nanoparticles comprising a spark generator; the spark generator comprising first and second electrodes, wherein the spark generator further comprises at least one power source which is arranged to be operative at a first energy level for maintaining a discharge

  8. Determination of urethral catheter surface lubricity.

    Science.gov (United States)

    Kazmierska, Katarzyna; Szwast, Maciej; Ciach, Tomasz

    2008-06-01

    Device for in-vitro measurement of static and kinetic friction coefficient of catheter surface was developed. Tribometer was designed and constructed to work with exchangeable counter-faces (polymers, tissue) and various types of tubes, in wet conditions in order to mimic in-vivo process. Thus seven commercially available urethral catheters, made from vinyl polymers, natural latex with silicone coating, all-silicone or hydrogel coated, and one made from polyvinylchloride with polyurethane/polyvinylpyrrolidone hydrogel coating obtained in our laboratory, were tested against three various counter faces: polymethacrylate (organic glass), inner part of porcine aorta and porcine bladder mucosa. Additionally, the hydrophility/hydrophobity of tested catheters was stated via water wetting contact angle measurement. Super-hydrophilic biomaterials revealed low friction on tissue and hydrophobic counter-face; slightly hydrophobic showed higher friction in both cases, while more hydrophobic manifested low friction on tissue but high on hydrophobic polymer. The smoothest friction characteristic was achieved in all cases on tissue counter-faces. The measured values of the static coefficient of friction of catheters on bladder mucosa counter-face were as follows: the highest (0.15) for vinyl and siliconised latex catheters and 3 folds lower (0.05) for all-silicone ones. Hydrogel coated catheters exhibited the lowest static and kinetic friction factors. PMID:18071872

  9. Haemolyzed samples: responsibility of short catheters.

    Science.gov (United States)

    Raisky, F; Gauthier, C; Marchal, A; Blum, D

    1994-01-01

    The haemolysis of blood samples is a source of error in the electrolytic and enzymatic determination in clinical biochemistry. This circumstance seems dependent on the material used for the venepuncture. In this study we compared three kinds of material in 350 patients who were sampled in the emergency department. This randomized study compared the haemolysis of blood samples collected with stainless steel needles and short catheters, either Teflon FEP (Cathlon Critikon) or polyurethane Vialon (Insyte Becton-Dickinson). Quantification of hemolysis was performed by assay of the optical density of plasma haemoglobin. Results were analysed, after verification of the randomization, by one-way analysis of variance by ranks. This study demonstrated a highly significant relation between occurrence of haemolysis and the sampling material, used according to its technical obligations. Haemolysis occurred frequently when short catheters were used in 42% and 55% of cases with the Teflon and Vialon catheters, respectively. Haemolysis was much less frequent with stainless steel needles (12%). This difference was even more marked for haemoglobin levels above 1.5 milligrams of plasma, where the incidence was 4.2%, 9% and 30%, respectively, for the stainless steel needles, the Teflon catheter and the Vialon catheter. This study induced our emergency department to take more blood samples with a needle, even if an infusion was to be given subsequently, or to take them using a Teflon catheter. PMID:7840428

  10. 心电图定位法在肿瘤患者中心静脉导管头端定位中的应用%The application of EKG location method in the cardiac veins catheter tip location in the tumor patients

    Institute of Scientific and Technical Information of China (English)

    张厚芳; 沈颂伟; 徐敏; 岳军; 沙娜

    2016-01-01

    目的:探讨心电图(EKG)定位法在中心静脉置管过程中确定送管长度的指导作用及术中定位的准确性。方法选择行中心静脉置管的肿瘤患者32例,置管时采取 EKG 数据,术后行 X 线胸片或胸部透视给予验证,判断 EKG 定位法的敏感度、特异度及一次性置管到位率。结果32例肿瘤患者中30例患者出现特征性 P 波,经 X 线胸片或胸透证实在上腔静脉或与右心房连接处,1例置入右心房,1例无 P 波在锁骨下静脉打折经调管后证实进入上腔静脉。结论EKG 定位法在深静脉置管导管尖端定位应用中具有较高的准确性,临床应用是可行的。%Objective To discuss the electrocardiogram(EKG)positioning method to the guiding role of determining the pipe length and the accuracy of operative localization in central venous catheterization procedure. Methods Chose 32 cases of tumor patients who had center venipunture.Use the catheter taken EKG data when cath-etering,and then given validation using postoperative chest X -ray or fluoroscopy.Judgment the sensitivity,specificity and disposable catheters success rate of the EKG positioning method.Results In the 32 cases of cancer patients, 30 patients had characteristic P waves,when the chest X -ray confirmed the superior vena cava or the junction with the right atrium,one case into the right atrium,when one case of non -P -wave in the subclavian after intravenous discounts tune into the tube after it confirmed the superior vena cava.Conclusion EKG positioning method with high accuracy in the deep venous catheter in the catheter tip positioning applications.The clinical applications are feasible.

