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Sample records for spanish catheter ablation

  1. Spanish Catheter Ablation Registry. 16th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2016).

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    Fontenla, Adolfo; García-Fernández, Javier; Ibáñez, José Luis

    2017-11-01

    This report describes the findings of the 2016 Spanish Catheter Ablation Registry. Data were retrospectively collected by means of a standardized questionnaire completed by each of the participating centers. Data were collected from 83 centers. A total of 13 482 ablation procedures were performed (the highest historically reported in this registry), with a mean of 162.4 ± 116 and a median of 136 procedures per center. The most frequently treated ablation targets were atrioventricular nodal re-entrant tachycardia (n = 3058; 22.7%), atrial fibrillation (n = 2953; 21.9%), and cavotricuspid isthmus (n = 2892; 21.4%). There was a peak in ablation procedures for atrial fibrillation, which, for the first time in this registry, became the second most treated substrate. After exclusion of atrial fibrillation and ventricular tachycardia with underlying heart disease, the overall success rate was 86%. The rate of major complications was 2.3%, and the mortality rate was 0.05%. In all, 2.7% of the ablations were performed in pediatric patients. The Spanish Catheter Ablation Registry systematically and uninterruptedly records the ablation procedures performed in Spain, showing a progressive rise in the number of ablations performed, with a high success rate and a low percentage of complications. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  2. Spanish Catheter Ablation Registry. 12th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2012).

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    Ferrero de Loma-Osorio, Ángel; Díaz-Infante, Ernesto; Macías Gallego, Alfonso

    2013-12-01

    This article presents the findings of the 2012 Spanish Catheter Ablation Registry. Data were collected in 2 ways: retrospectively using a standardized questionnaire, and prospectively using a central database. Each participating center selected its own preferred method of data collection. Seventy-four Spanish centers voluntarily contributed data to the survey. A total of 11 042 ablation procedures were analyzed, averaging 149 (103) per center. The 3 main conditions treated were atrioventricular nodal reentrant tachycardia (n=2842; 25.7%), cavotricuspid isthmus (n=2485; 23%), and accessory pathways (n=1999; 18%). Atrial fibrillation was the fourth most common substrate treated (n=1852; 17%), representing a slight increase. The number of ventricular arrhythmia ablation procedures was similar to that of 2011, but there was a decrease in procedures for ventricular tachycardia associated with postinfarction scarring. The overall success rate was 94.9%, major complications occurred in 1.9%, and the overall mortality rate was 0.04%. Data from the 2012 registry show that the number of ablations performed continued to increase. Overall, they also show a high success rate and a low number of complications. Ablation of complex substrates continued to increase, particularly in the case of atrial fibrillation. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  3. Spanish Catheter Ablation Registry. 13th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2013).

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    Ferrero de Loma-Osorio, Angel; Gil-Ortega, Ignacio; Pedrote-Martínez, Alonso

    2014-11-01

    This report presents the results of the 2013 Spanish Catheter Ablation Registry. Data were collected using 2 systems: retrospectively by completing a dedicated form and prospectively by reporting to a central database. Each participating center chose 1 of the 2 data collection methods. Eighty centers voluntarily contributed data to the registry. A total of 11 987 ablation procedures were performed, with a mean (standard deviation) of 149 (105) procedures per center. The 3 main arrhythmic substrates treated were atrioventricular nodal reentrant tachycardia (n=2959; 24.6%), cavotricuspid isthmus ablation (n=2700; 22.5%), and atrial fibrillation (n=2201; 18.4%). The number of ventricular ablation procedures was similar to the 2012 activity, but there was a slight increase in procedures for scar-related postmyocardial infarction ventricular tachycardia. The success rate was 94.4%, major complications occurred in 1.8%, and the mortality rate was 0.03%. In line with previous reports, the data from the 2013 registry show a continuing increase in the number of ablations performed. Overall, there was a high success rate and few complications. Ablation of complex substrates has continued to increase. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  4. Spanish Catheter Ablation Registry. 14th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2014).

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    Gil-Ortega, Ignacio; Pedrote-Martínez, Alonso; Fontenla-Cerezuela, Adolfo

    2015-12-01

    This report presents the findings of the 2014 Spanish Catheter Ablation Registry. For data collection, each center was allowed to choose freely between 2 systems: retrospective, requiring the completion of a standardized questionnaire, and prospective, involving reporting to a central database. Data were collected from 85 centers. A total of 12 871 ablation procedures were performed, for a mean of 149.5±103 procedures per center. The ablation targets most frequently treated were atrioventricular nodal reentrant tachycardia (n=3026; 23.5%), cavotricuspid isthmus (n=2833; 22.0%), and atrial fibrillation (n=2498; 19.4%). The number of ablation procedures for ventricular arrhythmias was similar to that of 2013, but there was a slight increase in the treatment of all the ventricular substrates, especially those associated with idiopathic ventricular tachycardia and scarring following myocardial infarction. The overall success rate was 95%, the rate of major complications was 1.3%, and the mortality rate was 0.02%. The 2014 registry shows that the number of ablation procedures performed continued its upward trend and that, overall, the success rate was high and the number of complications low. Ablation of complex conditions continued to increase. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  5. Spanish Catheter Ablation Registry. 15th Official Report of the Spanish Society of Cardiology Working Group on Electrophysiology and Arrhythmias (2015).

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    Pedrote, Alonso; Fontenla, Adolfo; García-Fernández, Javier

    2016-11-01

    This report presents the findings of the 2015 Spanish Catheter Ablation Registry. For data collection, each center was allowed to choose freely between 2 systems: retrospective, requiring the completion of a standardized questionnaire, and prospective, involving reporting to a central database. Data were collected from 82 centers. A total of 12 863 ablation procedures were performed, for a mean of 157±119 and a median of 138 procedures per center. The ablation target most frequently treated was cavotricuspid isthmus (n=2992 [23.2%]), followed by atrioventricular nodal reentrant tachycardia (n=2966 [23%]) and atrial fibrillation (n=2640 [20.5%]). There were fewer ablation procedures for atrial tachycardia, idiopathic ventricular tachycardia and accessory pathways, while those for ventricular tachycardia in ischemic cardiomyopathy remained steady. The overall success rate, excluding atrial fibrillation and ventricular tachycardia in cardiomyopathy, was 87.5%, the rate of major complications was 2%, and the mortality rate was 0.08%. The 2015 registry is the first to show a slight reduction in the number of centers sending in their results and in the total number of ablation procedures performed. The most frequently treated substrate was the cavotricuspid isthmus. There was also a slight decrease in the success rate. The complications and mortality rates remained low. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  6. Attitudes Towards Catheter Ablation for Atrial Fibrillation

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    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...

  7. 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.

  8. Catheter ablation of epicardial ventricular tachycardia

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    Takumi Yamada, MD, PhD

    2014-08-01

    Full Text Available Ventricular tachycardias (VTs can usually be treated by endocardial catheter ablation. However, some VTs can arise from the epicardial surface, and their substrate can be altered only by epicardial catheter ablation. There are two approaches to epicardial catheter ablation: transvenous and transthoracic. The transvenous approach through the coronary venous system (CVS has been commonly used because it is easily accessible. However, this approach may be limited by the distribution of the CVS and insufficient radiofrequency energy delivery. Transthoracic epicardial catheter ablation has been developed to overcome these limitations of the transvenous approach. It is a useful supplemental or even preferred strategy to eliminate epicardial VTs in the electrophysiology laboratory. This technique has been applied for scar-related VTs secondary to often non-ischemic cardiomyopathy and sometimes ischemic cardiomyopathy, and idiopathic VTs as the epicardial substrates of these VTs have become increasingly recognized. When endocardial ablation and epicardial ablation through the CVS are unsuccessful, transthoracic epicardial ablation should be the next option. Intrapericardial access is usually obtained through a subxiphoidal pericardial puncture. This approach might not be possible in patients with pericardial adhesions caused by prior cardiac surgery or pericarditis. In such cases, a hybrid procedure involving surgical access with a subxiphoid pericardial window and a limited anterior or lateral thoracotomy might be a feasible and safe method of performing an epicardial catheter ablation in the electrophysiology laboratory. Potential complications associated with this technique include bleeding and collateral damage to the coronary arteries and phrenic nerve. Although the risk of these complications is low, electrophysiologists who attempt epicardial catheter ablation should know the complications associated with this technique, how to minimize their

  9. Monitoring Atrial Fibrillation After Catheter Ablation.

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    Forleo, Giovanni B; Casella, Michela; Russo, Antonio Dello; Moltrasio, Massimo; Fassini, Gaetano; Tesauro, Manfredi; Tondo, Claudio

    2014-01-01

    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.

  10. Temperature-controlled irrigated tip radiofrequency catheter ablation

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    Petersen, H H; Chen, X; Pietersen, Adrian

    1998-01-01

    INTRODUCTION: In patients with ventricular tachycardias due to structural heart disease, catheter ablation cures radiofrequency ablation. Irrigated tip radiofrequency ablation using power control and high infusion rates enlarges lesion......: We conclude that temperature-controlled radiofrequency ablation with irrigated tip catheters using low target temperature and low infusion rate enlarges lesion size without increasing the incidence of cratering and reduces coagulum formation of the tip....

  11. Catheter Ablation of Tachyarrhythmias in Small Children

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    Andrew D. Blaufox

    2005-01-01

    Full Text Available An estimated 80,000-100,000 radiofrequency ablation (RFA procedures are performed in the United States each year.1 Approximately 1% of these are performed on pediatric patients at centers that contribute data to the Pediatric Radiofrequency Registry.2 Previous reports from this registry have demonstrated that RFA can safely and effectively be performed in pediatric patients.3,4 However, patients weighing less than 15 kg have been identified as being at greater risk for complications.3,4 Consequently, there has been great reluctance to perform RFA in small children such that children weighing less than 15 kg only represent approximately 6% of the pediatric RFA experience2 despite the fact that this age group carries the highest incidence of tachycardia, particularly supraventricular tachycardia (SVT.5 Factors other than the risk of complications contribute to the lower incidence of RFA in this group, including the natural history of the most common tachycardias (SVT, technical issues with RFA in small hearts, and the potential unknown long-term effects of RF applications in the maturing myocardium. Conversely, there are several reasons why ablation may be desirable in small children, including greater difficulties with medical management,6,7,8 the higher risk for hemodynamic compromise during tachycardia in infants with congenital heart disease (CHD, and the inability of these small children to effectively communicate their symptoms thereby making it more likely that their symptoms may go unnoticed until the children become more seriously ill. Before ultimately deciding that catheter ablation is indicated in small children, one must consider which tachycardias are likely to be ablated, the clinical presentation of these tachycardias, alternatives to ablation, the relative potential for success or complications, and modifications of the procedure that might reduce the risk of ablation in this group.

  12. Pulmonary vein stenosis after catheter ablation: electroporation versus radiofrequency.

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    van Driel, Vincent J H M; Neven, Kars G E J; van Wessel, Harry; du Pré, Bastiaan C; Vink, Aryan; Doevendans, Pieter A F M; Wittkampf, Fred H M

    2014-08-01

    Radiofrequency ablation inside pulmonary vein (PV) ostia can cause PV stenosis. A novel alternative method of ablation is irreversible electroporation, but the long-term response of PVs to electroporation ablation is unknown. In ten 6-month-old pigs (60-75 kg), the response of PVs to circular electroporation and radiofrequency ablation was compared. Ten consecutive, nonarcing, electroporation applications of 200 J were delivered 5 to 10 mm inside 1 of the 2 main PVs, using a custom-deflectable, 18-mm circular decapolar catheter. Inside the other PV, circular radiofrequency ablation was performed using 30 W radiofrequency applications via an irrigated 4-mm ablation catheter. PV angiograms were made before ablation, immediately after ablation, and after 3-month survival. PV diameters and heart size were measured. With electroporation ablation, PV ostial diameter decreased 11±10% directly after ablation, but had increased 19±11% after 3 months. With radiofrequency ablation, PV ostial diameter decreased 23±15% directly after ablation and remained 7±17% smaller after 3 months compared with preablation diameter despite a 21±7% increase in heart size during aging from 6 to 9 months. In this porcine model, multiple circumferential 200-J electroporation applications inside the PV ostia do not affect PV diameter at 3-month follow-up. Radiofrequency ablation inside PV ostia causes considerable PV stenosis directly after ablation, which persists after 3 months. © 2014 American Heart Association, Inc.

  13. Rising charges and costs for pediatric catheter ablation.

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    Burns, Kristin M; Evans, Frank; Pearson, Gail D; Berul, Charles I; Kaltman, Jonathan R

    2013-02-01

    Catheter ablation has been shown to be effective for pediatric tachyarrhythmias, but the associated charges and costs have not been described in the recent era. Understanding such contemporary trends may identify ways to keep an effective therapy affordable while optimizing clinical outcomes. We used the 1997-2009 Kids' Inpatient Databases to examine trends in charges and costs for pediatric catheter ablation and identify determinants of temporal changes. There were 7,130 discharges for catheter ablation in the sample. Mean age at ablation was 12.1 ± 0.2 years. Patients with congenital heart disease (CHD) made up 10% of the sample. Complications occurred in 8% of discharges. Mean total charges rose 219% above inflation (from $23,798 ± 1,072 in 1997 to $75,831 ± 2,065 in 2009). From 2003 to 2009, costs rose 25% (from $20,459 ± 780 in 2003 to $25,628 ± 992 in 2009). Charges for ablation increased markedly relative to surgical procedures, but with a similar slope to other catheter-based interventions. Multivariable analysis revealed that year (P charges. The same factors also predicted increased costs. Charges and costs varied considerably by region, particularly for high-volume centers (P Charges and costs for pediatric catheter ablation increased relative to other procedures and significantly outstripped inflation. Further study of complications, length of stay, and regional differences may help control rising costs while maintaining quality of care. © 2012 Wiley Periodicals, Inc.

  14. Rising Charges and Costs for Pediatric Catheter Ablation

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    BURNS, KRISTIN M.; EVANS, FRANK; PEARSON, GAIL D.; BERUL, CHARLES I.; KALTMAN, JONATHAN R.

    2018-01-01

    Introduction Catheter ablation has been shown to be effective for pediatric tachyarrhythmias, but the associated charges and costs have not been described in the recent era. Understanding such contemporary trends may identify ways to keep an effective therapy affordable while optimizing clinical outcomes. Methods We used the 1997-2009 Kids’ Inpatient Databases to examine trends in charges and costs for pediatric catheter ablation and identify determinants of temporal changes. Results There were 7,130 discharges for catheter ablation in the sample. Mean age at ablation was 12.1 ± 0.2 years. Patients with congenital heart disease (CHD) made up 10% of the sample. Complications occurred in 8% of discharges. Mean total charges rose 219% above inflation (from $23,798 ± 1,072 in 1997 to $75,831 ± 2,065 in 2009). From 2003 to 2009, costs rose 25% (from $20,459 ± 780 in 2003 to $25,628 ± 992 in 2009). Charges for ablation increased markedly relative to surgical procedures, but with a similar slope to other catheter-based interventions. Multivariable analysis revealed that year (P pediatric catheter ablation increased relative to other procedures and significantly outstripped inflation. Further study of complications, length of stay, and regional differences may help control rising costs while maintaining quality of care. PMID:23066833

  15. 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 radiofrequency ablation. Irrigated tip radiofrequency ablation using power control and high infusion rates enlarges lesion size, but has...

  16. Pacemaker implantation after catheter ablation for atrial fibrillation.

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    Deshmukh, Abhishek J; Yao, Xiaoxi; Schilz, Stephanie; Van Houten, Holly; Sangaralingham, Lindsey R; Asirvatham, Samuel J; Friedman, Paul A; Packer, Douglas L; Noseworthy, Peter A

    2016-01-01

    Sinus node dysfunction requiring pacemaker implantation is commonly associated with atrial fibrillation (AF), but may not be clinically apparent until restoration of sinus rhythm with ablation or cardioversion. We sought to determine frequency, time course, and predictors for pacemaker implantation after catheter ablation, and to compare the overall rates to a matched cardioversion cohort. We conducted a retrospective analysis using a large US commercial insurance database and identified 12,158 AF patients who underwent catheter ablation between January 1, 2005 and December 31, 2012. Over an average of 2.4 years of follow-up, 5.6 % of the patients underwent pacemaker implantation. Using the Cox proportional hazards models, we found that risk of risks of pacemaker implantation was associated with older age (50-64 and ≥65 versus pacemaker implantation between ablation patients and propensity score (PS)-matched cardioversion groups (3.5 versus. 4.1 % at 1 year and 8.8 versus 8.3 % at 5 years). Overall, pacemaker implantation occurs in about 1/28 patients within 1 year of catheter ablation. The overall implantation rate decreased between 2005 and 2012. Furthermore, the risk after ablation is similar to cardioversion, suggesting that patients require pacing due to a common underlying electrophysiologic substrate, rather than the ablation itself.

  17. Successful management of atrio-esophageal fistula after cardiac radiofrequency catheter ablation.

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    Shim, Hun Bo; Kim, Chilsung; Kim, Hong-Kwan; Sung, Kiick

    2013-04-01

    An increase in cardiac radiofrequency catheter ablation for treating refractory atrial fibrillation has resulted in an increased prevalence of complications. Among numerous complications of radiofrequency catheter ablation, atrio-esophageal fistula, although rare, is known to have fatal results. We report a case of successful management of an atrio-esophageal fistula as a complication of cardiac radiofrequency catheter ablation.

  18. Factors Influencing Lesion Formation During Radiofrequency Catheter Ablation

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    Olaf J. Eick

    2003-07-01

    Full Text Available In radiofrequency (RF ablation, the heating of cardiac tissue is mainly resistive. RF current heats cardiac tissue and in turn the catheter electrode is being heated. Consequently, the catheter tip temperature is always lower - or ideally equal - than the superficial tissue temperature. The lesion size is influenced by many parameters such as delivered RF power, electrode length, electrode orientation, blood flow and tissue contact. This review describes the influence of these different parameters on lesion formation and provides recommendations for different catheter types on selectable parameters such as target temperatures, power limits and RF durations

  19. A Tight Spot After Pulmonary Vein Catheter Ablation

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    Amir, Rabia; Yeh, Lu; Montealegre-Gallegos, Mario; Saraf, Rabya; Matyal, Robina; Mahmood, Feroze

    2016-01-01

    A 52-YEAR-OLD woman with a history of embolic stroke due to paroxysmal atrial fibrillation was referred to the authors’ institution for epicardial surgical pulmonary vein isolation with left atrial appendage resection. The patient had 2 previous failed pulmonary vein catheter ablations. Dense

  20. Irrigated Tip Catheters for Radiofrequency Ablation in Ventricular Tachycardia

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    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.

  1. Catheter ablation for ventricular tachyarrhythmia in patients with channelopathies

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    Nobuyuki Murakoshi, MD, PhD

    2016-10-01

    Full Text Available Drug treatment and/or implantable cardioverter defibrillator (ICD implantation are the most widely accepted first-line therapies for channelopathic patients who have recurrent syncope, sustained ventricular tachycardia (VT, or documented ventricular fibrillation (VF, or are survivors of cardiac arrest. In recent years, there have been significant advances in mapping techniques and ablation technology, coupled with better understanding of the mechanisms of ventricular tachyarrhythmia in channelopathies. Catheter ablation has provided important insights into the role of the Purkinje network and the right ventricular outflow tract in the initiation and perpetuation of VT/VF, and has evolved as a promising treatment modality for ventricular tachyarrhythmia even in channelopathies. When patients are exposed to a high risk of sudden cardiac death or deterioration of their quality of life due to episodes of tachycardia and frequent ICD discharges, catheter ablation may be an effective treatment option to reduce the risk of sudden cardiac death and decrease the frequency of cardiac events. In this review, we summarize the current understanding of catheter ablation for VT/VF in patients with channelopathies including Brugada syndrome, idiopathic VF, long QT syndrome, and catecholaminergic polymorphic VT.

  2. Catheter Ablation for Long-Standing Persistent Atrial Fibrillation.

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    Romero, Jorge; Gianni, Carola; Di Biase, Luigi; Natale, Andrea

    2015-01-01

    Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and represents a major burden to health care systems. Atrial fibrillation is associated with a 4- to 5-fold increased risk of thromboembolic stroke. The pulmonary veins have been identified as major sources of atrial triggers for AF. This is particularly true in patients with paroxysmal AF but not always the case for those with long-standing persistent AF (LSPAF), in which other locations for ectopic beats have been well recognized. Structures with foci triggering AF include the coronary sinus, the left atrial appendage (LAA), the superior vena cava, the crista terminalis, and the ligament of Marshall. More than 30 studies reporting results on radiofrequency ablation of LSPAF have been published to date. Most of these are observational studies with very different methodologies using different strategies. As a result, there has been remarkable variation in short- and long-term success, which suggests that the optimal ablation technique for LSPAF is still to be elucidated. In this review we discuss the different approaches to LSPAF catheter ablation, starting with pulmonary vein isolation (PVI) through ablation lines in different left atrial locations, the role of complex fractionated atrial electrograms, focal impulses and rotor modulation, autonomic modulation (ganglionated plexi), alcohol ablation, and the future of epicardial mapping and ablation for this arrhythmia. A stepwise ablation approach requires several key ablation techniques, such as meticulous PVI, linear ablation at the roof and mitral isthmus, electrogram-targeted ablation with particular attention to triggers in the coronary sinus and LAA, and discretionary right atrial ablation (superior vena cava, intercaval, or cavotricuspid isthmus lines).

  3. Long-term efficacy of catheter ablation as first-line therapy for paroxysmal atrial fibrillation

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    Nielsen, Jens Cosedis; Johannessen, Arne; Raatikainen, Pekka

    2016-01-01

    OBJECTIVE: The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) trial compared radiofrequency catheter ablation (RFA) with antiarrhythmic drug therapy (AAD) as first-line treatment for paroxysmal atrial fibrillation (AF). Endpoint of ablat......OBJECTIVE: The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) trial compared radiofrequency catheter ablation (RFA) with antiarrhythmic drug therapy (AAD) as first-line treatment for paroxysmal atrial fibrillation (AF). Endpoint...

  4. Use of a contact force-sensing ablation catheter with advanced catheter location significantly reduces fluoroscopy time and radiation dose in catheter ablation of atrial fibrillation.

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    Lee, Geoffrey; Hunter, Ross J; Lovell, Matthew J; Finlay, Malcom; Ullah, Waqas; Baker, Victoria; Dhinoja, Mehul B; Sporton, Simon; Earley, Mark J; Schilling, Richard J

    2016-02-01

    The aim of this study was to evaluate the 'real-world' impact of a novel contact force (CF)-sensing (SmartTouch™, Biosense Webster, Diamond Bar, CA, USA) catheter coupled with an advanced catheter location (ACL) system on fluoroscopy time and fluoroscopy dose during atrial fibrillation (AF) ablation. This was a retrospective observational cohort study of prospectively collected data of 1515 consecutive patients undergoing paroxysmal AF (PAF) and persistent AF (PerAF) ablation at a single institution between 2009 and 2014. Patients undergoing AF ablation with the SmartTouch catheter and the ACL system (SmartTouch group, n = 510) were compared with those undergoing AF ablation without this technology (control group, n = 1005). The primary outcomes were total fluoroscopy time (min) and fluoroscopy dose as measured by the dose-area product (mGy cm(2)). Secondary endpoints included total procedure time, total ablation time, and major cardiac complications (tamponade, pericardial effusion, and urgent cardiac surgery). The SmartTouch group had significantly lower fluoroscopy times (9.5 vs. 41 min, P fluoroscopy time of 3.5 min (interquartile range 6) for all AF ablations was achieved. There was no difference in the rate of cardiac complications (∼ 1.5%). SmartTouch™ CF-sensing catheter use with ACL™ during AF ablation significantly reduces fluoroscopy times by 77%, radiation dose by 71%, and procedural time by 19% but does not improve overall safety or the risk of cardiac complications. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

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

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    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...

  6. Limited fluoroscopy catheter ablation of accessory pathways in children.

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    Swissa, Moshe; Birk, Einat; Dagan, Tamir; Abby Naimer, Sody; Fogelman, Michal; Einbinder, Tom; Bruckheimer, Elchanan; Fogelman, Rami

    2017-10-01

    Limited fluoroscopy ablation using 3D electro-anatomical system (3DS) has been used for arrhythmias in children, however it is not a common practice. We aimed to facilitate a fluoroscopy limited approach for ablation of accessory pathways (AP) in children. Following electrophysiologic (EP) catheter placement a single dual-plane fluoroscopic image (right anterior oblique-30° and left anterior oblique-60° views) was acquired and the 3DS views were rotated to be a perfect match to the fluoroscopy. Ninety-four consecutive pediatric patients [mean age 11.8±4.1 (4.2-18) years, 61.7% males] with Wolf-Parkinson-White syndrome underwent ablation of an AP. Fifty-seven had manifest AP, 54 had left-sided AP (LSAP) and 40 had right-sided AP (RSAP). The acute success rate was 95.7% (90/94), with a recurrence rate of 1.1% (1/90) at a mean follow-up of 13±5.5 (4.4-22.9) months. Mean procedure and fluoroscopy times were 144±45 (55-262)min and 1.8±1.4 (0.1-5.6)min, respectively. Comparison of the first 20 procedures to the next 74 procedures demonstrated an extended procedure time (171±53min vs 135±38min, pfluoroscopy time, the number of long applications, the time to effect, and the acute success rate were similar. There were no permanent ablation-related complications. A limited fluoroscopy approach for ablation of AP in children using 3DS is easily acquired, adapted, reduces the fluoroscopy time, and has an excellent efficacy and safety profile. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  7. Tissue temperatures and lesion size during irrigated tip catheter radiofrequency ablation

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    Petersen, H H; Chen, X; Pietersen, Adrian

    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...

  8. Identifying sites for catheter ablation of ventricular tachycardia.

    Science.gov (United States)

    Stevenson, W G; Sager, P; Nademanee, K; Hassan, H; Middlekauff, H R; Saxon, L A; Wiener, I

    1992-06-01

    The approach to localizing sites for catheter ablation of ventricular tachycardia foci depends on the type of tachycardia. In large reentry circuits such as those arising from infarct scars, areas of slow conduction in and around the scar should be targeted. During sinus rhythm, these can be suspected from the presence of fractionated electrograms and, at some sites, long stimulus to QRS delays during pacing. Slow conduction areas can be classified as: 1. central slow conduction zone sites, 2. exits from the slow conduction zone, 3. entrances to the slow conduction zone, and 4. bystander areas which are not involved in the tachycardia circuit. In the central slow conduction zone stimulation entrains or resets tachycardia with a long stimulus to QRS (S-QRS) delay (40 to greater than 300 ms) without altering the QRS morphology (entrainment with concealed fusion). At slow conduction zone exits, presystolic electrograms are recorded during VT, the pacemap matches the VT QRS morphology, and with pacing during VT the S-QRS interval is relatively short and VT may or may not be entrained. At entrances to the slow conduction zone electrogram timing is variable but early diastolic electrograms are expected and the pace-map QRS may differ from the VT QRS morphology. Relatively late stimuli or slow trains of stimuli entrain VT with concealed fusion with a relatively longer S-QRS interval than observed in the central slow conduction zone. Early stimuli may entrain VT while altering the QRS morphology due to propagation of the stimulated antidromic wavefront out of the scar from a site other than the tachycardia exit. At bystander sites electrogram timing, pace-mapping, and the effects of programmed stimulation are variable but may occasionally mimic reentry circuit sites. Relatively late stimuli are likely to capture the site without altering the VT. If discrete electrograms are present, analysis of these during pacing may provide further evidence that the site is not in the

  9. Catheter ablation of atrial tachycardia after interatrial defect repair with patch apposition.

    Science.gov (United States)

    Nguyen, B L; Garante, C M; Tersigni, F; Sergiacomi, R; Petrassi, M; Di Matteo, A; Tufano, F; Alessandri, N

    2012-02-01

    A 54-year-old woman with history of septal atrial mixoma surgically treated and drug-refractory supraventricular tachyarrhythmia underwent catheter ablation of macro-reentry areas near the pericardial patch placed to repair an interatrial defect. The use of ablative therapy has been successful to cure this arrhythmia.

  10. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Catheter Ablation of Focal Atrial Tachycardia Using Remote Magnetic Navigation

    DEFF Research Database (Denmark)

    Liu, Xiao-Yu; Jacobsen, Peter Karl; Pehrson, Steen

    2018-01-01

    , a total of 56 atrial foci were found. Acute success of the primary ablation was obtained in 52 patients (98%). Mean procedure duration was 109 ± 35 min, ablation duration was 401 sec (interquartile range [IQR], 332 sec), and fluoroscopy time was 5.0 min (IQR, 3.0 min). After a mean follow-up of 31 ± 18...

  13. 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...

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

    DEFF Research Database (Denmark)

    Nilsson, Brian; Chen, Xu; Pehrson, Steen

    2005-01-01

    AIM: Sinus tachycardia has been observed following radiofrequency (RF) catheter ablation for various kinds of supraventricular tachycardia. This study is aimed at determining the occurrence of changes in sinus-rhythm heart rate (HR) after pulmonary vein (PV) isolation in patients with paroxysmal...

  15. Extremely low-frame-rate digital fluoroscopy in catheter ablation of atrial fibrillation

    Science.gov (United States)

    Lee, Ji Hyun; Kim, Jun; Kim, Minsu; Hwang, Jongmin; Hwang, You Mi; Kang, Joon-Won; Nam, Gi-Byoung; Choi, Kee-Joon; Kim, You-Ho

    2017-01-01

    Abstract Despite the technological advance in 3-dimensional (3D) mapping, radiation exposure during catheter ablation of atrial fibrillation (AF) continues to be a major concern in both patients and physicians. Previous studies reported substantial radiation exposure (7369–8690 cGy cm2) during AF catheter ablation with fluoroscopic settings of 7.5 frames per second (FPS) under 3D mapping system guidance. We evaluated the efficacy and safety of a low-frame-rate fluoroscopy protocol for catheter ablation for AF. Retrospective analysis of data on 133 patients who underwent AF catheter ablation with 3-D electro-anatomic mapping at our institute from January 2014 to May 2015 was performed. Since January 2014, fluoroscopy frame rate of 4-FPS was implemented at our institute, which was further decreased to 2-FPS in September 2014. We compared the radiation exposure quantified as dose area product (DAP) and effective dose (ED) between the 4-FPS (n = 57) and 2-FPS (n = 76) groups. The 4-FPS group showed higher median DAP (599.9 cGy cm2; interquartile range [IR], 371.4–1337.5 cGy cm2 vs. 392.0 cGy cm2; IR, 289.7–591.4 cGy cm2; P fluoroscopy setting. PMID:28614264

  16. 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.

  17. Effect of Left Atrial Ablation Process and Strategy on Microemboli Formation During Irrigated Radiofrequency Catheter Ablation in an In Vivo Model.

    Science.gov (United States)

    Takami, Mitsuru; Lehmann, H Immo; Parker, Kay D; Welker, Kirk M; Johnson, Susan B; Packer, Douglas L

    2016-01-01

    Formation of microemboli during catheter ablation has been suggested as a cause for asymptomatic cerebral emboli. However, it is unknown which part of the process and ablation setting/strategy is most strongly related to this occurrence. A total of 27 pigs were used. Catheter/sheath manipulations in left atrium were performed in 25 of 27 pigs outfitted with microemboli monitoring systems. Ablations using open-irrigated radiofrequency catheters were performed in 18 of 25 pigs. Two of 27 pigs did not undergo left atrial procedures and were injected with microembolic materials in the carotid artery to serve as positive controls. In total, 334 sheath/catheter manipulations (transseptal puncture, sheath flushing, catheter insertion, pulmonary vein venography, and sheath exchange) and 333 radiofrequency applications (power setting, 30/50 W; point-by-point/drag ablations) were analyzed. High microbubble volume in the extracorporeal circulation loop and a high number of microembolic signals in carotid artery were observed during sheath/catheter manipulations especially in saline/contrast injections at fast speed and ablations with steam pop. Fast sheath flushing produced significantly higher microbubble volume than slow sheath flushing (median, 12 200 versus 121 nL; Pdrag ablations, and steam pop. Brain magnetic resonance imaging showed positive-embolic lesions in control pigs. Formation of microbubbles was the greatest during fast saline/contrast injections and steam pops, whereas high-power radiofrequency applications, drag ablations, and steam pops produced most of the microparticles. © 2016 American Heart Association, Inc.

  18. An Approach to Catheter Ablation of Cavotricuspid Isthmus Dependent Atrial Flutter

    Directory of Open Access Journals (Sweden)

    Mark D O’Neill

    2006-04-01

    Full Text Available Much of our understanding of the mechanisms of macro re-entrant atrial tachycardia comes from study of cavotricuspid isthmus (CTI dependent atrial flutter. In the majority of cases, the diagnosis can be made from simple analysis of the surface ECG. Endocardial mapping during tachycardia allows confirmation of the macro re-entrant circuit within the right atrium while, at the same time, permitting curative catheter ablation targeting the critical isthmus of tissue located between the tricuspid annulus and the inferior vena cava. The procedure is short, safe and by demonstration of an electrophysiological endpoint - bidirectional conduction block across the CTI - is associated with an excellent outcome following ablation. It is now fair to say that catheter ablation should be considered as a first line therapy for patients with documented CTI-dependent atrial flutter.

  19. Catheter ablation of pediatric AV nodal reentrant tachycardia: results in small children.

    Science.gov (United States)

    Krause, Ulrich; Backhoff, David; Klehs, Sophia; Kriebel, Thomas; Paul, Thomas; Schneider, Heike E

    2015-11-01

    AV nodal reentrant tachycardia (AVNRT) is commonly encountered in pediatric patients. Definite treatment can be achieved by catheter ablation. The purpose of the study was to evaluate the efficacy and safety of AVNRT ablation focusing on children with a body weight ≤25 kg. Catheter ablation of AVNRT was attempted in 253 patients. Median age was 12.5 years; median body weight was 48.7 kg. 25 (9.9 %) children had a body weight ≤25 kg. Congenital heart disease was present in 6 patients (2.4 %). Procedural success was achieved in 98 % using radiofrequency, in 100 % using cryoenergy alone, and in 94 % using both energy sources. In patients with a body weight ≤25 kg, success was achieved in 96 %. In patients ≤25 kg, fluoroscopy and procedure duration did not differ from those >25 kg. The rate of major complications was significantly higher in the patients ≤25 kg (12 vs. 2.2 %, p = 0.04). Permanent AV block after RF ablation occurred in 2 patients with congenital heart disease and one infant with a body weight of 8.7 kg. Catheter ablation of AVNRT in children and adolescents was safe and effective. Infants and small children with a body weight ≤25 kg had a higher prevalence of serious complications. This should alert physicians in decision making toward catheter ablation in these patients. In patients with congenital heart disease and different anatomy of the cardiac conduction system, operators must be aware of an increased risk for AV block.

  20. Ablation of atrial fibrillation and esophageal injury: Role of bipolar and unipolar energy using a novel multipolar irrigated ablation catheter.

    Science.gov (United States)

    Di Monaco, Antonio; Quadrini, Federico; Katsouras, Grigorios; Caccavo, Vincenzo; Troisi, Federica; Quatraro, Francesco; Cecere, Giacomo; Langialonga, Tommaso; Grimaldi, Massimo

    2015-06-01

    The circular nMARQ ablation catheter is a useful tool for pulmonary vein isolation (PVI). Some studies reported a high incidence of esophageal lesions by using this catheter. The primary aim of this study was to compare the effects on the esophageal wall of bipolar and unipolar energy applied by the nMARQ ablation catheter during AF ablation. Forty patients (mean age 53 ± 8 years; 26 [65%] men) were enrolled to perform PVI for symptomatic atrial fibrillation. Thirty patients underwent PVI with the nMARQ catheter (group 1) and 10 patients with the ThermoCool Surround Flow catheter (group 2). The procedures were performed with the CARTO3 system. All patients received an esophageal temperature probe. In group 1, we delivered unipolar energy on the left posterior wall with power between 15 and 18 W or bipolar energy with power at 15 W. In group 2, unipolar energy was delivered on the posterior atrial wall at 20-25 W power. All patients underwent esophagoscopy the day after the procedure. No patients had procedural complications. In group 1, bipolar energy was associated with a lower esophageal temperature increase as compared with unipolar energy (0.6°C [range 0-2.2°C] vs 2.1°C [range 0.8-2.9°C]; P energy was associated with a similar temperature increase in the 2 groups (1.9°C [range 0.8-2.9°C] in group 1 vs 1.7°C [range 0.7-2.9°C] in group 2; P = .49). No patient had esophageal injury. The use of the nMARQ catheter for PVI is feasible and safe. The use of 15 W for bipolar energy or 15-18 W for unipolar energy is an optimal strategy to avoid esophageal injury with this new catheter. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  1. The Incidence of Audible Steam Pops Is Increased and Unpredictable With the ThermoCool® Surround Flow Catheter During Left Atrial Catheter Ablation: A Prospective Observational Study.

    Science.gov (United States)

    Theis, Cathrin; Rostock, Thomas; Mollnau, Hanke; Sonnenschein, Sebastian; Himmrich, Ewald; Kämpfner, Denise; Ocete, Blanca Quesada; Bock, Karsten; Münzel, Thomas; Konrad, Torsten

    2015-06-08

    Open irrigated radiofrequency (RF) ablation catheters with a porous tip (56 holes, TC-SF) permit delivering RF energy in a temperature-controlled mode without temperature rise. This prospective observational study investigated the association of different catheter parameters on the occurrence of audible steam pops during left atrial (LA) ablation. A total of 226 patients underwent TC-SF catheter ablation for atrial fibrillation. RF power delivery, impedance and catheter tip temperature were continually recorded throughout the ablation. Pulmonary vein isolation was performed with a maximum of 27 W and LA electrogram-guided or linear ablation with a maximum of 30 W. A total of 59 audible steam pops occurred, 2 of them resulting in pericardial tamponade. In the initial 89 patients, with an irrigation flow rate of 10 mL/min, 18 steam pops with one tamponade occurred in 12 (14%) patients. Subsequently, the irrigation flow rate was increased to 20 mL/min in the following 137 patients, resulting in the occurrence of 41 steam pops including one case of tamponade in a total of 30 (22%) patients. The maximal power was significantly higher in RF applications associated with a pop than those that did not. In only 12 (20%) steam pops, a significant impedance change occurred immediately before pop occurrence (4 [7%] impedance rise >10 ohm, 8 [13%] impedance drop >15 ohm). The TC-SF catheter does not provide sufficient feedback from the ablated tissue to prevent steam popping. © 2015 Wiley Periodicals, Inc.

  2. 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

    later recurrence. METHODS AND RESULTS: In a two-centre, randomized, double-blind, placebo-controlled study, we randomized a total of 212 patients undergoing AF ablation. Patients were stratified according to type of AF (paroxysmal/persistent) and history of previous AF ablation and randomly assigned...... to 8 weeks of oral amiodarone therapy or matched placebo following catheter ablation. Patients were followed for 6 months. Analyses were performed according to the intention-to-treat principle. Of 212 enrolled patients [median age 61 (inter-quartile range 54-66), 83% male, 50% paroxysmal, 29...... 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...

  3. PVCs, PVC-Induced Cardiomyopathy, and the Role of Catheter Ablation.

    Science.gov (United States)

    Sharma, Esseim; Arunachalam, Karuppiah; Di, Mengyang; Chu, Antony; Maan, Abhishek

    2017-06-01

    Premature ventricular contractions (PVCs) are common arrhythmias noticed in the clinical setting because of premature depolarization of the ventricular myocytes. Although often thought to be reflective of underlying disease rather than intrinsically harmful, PVCs have recently been linked with worse outcomes in patients without significant cardiac disease. Long-term exposure to a high PVC burden can lead to the development of PVC-induced cardiomyopathy. The pathogenesis of this condition is poorly understood at the current time. Many studies have suggested that catheter ablation of these PVCs may result in reversal of the PVC-induced cardiomyopathy. This article will go over the natural history of PVCs and PVC-induced cardiomyopathy, as well as review the current literature on the role of catheter ablation in treating PVC-induced cardiomyopathy.

  4. Exclusion of fluoroscopy use in catheter ablation procedures: six years of experience at a single center.

    Science.gov (United States)

    Fernández-Gómez, Juan M; Moriña-Vázquez, Pablo; Morales, Elena Del Rio; Venegas-Gamero, José; Barba-Pichardo, Rafael; Carranza, Manuel Herrera

    2014-06-01

    Nonfluoroscopic mapping systems have demonstrated significant reduction of radiation exposure in radiofrequency (RF) catheter ablation procedures. However, their use as only imaging guide is still limited. To evaluate the usefulness of a completely nonfluoroscopic approach to catheter ablation of supraventricular arrhythmias using the Ensite-NavX™ electroanatomical navigation system. During 6 years, all consecutive patients referred for RF catheter ablation of regular supraventricular tachycardia (SVT) were admitted for a "zero-fluoroscopy" approach and studied prospectively. The only exclusion criterion was the need to perform a transseptal puncture. A total of 340 procedures were performed on 328 patients (179 men, age 55.7 ± 18.6 years). One hundred fifty-three patients had typical atrial flutter (AFL), 146 had AV nodal reentrant tachycardia (AVNRT), 35 had AV reciprocating tachycardia (AVRT), 4 patients had incisional atrial flutter (IAF), and 2 had focal atrial tachycardia (AT). Procedural success was achieved in 337 of the cases (99.1%). In 322 (94.7%), the procedure was completed without any fluoroscopy use. Mean procedure time was 110.5 ± 51.8 minutes. Mean RF application time was 9.8 ± 12.8 minutes and the number of RF lesions was 16.43 ± 15.8. Only 1 major complication related to vascular access was recorded. During follow-up, there were 12 recurrences (3.5%) (8 patients from the AVNRT group, 4 patients from the AP group). RF catheter ablation of SVT with an approach completely guided by the NavX system and without use of fluoroscopy is feasible, safe, and effective. © 2014 Wiley Periodicals, Inc.