  11. Cardiac arrest in intensive care unit: Case report and future recommendations

    Directory of Open Access Journals (Sweden)

    Mohammad A

    2010-01-01

    Full Text Available Initiation of hemofiltration in a patient in septic shock can cause hemodynamic compromise potentially leading to cardiac arrest. We propose that the standard ′4Hs and 4Ts′ approach to the differential diagnosis of a cardiac arrest should be supplemented in critically ill patients with anaphylaxis and human and technical errors involving drug administration (the 5 th H and T. To illustrate the point, we report a case where norepinephrine infused through a central venous catheter (CVC was being removed by the central venovenous hemofiltration (CVVH catheter causing the hemodynamic instability. CVVH has this potential of interfering with the systemic availability of drugs infused via a closely located CVC.

  12. Microwave Treatment for Cardiac Arrhythmias

    Science.gov (United States)

    Hernandez-Moya, Sonia

    2009-01-01

    NASA seeks to transfer the NASA developed microwave ablation technology, designed for the treatment of ventricular tachycardia (irregular heart beat), to industry. After a heart attack, many cells surrounding the resulting scar continue to live but are abnormal electrically; they may conduct impulses unusually slowly or fire when they would typically be silent. These diseased areas might disturb smooth signaling by forming a reentrant circuit in the muscle. The objective of microwave ablation is to heat and kill these diseased cells to restore appropriate electrical activity in the heart. This technology is a method and apparatus that provides for propagating microwave energy into heart tissues to produce a desired temperature profile therein at tissue depths sufficient for thermally ablating arrhythmogenic cardiac tissue while preventing excessive heating of surrounding tissues, organs, and blood. A wide bandwidth double-disk antenna is effective for this purpose over a bandwidth of about six gigahertz. A computer simulation provides initial screening capabilities for an antenna such as antenna, frequency, power level, and power application duration. The simulation also allows optimization of techniques for specific patients or conditions. In comparison with other methods that involve direct-current pulses or radio frequencies below 1 GHz, this method may prove more effective in treating ventricular tachycardia. This is because the present method provides for greater control of the location, cross-sectional area, and depth of a lesion via selection of the location and design of the antenna and the choice of microwave power and frequency.

  13. Validação do reprocessamento de cateteres cardíacos angiográficos: uma avaliação da funcionalidade e da integridade Validación del reprocesamiento de catéteres cardíacos angiográficos: una evaluación de la funcionalidad e integridad Reprocessing validation of angiographic cardiac catheters: an evaluation of the functionality and integrity

    Directory of Open Access Journals (Sweden)

    Thabata Coaglio Lucas

    2010-12-01

    Full Text Available Objetivou-se validar o reprocessamento de cateteres cardíacos angiográficos quanto às suas características de funcionalidade mecânica e à integridade molecular e micro-estrutural da cadeia polimérica. Pesquisa experimental, aplicada, comparativa e controlada. Construiu-se uma bancada de simulação de uma arteriografia de coronária esquerda para simular um estresse mecânico e biológico em cateteres. Testou-se a funcionalidade por ensaio de tração e a integridade por Espectroscopia na Região do Infravermelho e Microscopia Eletrônica de Varredura. Evidenciou-se uma tendência ao aumento da rigidez a cada acréscimo do número de reprocessamento (pEl objetivo del trabajo fue validar el reprocesamiento de catéteres cardíacos angiográficos en cuanto a sus características de funcionalidad mecánica e integridad molecular y microestructural de la cadena de polímeros. Investigación experimental, aplicada, comparativa y controlada. Se construyó un banco de simulación de una arteriografía de coronaria izquierda para simular un estrés mecánico y biológico en catéteres. Se testeó la funcionalidad por ensayo de tracción y la integridad por Espectroscopía Local Infrarroja y Microscopía Electrónica de Barrido. Se evidenció una tendencia al aumento de la rigidez en cada incremento del número de reprocesamientos (pThe objective of this study was to validate the reprocessing of angiographic cardiac catheters regarding their characteristics of mechanical functionality and the molecular and micro-structural integrity of the polymeric chain. This is an experimental, applied, comparative and controlled study. A simulation set was built for a left coronary angiography in order to simulate mechanical and biological stress in the catheters. Traction tests were performed for the functionality and the integrity was tested through Infrared Spectrometry and Scanning Electronic Microscopy. The study evidenced a tendency to an increase in