  5. Catheter Ablation of Recurrent Lone Atrial Fibrillation in Teenagers with a Structurally Normal Heart.

    Science.gov (United States)

    Balaji, Seshadri; Kron, Jack; Stecker, Eric C

    2016-01-01

    Atrial fibrillation (AF) is rare in teenagers. There are few reports and no clear guidelines on the management of AF with catheter ablation in teenagers. A case series of teenagers (teenage boys aged 15-17 years underwent catheter ablation of AF. All but one had failed antiarrhythmic medical therapy. Two had focal triggers and underwent culprit vein isolation (one recurred and so underwent isolation of an additional vein), and two had no focal triggers identified and so underwent isolation of all four pulmonary veins (PVs). At follow-up ranging from 2-6 years, one patient who underwent isolation of all four veins had recurrence of paroxysmal AF. All others have had medium and long-term success with complete absence of AF. None are on long-term antiarrhythmic therapy. No patient had a procedural or postprocedure complication. A cautious attempt at catheter ablation may be appropriate in teenagers with paroxysmal AF and a structurally normal heart who fail pharmacologic therapy. Culprit vein(s) isolation should be preferred if possible but if no focal triggers are identified, isolation of all PVs appears to be beneficial. © 2015 Wiley Periodicals, Inc.

  6. First In Vivo Use of a Capacitive Micromachined Ultrasound Transducer Array–Based Imaging and Ablation Catheter

    Science.gov (United States)

    Stephens, Douglas N.; Truong, Uyen T.; Nikoozadeh, Amin; Oralkan, Ömer; Seo, Chi Hyung; Cannata, Jonathan; Dentinger, Aaron; Thomenius, Kai; de la Rama, Alan; Nguyen, Tho; Lin, Feng; Khuri-Yakub, Pierre; Mahajan, Aman; Shivkumar, Kalyanam; O’Donnell, Matt; Sahn, David J.

    2012-01-01

    Objectives The primary objective was to test in vivo for the first time the general operation of a new multifunctional intracardiac echocardiography (ICE) catheter constructed with a microlinear capacitive micromachined ultrasound transducer (ML-CMUT) imaging array. Secondarily, we examined the compatibility of this catheter with electroanatomic mapping (EAM) guidance and also as a radiofrequency ablation (RFA) catheter. Preliminary thermal strain imaging (TSI)-derived temperature data were obtained from within the endocardium simultaneously during RFA to show the feasibility of direct ablation guidance procedures. Methods The new 9F forward-looking ICE catheter was constructed with 3 complementary technologies: a CMUT imaging array with a custom electronic array buffer, catheter surface electrodes for EAM guidance, and a special ablation tip, that permits simultaneous TSI and RFA. In vivo imaging studies of 5 anesthetized porcine models with 5 CMUT catheters were performed. Results The ML-CMUT ICE catheter provided high-resolution real-time wideband 2-dimensional (2D) images at greater than 8 MHz and is capable of both RFA and EAM guidance. Although the 24-element array aperture dimension is only 1.5 mm, the imaging depth of penetration is greater than 30 mm. The specially designed ultrasound-compatible metalized plastic tip allowed simultaneous imaging during ablation and direct acquisition of TSI data for tissue ablation temperatures. Postprocessing analysis showed a first-order correlation between TSI and temperature, permitting early development temperature-time relationships at specific myocardial ablation sites. Conclusions Multifunctional forward-looking ML-CMUT ICE catheters, with simultaneous intracardiac guidance, ultrasound imaging, and RFA, may offer a new means to improve interventional ablation procedures. PMID:22298868

  7. First in vivo use of a capacitive micromachined ultrasound transducer array-based imaging and ablation catheter.

    Science.gov (United States)

    Stephens, Douglas N; Truong, Uyen T; Nikoozadeh, Amin; Oralkan, Omer; Seo, Chi Hyung; Cannata, Jonathan; Dentinger, Aaron; Thomenius, Kai; de la Rama, Alan; Nguyen, Tho; Lin, Feng; Khuri-Yakub, Pierre; Mahajan, Aman; Shivkumar, Kalyanam; O'Donnell, Matt; Sahn, David J

    2012-02-01

    The primary objective was to test in vivo for the first time the general operation of a new multifunctional intracardiac echocardiography (ICE) catheter constructed with a microlinear capacitive micromachined ultrasound transducer (ML-CMUT) imaging array. Secondarily, we examined the compatibility of this catheter with electroanatomic mapping (EAM) guidance and also as a radiofrequency ablation (RFA) catheter. Preliminary thermal strain imaging (TSI)-derived temperature data were obtained from within the endocardium simultaneously during RFA to show the feasibility of direct ablation guidance procedures. The new 9F forward-looking ICE catheter was constructed with 3 complementary technologies: a CMUT imaging array with a custom electronic array buffer, catheter surface electrodes for EAM guidance, and a special ablation tip, that permits simultaneous TSI and RFA. In vivo imaging studies of 5 anesthetized porcine models with 5 CMUT catheters were performed. The ML-CMUT ICE catheter provided high-resolution real-time wideband 2-dimensional (2D) images at greater than 8 MHz and is capable of both RFA and EAM guidance. Although the 24-element array aperture dimension is only 1.5 mm, the imaging depth of penetration is greater than 30 mm. The specially designed ultrasound-compatible metalized plastic tip allowed simultaneous imaging during ablation and direct acquisition of TSI data for tissue ablation temperatures. Postprocessing analysis showed a first-order correlation between TSI and temperature, permitting early development temperature-time relationships at specific myocardial ablation sites. Multifunctional forward-looking ML-CMUT ICE catheters, with simultaneous intracardiac guidance, ultrasound imaging, and RFA, may offer a new means to improve interventional ablation procedures.

  8. Utility of intracardiac ultrasound imaging to guide pulmonary vein ablation using laser balloon catheter.

    Science.gov (United States)

    Leite, Luiz; Su, Wilber; Johnson, Susan B; Milton, Mark; Henz, Benhur; Sarabanda, Alvaro; Santos, Simone N; Packer, Douglas L

    2009-12-01

    Pulmonary vein isolation (PVI) with balloon catheter has been used as the endpoint for AF ablation. To determine the usefulness of intracardiac ultrasound (ICUS) to guide PVI using laser balloon catheter. 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. 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%. 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.

  9. Clinical utility of the Covidien Closure Fast™ Endovenous Radiofrequency Ablation Catheter

    Directory of Open Access Journals (Sweden)

    Braithwaite SA

    2014-06-01

    Full Text Available Simon A Braithwaite,1 Bruce D Braithwaite2 1University College Hospital Medical School, London, UK; 2Department of Cardiovascular Medicine, University of Nottingham, Nottingham, UK Abstract: The Closure Fast™ Endovenous Radiofrequency Ablation Catheter is the latest version of a minimally invasive system for the treatment of patients with superficial venous disease. The Closure Fast™ catheter heats the vein wall to 120°C, causing denaturation of the collagen of the vein wall and contraction of the vessel such that no blood can flow through it. Nearly one million systems have been sold since the product was launched. Many, if not all, patients can be treated under local anesthesia with the Closure Fast™ catheter. Duplex ultrasound reports occlusion rates for the treated vein of 94%–98% at 1 year and 85%–93% at 3 years. The system produces average postoperative pain scores of less than 2 out of 10 on a visual analog score. In the first postoperative week, 76% of patients do not require analgesia. Some 45% of patients return to normal activity on the first postoperative day. Serious complications appear to be rare following the Closure Fast™ procedure. Transient paresthesia occurs in 0.2% of cases, thrombophlebitis in 1%–10%, and thromboembolic events in up to 1.4%, mainly heat-induced thrombosis. Closure Fast™ adds significant costs to treating superficial venous disease but studies have shown it to be cost-effective when used in an office setting. Keywords: Closure Fast, catheter, Endovenous Radiofrequency Ablation Catheter

  10. 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

  11. Catheter ablation of three macroreentrant atrial tachycardias after surgical repair of Double-Outlet Right Ventricle

    Directory of Open Access Journals (Sweden)

    Tadashi Wada

    2012-06-01

    Full Text Available A 54-year-old man with a surgically repaired double-outlet right ventricle (DORV presented with palpitations and worsening right heart failure. His 12-lead ECG showed atrial tachycardia (AT with an atrial cycle length (CL of 300 ms and an inverted saw-tooth F-wave pattern in the inferior leads II, III, and aVF typical of atrial flutter. Electrophysiological study and radiofrequency catheter ablation were performed. A total of 3 sustained ATs (AT1–AT3 were induced. Using the electroanatomical mapping system, CARTO3, and conventional mapping techniques, the ATs were identified as macroreentrant tachycardias circling around an incisional line on the free wall of the right atrium (AT1, the tricuspid annulus (AT2, and low voltage area in the lateral wall including the right septum (AT3. Accuracy of CARTO3 in three-dimensional reconstruction was sufficient to elucidate anatomical features (including catheter sites, incision, and low voltage areas and macroreentrant circuits. However, conventional mapping techniques were also necessary to identify the mechanism of the tachycardias, and therefore to eliminate all of them successfully. This case demonstrates that the use of combined conventional and electroanatomical mapping techniques, such as CARTO3, can be helpful in identifying the critical isthmus for catheter ablation of macroreentrant AT in patients with surgically corrected congenital heart disease (CHD.

  12. [Catheter ablation of atrio-ventricular accessory pathways in the era of ablation therapy of complex arrhythmias: a changing perspective for oncoming generation of electrophysiologists].

    Science.gov (United States)

    Fiala, M; Chovančík, J; Wojnarová, D; Szymeczek, H; Pindor, J; Bulková, V; Neuwirth, R; Jiravský, O; Vavřík, D; Krawiec, S; Januška, J

    2012-06-01

    Catheter ablation of atrio-ventricular accessory pathways has become a routine treatment method. However, its perspective has been changing in the era of ablation of complex arrhythmias. This study was aimed at evaluating accessory pathways ablation efficacy within the last nine years at one center. From February 2002 to June 2011, catheter ablation of accessory pathways was performed in 247 patients (100 females, 42 ± 16 years). Elimination of accessory pathways conduction in both directions was the procedure endpoint. Immediate accessory pathways conduction elimination at the first ablation was achieved in 228 (92%) patients. Ablation failed to eliminate accessory pathways conduction in 19 (8%) patients, or accessory pathways conduction subsequently recurred in another 7 (3%) patients. Repeat ablation was completed in 20 (8%) patients, 2 patients underwent a third ablation procedure. In total, accessory pathway was permanently eliminated in 238 (96%) patients. Ablation failure was connected with a risky position in the vicinity of atrio-ventricular conduction system in 6 (67 %) out of 9 patients. By the individual A, B, C, D operators experience, efficacy of the first procedure/total efficacy, was 97%/99%, 90%/96%, 87%/87%, and 91%/91%, respectively (comparison of inter-operator efficacy of the first and repeat ablation by Kruskal-Wallis ANOVA test: p = 0,19 and 0,05, respectively). Accessory pathways ablation efficacy exceeds 95%, and ablation failure is dominantly related to the accessory pathways location close to the atrio-ventricular conduction system. Individual operator's experience was associated with a certain disparity between high and nearly absolute accessory pathways ablation efficacy.

  13. Direct thermography-a new in vitro method to characterize temperature kinetics of ablation catheters.

    Science.gov (United States)

    Fiek, M; Gindele, F; von Bary, C; Muessig, D; Lucic, A; Hoffmann, E; Reithmann, C; Steinbeck, G

    2013-10-01

    For the treatment of increasingly complex cardiac arrhythmias, new catheter designs as well as alternative energy sources are constantly being developed. However, there is presently no in vitro method available for assessment of the temperature changes induced at various myocardial levels during energy delivery. Therefore, our study was aimed at developing an in vitro model to record and display the temperature kinetics during ablation in the entire muscle cross section. A sapphire glass pane was inserted into one wall of the in vitro experimental set-up. Due to its thermodynamic properties, the temperature distribution in an adjacent cross section of the cardiac muscle can be measured exactly ( 1 °C) through this pane by means of a thermography camera. Computer-supported image processing enables the colour-coded and two-dimensional display of the temperature kinetics during the energy application at any location of the myocardial cross section (± 0.5 mm). This new measuring methodology was validated by direct temperature measurements utilizing several intramyocardial thermo elements. This new method allows a temporal and spatial analysis of the temperature phenomena during ablation without the interference and spatial limitation of intramyocardial temperature probes. New ablation technologies can thus be evaluated, independent of the catheter configuration or source of energy used.

  14. Pain perception during esophageal warming due to radiofrequency catheter ablation in the left atrium.

    Science.gov (United States)

    Galeazzi, Marco; Ficili, Sabina; Dottori, Serena; Elian, Mohamed Abdelkader; Pasceri, Vincenzo; Venditti, Franco; Russo, Maurizio; Lavalle, Carlo; Pandozi, Angela; Pandozi, Claudio; Santini, Massimo

    2010-03-01

    We investigated the relationship among esophageal warming, pain perception, and the site of radiofrequency (RF) delivery in the left atrium (LA) during the course of catheter ablation of atrial fibrillation. Such a procedure in awake patients is often linked to the development of visceral pain and esophageal warming. As a consequence, potentially dangerous complications have been described. Twenty patients undergoing RF ablation in the LA were studied. An esophageal probe (EP) capable of measuring endoesophageal temperature (ET) was positioned before starting the procedure. The relative position of the EP and the tip of the ablator were evaluated through fluoroscopy imaging before starting each RF delivery, during which the highest value of the temperature was collected. After RF withdrawal, the patients were asked to define the intensity of the experienced pain by using a score index ranging from 0 (no pain) to 4 (pain requiring immediate RF interruption). The mean ET value during ablation was 39.59 +/- 4.71 degrees C. The EP proximity to the ablator's tip showed a high correlation with the development of the highest ET values (Spearman's rank correlation coefficient r = 0.49, confidence interval (CI) 0.55-0.41). Moreover, the highest values of pain intensity were reported when the RF was delivered to the atrial zones close to the EP projection (r = 0.50, CI 0.55-0.42) and when the highest ET levels were reached (r = 0.38, CI 0.30-0.45). Pain perception in LA ablation is significantly related to esophageal warming and is higher when the RF is delivered near the esophagus. It seems advisable to perform ET monitoring in sedated patients to avoid short- and long-term jeopardizing of the esophageal wall.

  15. An efficient cardiac mapping strategy for radiofrequency catheter ablation with active learning.

    Science.gov (United States)

    Feng, Yingjing; Guo, Ziyan; Dong, Ziyang; Zhou, Xiao-Yun; Kwok, Ka-Wai; Ernst, Sabine; Lee, Su-Lin

    2017-07-01

    A major challenge in radiofrequency catheter ablation procedures is the voltage and activation mapping of the endocardium, given a limited mapping time. By learning from expert interventional electrophysiologists (operators), while also making use of an active-learning framework, guidance on performing cardiac voltage mapping can be provided to novice operators or even directly to catheter robots. A learning from demonstration (LfD) framework, based upon previous cardiac mapping procedures performed by an expert operator, in conjunction with Gaussian process (GP) model-based active learning, was developed to efficiently perform voltage mapping over right ventricles (RV). The GP model was used to output the next best mapping point, while getting updated towards the underlying voltage data pattern as more mapping points are taken. A regularized particle filter was used to keep track of the kernel hyperparameter used by GP. The travel cost of the catheter tip was incorporated to produce time-efficient mapping sequences. The proposed strategy was validated on a simulated 2D grid mapping task, with leave-one-out experiments on 25 retrospective datasets, in an RV phantom using the Stereotaxis Niobe ® remote magnetic navigation system, and on a tele-operated catheter robot. In comparison with an existing geometry-based method, regression error was reduced and was minimized at a faster rate over retrospective procedure data. A new method of catheter mapping guidance has been proposed based on LfD and active learning. The proposed method provides real-time guidance for the procedure, as well as a live evaluation of mapping sufficiency.

  16. Transradial Approach of Alcohol Septal Ablation Using a Sheathless Guiding Catheter: A Feasibility Study.

    Science.gov (United States)

    Isawa, Tsuyoshi; Tada, Norio; Ootomo, Tatsushi; Sakurai, Mie; Takizawa, Kaname; Inoue, Naoto

    2015-11-01

    We aimed to investigate the feasibility and safety of alcohol septal ablation (ASA) via transradial approach using a sheathless guiding catheter. Although ASA is conventionally performed via the femoral artery, there is a potential risk of bleeding and other vascular complications. The transradial approach may be associated with a lower rate of such complications. A sheathless guiding catheter, with an advanced hydrophilic coating along its full length, could reduce radial artery occlusion and spasm. We enrolled 14 consecutive patients with hypertrophic obstructive cardiomyopathy treated with ASA via the radial access at Sendai Kousei Hospital from December 2012 to May 2014. Left radial access was used for the sheathless guiding catheter, while right radial access was used for monitoring left ventricular pressure with a 4 Fr diagnostic catheter. A temporary pacemaker was inserted via the right jugular vein. Procedural success rate was 93% (13/14 patients). The left ventricular outflow tract pressure gradient at rest was reduced from a median of 128 mm Hg (interquartile range, 49-147 mm Hg) at baseline to a median of 16 mm Hg (interquartile range, 13-26 mm Hg) at 30-day follow-up (P=.01). The New York Heart Association functional class improved from a median of II (II-III) at baseline to a median of I (I-I) at 30-day follow-up (P=.01). There were no cases of access-site complication, including radial artery occlusion and spasm. The transradial approach using a sheathless guiding catheter was feasible and safe for ASA.

  17. Presence and extent of coronary artery disease as predictor for AF recurrences after catheter ablation: The Leipzig Heart Center AF Ablation Registry.

    Science.gov (United States)

    Kornej, Jelena; Hindricks, Gerhard; Arya, Arash; Sommer, Philipp; Husser, Daniela; Rolf, Sascha; Bollmann, Andreas

    2015-02-15

    Occlusion of the right coronary artery (RCA) may promote atrial fibrillation (AF) by creating a right atrial substrate. However, the presence and extent of coronary artery disease (CAD) is usually not considered to tailor AF ablation strategies. This study was aimed to analyze the possible association between the presence and extent of CAD and rhythm outcomes of left-atrial AF catheter ablation. 1310 patients (60 ± 10 years, 67% males, 63% paroxysmal AF) from The Leipzig Heart Center AF Ablation Registry undergoing de novo AF catheter ablation were included. CAD was defined as stenosis ≥ 50% in the left main coronary artery and ≥ 70% in one or several of the major coronary arteries. AF recurrences were defined as any atrial arrhythmia lasting >30s and occurring within the first week (early recurrences, ERAF) or between 3 and 12 months (late recurrences, LRAF) after ablation and were assessed with serial 7-day Holter ECG. 152 patients (11.6%) had significant CAD; 89 (59%) had one, 35 (23%) two and 28 (18%) three vessel disease; 72 (47%) patients had RCA involvement. Occurrence of AF recurrences was comparable in CAD (p=0.625 and 0.568 for ERAF and LRAF, respectively). Among patients with CAD, neither the location (RCA versus non-RCA) nor the extent of CAD (single versus multiple vessel disease) was associated with rhythm outcomes after AF catheter ablation (all p>0.05). The presence and extent of CAD seem not to impact on rhythm outcome of AF catheter ablation in the entire cohort. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  18. Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with orthotopic heart transplantation by bicaval anastomosis.

    Science.gov (United States)

    Rodríguez de Armas, Lissette; Dorantes, Margarita; Castro, Jesús; Tornés, Francisco José; Rodríguez, Julio César; Fayad, Yanela; Almeida, Javier

    2006-04-01

    Patients with orthotopic heart transplantation may have a variety of arrhythmias. There are reports of successful radiofrequency catheter ablation of some of them. Two months after orthotopic cardiac transplantation by bicaval anastomosis, a 49-year-old man developed episodes of tachycardia. The patient developed with dyspnoea and hypotension during typical atrioventricular nodal reentrant tachycardia (AVNRT) revealed by electrocardiogram. During programmed atrial stimulation with progressively increasing prematurity, dual auriculoventricular nodal physiology was observed and AVNRT was induced. This tachycardia was successfully eliminated without complications by radiofrequency catheter ablation of the slow pathway. The patient remained asymptomatic at 4-month follow-up.

  19. [Zero-fluoroscopy catheter ablation for idiopathic premature ventricular contractions from the aortic sinus cusp].