  14. Cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Dewey, Marc [Charite - Universitaetsmedizin Berlin (Germany). Inst. fuer Radiologie

    2011-07-01

    Computed tomography of the heart has become a highly accurate diagnostic modality that is attracting increasing attention. This extensively illustrated book aims to assist the reader in integrating cardiac CT into daily clinical practice, while also reviewing its current technical status and applications. Clear guidance is provided on the performance and interpretation of imaging using the latest technology, which offers greater coverage, better spatial resolution, and faster imaging. The specific features of scanners from all four main vendors, including those that have only recently become available, are presented. Among the wide range of applications and issues to be discussed are coronary artery bypass grafts, stents, plaques, and anomalies, cardiac valves, congenital and acquired heart disease, and radiation exposure. Upcoming clinical uses of cardiac CT, such as plaque imaging and functional assessment, are also explored. (orig.)

  15. Cardiac echinococcosis

    Directory of Open Access Journals (Sweden)

    Ivanović-Krstić Branislava A.

    2002-01-01

    Full Text Available Cardiac hydatid disease is rare. We report on an uncommon hydatid cyst localized in the right ventricular wall, right atrial wall tricuspid valve left atrium and pericard. A 33-year-old woman was treated for cough, fever and chest pain. Cardiac echocardiograpic examination revealed a round tumor (5.8 x 4 cm in the right ventricular free wall and two smaller cysts behind that tumor. There were cysts in right atrial wall and tricuspidal valve as well. Serologic tests for hydatidosis were positive. Computed tomography finding was consistent with diagnosis of hydatid cyst in lungs and right hylar part. Surgical treatment was rejected due to great risk of cardiac perforation. Medical treatment with albendazole was unsuccessful and the patient died due to systemic hydatid involvement of the lungs, liver and central nervous system.

  16. Ablation of left-deviated dual atrioventricular nodal pathway from coronary sinus

    Institute of Scientific and Technical Information of China (English)

    HUANG Wei-bin; HONG Jiang; WANG Yan; ZHOU Fa-guang; ZENG Zhao-pin; GONG Yan; SUN Bao-gui; WANG Le-xin

    2009-01-01

    @@ Atrioventricular nodal reentrant tachycardia (AVNRT) is one of the most common types of paroxysmal supraventricular tachycardia. The mechanism of AVNRT is reentry associated with dual or multiple atrioventricular nodal (AVN) pathways. Typical AVNRT pathways,including fast and slow pathways, are confined in the right atrium. Radiofrequency catheter ablation of the slow pathway, and occasionally the fast pathway, has become the definitive treatment of choice for most symptomatic patients. Besides typical AVNRT, there exists some atypical AVNRT with various manifestations. Several groups have reported successful ablation of the leftward dual AVN pathway from the left side of the heart.1-3 We present one case of left-sided AVN as well as dual AVN pathway. The tachycardia was successfully eliminated by ablation of the slow pathway deep in the coronary sinus.

  17. Towards Real-Time Computation of Cardiac Electrophysiology for Training Simulator

    OpenAIRE

    Talbot, Hugo; Duriez, Christian; Courtecuisse, Hadrien; Relan, Jatin; Sermesant, Maxime; Cotin, Stéphane; Delingette, Hervé

    2012-01-01

    This work aims at developing a training simulator for interventional radiology and thermo-ablation of cardiac arrhythmias. To achieve this, a real-time model of the cardiac electrophysiology is needed, which is very challenging due to the stiff equations involved. In this paper, we detail our contributions in order to obtain efficient cardiac electrophysiology simulations. First, an adaptive parametrisation of the Mitchell-Schaeffer model as well as numerical optimizations are proposed. An ac...

  18. Malfunctioning central venous catheters in children: a diagnostic approach

    Energy Technology Data Exchange (ETDEWEB)

    Barnacle, Alex; Arthurs, Owen J.; Roebuck, Derek; Hiorns, Melanie P. [Great Ormond Street Hospital, Radiology Department, London (United Kingdom)

    2008-04-15

    Central venous access is increasingly becoming the domain of the radiologist, both in terms of the insertion of central venous catheters (CVCs) and in the subsequent management of these lines. This article seeks to provide an overview of the CVC types available for paediatric patients and a more detailed explanation of the spectrum of complications that may lead to catheter malfunction. A standard catheter contrast study or 'linogram' technique is described. The normal appearances of such a study and a detailed pictorial review of abnormal catheter studies are provided, together with a brief overview of how information from catheter investigations can guide the management of catheter complications. (orig.)

  19. Intrafetal alcohol ablation of an acardiac twin

    Directory of Open Access Journals (Sweden)

    Zahar Azuar Zakaria

    <