    Science.gov (United States)

    Zhu, Ting-Yan; Liu, Shen-Rong; Chen, Yan-Yu; Xie, Liang-Zhen; He, Li-Wei; Meng, Su-Rong; Peng, Jian

    2016-08-20

    To compare the safety, feasibility, and efficacy of a completely nonfluoroscopic approach to radiofrequency catheter ablation (RFCA) using CARTO3 and ablation with conventional fluoroscopic guidance for treatment of idiopathic premature ventricular contractions from the aortic sinus cusp (ASC-PVCs). From April 2013 to October 2015, we prospectively enrolled 52 consecutive patients with ASC-PVCs scheduled for either CARTO3 mapping-guided zero-fluoroscopy ablation (group A, n=23) or conventional fluoroscopic ablation (group B, n=29). The success rates, rates of complications, rates of recurrences, number of radiofrequency applications, procedure time, mapping time and fluoroscopy time were compared between the 2 groups. s No significant differences were found in the success rates between the 2 groups [22/23 (96%) vs 24/29 (83%), P=0.21]. No major complications occurred during the procedures in either group. There was no significant difference with regard to the procedure time between the two groups (79.6∓8.8 vs 77.4∓7.2 min, P=0.332). The procedure was completed without any fluoroscopy use in group A, while the mean fluoroscopy time in group B was 23.1∓6.0 min. Group A showed a shorter mapping time than group B (4.3∓1.7 vs 7.8∓2.6 min, Pfluoroscopy approach can shorten the total procedure time and the ablation time with significantly reduced RF applications to eliminate ionizing radiation exposure in RFCA. RFCA guided by CARTO3 system without fluoroscopy is feasible, safe, and effective for treatment of ASC-PVCs.

  20. Catheter Ablation

    Science.gov (United States)

    ... Heart and Vascular Diseases Precision Medicine Activities Obesity, Nutrition, and Physical Activity Population and Epidemiology Studies Women’s Health All Science A-Z Grants and Training Grants and Training ...

  1. Robotic ablation of atrial fibrillation with a new remote catheter system.

    Science.gov (United States)

    Wutzler, Alexander; Wolber, Thomas; Parwani, Abdul Shokor; Huemer, Martin; Attanasio, Philipp; Blaschke, Florian; Haegeli, Laurent; Haverkamp, Wilhelm; Duru, Firat; Boldt, Leif-Hendrik

    2014-09-01

    Pulmonary vein isolation (PVI) is widely established as a curative treatment option for atrial fibrillation (AF). A wide range of techniques to improve catheter manipulation and steerability has been developed over the past years. A new remote catheter system (RCS) has recently become available (Amigo Remote Catheter System, Catheter Robotics, Budd Lake, NJ, USA). Here, we present a dual-center study on the RCS for left atrial mapping and PVI in patients with paroxysmal AF compared to a control group undergoing conventional PVI. One hundred nineteen patients who underwent PVI for paroxysmal AF were studied. Forty patients underwent PVI with the use of the RCS. Seventy-nine patients, who underwent conventional PVI, served as control group. Procedural data were compared between the two groups. PVI was achieved in all patients. In the RCS group compared to standard ablation group, there were no significant differences in procedure duration (159.1 ± 45.4 vs. 146 ± 30.1 min, p = 0.19), total energy delivery (78,146.3 ± 26,992.4 vs. 87,963.9 ± 79,202.1 Ws, p = 0.57), and total fluoroscopy time (21.2 ± 8.6 vs. 23.9 ± 5.4 min, p = 0.15). Operator fluoroscopy exposure was significantly reduced in the RCS group (13.4 ± 6.1 vs. 23.9 ± 5.4 min, p < 0.001). These initial results suggest that left atrial mapping and PVI are feasible with the use of the Amigo RCS. Acute procedural efficacy is comparable to the standard approach. The use of the Amigo RCS leads to a significant reduction of operator fluoroscopy exposure.

  2. 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

    Aim. The aim of this study was to assess the predictive value of inflammatory markers in patients with paroxysmal/ persistent atrial fibrillation (AF) treated with radiofrequency (RF) catheter ablation. Methods. Forty-six consecutive patients, mean age 55 years (range 31 - 81 yrs), with paroxysmal...

  3. Does Left Atrial Volume and Pulmonary Venous Anatomy Predict the Outcome of Catheter Ablation of Atrial Fibrillation ?

    NARCIS (Netherlands)

    Hof, Irene; Chilukuri, Karuna; Arbab-Zadeh, Armin; Scherr, Daniel; Dalal, Darshan; Nazarian, Saman; Henrikson, Charles; Spragg, David; Berger, Ronald; Marine, Joseph; Calkins, Hugh

    Introduction: Preprocedural factors may be helpful in selecting patients with atrial fibrillation (AF) for treatment with catheter ablation and in making an assumption regarding their prognosis. The aims of this study were to investigate whether left atrial (LA) volume and pulmonary venous (PV)

  4. Virtual ablation for atrial fibrillation in personalized in-silico three-dimensional left atrial modeling: comparison with clinical catheter ablation.

    Science.gov (United States)

    Hwang, Minki; Kwon, Soon-Sung; Wi, Jin; Park, Mijin; Lee, Hyun-Seung; Park, Jin-Seo; Lee, Young-Seon; Shim, Eun Bo; Pak, Hui-Nam

    2014-09-01

    Although catheter ablation is an effective rhythm control strategy for atrial fibrillation (AF), empirically-based ablation has a substantial recurrence rate. The purposes of this study were to develop a computational platform for patient-specific virtual AF ablation and to compare the anti-fibrillatory effects of 5 different virtual ablation protocols with empirically chosen clinical ablations. We included 20 patients with AF (65% male, 60.1 ± 10.5 years old, 80% persistent AF [PeAF]) who had undergone empirically-based catheter ablation: circumferential pulmonary vein isolation (CPVI) for paroxysmal AF (PAF) and additional posterior box lesion (L1) and anterior line (L2) for PeAF. Using patient-specific three-dimensional left atrial (LA) geometry, we generated a finite element model and tested the AF termination rate after 5 different virtual ablations: CPVI alone, CPVI + L1, CPVI + L1,2, CPVI with complex fractionated atrial electrogram (CFAE) ablation, and CFAE ablation alone. 1. Virtual CPVI + L1,2 ablation showed the highest AF termination rate in overall patients (55%) and PeAF patients (n = 16, 62.5%). 2. The virtual AF maintenance duration was shortest in the case of virtual CPVI + L1,2 ablation in overall patients (2.19 ± 1.28 vs. 2.91 ± 1.04 s, p = 0.009) and in patients with PeAF (2.05 ± 1.23 vs. 2.93 ± 10.2 s, p = 0.004) compared with other protocols. Virtual AF ablation using personalized in-silico model of LA is feasible. Virtual ablation with CPVI + L1,2 shows the highest antifibrillatory effect, concordant with the empirical ablation protocol in patients with PeAF. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Electrophysiologic characteristics and catheter ablation of ventricular tachyarrhythmias among patients with heart failure on ventricular assist device support.

    Science.gov (United States)

    Cantillon, Daniel J; Bianco, Christopher; Wazni, Oussama M; Kanj, Mohamed; Smedira, Nicholas G; Wilkoff, Bruce L; Starling, Randall C; Saliba, Walid I

    2012-06-01

    Ventricular tachyarrhythmias (VT) are common among ventricular assist device (VAD) recipients, yet electrophysiologic (EP) characteristics and catheter ablation outcomes remain uncharacterized. To evaluate the EP characteristics and catheter ablation outcomes for VTs among heart failure patients on VAD support. The Cleveland Clinic registry of consecutive patients undergoing VAD placement in 1991-2010 with medically refractory, symptomatic VT referred for EP study and catheter ablation. Among 611 recipients of VAD (mean age 53.3 ± 12.4 years, 80% men), 21 patients (3.4%) were referred for 32 EP procedures, including 11 patients (52%) presenting with implantable cardioverter-defibrillator therapy (13 shocks, 26 antitachycardia pacing). Data from 44 inducible tachycardias (mean cycle length 339 ± 59 ms) demonstrated monomorphic VT (n = 40, 91%; superior axis 52%, right bundle branch block morphology 41%) and polymorphic ventricular tachycardia (PMVT)/ventricular fibrillation (n = 4, 8%). Electroanatomic mapping of 28 tachycardias in 20 patients demonstrated reentrant VT related to intrinsic scar (n = 21 of 28, 75%) more commonly than the apical inflow cannulation site (n = 4 of 28, 14%), focal/microreentry VT (n = 2 of 28, 7%), or bundle branch reentry (n = 1 of 28, 3.5%). Catheter ablation succeeded in 18 of 21 patients (86%). VT recurred in 7 of 21 patients (33%) at a mean of 133 ± 98 days, and 6 patients (29%) required repeat procedures, with subsequent recurrence in 4 of 21 patients (19%). Catheter ablation of VT is effective among recipients of VAD. Intrinsic myocardial scar, rather than the apical device cannulation site, appears to be the dominant substrate. Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  6. Catheter Ablation of Ectopic Atrial Tachycardia Originating from the Left Atrial Appendage using CARTOMERGE® System

    Directory of Open Access Journals (Sweden)

    Masahiko Goya, MD

    2008-01-01

    Full Text Available A 70-year-old woman was referred because of drug resistant and daily incessant palpitation attack. She had undergone two previous unsuccessful radiofrequency catheter ablations at another hospital. The physical examination, chest X-ray, and echocardiogram were all normal. The 12-lead ECG during tachycardia showed narrow QRS, short PR tachycardia and negative polarity of the P wave in leads I and aVL (Fig. 1A. The ECG monitor showed incessant tachycardia with warming-up phenomenon. Three dimensional electroanatomical map integrated with CT imaging (CARTOMERGE®, Biosense Webster Inc. clearly revealed the radial activation pattern originating from the basalo-postero-inferior aspect of the left atrial appendage. Radiofrequency energy application at this site eliminated tachycardia permanently.

  7. Utility of intracardiac echocardiography for catheter ablation of complex cardiac arrhythmias in a medium-volume training center.

    Science.gov (United States)

    Filgueiras-Rama, David; de Torres-Alba, Fernando; Castrejón-Castrejón, Sergio; Estrada, Alejandro; Figueroa, Jorge; Salvador-Montañés, Óscar; López, Teresa; Moreno-Yanguela, Mar; López Sendón, José L; Merino, José L

    2015-04-01

    New electrophysiology tools like intracardiac echocardiography (ICE) might help to minimize and early detect complications during cardiac ablation procedures. The aim of the study was to assess the utility and vascular safety of ICE during catheter ablation of complex cardiac arrhythmias in a medium-volume training center. Prospective, observational study consisted of consecutive patients who underwent catheter-based ablation of complex cardiac arrhythmias. All procedures were performed using three-dimensional electro-anatomical mapping and routine cannulation of right and left femoral veins. The ICE probe was initially positioned at the mid-level of the right atrium and properly moved to monitor different steps of the procedure and identify complications. All procedure-related vascular complications were registered. One hundred two patients (age 61.4 ± 13.1 years, 69 male) underwent 110 ablation procedures. Pulmonary vein isolation was the most common ablation substrate (55.4%). Ventricular tachycardia (17.2%) and left atrial flutter procedures (16.4%) were also common. The use of ICE enabled us to early initiate anticoagulation and to optimize the transseptal puncture. It also provided the capability to early detect life-threatening complications such as tamponade (3.6%), along with important information during the procedure such as exact catheter location, lesion formation, and stability during radiofrequency delivery. Such benefits were not associated with a higher number of vascular complications. The use of ICE during catheter-based ablation of complex cardiac substrates provides technical features that may decrease complications and increase accuracy while applying radiofrequency, especially in training centers where fellows start to perform complex procedures. © 2014, Wiley Periodicals, Inc.

  8. The APPLE Score - A Novel Score for the Prediction of Rhythm Outcomes after Repeat Catheter Ablation of Atrial Fibrillation.

    Directory of Open Access Journals (Sweden)

    Jelena Kornej

    Full Text Available Arrhythmia recurrences after catheter ablation occur in up to 50% within one year but their prediction remains challenging. Recently, we developed a novel score for the prediction of rhythm outcomes after single AF ablation demonstrating superiority to other scores. The current study was performed to 1 prove the predictive value of the APPLE score in patients undergoing repeat AF ablation and 2 compare it with the CHADS2 and CHA2DS2-VASc scores.Rhythm outcome between 3-12 months after AF ablation were documented. The APPLE score (one point for Age >65 years, Persistent AF, imPaired eGFR (<60 ml/min/1.73m2, LA diameter ≥43 mm, EF <50% was calculated in every patient before procedure.379 consecutive patients from The Leipzig Heart Center AF Ablation Registry (60±10 years, 65% male, 70% paroxysmal AF undergoing repeat AF catheter ablation were included. Arrhythmia recurrences were observed in 133 patients (35%. While the CHADS2 (AUC 0.577, p = 0.037 and CHA2DS2-VASc scores (AUC 0.590, p = 0.015 demonstrated low predictive value, the APPLE score showed better prediction of arrhythmia recurrences (AUC 0.617, p = 0.002 than other scores (both p<0.001. Compared to patients with an APPLE score of 0, the risk (OR for arrhythmia recurrences was 2.9, 3.0 and 6.0 (all p<0.01 for APPLE scores 1, 2, or ≥3, respectively.The novel APPLE score is superior to the CHADS2 and CHA2DS2-VASc scores for prediction of rhythm outcomes after repeat AF catheter ablation. It may be helpful to identify patients with low, intermediate or high risk for recurrences after repeat procedure.

  9. Prolonged PR interval predicts clinical recurrence of atrial fibrillation after catheter ablation.

    Science.gov (United States)

    Park, Junbeom; Kim, Tae-Hoon; Lee, Jihei Sara; Park, Jin Kyu; Uhm, Jae Sun; Joung, Boyoung; Lee, Moon Hyoung; Pak, Hui-Nam

    2014-10-07

    A prolonged PR interval is known to be a poor prognostic factor in cardiovascular disease. The aim of this study was to investigate the association between PR interval and clinical outcome in patients undergoing radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). We prospectively included 576 patients with AF (75.5% male, 57.8±11.6 years old, 68.8% paroxysmal AF) who underwent RFCA. We analyzed preprocedural sinus rhythm ECGs obtained in the absence of antiarrhythmic drug, and all enrolled patients were categorized into 4 groups based on the quartile values of the PR interval (166, 182, and 202 ms), and were analyzed according to the left atrium (LA) volume (CT; Computed tomography), LA voltage (NavX), and clinical outcome of AF ablation. Based on quartile value of PR interval, the highest quartile of PR interval (Q4; PR ≥202 ms) was oldest (PPR interval was a significant predictor of AF recurrence after RFCA of AF (HR=1.969, 95% CI 1.343 to 2.886, P=0.001). The PR interval was closely associated with advanced LA remodeling due to AF, and had a noninvasive significant predictive value of clinical recurrence of AF after RFCA. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  10. 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.

  11. Ten-year outcomes of monomorphic ventricular tachycardia catheter ablation in repaired tetralogy of Fallot.

    Science.gov (United States)

    Laredo, Mikaël; Frank, Robert; Waintraub, Xavier; Gandjbakhch, Estelle; Iserin, Laurence; Hascoët, Sebastien; Himbert, Caroline; Gallais, Yves; Hidden-Lucet, Françoise; Duthoit, Guillaume

    2017-05-01

    Monomorphic ventricular tachycardia (MVT) is common in adults with repaired tetralogy of Fallot (TOF), and is associated with sudden cardiac death. Management of MVT is not defined, and results of catheter ablation (CA) are limited. To evaluate long-term outcomes of MVT CA in repaired TOF. Thirty-four patients (mean age 32±10.3 years; 59% male) with repaired TOF underwent CA for symptomatic MVT between 1990 and 2012 in our centre; direct-current ablation (DCA) was used in 6%, radiofrequency followed by DCA in 29% and radiofrequency alone in 65%. Right ventricular (RV) dysfunction was present in 35% and left ventricular (LV) dysfunction in 21%. Mean numbers of clinical and induced MVTs were 1 and 2, respectively. Mean VT rate was 225±95bpm. Ablation targeted a single site (range 1-2), which was RV outflow tract in 85%. Primary success, defined as ventricular tachycardia (VT) termination during CA and final non-inducibility, was obtained in 82%. Seven patients (21%) required redo ablation in the first 3 months (before 2004; DCA). No death related to CA occurred. Mean follow-up time was 9.5±5.2 years. Antiarrhythmic therapy was discontinued in 71%. There were two cases of sudden cardiac death and four VT recurrences. Freedom from death and arrhythmia recurrence was 94% at 5 years, 81% at 10 years and 70% at 20 years. Global survival was 91% at 20 years. Baseline LV ejection fraction<60% was significantly associated with ventricular arrhythmia recurrence (hazard ratio 16.4, 95% confidence interval 1.8-147; P=0.01). CA can safely address macroreentrant MVT in repaired TOF patients with an acceptable long-term rate of recurrence in this high-risk population. Anatomical classification of isthmuses with electroanatomical mapping provides reproducible endpoints for CA. Attention should be given to LV systolic function in risk assessment and selection of candidates for implantable cardioverter-defibrillator. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  12. Virtual In-Silico Modeling Guided Catheter Ablation Predicts Effective Linear Ablation Lesion Set for Longstanding Persistent Atrial Fibrillation: Multicenter Prospective Randomized Study.

    Science.gov (United States)

    Shim, Jaemin; Hwang, Minki; Song, Jun-Seop; Lim, Byounghyun; Kim, Tae-Hoon; Joung, Boyoung; Kim, Sung-Hwan; Oh, Yong-Seog; Nam, Gi-Byung; On, Young Keun; Oh, Seil; Kim, Young-Hoon; Pak, Hui-Nam

    2017-01-01

    Objective: Radiofrequency catheter ablation for persistent atrial fibrillation (PeAF) still has a substantial recurrence rate. This study aims to investigate whether an AF ablation lesion set chosen using in-silico ablation (V-ABL) is clinically feasible and more effective than an empirically chosen ablation lesion set (Em-ABL) in patients with PeAF. Methods: We prospectively included 108 patients with antiarrhythmic drug-resistant PeAF (77.8% men, age 60.8 ± 9.9 years), and randomly assigned them to the V-ABL ( n = 53) and Em-ABL ( n = 55) groups. Five different in-silico ablation lesion sets [1 pulmonary vein isolation (PVI), 3 linear ablations, and 1 electrogram-guided ablation] were compared using heart-CT integrated AF modeling. We evaluated the feasibility, safety, and efficacy of V-ABL compared with that of Em-ABL. Results: The pre-procedural computing time for five different ablation strategies was 166 ± 11 min. In the Em-ABL group, the earliest terminating blinded in-silico lesion set matched with the Em-ABL lesion set in 21.8%. V-ABL was not inferior to Em-ABL in terms of procedure time ( p = 0.403), ablation time ( p = 0.510), and major complication rate ( p = 0.900). During 12.6 ± 3.8 months of follow-up, the clinical recurrence rate was 14.0% in the V-ABL group and 18.9% in the Em-ABL group ( p = 0.538). In Em-ABL group, clinical recurrence rate was significantly lower after PVI+posterior box+anterior linear ablation, which showed the most frequent termination during in-silico ablation (log-rank p = 0.027). Conclusions: V-ABL was feasible in clinical practice, not inferior to Em-ABL, and predicts the most effective ablation lesion set in patients who underwent PeAF ablation.

  13. PR Interval Associated Genes, Atrial Remodeling and Rhythm Outcome of Catheter Ablation of Atrial Fibrillation—A Gene-Based Analysis of GWAS Data

    Directory of Open Access Journals (Sweden)

    Daniela Husser

    2017-12-01

    Full Text Available Background: PR interval prolongation has recently been shown to associate with advanced left atrial remodeling and atrial fibrillation (AF recurrence after catheter ablation. While different genome-wide association studies (GWAS have implicated 13 loci to associate with the PR interval as an AF endophenotype their subsequent associations with AF remodeling and response to catheter ablation are unknown. Here, we perform a gene-based analysis of GWAS data to test the hypothesis that PR interval candidate genes also associate with left atrial remodeling and arrhythmia recurrence following AF catheter ablation.Methods and Results: Samples from 660 patients with paroxysmal (n = 370 or persistent AF (n = 290 undergoing AF catheter ablation were genotyped for ~1,000,000 SNPs. Gene-based association was investigated using VEGAS (versatile gene-based association study. Among the 13 candidate genes, SLC8A1, MEIS1, ITGA9, SCN5A, and SOX5 associated with the PR interval. Of those, ITGA9 and SOX5 were significantly associated with left atrial low voltage areas and left atrial diameter and subsequently with AF recurrence after radiofrequency catheter ablation.Conclusion: This study suggests contributions of ITGA9 and SOX5 to AF remodeling expressed as PR interval prolongation, low voltage areas and left atrial dilatation and subsequently to response to catheter ablation. Future and larger studies are necessary to replicate and apply these findings with the aim of designing AF pathophysiology-based multi-locus risk scores.

  14. Integrated HIFU Drive System on a Chip for CMUT-Based Catheter Ablation System.

    Science.gov (United States)

    Farhanieh, Omid; Sahafi, Ali; Bardhan Roy, Rupak; Ergun, Arif Sanli; Bozkurt, Ayhan

    2017-06-01

    Conventional High Intensity Focused Ultrasound (HIFU) is a therapeutic modality which is extracorporeally administered. In applications where a relatively small HIFU lesion is required, an intravascular HIFU probe can be deployed to the ablation site. In this paper, we demonstrate the design and implementation a fully integrated HIFU drive system on a chip to be placed on a 6 Fr catheter probe. An 8-element capacitive micromachined ultrasound transducer (CMUT) ring array of 2 mm diameter has been used as the ultrasound source. The driver chip is fabricated in 0.35 μm AMS high-voltage CMOS technology and comprises eight continuous-wave (CW) high-voltage CMUT drivers (10.9 ns and 9.4 ns rise and fall times at 20 V pp output into a 15 pF), an eight-channel digital beamformer (8-12 MHz output frequency with 11.25 ° phase accuracy) and a phase locked loop with an integrated VCO as a tunable clock source (128-192 MHz). The chip occupies 1.85 × 1.8 mm 2 area including input and output (I/O) pads. When the transducer array is immersed in sunflower oil and driven by the IC with eight 20 V pp CW pulses at 10 MHz, real-time thermal images of the HIFU beam indicate that the focal temperature rises by 16.8  ° C in 11 seconds. Each HV driver consumes around 67 mW of power when driving the CMUT array at 10 MHz, which adds up to 560 mW for the whole chip. FEM based analysis reveals that the outer surface temperature of the catheter is expected to remain below the 42  ° C tissue damage limit during therapy.

  15. Vascular Complications During Catheter Ablation of Cardiac Arrhythmias: A Comparison Between Vascular Ultrasound Guided Access and Conventional Vascular Access.

    Science.gov (United States)

    Sharma, Parikshit S; Padala, Santosh K; Gunda, Sampath; Koneru, Jayanthi N; Ellenbogen, Kenneth A

    2016-10-01

    Vascular access related complications are the most common complications from catheter based EP procedures and have been reported to occur in 1-13% of cases. We prospectively assessed vascular complications in a large series of consecutive patients undergoing catheter based electrophysiologic (EP) procedures with ultrasound (US) guided vascular access versus conventional access. Consecutive patients undergoing catheter ablation procedures at VCU medical center were included. US guided access was obtained in all cases starting June 2015 (US group) while modified Seldinger technique without US guidance (non-US group) was used in cases prior to this date. All vascular complications were recorded for a 30-day period after the procedure. A total of 689 patients underwent 720 procedures. Ablations for ventricular tachyarrhythmias (ventricular tachycardia: VT, premature ventricular contractions: PVCs) accounted for 89 (12%) cases; atrial fibrillation (AF) ablations accounted for 328 procedures (46%) and other catheter based procedures accounted for 42% of cases. A significantly higher incidence of complications was noted in the non-US group compared with the US group (19 [5.3%] vs. 4 [1.1%], respectively, P = 0.002). Major complications were also higher among the non-US group (9 [2.5%] vs. 2 [0.6%], P = 0.03). Increasing age (P = 0.04) and non-US guided vascular access (P = 0.002) were associated with a higher risk of vascular access complications. In a large series of patients undergoing catheter based EP procedures for cardiac arrhythmias, US guided vascular access was associated with a significantly decreased 30-day risk of vascular complications. © 2016 Wiley Periodicals, Inc.

  16. 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.

  17. Isolation of canine coronary sinus musculature from the atria by radiofrequency catheter ablation prevents induction of atrial fibrillation.

    Science.gov (United States)

    Morita, Hiroshi; Zipes, Douglas P; Morita, Shiho T; Wu, Jiashin

    2014-12-01

    The junction between the coronary sinus (CS) musculature and both atria contributes to initiation of atrial tachyarrhythmias. The current study investigated the effects of CS isolation from the atria by radiofrequency catheter ablation on the induction and maintenance of atrial fibrillation (AF). Using an optical mapping system, we mapped action potentials at 256 surface sites in 17 isolated and arterially perfused canine atrial tissues containing the entire musculature of the CS, right atrial septum, posterior left atrium, left inferior pulmonary vein, and vein of Marshal. Rapid pacing from each site before and after addition of acetylcholine (0.5 μmol/L) was applied to induce AF. Epicardial radiofrequency catheter ablation at CS-atrial junctions isolated the CS from the atria. Rapid pacing induced sustained AF in all tissues after acetylcholine. Microreentry within the CS drove AF in 88% of preparations. Reentries associated with the vein of Marshall (29%), CS-atrial junctions (53%), right atrium (65%), and pulmonary vein (76%) (frequently with 2-4 simultaneous circuits) were additional drivers of AF. Radiofrequency catheter ablation eliminated AF in 13 tissues before acetylcholine (Patrial tissue. The results suggest that CS can be a substrate of recurrent AF in patients after pulmonary vein isolation and that CS isolation might help prevent recurrent AF. © 2014 American Heart Association, Inc.

  18. Prediction and prognosis of ventricular tachycardia recurrence after catheter ablation with remote magnetic navigation for electrical storm in patients with ischemic cardiomyopathy

    DEFF Research Database (Denmark)

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

    2017-01-01

    BACKGROUND: Ventricular tachycardia (VT) recurrence after catheter ablation for electrical storm is commonly seen in patients with ischemic cardiomyopathy (ICM). HYPOTHESIS: We hypothesized that VT recurrence can be predicted and be related to the all-cause death after VT storm ablation guided by...

  19. Number of ablated spots in the course of renal sympathetic denervation in CKD patients with uncontrolled hypertension: EnligHTN vs. Standard irrigated cardiac ablation catheter.

    Science.gov (United States)

    Kiuchi, M G; Chen, S; Rodrigues Paz, L M; Pürerfellner, H

    Hypertension was both a mutual cause and the main concern of chronic kidney disease (CKD). Blood pressure control is more problematic in the company of CKD. This study compares the effects of renal sympathetic denervation (RSD) on 24-h ambulatory blood pressure measurements (ABPM) and renal function in individuals with CKD and uncontrolled hypertension by unlike a number of ablated spots using the EnligHTN catheter and the standard irrigated cardiac ablation catheter (SICAC), Flexability. The 112 subjects were randomly divided into two groups according to the catheter that would be used in the procedure EnligHTN (n=56) or Flexability (n=56). Into each group, we created 5 subgroups according to the number of ablated spots: 4, 8, 12, 16 and 20. All of them were followed for exactly 6 months to assess all the parameters measured in this investigation. Comparing the Δ 24-h systolic ABPM according to the number of ablated spots 4 and 20 for EnligHTN vs. Flexability, respectively, the differences were: -3.6±0.9 vs. -6.3±1.4mmHg (P<0.0001), and -13.9±4.8 vs. -36.3±4.3mmHg (P<0.0001). The comparisons between Δ estimated glomerular filtration rate (eGFR) according to the number of ablated spots 4 and 20 for EnligHTN vs. Flexability, respectively, were: +2.7±4.0 vs. +6.0±8.4mL/min/1.73m 2 (P=0.2287), and +11.9±6.0 vs. +21.4±8.7mL/min/1.73m 2 (P=0.0222). The RSD reduced the mean 24-h ABPM in subjects with CKD and uncontrolled hypertension and improved the renal function in both groups. These effects were more marked and important in subgroups underwent a great number of ablated spots using the SICAC. Copyright © 2017 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Catheter ablation of ventricular tachycardia in nonischemic cardiomyopathy: A propensity score-matched analysis of in-hospital outcomes in the United States.

    Science.gov (United States)

    Briceño, David F; Gupta, Tanush; Romero, Jorge; Kolte, Dhaval; Khera, Sahil; Villablanca, Pedro A; Tran, An; Mohanty, Sanghamitra; Trivedi, Chintan; Mohanty, Prasant; Gianni, Carola; Kim, Soo G; Garcia, Mario; Fonarow, Gregg C; Bhatt, Deepak L; Natale, Andrea; Di Biase, Luigi

    2018-02-05

    Monomorphic ventricular tachycardia (VT) is an important cause of morbidity and mortality. Use and outcome data of catheter ablation for VT in nonischemic cardiomyopathy (NICM) are limited. We obtained data from the 2003-2014 National Inpatient Sample databases. We used propensity score matching to compare patients undergoing catheter ablation versus medical therapy of VT related to NICM, and described the temporal trends in utilization and in-hospital outcomes of catheter ablation of VT in patients with NICM in the United States. From 2003 to 2014, of 133,529 patients hospitalized with the principal diagnosis of VT in NICM, 14,651 (11.0%) underwent catheter ablation. In this period, there was an increasing trend in utilization of catheter ablation (9.3% in 2003-2004 to 12.1% in 2003-2014, adjusted OR [per year], 1.12; 95% CI, 1.08-1.16; P trend  < 0.001). After propensity score matching, in-hospital mortality occurred in 172 of 14,318 (1.2%) patients in the catheter ablation group, compared with 297 of 14,156 (2.1%) of patients undergoing medical therapy (47% lower; 43% relative difference [adjusted OR, 0.53; 95% CI, 0.43-0.66]). In patients with NICM, catheter ablation of VT is associated with lower in-hospital mortality compared with those managed medically. The utilization rates of CA for VT related to NICM have increased in the past decade. Adequately powered randomized trials will be necessary to confirm these findings. © 2018 Wiley Periodicals, Inc.

  1. Ablation of lumbar sympathetic ganglia by absolute ethanol injection and paravertebral catheter placement under CT guidance: evaluation of the efficacy

    International Nuclear Information System (INIS)

    Xu Hua; Xiong Yuanchang; Shao Chengwei; Zuo Changjing; Sheng Jing; Tian Jianming

    2009-01-01

    Objective: To evaluate the ablation of lumbar sympathetic ganglia by using single injection of absolute ethanol and retaining a paravertebral catheter under CT guidance for the treatment of lower extremity ischemia. Methods: Single absolute ethanol injection of L2 sympathetic ganglia was done in 25 cases (group B), single absolute ethanol injection of L2 sympathetic ganglia together with placement of a paravertebral catheter at L3 was carried out in 23 cases (group BT). All the procedures were performed under CT guidance. Three days after the procedure, the pain severity of the lower limbs was evaluated based on VAS method. If the patient in group BT still had a VAS score ≥4 on the third day, 3 ml of 1% lidocaine was infected via the retained catheter in the prone position. If VAS score became ≤3 at 5 min after the injection, additional 5 ml of ethanol was given through the catheter. The pain severity was evaluated again one week later. VAS score, analgesic dose and temperature of lower limbs were recorded. Results: One week after the procedure the excellent rate and effective rate for group B were 32% and 80% respectively, while for group BT were 60.9% and 95.7% respectively, with a significant difference between two groups (P<0.01). Conclusion: For the ablation of lumbar sympathetic ganglia the combination of single absolute ethanol injection with paravertebral catheter placement under CT guidance is superior to the single absolute ethanol injection. This technique is more individual with better results and is more likely to be accepted by the patients. (authors)

  2. 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.

  3. Progression of atrial fibrillation after catheter ablation procedure and antiarrhythmic drug therapy in patients with paroxysmal AF

    Directory of Open Access Journals (Sweden)

    А. А. Симонян

    2016-11-01

    Full Text Available Aim. This prospective randomized study was aimed to assess the progression of atrial fibrillation (AF after ablation procedure and antiarrhythmic drug therapy (AAD in patients with paroxysmal AF by means of implantable cardiac monitors (ICM. Methods. The study enrolled 92 patients with paroxysmal AF, who were eligible either for catheter ablation or AAD. The patients were randomized into two groups: 1 AAD + ICM implantation (group I; n=46, and 2 AF catheter ablation (CA + ICM implantation (group II; n=46, and 2. The primary endpoint was AF progression according to ICM data. The AF progression was defined as AF burden > 30%. A complication rate after ablation procedure and side effects of AAD were determined as the secondary endpoints. The follow up of this study was 24 months. Results. By the end of the follow-up period, AF progression was observed in 27 (58.7% patients in the AAD group and 10 (21.7% patients in the CA group (р=0.0003; HR 0.37, 95% CI [0.17-0.76], р=0.007, Cox regression. 13 (28,3% patients in the AAD group and 2 (4.3% in the CA group (р=0.002 developed persistent AF. The complication rate in the AAD group was 24% (11 patients and 6.5 % (3 patients in the CA group (р=0.02.Conclusion. Radiofrequency ablation of AF leads to a significant decrease in AF progression when compared with antiarrhythmic drug therapy in patients with paroxysmal AF, which was confirmed by implantable cardiac monitors data.Received 12 July 2016. Accepted 22 August 2016.Funding: The study had no sponsorship.Conflict of interest: The authors declare no conflict of interest.

  4. The influence of residual apixaban on bleeding complications during and after catheter ablation of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Yutaro Mukai

    2017-10-01

    Conclusions: Low residual plasma apixaban is associated with a higher incidence of bleeding complications during/after AF ablation, potentially because of a greater heparin requirement during AF ablation.

  5. A fast slam approach to freehand 3-d ultrasound reconstruction for catheter ablation guidance in the left atrium.

    Science.gov (United States)

    Koolwal, Aditya B; Barbagli, Federico; Carlson, Christopher R; Liang, David H

    2011-12-01

    We present a method for real-time, freehand 3D ultrasound (3D-US) reconstruction of moving anatomy, with specific application towards guiding the catheter ablation procedure in the left atrium. Using an intracardiac echo (ICE) catheter with a pose (position/orientation) sensor mounted to its tip, we continually mosaic 2D-ICE images of a left atrium phantom model to form a 3D-US volume. Our mosaicing strategy employs a probabilistic framework based on simultaneous localization and mapping (SLAM), a technique commonly used in mobile robotics for creating maps of unexplored environments. The measured ICE catheter tip pose provides an initial estimate for compounding 2D-ICE image data into the 3D-US volume. However, we simultaneously consider the overlap-consistency shared between 2D-ICE images and the 3D-US volume, computing a "corrected" tip pose if need be to ensure spatially-consistent reconstruction. This allows us to compensate for anatomic movement and sensor drift that would otherwise cause motion artifacts in the 3D-US volume. Our approach incorporates 2D-ICE data immediately after acquisition, allowing us to continuously update the registration parameters linking sensor coordinates to 3D-US coordinates. This, in turn, enables real-time localization and display of sensorized therapeutic catheters within the 3D-US volume for facilitating procedural guidance. Copyright © 2011 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  6. 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

  7. Low rate of asymptomatic cerebral embolism and improved procedural efficiency with the novel pulmonary vein ablation catheter GOLD: results of the PRECISION GOLD trial.

    Science.gov (United States)

    De Greef, Yves; Dekker, Lukas; Boersma, Lucas; Murray, Stephen; Wieczorek, Marcus; Spitzer, Stefan G; Davidson, Neil; Furniss, Steve; Hocini, Mélèze; Geller, J Christoph; Csanádi, Zoltan

    2016-05-01

    This prospective, multicentre study (PRECISION GOLD) evaluated the incidence of asymptomatic cerebral embolism (ACE) after pulmonary vein isolation (PVI) using a new gold multi-electrode radiofrequency (RF) ablation catheter, pulmonary vein ablation catheter (PVAC) GOLD. Also, procedural efficiency of PVAC GOLD was compared with ERACE. The ERACE study demonstrated that a low incidence of ACE can be achieved with a platinum multi-electrode RF catheter (PVAC) combined with procedural manoeuvres to reduce emboli. A total of 51 patients with paroxysmal atrial fibrillation (AF) (age 57 ± 9 years, CHA2DS2-VASc score 1.4 ± 1.4) underwent AF ablation with PVAC GOLD. Continuous oral anticoagulation using vitamin K antagonists, submerged catheter introduction, and heparinization (ACT ≥ 350 s prior to ablation) were applied. Cerebral magnetic resonance imaging (MRI) scans were performed within 48 h before and 16-72 h post-ablation. Cognitive function assessed by the Mini-Mental State Exam at baseline and 30 days post-ablation. New post-procedural ACE occurred in only 1 of 48 patients (2.1%) and was not detectable on MRI after 30 days. The average number of RF applications per patient to achieve PVI was lower in PRECISION GOLD (20.3 ± 10.0) than in ERACE (28.8 ± 16.1; P = 0.001). Further, PVAC GOLD ablations resulted in significantly fewer low-power (GOLD in combination with established embolic lowering manoeuvres results in a low incidence of ACE. Pulmonary vein ablation catheter GOLD demonstrates improved biophysical efficiency compared with platinum PVAC. ClinicalTrials.gov NCT01767558. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.

  8. Lesion dimensions during temperature-controlled radiofrequency catheter ablation of left ventricular porcine myocardium

    DEFF Research Database (Denmark)

    Høgh Petersen, H; Chen, X; Pietersen, Adrian

    1999-01-01

    BACKGROUND: It is important to increase lesion size to improve the success rate for radiofrequency ablation of ischemic ventricular tachycardia. This study of radiofrequency ablation, with adjustment of power to approach a preset target temperature, ie, temperature-controlled ablation, explores...

  9. Intra-cardiac and peripheral levels of biochemical markers of fibrosis in patients undergoing catheter ablation for atrial fibrillation

    DEFF Research Database (Denmark)

    Begg, Gordon A; Karim, Rashed; Oesterlein, Tobias

    2017-01-01

    Aims: Measurement of circulating biomarkers of fibrosis may have a role in selecting patients and treatment strategy for catheter ablation. Pro-collagen type III N-terminal pro-peptide (PIIINP), C-telopeptide of type I collagen (ICTP), fibroblast growth factor 23 (FGF-23), and galectin 3 (gal-3......). Femoral venous, left and right atrial, and coronary sinus blood were analysed using ELISA to determine biomarker levels. Levels were compared with control patients (n = 36) and baseline characteristics, including left atrial voltage mapping data. C-telopeptide of type I collagen levels were higher in AF...

  10. A novel approach in the use of radiofrequency catheter ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy.

    Science.gov (United States)

    Shelke, Abhijeet B; Menon, Rajeev; Kapadiya, Anuj; Yalagudri, Sachin; Saggu, Daljeet; Nair, Sandeep; Narasimhan, C

    Alcohol septal ablation (ASA) is a therapeutic alternative to surgical myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM). However, the anatomical variability of the septal branch, risk of complete heart block, and late onset ventricular arrhythmias are limitations to its therapeutic usage. There is recent interest in the use of radiofrequency catheter ablation (RFCA) as a therapeutic option in HOCM. We aimed to assess the safety and efficacy of RFCA in the treatment of symptomatic HOCM. Seven patients with symptomatic HOCM (mean age 43.7±15.6 years, five males), and significant left ventricular outflow tract (LVOT) gradient despite optimal drug therapy, underwent ablation of the hypertrophied interventricular septum. These patients had unfavorable anatomy for ASA. Ablation was performed under 3D electro-anatomical system guidance using an open irrigated tip catheter. The region of maximal LV septal bulge as seen on intracardiac echocardiography was targeted. Patients were followed up at 1, 6, and 12 months post-procedure. The mean baseline LVOT gradient by Doppler echocardiography was 81±14.8mm of Hg which reduced to 48.5±22.6 (p=0.0004), 49.8±19.3 (p=0.0004), and 42.8±26.1mm of Hg (p=0.05) at 1, 6, and 12 months respectively. Symptoms improved at least by one NYHA class in all but one patient. One patient developed transient pulmonary edema post-RFA. There were no other complications. RFCA of the hypertrophied septum causes sustained reduction in the LVOT gradient and symptomatic improvement among patients with HOCM. Electroanatomical mapping helps to perform the procedure safely. Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  11. 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.

  12. 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.

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

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    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.

  14. Role of contact force-guided radiofrequency catheter ablation for treatment of atrial fibrillation: A systematic review and meta-analysis.

    Science.gov (United States)

    Lin, Hui; Chen, Yi-He; Hou, Jian-Wen; Lu, Zhao-Yang; Xiang, Yin; Li, Yi-Gang

    2017-09-01

    CF-sensing catheter emerged as a novel ablation technology and was increasingly used in clinical practice. Nonetheless, available evidence of efficacy and safety comparison between CF-guided RF catheter ablation and non-CF-guided ablation for treatment of AF was still lacking. Twenty-two eligible studies were included after systematic review through the MEDLINE, Google Scholar, the Cochrane Library and PubMed databases. AF/atrial tachycardia-free survival was markedly improved in CF-guided catheter ablation compared with non-CF-guided ablation at a median 12-month follow-up (RR: 1.12, 95% CI: 1.06-1.19, P = 0.000, fixed). Notably, CF-guided catheter ablation presented a robust survival benefit for treatment of paroxysmal AF (RR: 1.10, 95% CI: 1.03-1.18, P = 0.005, fixed), but not persistent AF (RR: 1.07, 95% CI: 0.89-1.28, P = 0.466, fixed). Moreover, procedure time (WMD: -23.87, 95% CI: -33.83 to -13.91, P = 0.000, random), fluoroscopy time (WMD: -7.78, 95% CI: -13.93 to -1.63, P = 0.013, random) and RF time (WMD: -3.98, 95% CI: -7.78 to -0.17, P = 0.040, random) were significantly reduced in CF-guided catheter ablation. The incidence of procedure-related complications did not differ between these two technologies (RR: 0.83, 95% CI: 0.59 to 1.16, P = 0.271, fixed). CF-guided RF catheter ablation was associated with a significant AF/atrial tachycardia-free survival benefit compared with non-CF-guided ablation in patients with paroxysmal AF rather than persistent AF. In addition, CF-guided ablation strategy also reduced the procedure time, fluoroscopy time, as well as RF time despite no distinct effect on the alleviation of procedure-related complications. © 2017 Wiley Periodicals, Inc.

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

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    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

  16. Wolff-Parkinson-White syndrome in the era of catheter ablation: insights from a registry study of 2169 patients.

    Science.gov (United States)

    Pappone, Carlo; Vicedomini, Gabriele; Manguso, Francesco; Saviano, Massimo; Baldi, Mario; Pappone, Alessia; Ciaccio, Cristiano; Giannelli, Luigi; Ionescu, Bogdan; Petretta, Andrea; Vitale, Raffaele; Cuko, Amarild; Calovic, Zarko; Fundaliotis, Angelica; Moscatiello, Mario; Tavazzi, Luigi; Santinelli, Vincenzo

    2014-09-02

    The management of Wolff-Parkinson-White is based on the distinction between asymptomatic and symptomatic presentations, but evidence is limited in the asymptomatic population. The Wolff-Parkinson-White registry was an 8-year prospective study of either symptomatic or asymptomatic Wolff-Parkinson-White patients referred to our Arrhythmology Department for evaluation or ablation. Inclusion criteria were a baseline electrophysiological testing with or without radiofrequency catheter ablation (RFA). Primary end points were the percentage of patients who experienced ventricular fibrillation (VF) or potentially malignant arrhythmias and risk factors. Among 2169 enrolled patients, 1001 (550 asymptomatic) did not undergo RFA (no-RFA group) and 1168 (206 asymptomatic) underwent ablation (RFA group). There were no differences in clinical and electrophysiological characteristics between the 2 groups except for symptoms. In the no-RFA group, VF occurred in 1.5% of patients, virtually exclusively (13 of 15) in children (median age, 11 years), and was associated with a short accessory pathway antegrade refractory period (PParkinson-White syndrome essentially depends on intrinsic electrophysiological properties of AP rather than on symptoms. RFA performed during the same procedure after electrophysiological testing is of benefit in improving the long-term outcomes. © 2014 American Heart Association, Inc.

  17. [Initial experience of catheter ablation of ventricular tachycardia originate from endocardium via direct ventricle puncture access in patients underwent mechanical valve implantation].

    Science.gov (United States)

    Wu, L M; Bao, J R; Zheng, L H; Chen, G; Ding, L G; Yao, Y

    2018-03-24

    Objective: To evaluate the results of catheter ablation of ventricular tachycardia (VT) via direct ventricle puncture access in patients without traditional approach. Methods: Two idiopathic left fasicular VT patients with mechanical aortic and mitrial valve repalcement and 1 patient with right ventricular originated VT post mechanical tricuspid valve repalcement from March 2010 to July 2012 in Fuwai hospital were enrolled in this study. For left fasicular VT patients, catheter ablation was performed using transapical left ventricular access via minithoracotomy. For the patient with right ventricular originated VT, catheter ablation was performed via percutaneous right ventricle puncture at xiphoid. Abaltion was guided under EnSite NavX mapping system. The feasibility of VT ablation via direct ventricle puncture access and long-term VT recurrence were investigated. Results: Catheter ablation was successful in all patients, and all clinical VTs were eliminated. The procedure time was 53, 62 and 74 minutes respectively with radiation time 11, 16 and 20 minutes. The ablation time was 130, 170 and 240 seconds individually. No procedure related complication occurred. After a follow-up time of 76, 55 and 82 months respectively, no VT recurrence was found in patients with left fasicular VT. New-onset VT with different morphology with previous VT was recorded in the patient with right ventricular originated VT, subcutaneous implantable defibrillator was implanted finally in this patient. Conclusions: For patients with endocardial origined ventricular arrhythmias which could not be ablated via traditional approaches, direct ventricle puncture access with hybrid techniques provides a new approach foreliminating VTs in these patients.

  18. Magnetic-guided catheter ablation of twin AV nodal reentrant tachycardia in a patient with left atrial isomerism, interrupted inferior vena cana, and Kawashima-Fontan procedure.

    Science.gov (United States)

    Bessière, Francis; Mongeon, François-Pierre; Therrien, Judith; Khairy, Paul

    2017-12-01

    Twin AV nodal reentrant tachycardia most commonly occurs in patients with complex congenital heart disease who have two distinct AV nodes, His bundles, and non-preexcited QRS morphologies. Catheter ablation of the weaker AV node may be hindered by anatomical complexities. In such cases, remote magnetic guidance offers a potentially effective solution.

  19. Association between C-reactive protein and atrial fibrillation recurrence after catheter ablation: a meta-analysis.

    Science.gov (United States)

    Jiang, Zhouqin; Dai, Limeng; Song, Zhiyuan; Li, Huakang; Shu, Maoqin

    2013-09-01

    Atrial fibrillation (AF) is associated with inflammation. Increased serum C-reactive protein (CRP) levels are important representatives of an inflammatory state of AF. A variety of studies have evaluated whether increased CRP levels have an association with AF recurrence after catheter ablation. However, the results remain inconsistent, therefore, this meta-analysis was conducted to offer suggestions. Increased baseline CRP have an association with AF recurrence after catheter ablation. Electronic databases including PubMed, Embase, Medline, ISI Web of Knowledge, and ScienceDirect were searched until December 31, 2012 for any CRP-associated studies. Overall and subgroup analyses were performed. Standardized mean difference (SMD) and 95% confidence interval (CI) were used to evaluate the associations between CRP levels and postablation AF recurrence. Statistical analysis was performed with Review Manager 5.2 and Stata 11.0. Seven available studies were identified, which included 526 patients (179 recurrence vs 347 no recurrence). Overall, increased baseline CRP levels had significant positive association with postablation AF recurrence. The SMD in the CRP levels was 0.65 units (95% CI: 0.30-0.99), and the z-score for overall effect was 3.70 (P = 0.0002). The heterogeneity test showed that there were moderate differences between individual studies (P = 0.006, I(2) = 67%). Metaregression revealed that different sample sizes of studies possibly accounted for the heterogeneity. Positive associations were also found in subgroup analyses based on sample size. When stratifying for ethnicity, similarly significant associations were found in both European (Caucasian) and Asian populations. Investigations demonstrate that baseline CRP levels are greater in patients with postablation AF recurrence. Further studies with larger sample size and delicate design for CRP should be conducted. © 2013 Wiley Periodicals, Inc.

  20. Pulmonary vein isolation using a second-generation cryoballoon catheter: a randomized comparison of ablation duration and method of deflation.

    Science.gov (United States)

    Andrade, Jason G; Dubuc, Marc; Guerra, Peter G; Landry, Evelyn; Coulombe, Nicolas; Leduc, Hugues; Rivard, Léna; Macle, Laurent; Thibault, Bernard; Talajic, Mario; Roy, Denis; Khairy, Paul

    2013-06-01

    Optimal cryoballoon ablation parameters for pulmonary vein (PV) isolation remain to be defined. We conducted a randomized preclinical trial to compare 2- versus 4-minute ablation lesions and assess the safety of active (forced) cryoballoon deflation. Thirty-two dogs underwent PV isolation with a second-generation 23 mm cryoballoon catheter. The left superior (LSPV) and inferior (LIPV) PVs were randomized in a factorial design to (1) a single 2- versus 4-minute cryoapplication, and (2) passive versus active cryoballoon deflation. Animals were survived for 30 days, after which histopathologic analysis was performed. Acute PV isolation was attained in 89.8% of PVs after a single application (93.8% LSPV, 85.2% LIPV; P = 0.2823). Mean time to PV isolation was 29.5 ± 18.5 seconds. Although 4-minute lesions were associated with a thicker neointima than 2-minute lesions (223.8 μm versus 135.6 μm; P = 0.007), no differences were observed in procedural characteristics (freezing temperature, rewarming time), rates of acute PV isolation, or the achievement of complete circumferentially transmural lesions at 30 days (78.7% overall; 86.2% for 2 minutes vs 70.0% for 4 minutes; P = 0.285). Active deflation was associated with faster balloon rewarming but not with significant differences in mean or maximum neointimal thickness. A single application with the second-generation cryoballoon catheter results in a high rate of PV isolation. The degree of vascular injury was not increased by active balloon deflation and no differences in acute efficacy or mature transmural circumferential lesions were observed with 2- versus 4-minute applications. © 2013 Wiley Periodicals, Inc.

  1. Assessments of pulmonary vein and left atrial anatomical variants in atrial fibrillation patients for catheter ablation with cardiac CT

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    Chen, Jing; Yang, Zhi-Gang; Xu, Hua-Yan; Shi, Ke; Long, Qi-Hua [Sichuan University, Department of Radiology, West China Hospital, Chengdu, Sichuan (China); Guo, Ying-Kun [Sichuan University, Department of Radiology, West China Second University Hospital, Chengdu (China)

    2017-02-15

    To provide a road map of pulmonary vein (PV) and left atrial (LA) variants in patients with atrial fibrillation (AF) before catheter ablation procedure using cardiac CT. Cardiac CT was performed in 1420 subjects for accurate anatomical information, including 710 patients with AF and 710 matched controls without AF. PV variants, PV ostia and spatial orientation, LA enlargement, and left atrial diverticulum (LAD) were measured, respectively. Differences between these two groups were also respectively compared. Some risk factors for the occurrence of LAD were analyzed. In total, PV variants were observed in 202 (28.5 %) patients with AF patients and 206 (29.0 %) controls without AF (p = 0.8153). The ostial sizes of all accessory veins were generally smaller than those of the typical four PVs (p = 0.0153 to 0.3958). There was a significant difference of LA enlargement between the AF and control groups (36.3 % vs. 12.5 %, p < 0.0001), while the prevalence of LAD was similar in these two groups (43.2 % vs. 41.9 %, p = 0.6293). PV variants are common. Detailed knowledge of PVs and LA variants are helpful for providing anatomical road map to determine ablation strategy. (orig.)

  2. 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.

  3. [Reduction of radiological exposure time during radiofrequency catheter ablation procedures using a novel intracardiac localization system based on the Ohm's law].

    Science.gov (United States)

    Catanzariti, Domenico; Maines, Massimiliano; De Girolamo, Piergiuseppe; Cozzi, Fulvio; Cemin, Claudio; Vergara, Giuseppe

    2004-08-01

    Three-dimensional nonfluoroscopic system may be helpful to guide radiofrequency catheter ablation procedures and to reduce the radiological exposure. A new intracardiac navigation and multicatheter visualization system based on Ohm's law (LocaLisa, Medtronic, Minneapolis, MN, USA) has been recently introduced. The aim of our study was to assess the efficacy of the Loca-Lisa system in comparison to fluoroscopy-based approach in reducing the radiological exposure time required for radiofrequency catheter ablation procedures. One hundred and thirty-seven consecutive patients underwent LocaLisa-based radiofrequency catheter ablation procedures in our cardiac electrophysiology laboratory during 19 months of LocaLisa utilization (from October 2001 to April 2003): 46 atrial flutter, 44 atrioventricular node reentrant tachycardia, 16 atrioventricular reentry tachycardia due to atrioventricular accessory pathway, 14 atrial fibrillation, 11 ectopic atrial tachycardia, and 6 atrioventricular node modulation. We retrospectively compared the radiological exposure times of this group of patients to those of the last 137 patients undergone fluoroscopy-based radiofrequency catheter ablation procedures for curing the same index arrhythmia by the same procedural protocol. The mean radiological exposure time was significantly shorter for the LocaLisa-based radiofrequency catheter ablation procedures (16 +/- 12 vs 34 +/- 17 min; reduction of 53%, p < 0.01) and it occurred for all the arrhythmia types. The reduction was of 64% (from 39 +/- 18 to 14 +/- 12 min, p < 0.01) for atrial flutter, 42% (from 24 +/- 10 to 14 +/- 11 min, p < 0.01) for atrioventricular nodal reentrant tachycardia, 30% (from 40 +/- 14 to 28 +/- 14 min, p = 0.02) for atrioventricular reentry tachycardia, 57% (from 49 +/- 12 to 21 +/- 13 min, p < 0.01) for atrial fibrillation (right atrial linear lesions), 50% (from 38 +/- 12 to 19 +/- 8 min, p < 0.01) for ectopic atrial tachycardia and 42% (from 12 +/- 11 to 7 +/- 5

  4. Radiofrequency catheter ablation of atrioventricular node reentrant tachycardia in children with limited fluoroscopy.

    Science.gov (United States)

    Swissa, Moshe; Birk, Einat; Dagan, Tamir; Naimer, Sody Abby; Fogelman, Michal; Einbinder, Tom; Bruckheimer, Elchanan; Fogelman, Rami

    2017-06-01

    Limited fluoroscopy cryo-ablation using a 3D electro-anatomical system (3DS) has been used for AVNRT in children. We aimed to facilitate a fluoroscopy limited approach of RF ablation of AVNRT in children. A retrospective study was performed of procedure parameters in children undergoing RF ablation of AVNRT in 75 consecutive children (June 2011 to November 2013 - Group A) using standard fluoroscopy techniques compared to those of 64 consecutive children (December 2013 to May 2015 - Group B), using a fluoroscopy limited approach with 3DS. The acute success rate was 98.7% (74/75) and 98.4% (63/64) for groups A and B, respectively. The recurrence rate was 2.7% (2/74) and 0% (0/63) with a mean follow-up period of 45.5±12.1 and 14.3±6.1months for group A and group B, respectively. The mean procedure and fluoroscopy times were significantly lower for group B compared to group A (119±37 (43-203) and 0.83±1.04 (0.05-3.83) minutes versus 146±53 (72-250) and 16.1±8.9 (4.39-55) minutes, pfluoroscopy limited approach for RF ablation of AVNRT in children using a 3DS is easily acquired and adapted, and significantly reduces the fluoroscopy and procedure time with excellent efficacy, safety and low recurrence rate. This study confirmed that a 3D mapping system (3DS) to guide ablations of AVNRT in children reduces radiation exposure. Combined, limited fluoroscopy and 3DS in a methodology that resembles the familiar conventional fluoroscopy approach for RF ablation of AVNRT in children is proposed. Combined limited fluoroscopy and RF-energy in children with AVNRT are associated with a shorter procedure time, minimal fluoroscopy time, a high success rate and a low recurrence rate. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Risk of atrial fibrillation, stroke, and death after radiofrequency catheter ablation of typical atrial flutter.

    Science.gov (United States)

    Seara, Javier García; Roubin, Sergio Raposeiras; Gude Sampedro, Francisco; Barreiro, Vanessa Balboa; Sande, José Martínez; Mañero, Moisés Rodriguez; Grandio, Pilar Cabans; Alvarez, Belen; Juanatey, José González

    2014-07-01

    The purpose of this study was to assess the incidence, predictors, and prognostic clinical impact of atrial fibrillation (AF) over time after cavotricuspid isthmus (CTI) ablation of typical atrial flutter (AFL). This was a follow-up observational study using 408 patients who underwent CTI AFL ablation between 1998 and 2010. The relationships between the different predictors and the outcomes (AF, stroke, and death) were modeled by means of multistate Cox model analyses. The incident rate of AF per 100 person-years during follow-up was 10.2 (95 % CI 8.7-11.8). Prior AF and chronic obstructive pulmonary disease (COPD) were the only independent variables to predict AF occurrence in the population. Their hazard ratios (HRs) were 2.55 (95 % CI 1.84-3.52) and 1.56 (95 % CI 1.08-2.27), respectively. Patients who transitioned to AF had an increased risk of death by an HR of 2.82 (95 % CI 1.88-4.70) and an increased risk of stroke by an HR of 2.93 (95 % CI 1.12-8.90). Age, COPD, and heart failure (HF) were predictive factors of death by HRs of 1.05 (95 % CI 1.00-1.08), 2.85 (95 % CI 1.39-5.83), and 2.72 (95 % CI 1.15-6.40), respectively. Age, smoking, COPD, and HF were predictive factors of death in the group of patients with AF during follow-up. HRs were 1.07 (95 % CI 1.02-1.12), 2.55 (95 % CI 1.55-4.21), 7.60 (95 % CI 3.01-19.16), and 3.07 (95 % CI 1.18-7.95), respectively. The transition to AF after CTI AFL ablation was high during a long-term follow-up period and maintained over time. Prior AF and COPD were the primary predictors of transition to AF after CTI AFL ablation. Patients who transitioned to AF had an increased risk of stroke and a more than twofold mortality rate. These clinical implications make it necessary to investigate AF after CTI ablation.

  6. [Clinical analysis of 19 cases of pregnant women with rapid arrhythmia in the treatment of radiofrequency catheter ablation].

    Science.gov (United States)

    Chu, L; Zhang, J; Li, Y N; Long, D Y

    2016-10-25

    Objective: To investigate the risk of radiofrequency catheter ablation and maternal and infant in pregnant women with rapid arrhythmia during pregnancy. Methods: The clinical data of the 19 cases of pregnancy complicated with rapid arrhythmia were retrospectively analyzed and followed up, including the gestational week, the type of arrhythmia, the treatment, and the outcome of the mother and child in Beijing Anzhen Hospital of Capital Medical University from January 2002 to March 2016. Results: (1)Clinical characteristics: the ages of the 19 cases were(31±4)years old(ranged from 26 to 35 years old), the onset gestational ages were(21±4)weeks(ranged from 15 to 32 weeks). paroxysmal palpitation, chest tightness, dizziness, and blurred vision. Arrhythmia types: 1 case of atrial flutter and atrial tachycardia, 1 case of atrial flutter and atrial fibrillation, 1 case of atrial fibrillation, 3 cases of supraventricular tachycardia, 1 case of atrial tachycardia and supraventricular tachycardia, 4 cases of ventricular tachycardia, 3 cases of ventricular premature beats and ventricular tachycardia, and 5 cases of atrial tachycardia. All cases were treated by drugs, but all failed 2 cases of them were performed esophageal pacing and cardioversion and also failed.(2)Treatment plan: 19 cases after treatment of arrhythmia, completely terminated, the first 7 patients(from 2002 to 2014)were operated in a small amount of radiation under the guidance, the other 12 patients(after 2015)were carried out in the Ensite NavX mapping system, whichwere operated with zero radiation. Complications and adverse reactions: 1 case of uterine contraction end operation and was gived magnesium sulfate 3 days intravenous inhibition of uterine contractions, 1 case occurred vagal reflex caused by reduced blood pressure and was gived fluid infusion utill normal blood pressure.(3)Maternal and neonatal outcomes: in addition 1 case of pregnancy to give up, the remaining 18 cases were full-term pregnant

  7. A comparative analysis of clinical outcomes and disposable costs of different catheter ablation methods for the treatment of atrioventricular nodal reentrant tachycardia

    OpenAIRE

    Berman, Adam E; Rivner, Harold; Chalkley, Robin; Heboyan, Vahé

    2017-01-01

    Adam E Berman,1–4 Harold Rivner,1 Robin Chalkley,1 Vahé Heboyan2 1Department of Medicine, Medical College of Georgia, 2Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, 3Division of Cardiology, 4Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA, USA Background: Catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) is a commonly performed electrophysiology (EP) procedure. Few data ...

  8. 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.

  9. Why can pulmonary vein stenoses created by radiofrequency catheter ablation worsen during and after follow-up ? A potential explanation

    Directory of Open Access Journals (Sweden)

    Dorsaz Pierre-André

    2008-05-01

    Full Text Available Abstract Background Radiofrequency catheter ablation of excitation foci inside pulmonary veins (PV generates stenoses that can become quite severe during or after the follow-up period. Since severe PV stenoses have most often disastrous consequences, it would be important to know the underlying mechanism of this temporal evolution. The present study proposes a potential explanation based on mechanical considerations. Methods we have used a mathematical-physical model to examine the cyclic increase in axial wall stress induced in the proximal (= upstream, non-stenosed segment of a stenosed pulmonary vein during the forward flow phases. In a representative example, the value of this increase at peak flow was calculated for diameter stenoses (DS ranging from 1 to 99%. Results The increase becomes appreciable at a DS of roughly 30% and rise then strongly with further increasing DS value. At high DS values (e.g. > 90% the increase is approximately twice the value of the axial stress present in the PV during the zero-flow phase. Conclusion Since abnormal wall stresses are known to induce damages and abnormal biological processes (e.g., endothelium tears, elastic membrane fragmentations, matrix secretion, myofibroblast generation, etc in the vessel wall, it seems plausible that the supplementary axial stress experienced cyclically by the stenotic and the proximal segments of the PV is responsible for the often observed progressive reduction of the vessel lumen after healing of the ablation injury. In the light of this model, the only potentially effective therapy in these cases would be to reduce the DS as strongly as possible. This implies most probably stenting or surgery.

  10. Catheter Ablation of Idiopathic Left Posterior Fascicular Ventricular Tachycardia: Predicting the Site of Origin via Mapping and Electrocardiography.

    Science.gov (United States)

    Ma, Wei; Lu, Fengmin; Shehata, Michael; Wang, Xunzhang; Zhang, Fan; Chen, Bingwei; Wu, Dongyan; He, Le; Sun, Shan; Cheng, Aijuan; Ding, Jun; Cong, Hongliang; Xu, Jing

    2017-11-01

    We report the 12-lead ECG morphology of left posterior fascicular ventricular tachycardia (LPF-VT) and the relationship between His-ventricular (HV) interval and site of origin in LPF-VT. We studied 41 patients who underwent successful catheter ablation of LPF-VT with HV interval >0 ms (n=8; proximal-LPF group), HV interval 0 to -15 ms (n=15; middle-LPF group), and HV interval <-15 ms (n=18; distal-LPF group). The earliest mapped presystolic potential (PP)-QRS interval was 34.1±4.2, 24.5±3.2, and 19.4±2.8 ms in proximal-, middle-, and distal-LPF groups. The earliest PP ratio (PP-QRS interval during VT/HV interval during sinus rhythm) was 0.59±0.05, 0.45±0.07, and 0.31±0.05 in the proximal-, middle-, and distal-LPF groups. There were statistically significant differences between the 3 groups in earliest PP ratio, and there was close correlation between the HV interval during LPF-VT and earliest PP ratio. The QRS duration in the proximal-LPF group (114±6 ms) was significantly narrower compared with the middle-LPF group (128±5 ms) and distal-LPF group (140±6 ms). In leads I and V6, the ratio of R/S tended to be greater in the proximal-LPF group compared with the other 2 groups. QRS duration, the ratio of R/S in leads V6, and lead I could predict a proximal or distal origin site of LPF-VT with high sensitivity and specificity. The HV interval and 12-lead ECG morphology of LPF-VT may help predict the successful site of origin and prove useful in guiding an effective ablation strategy. © 2017 American Heart Association, Inc.

  11. 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)

    Nagashima, Koichi; Okumura, Yasuo; Watanabe, Ichiro

    2011-01-01

    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 cm 3 vs. 158.3±47.2 cm 3 vs. 226.4±93.3 cm 3 (P 3 vs. 41.3±15.3 cm 3 vs. 66.8±35.1 cm 3 (P 3 vs. 106.2±27.3 cm 3 , P=0.021; LA-EAT: 34.0±10.6 cm 3 vs. 21.8±6.9 cm 3 , 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 cm 3 vs. 153.5±42.7 cm 3 , P=0.0002; LA-EAT: 69.6±35.5 cm 3 vs. 40.7±13.9 cm 3 , 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)

  12. Successful Catheter Ablation for Paroxysmal Atrial Fibrillation in a Patient with Double-chambered Right Ventricle.

    Science.gov (United States)

    Shioji, Keisuke; Kurita, Takashi; Kawai, Takafumi; Uegaito, Takashi; Motoki, Koichiro; Matsuda, Mitsuo; Miyazaki, Shunichi

    2016-01-01

    We herein describe an adult case of double-chambered right ventricle (DCRV) with symptomatic drug-intolerant paroxysmal atrial fibrillation (PAf). The woman was referred to undergo radiofrequency ablation (RFA), and mapping of the pulmonary veins (PVs) demonstrated that a spontaneous spike potential originating from the left inferior PV (LIPV) induced sustained Af in the second procedure. Accordingly, the LIPV was regarded as the arrhythmogenic PV. Since complete isolation of the PVs, the sinus rhythm has been maintained for at least two years. This is the first report to describe that RFA for drug-intolerant PAf was useful in a patient with DCRV.

  13. Association between success rate and citation count of studies of radiofrequency catheter ablation for atrial fibrillation: possible evidence of citation bias.

    Science.gov (United States)

    Perino, Alexander C; Hoang, Donald D; Holmes, Tyson H; Santangeli, Pasquale; Heidenreich, Paul A; Perez, Marco V; Wang, Paul J; Turakhia, Mintu P

    2014-09-01

    The preferential citation of studies with the highest success rates could exaggerate perceived effectiveness, particularly for treatments with widely varying published success rates such as radiofrequency catheter ablation for atrial fibrillation. We systematically identified observational studies and clinical trials of radiofrequency catheter ablation of atrial fibrillation between 1990 and 2012. Generalized Poisson regression was used to estimate association between study success rate and total citation count, adjusting for sample size, journal impact factor, time since publication, study design, and whether first or last author was a consensus-defined pre-eminent expert. We identified 174 articles meeting our inclusion criteria (36 289 subjects). After adjustment only for time since publication, a 10-point increase above the mean in pooled reported success rates was associated with a 17.8% increase in citation count at 5 years postpublication (95% confidence interval, 7.1-28.4%; Pcitation count; 95% confidence interval, 7.6-29.6%; Pcitation count, which may indicate citation bias. To readers of the literature, radiofrequency catheter ablation of atrial fibrillation could be perceived to be more effective than the data supports. These findings may have implications for a wide variety of novel cardiovascular therapies. © 2014 American Heart Association, Inc.

  14. 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.)

  15. Electrical and thermal effects of esophageal temperature probes on radiofrequency catheter ablation of atrial fibrillation: results from a computational modeling study.

    Science.gov (United States)

    Pérez, Juan J; D'Avila, Andre; Aryana, Arash; Berjano, Enrique

    2015-05-01

    Luminal esophageal temperature (LET) monitoring is commonly employed during catheter ablation of atrial fibrillation (AF) to detect high esophageal temperatures during radiofrequency (RF) delivery along the posterior wall of the left atrium. However, it has been recently suggested that in some cases the esophageal probe itself may serve as an RF "antenna" and promote esophageal thermal injury. The aim of this study was to assess the electrical and thermal interferences induced by different types of commercially available esophageal temperature probes (ETPs) on RF ablation. In this study, we developed a computational model to assess the electrical and thermal effects of 3 different types of ETPs: a standard single-sensor and 2 multisensor probes (1 with and 1 without metallic surfaces). LET monitoring invariably underestimated the maximum temperature reached in the esophageal wall. RF energy cessation guided by LET monitoring using an ETP yielded lower esophageal wall temperatures. Also, the phenomenon of thermal latency was observed, particularly in the setting of LET monitoring. Most importantly, while only the ETP with a metallic surface produced minimal electrical alterations, the magnitude of this interference did not appear to be clinically significant. Temperature rises in both the esophageal wall and the ETP seem to be primarily produced by thermal conduction, and not caused by electrical and/or thermal interactions between the ablation catheter and the ETP, itself. As such, the proposed notion of the "antenna effect" producing satellite esophageal lesions during AF ablation was not evident in this study. © 2015 Wiley Periodicals, Inc.

  16. 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)

    Cotelo, E.; Pouso, J.; Reyes, W.

    2001-01-01

    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)

  17. Radiofrequency Catheter Ablation of Coexistent Idiopathic Left Ventricular Tachycardia and Atrioventricular Nodal Reentrant Tachycardia

    Directory of Open Access Journals (Sweden)

    Ken-Pen Weng

    2005-10-01

    Full Text Available A healthy 15-year-old male patient presented with a 6-month history of recurrent attacks of palpitations. On multiple emergency room visits, a sustained wide QRS complex tachycardia with a right bundle branch block and northwest axis deviation was documented. The tachycardia was not terminated by intravenous adenosine, but was suppressed with intravenous verapamil. There was no evidence of structural heart disease, myocarditis, long QT syndrome, or electrolyte imbalance after a series of standard examinations. Idiopathic left ventricular tachycardia (ILVT was suspected. Electrophysiologic studies revealed 2 inducible tachycardias, which were shown to represent atrioventricular nodal reentrant tachycardia (AVNRT and ILVT. Transformation from AVNRT to ILVT occurred spontaneously following atrial pacing. Successful ablation of ILVT and the slow atrioventricular nodal pathway resulted in cure of the double tachycardia.

  18. Three-dimensional atrial wall thickness maps to inform catheter ablation procedures for atrial fibrillation.

    Science.gov (United States)

    Bishop, Martin; Rajani, Ronak; Plank, Gernot; Gaddum, Nicholas; Carr-White, Gerry; Wright, Matt; O'Neill, Mark; Niederer, Steven

    2016-03-01

    Transmural lesion formation is critical to success in atrial fibrillation ablation and is dependent on left atrial wall thickness (LAWT). Pre- and peri-procedural planning may benefit from LAWT measurements. To calculate the LAWT, the Laplace equation was solved over a finite element mesh of the left atrium derived from the segmented computed tomographic angiography (CTA) dataset. Local LAWT was then calculated from the length of field lines derived from the Laplace solution that spanned the wall from the endocardium or epicardium. The method was validated on an atrium phantom and retrospectively applied to 10 patients who underwent routine coronary CTA for standard clinical indications at our institute. The Laplace wall thickness algorithm was validated on the left atrium phantom. Wall thickness measurements had errors of atrial wall thickness measurements were performed on 10 patients. Successful comprehensive LAWT maps were generated in all patients from the coronary CTA images. Mean LAWT measurements ranged from 0.6 to 1.0 mm and showed significant inter and intra patient variability. Left atrial wall thickness can be measured robustly and efficiently across the whole left atrium using a solution of the Laplace equation over a finite element mesh of the left atrium. Further studies are indicated to determine whether the integration of LAWT maps into pre-existing 3D anatomical mapping systems may provide important anatomical information for guiding radiofrequency ablation. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  19. Comparative efficacy and safety of contact force-sensing catheter and second-generation cryoballoon ablation for atrial fibrillation: a meta-analysis

    Directory of Open Access Journals (Sweden)

    X. Zhou

    Full Text Available This meta-analysis compared the efficacy and safety of the contact force (CF-sensing catheter and second-generation cryoballoon (CB ablation for treating atrial fibrillation (AF. Six controlled clinical trials comparing ablation for AF using a CF-sensing catheter or second-generation CB were identified from PubMed, EMBASE, Cochrane Library, Wanfang Data, and China National Knowledge Infrastructure. The procedure duration was significantly lower in the CB group compared with that in the CF group [mean difference (MD=29.4; 95%CI=17.84–40.96; P=0.01], whereas there was no difference between the groups for fluoroscopy duration (MD=0.59; 95%CI=–4.48–5.66; P=0.82. Moreover, there was no difference in the incidence of non-lethal complications (embolic event, tamponade, femoral/subclavian hematoma, arteriovenous fistula, pulmonary vein stenosis, phrenic nerve palsy, and esophageal injury between the CB and the CF groups (8.38 vs 5.35%; RR=0.66; 95%CI=0.37–1.17; P=0.15. Transient phrenic nerve palsy occurred in 17 of 326 patients (5.2% of the CB group vs none in the CF group (RR=0.12; 95%CI=0.03–0.43; P=0.001. A comparable proportion of patients in CF and CB groups suffered from AF recurrence during the 12-month follow-up after a single ablation procedure [risk ratio (RR=1.03; 95%CI=0.78–1.35; P=0.84]. AF ablation using CF-sensing catheters and second-generation CB showed comparable fluoroscopy duration and efficacy (during a 12-month follow-up, with shorter procedure duration and different complications in the CB group.

  20. Renal function and risk of stroke and bleeding in patients undergoing catheter ablation for atrial fibrillation: Comparison between uninterrupted direct oral anticoagulants and warfarin administration.

    Science.gov (United States)

    Yanagisawa, Satoshi; Inden, Yasuya; Fujii, Aya; Ando, Monami; Funabiki, Junya; Murase, Yosuke; Takenaka, Masaki; Otake, Noriaki; Ikai, Yoshihiro; Sakamoto, Yusuke; Shibata, Rei; Murohara, Toyoaki

    2018-03-01

    The effect of uninterrupted oral anticoagulant use in patients with chronic kidney disease (CKD) during catheter ablation for atrial fibrillation (AF) is not fully understood. The present study aimed to evaluate the safety and efficacy of periprocedural uninterrupted direct oral anticoagulant (DOAC) use compared with those of uninterrupted warfarin use in patients undergoing catheter ablation for AF stratified by various renal function groups. A total of 2091 patients were retrospectively included in this study. The study population was divided into 4 groups: creatinine clearance level ≥80 mL/min (n = 1086), 50-79 mL/min (n = 774), 15-49 mL/min (n = 209), and <15 mL/min (n = 22). We investigated periprocedural complications and compared them between uninterrupted DOAC and warfarin groups. There was no significant difference in thromboembolic events among the 4 groups (0.6%, 0.6%, 1.0%, and 0%, respectively; P = .792). However, major bleeding events (0.9%, 1.4%, 4.8%, and 4.5%; P < .001) and minor bleeding events (4.1%, 6.1%, 11.5%, and 13.6%; P < .001) primarily occurred in patients with CKD. The rate of periprocedural complications in the DOAC group was similar to that in the warfarin group for each renal function category. Adverse events did not differ after adjustment using propensity score-matched analysis. Multivariate analysis showed that lower body weight, antiplatelet drug use, initial ablation session, and CKD were independent predictors of adverse events. The periprocedural bleeding risk was increased in patients with CKD. Uninterrupted DOAC and warfarin administration during catheter ablation for AF in patients with CKD is feasible and effective. Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  1. Lesion dimensions during temperature-controlled radiofrequency catheter ablation of left ventricular porcine myocardium: impact of ablation site, electrode size, and convective cooling

    DEFF Research Database (Denmark)

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

    1999-01-01

    It is important to increase lesion size to improve the success rate for radiofrequency ablation of ischemic ventricular tachycardia. This study of radiofrequency ablation, with adjustment of power to approach a preset target temperature, ie, temperature-controlled ablation, explores the effect...

  2. Clinical outcomes of AF patients treated with the first and second-generation of circular mapping and ablation catheter: insights from a real world multicenter experience.

    Science.gov (United States)

    Rovaris, Giovanni; De Filippo, Paolo; Laurenzi, Francesco; Zanotto, Gabriele; Bottoni, Nicola; Pozzi, Mattia; Giofrè, Fabrizio; De Girolamo, Piergiuseppe; Visentin, Emanuela; Piazzi, Elena; Ferrari, Paola

    2017-12-01

    Complete pulmonary vein isolation (PVI) is the best documented target for catheter ablation, and different technologies have shown comparable outcomes. The multielectrode phased-RF/duty cycled (PhRF/DC) pulmonary vein ablation catheter (PVAC) and its second generation (PVAC-GOLD) have shown promising clinical results in single and multicenter experiences. Our aim is to assess and compare the safety and efficacy in the real clinical practice among two generations of circular PhRF/DC catheters by performing PVI in patients suffering from recurrent atrial fibrillation (AF). Eighty-four AF patients treated with PVAC and 64 with PVAC-GOLD were prospectively followed in five Italian cardiology centers in the mainframe of the 1STOP-ClinicalService project. Fluoroscopic and total procedure time were significantly different in the two groups. In particular, in the PVAC-GOLD group, the mean fluoroscopic time was 22.8 ± 12.7 min vs 31.6 ± 18.9 in the PVAC group (p = 0.002), and the mean total procedure duration was 117.6 ± 36.0 vs 147.4 ± 40.6, in the PVAC-GOLD group and the PVAC group, respectively (p = 0.001). Only two out of 148 patients reported a peri-procedural complication. Over 20.9 ± 12.0 months of follow-up, AF recurrence occurred in 58 patients. Kaplan-Meier freedom from AF recurrence did not differ between the two groups (64.1 ± 10% in the PVAC group vs 68.2 ± 9% in the PVAC-GOLD group at 1 year, p = ns). In our multicenter analysis, AF ablation using two generations of circular PhRF/DC catheters is safe and effective. No difference was observed in terms of safety and efficacy of the AF ablation between the two catheters, with the mean procedural time being shorter in the PVAC-GOLD group.

  3. The Effect of Catheter Ablation on Left Atrial Size and Function for Patients with Atrial Fibrillation: An Updated Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Bin Xiong

    Full Text Available Catheter ablation (CA for atrial fibrillation (AF is now an important therapeutic modality for patients with AF. However, data regarding changes in left atrial (LA function after CA have indicated conflicting results depending on the AF types, follow-up period, and the analytical imaging tools. The objective of this review was to analyze the effect of CA on the LA size and function for patients with AF.We searched for studies regarding LA size and function pre- and post-ablation in PubMed, Embase, the Cochrane Library, and Web of Knowledge through May 2014. LA function was measured by LA ejective fraction (LAEF, LA active ejective fraction (LAAEF, or both. Total and subgroup analyses were implemented using Cochrane Review Manager Version 5.2. Weighted mean differences with 95% confidence intervals were used to express the results of continuous outcomes using fixed or random effect models. I2 was used to calculate heterogeneity. To assess publication bias, Egger's test and Begg's funnel plot were performed using Stata 12.0.Twenty-five studies (2040 enrolled patients were selected for this meta-analysis. The LA diameter (LAD, maximum LA volume, and minimal LA volume were significantly decreased post-ablation, as compared with those at a pre-ablation visit. Compared with the pre-ablation outcomes, we found no significant differences in LAEF/LAAEF at a post-ablation follow-up. Decreases in LA volume and LAEF remained significant post-ablation for paroxysmal AF (PAF; however, the LAEF was insignificant changes in persistent AF (PeAF. Heterogeneity was significant in spite which individual study was excluded. A publication bias was not found. In a meta-regression analysis, we did not find any factor that contributed to the heterogeneity.With CA, LA volumes and LAD were decreased significantly in patients with AF; LAEF was not significant changes in patients with PeAF but decreased in those with PAF.

  4. Identification of reentry circuit sites during catheter mapping and radiofrequency ablation of ventricular tachycardia late after myocardial infarction.

    Science.gov (United States)

    Stevenson, W G; Khan, H; Sager, P; Saxon, L A; Middlekauff, H R; Natterson, P D; Wiener, I

    1993-10-01

    Ventricular tachycardia reentry circuits in chronic infarct scars can contain slow conduction zones, which are difficult to distinguish from bystander areas adjacent to the circuit during catheter mapping. This study developed criteria for identifying reentry circuit sites using computer simulations. These criteria then were tested during catheter mapping in humans to predict sites at which radiofrequency current application terminated ventricular tachycardia. In computer simulations, effects of single stimuli and stimulus trains at sites in and adjacent to reentry circuits were analyzed. Entrainment with concealed fusion, defined as ventricular tachycardia entrainment with no change in QRS morphology, could occur during stimulation in reentry circuit common pathways and adjacent bystander sites. Pacing at reentry circuit common pathway sites, the stimulus to QRS (S-QRS) interval equals the electrogram to QRS interval (EG-QRS) during tachycardia. The postpacing interval from the last stimulus to the following electrogram equals the tachycardia cycle length. Pacing at bystander sites the S-QRS exceeds the EG-QRS interval when the conduction time from the bystander site to the circuit is short but may be less than or equal to the EG-QRS interval when the conduction time to the circuit is long. The postpacing interval, however, always exceeds the tachycardia cycle length. When conduction in the circuit slows during pacing, the S-QRS and postpacing intervals increase and the slowest stimulus train most closely reflects conduction times during tachycardia. Endocardial catheter mapping and radiofrequency ablation were performed during 31 monomorphic ventricular tachycardias in 15 patients with drug refractory ventricular tachycardia late after myocardial infarction. During ventricular tachycardia, trains of electrical stimuli or scanning single stimuli were evaluated before application of radiofrequency current at the same site. Radiofrequency current terminated

  5. Results of Cryoenergy and Radiofrequency-Based Catheter Ablation for Treating Ventricular Arrhythmias Arising From the Papillary Muscles of the Left Ventricle, Guided by Intracardiac Echocardiography and Image Integration.

    Science.gov (United States)

    Rivera, Santiago; Ricapito, Maria de la Paz; Tomas, Leandro; Parodi, Josefina; Bardera Molina, Guillermo; Banega, Rodrigo; Bueti, Pablo; Orosco, Agustin; Reinoso, Marcelo; Caro, Milagros; Belardi, Diego; Albina, Gaston; Giniger, Alberto; Scazzuso, Fernando

    2016-04-01

    Catheter radiofrequency ablation of ventricular arrhythmias (VAs) arising from the left ventricle's papillary muscles has been associated with inconsistent results. The use of cryoenergy versus radiofrequency has not been compared yet. This study compares outcomes and complications of catheter ablation of VA from the papillary muscles of the left ventricle with either cryoenergy or radiofrequency. Twenty-one patients (40±12 years old; 47% males; median ejection fraction 59±7.3%) with drug refractory premature ventricular contractions or ventricular tachycardia underwent catheter cryoablation or radiofrequency ablation. VAs were localized using 3-dimensional mapping, multidetector computed tomography, and intracardiac echocardiography, with arrhythmia foci being mapped at either the anterolateral papillary muscle or posteromedial papillary muscles of the left ventricle. Focal ablation was performed using an 8-mm cryoablation catheter or a 4-mm open-irrigated radiofrequency catheter, via transmitral approach. Acute success rate was 100% for cryoenergy (n=12) and 78% for radiofrequency (n=9; P=0.08). Catheter stability was achieved in all patients (100%) treated with cryoenergy, and only in 2 (25%) patients treated with radiofrequency (P=0.001). Incidence of multiple VA morphologies was observed in 7 patients treated with radiofrequency (77.7%), whereas none was observed in those treated with cryoenergy (P=0.001). VA recurrence at 6 months follow-up was 0% for cryoablation and 44% for radiofrequency (P=0.03). Cryoablation was associated with higher success rates and lower recurrence rates than radiofrequency catheter ablation, better catheter stability, and lesser incidence of polymorphic arrhythmias. © 2016 American Heart Association, Inc.

  6. Responders and nonresponders after catheter ablation procedure and antiarrhythmic drug therapy in patients with paroxysmal AF: data from implantable cardiac monitors

    Directory of Open Access Journals (Sweden)

    А. А. Симонян

    2016-11-01

    Full Text Available Aim. The aim of this study was to assess the number of responders and nonresponders after catheter ablation procedure and antiarrhythmic drug therapy (AAD in patients with paroxysmal AF through implantable cardiac monitors (ICM. Methods. 92 patients with paroxysmal AF were randomized into two groups: 1 AAD + ICM implantation (group I; n=46, and 2 AF catheter ablation (CA + ICM implantation (group II; n=46, and 2. Patients with an AF% < 0.5% were considered AF-free (responders. Patients with AF% > 0.5% were classified as nonresponders. The follow up of this study was 24 months.Results. At the end of the follow-up period 13 (28.3% patients in AAD group and 29 (63 % patients in CA group were responders (log-rank test; р=0.0009; HR 2,6; 95% CI [1.44-4.69], р=0.001, Cox regression. According to multivariate logistic regression analysis data, AF burden>4.5% during the first two months after treatment (odds ratio [OR]=38,9; 95% confidence interval [CI], 6.2–245; P<0.001, arterial hypertension (OR=12.7; 95% CI, 1.9–85.3; P=0.009 and AF duration more than 5 years (OR=8.5; 95% CI, 1.04–69.6; P=0.044 were independent predictors of AF burden progression Conclusion. According to implantable cardiac monitors data, in patients with paroxysmal AF radiofrequency catheter ablation as compared to antiarrhythmic drug therapy results in higher percentage of responders.Received 10 July 2016. Accepted 22 August 2016.Funding: The study had no sponsorship. Conflict of interest: The authors declare no conflict of interest.

  7. Catheter ablation of persistent atrial fibrillation in a patient with cor triatriatum sinister demonstrating a total common trunk of the pulmonary vein.

    Science.gov (United States)

    Tokuda, Michifumi; Yamane, Teiichi; Tokutake, Kenichi; Yokoyama, Kenichi; Hioki, Mika; Narui, Ryohsuke; Tanigawa, Shin-Ichi; Yamashita, Seigo; Inada, Keiichi; Matsuo, Seiichiro; Yoshimura, Michihiro

    2016-02-01

    A 57-year-old male with persistent atrial fibrillation (AF) was referred for catheter ablation. Multidetector computed tomography (MDCT) revealed that a membrane divided the left atrium into two chambers, thus indicating the presence of cor triatriatum sinister. A 3D image reconstructed by MDCT showed that the accessory atrium received the left common and the right side PVs, as if it were a total common trunk, and this then flowed into the main atrium. After isolation of the pulmonary vein and posterior wall from the left atrium, AF could not be induced by any programmed pacing. The patient has remained free from AF during the 1 year of follow-up.

  8. Successful radiofrequency catheter ablation assisted by the CartoSound® system for outflow tract origin nonsustained ventricular tachycardia in a patient with a severely deformed thorax

    Directory of Open Access Journals (Sweden)

    Naoaki Onishi

    2014-02-01

    Full Text Available We report the case of a 72-year-old man with a nonsustained ventricular tachycardia and a history of palpitations. He had a severely deformed thorax since childhood due to spinal caries. An integrated computed tomography image of the outflow tract region from the CartoSound® system revealed the detailed anatomical information around the origin of the tachycardia and that the left anterior descending coronary artery was very close (<10 mm to the target site. We carefully ablated that site with a 3.5-mm cooled-tip catheter while confirming it in the sound view, and succeeded without any complications.

  9. Management of focal atrial tachycardias originating from the atrial appendage with the combination of radiofrequency catheter ablation and minimally invasive atrial appendectomy.

    Science.gov (United States)

    Guo, Xiao-gang; Zhang, Jin-lin; Ma, Jian; Jia, Yu-he; Zheng, Zhe; Wang, Hong-yue; Su, Xi; Zhang, Shu

    2014-01-01

    Focal atrial tachycardias (ATs) originating from the left and the right atrial appendage (AA) were the most difficult to eliminate. To evaluate the safety and long-term efficacy of minimally invasive surgical atrial appendectomy in combination with radiofrequency catheter ablation (RFCA) in the management of focal atrial appendage tachycardias (AATs). We included 42 consecutive patients with 42 AATs confirmed by activation mapping and contrast venography. Thirty of them were successfully managed with RFCA (RFCA-successful group), while the remaining 12 (28.6%) finally resorted to video-assisted thoracoscopic atrial appendectomy owing to RFCA failure (resort-to-surgery group). We searched for predictors of RFCA failure, and the need for surgery by using a binomial logistic regression model. In the RFCA-successful group, 6 (20.0%) patients experienced recurrence and re-do ablation and 11 (36.7%) AATs originated from distal AAs. In the resort-to-surgery group, the tachycardias involved exclusively distal AAs and required more RFCA attempts compared with those of the RFCA-successful group (1.58 ± 0.51 vs 1.20 ± 0.41; P = .0165). During atrial appendectomy, incessant ATs were terminated immediately after resection of the AA at the base. Long-term success was achieved in all 42 patients with a follow-up of 29.1 ± 17.5 months. No complications occurred. Fourteen patients with tachycardia-induced cardiomyopathy recovered fully. We identified origin at distal AATs and longer time to tachycardia termination by ablation as predictors of RFCA failure and the need for surgical intervention. ATs originating from the distal portion of AA were more refractory to RFCA. The combination of catheter ablation and video-assisted thoracoscopic atrial appendectomy was an effective strategy to manage AATs. © 2014 Heart Rhythm Society Published by Heart Rhythm Society All rights reserved.

  10. 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

  11. An Aggressive Strategy for Maintenance of Sinus Rhythm Including a Combination of Catheter Ablation and Antiarrhythmic Drug Therapy Benefits Patients with Chronic Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Tetsuya Haruna, MD

    2009-01-01

    Full Text Available The effects of restoration and maintenance of sinus rhythm by a combination of catheter ablation and antiarrhythmic drugs (AADs on atrial function in patients with chronic atrial fibrillation (AF remain unknown. In 15 patients with chronic AF (>1 year, we attempted to restore and maintain sinus rhythm by ablation targeting complex fractionated atrial electrocardiograms (CFAEs combined with pulmonary vein isolation with or without AADs. Sinus rhythm was restored in all patients. At 17:7 ± 7:2 months after AF ablation, maintenance of sinus rhythm was achieved in 20% of patients without AADs and in 73.3% of patients with AADs. The left atrial diameter decreased significantly by 9:5 ± 8:1% (P < 0:05 during the 12-month followup. AADs did not have any adverse effects. The aggressive strategy for maintenance of sinus rhythm involving AF ablation and AADs potentially led to recovery of structural changes in the LA in patients with chronic AF.

  12. Characteristics of Cavotricuspid Isthmus Ablation for Atrial Flutter Guided by Novel Parameters Using a Contact Force Catheter.

    Science.gov (United States)

    Gould, Paul A; Booth, Cameron; Dauber, Kieran; Ng, Kevin; Claughton, Andrew; Kaye, Gerald C

    2016-12-01

    This study sought to investigate specific contact force (CF) parameters to guide cavotricuspid isthmus (CTI) ablation and compare the outcome with a historical control cohort. Patients (30) undergoing CTI ablation were enrolled prospectively in the Study cohort and compared with a retrospective Control cohort of 30 patients. Ablation in the Study cohort was performed using CF parameters >10 g and g. The Control cohort underwent traditionally guided CTI ablation. Traditional parameters (electrogram and impedance change) were assessed in both cohorts. All ablations regardless of achieving targets were included in data analysis. Bidirectional CTI block was achieved in all of the Study and 27 of the Control cohort. Atrial flutter recurred in 3 (10%) patients (follow-up 564 ± 212 days) in the study cohort and in 3 (10%) patients (follow-up 804 ± 540 days) in the Control cohort. There were no major complications in either cohort. Traditional parameters correlated poorly with CF parameters. In the Study cohort, flutter recurrence was associated with significantly lower FTI and ablation duration, but was not associated with total average CF. CTI ablation can be safely performed using CF parameters guiding ablation, with similar long-term results to a historical ablation control group. Potentially CF parameters may provide adjunctive information to enable a more efficient CTI ablation. Further research is required to confirm this. © 2016 Wiley Periodicals, Inc.

  13. Detection of inadvertent catheter movement into the coronary sinus ostium or middle cardiac vein by real-time impedance monitoring prior to radiofrequency ablation in the right atrial posteroseptal region.

    Science.gov (United States)

    Pollak, Scott J; Seckel, Heather; Monir, Joseph; Ebra, George; Monir, George

    2012-09-01

    The objective of this study was to evaluate the use of continuous catheter impedance monitoring prior to ablation to facilitate differentiation of the coronary sinus ostium (CSO) and the middle cardiac vein (MCV) from the right atrial posteroseptal region (RPS). Empiric observations have suggested that continuous catheter impedance monitoring could differentiate the CSO and MCV from the RPS region. Radiofrequency ablation in the MCV or coronary sinus has been associated with coronary artery injury. Differentiation of these areas may be difficult with either fluoroscopy or electrogram characteristics. Continuous impedance measurements using a 4-mm Navistar (Biosense Webster) ablation catheter were conducted in 17 consecutive patients undergoing ablation for supraventricular tachycardia. The average impedance value was recorded at the right atrial septum (RS) posterior to the bundle of His, the RPS region, within 1 cm inside the CSO and in the MCV. These areas were confirmed and demarcated with 3-D mapping and biplane fluoroscopy. A significant increase in impedance was observed between the CSO (X = 146.6 ± 24.8) and RPS [Formula: see text] regions (p regions. Continuous impedance measurements during mapping can facilitate differentiation of catheter locations inside the CSO and MCV from extracoronary sinus regions. This may reduce the risk of inadvertent coronary artery damage during the ablation procedure.

  14. 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...

  15. Ablation of typical atrial flutter using a non-fluoroscopic catheter tracking system vs. conventional fluoroscopy--results from a prospective randomized study.

    Science.gov (United States)

    Schoene, Katharina; Rolf, Sascha; Schloma, Denis; John, Silke; Arya, Arash; Dinov, Borislav; Richter, Sergio; Bollmann, Andreas; Hindricks, Gerhard; Sommer, Philipp

    2015-07-01

    Reduction of radiation exposure using a sensor-based non-fluoroscopic catheter tracking (NFCT) system (MediGuide™, St Jude Medical, Inc.) was recently demonstrated by retrospective comparisons. We aimed to prospectively compare the effects of using NFCT vs. standard fluoroscopy on procedural parameters in patients undergoing radiofrequency ablation of typical atrial flutter. We prospectively randomized 40 patients undergoing cavotricuspid isthmus ablation for typical atrial flutter to either NFCT (n = 20) or conventional fluoroscopy (CONV, n = 20). Procedural parameters such as fluoroscopy time, radiation dose, and procedure duration, as well as periprocedural complications were compared. There were no statistically significant differences in baseline characteristics between the two groups. Bidirectional isthmus block was achieved in all patients. Fluoroscopy time was significantly reduced in the NFCT group {0.3 [inter-quartile range (IQR) 0.2; 0.48] min} when compared with CONV [5.7 (IQR 4.2; 11.5) min] (P fluoroscopy in patients undergoing radiofrequency ablation of typical atrial flutter, NFCT significantly reduced both radiation dose and fluoroscopy time with no effects on procedural duration. These findings support the incorporation of NFCT in routine clinical use. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  16. 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.)

  17. 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

    International Nuclear Information System (INIS)

    Tintera, Jaroslav; Porod, Vaclav; Rolencova, Eva; Fendrych, Pavel; Cihak, Robert; Mlcochova, Hanka; Kautzner, Josef

    2006-01-01

    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.)

  18. Effects of Alpha Lipoic Acid on Multiple Cytokines and Biomarkers and Recurrence of Atrial Fibrillation Within 1 Year of Catheter Ablation.

    Science.gov (United States)

    Sardu, Celestino; Santulli, Gaetano; Santamaria, Matteo; Barbieri, Michelangela; Sacra, Cosimo; Paolisso, Pasquale; D'Amico, Fabio; Testa, Nicola; Caporaso, Igor; Paolisso, Giuseppe; Marfella, Raffaele; Rizzo, Maria Rosaria

    2017-05-01

    Catheter ablation (CA) is a procedure commonly used to restore sinus rhythm in patients with atrial fibrillation (AF). However, AF recurrence after CA remains a relevant clinical issue. We tested the effects of an oral antioxidant treatment (alpha lipoic acid [ALA]) on AF recurrence post-CA. Patients with paroxysmal AF have been enrolled in a randomized, prospective, double-blind, controlled placebo trial. After CA, patients have been randomly assigned to receive ALA oral supplementation (ALA group) or placebo (control group) and evaluated at baseline and after a 12-month follow-up: 73 patients completed the 12-month follow-up (ALA: 33 and control: 40). No significant difference has been detected between the 2 groups at baseline. Strikingly, 1 year after CA, ALA therapy significantly reduced serum markers of inflammation. However, there was no significant difference in AF recurrence events at follow-up comparing ALA with placebo group. Multivariate analysis revealed that the only independent prognostic risk factor for AF recurrence after CA is age. In conclusion, ALA therapy reduces serum levels of common markers of inflammation in ablated patients. Nevertheless, ALA does not prevent AF recurrence after an ablative treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Non-invasive prediction of catheter ablation outcome in persistent atrial fibrillation by fibrillatory wave amplitude computation in multiple electrocardiogram leads.

    Science.gov (United States)

    Zarzoso, Vicente; Latcu, Decebal G; Hidalgo-Muñoz, Antonio R; Meo, Marianna; Meste, Olivier; Popescu, Irina; Saoudi, Nadir

    2016-12-01

    Catheter ablation (CA) of persistent atrial fibrillation (AF) is challenging, and reported results are capable of improvement. A better patient selection for the procedure could enhance its success rate while avoiding the risks associated with ablation, especially for patients with low odds of favorable outcome. CA outcome can be predicted non-invasively by atrial fibrillatory wave (f-wave) amplitude, but previous works focused mostly on manual measures in single electrocardiogram (ECG) leads only. To assess the long-term prediction ability of f-wave amplitude when computed in multiple ECG leads. Sixty-two patients with persistent AF (52 men; mean age 61.5±10.4years) referred for CA were enrolled. A standard 1-minute 12-lead ECG was acquired before the ablation procedure for each patient. F-wave amplitudes in different ECG leads were computed by a non-invasive signal processing algorithm, and combined into a mutivariate prediction model based on logistic regression. During an average follow-up of 13.9±8.3months, 47 patients had no AF recurrence after ablation. A lead selection approach relying on the Wald index pointed to I, V1, V2 and V5 as the most relevant ECG leads to predict jointly CA outcome using f-wave amplitudes, reaching an area under the curve of 0.854, and improving on single-lead amplitude-based predictors. Analysing the f-wave amplitude in several ECG leads simultaneously can significantly improve CA long-term outcome prediction in persistent AF compared with predictors based on single-lead measures. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  20. Low Left Atrial Compliance Contributes to the Clinical Recurrence of Atrial Fibrillation after Catheter Ablation in Patients with Structurally and Functionally Normal Heart.

    Science.gov (United States)

    Park, Junbeom; Yang, Pil-sung; Kim, Tae-Hoon; Uhm, Jae-Sun; Kim, Joung-Youn; Joung, Boyoung; Lee, Moon-Hyoung; Hwang, Chun; Pak, Hui-Nam

    2015-01-01

    Stiff left atrial (LA) syndrome was initially reported in post-cardiac surgery patients and known to be associated with low LA compliance. We investigated the physiological and clinical implications of LA compliance by estimating LA pulse pressure (LApp) among patients with atrial fibrillation (AF) and structurally and functionally normal heart. Among 1038 consecutive patients with LA pressure measurements before AF ablation, we included 334 patients with structurally and functionally normal heart (81.7% male, 54.1±10.6 years, 77.0% paroxysmal AF) after excluding those with hypertension, diabetes, and previous ablation or cardiac surgery. We measured LApp (peak-nadir LA pressure) at the beginning of the ablation procedure and compared the values with clinical parameters and the AF recurrence rate. AF patients with normal heart were younger and more frequently male and had paroxysmal AF, a lower body mass index, and a lower LApp compared to others (all p<0.05). Based on the median value, the low LA compliance group (LApp≥13 mmHg) had a smaller LA volume index and lower LA voltage (all p<0.05) compared to the high LA compliance group. During a mean follow-up of 16.7±11.8 months, low LA compliance was independently associated with two fold-higher risk of clinical AF recurrence (HR:2.202; 95%CI:1.077-4.503; p = 0.031). Low LA compliance, as determined by an elevated LApp, was associated with a smaller LA volume index and lower LA voltage and independently associated with higher clinical recurrence after catheter ablation in AF patients with structurally and functionally normal heart.

  1. The impact of supraventricular ectopic complexes in different age groups and risk of recurrent atrial fibrillation after antiarrhythmic medication or catheter ablation

    DEFF Research Database (Denmark)

    Alhede, Christina; Lauridsen, Trine K; Johannessen, Arne

    2018-01-01

    INTRODUCTION: Supraventricular ectopic complexes (SVEC) are known risk factors of recurrent atrial fibrillation (AF). However, the impact of SVEC in different age groups is unknown. We aimed to investigate the risk of AF recurrence with higher SVEC burden in patients ±57years, respectively, after....... RESULTS: Age >57years were significantly associated with higher AF recurrence rate after CA (58% vs 36%, p=0.02). After CA, we observed a higher SVEC burden during follow-up in patients >57years which was not observed in the younger age group treated with CA (p=0.006). High SVEC burden at 3months after CA...... treatment with antiarrhythmic medication (AAD) or catheter ablation (CA). METHODS: In total, 260 patients with LVEF >40% and age ≤70 years were randomized to AAD (N=132) or CA (N=128) as first-line treatment for paroxysmal AF. All patients underwent 7-day Holter monitoring at baseline, and after 3, 6, 12...

  2. Intracardiac echo-guided radiofrequency catheter ablation of atrial fibrillation in patients with atrial septal defect or patent foramen ovale repair: a feasibility, safety, and efficacy study.

    Science.gov (United States)

    Lakkireddy, Dhanunjaya; Rangisetty, Umamahesh; Prasad, Subramanya; Verma, Atul; Biria, Mazda; Berenbom, Loren; Pimentel, Rhea; Emert, Martin; Rosamond, Thomas; Fahmy, Tamer; Patel, Dimpi; Di Biase, Luigi; Schweikert, Robert; Burkhardt, David; Natale, Andrea

    2008-11-01

    Intracardiac Echo-Guided Radiofrequency Catheter. Patients with atrial septal defect (ASD) are at higher risk for atrial fibrillation (AF) even after repair. Transseptal access in these patients is perceived to be difficult. We describe the feasibility, safety, and efficacy of pulmonary vein antral isolation (PVAI) in these patients. We prospectively compared post-ASD/patent foramen ovale (PFO) repair patients (group I, n = 45) with age-gender-AF type matched controls (group II, n = 45). All the patients underwent PVAI through a double transseptal puncture with a roving circular mapping catheter technique guided by intracardiac echocardiography (ICE). The short-term (3 months) and long-term (12 month) failure rates were assessed. In group I, 23 (51%) had percutaneous closure devices and 22 (49%) had a surgical closure. There was no significant difference between group I and II in the baseline characteristics. Intracardiac echo-guided double transseptal access was obtained in 98% of patients in group I and in 100% of patients in group II. PVAI was performed in all patients, with right atrial flutter ablation in 7 patients in group I and in 4 patients in group II. Over a mean follow-up of 15 +/- 4 months, group I had higher short-term (18% vs 13%, P = 0.77) and long-term recurrence (24% vs 18%, P = 0.6) than group II. There was no significant difference in the perioperative complications between the two groups. Echocardiography at 3 months showed interatrial communication in 2 patients in group I and 1 patient in group II, which resolved at 12 months. Percutaneous AF ablation using double transseptal access is feasible, safe, and efficacious in patients with ASD and PFO repairs.

  3. 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.

  4. Initial experience of a novel mapping system combined with remote magnetic navigation in the catheter ablation of atrial fibrillation

    DEFF Research Database (Denmark)

    Lin, Changjian; Pehrson, Steen; Jacobsen, Peter Karl

    2017-01-01

    underwent pulmonary vein antrum isolation. Additional complex fractionated atrial electrograms (CFAEs) ablation was performed for PsAF. Procedural, ablation, and fluoroscopy times were recorded and complications were assessed. RESULTS: Electrophysiological end points were achieved in all patients. Using......). Procedure time (117.9 ± 29.6 minutes vs. 119.2 ± 29.7 minutes, P = 0.89), fluoroscopy time (6.1 ± 2.4 minutes vs. 4.8 ± 2.2 minutes, P = 0.07), and ablation time (28.0 ± 12.9 minutes vs. 27.9 ± 15.8 minutes, P = 0.98) were similar in Group A versus Group B, respectively. No complications occurred in either...

  5. Radiofrequency catheter ablation maintains its efficacy better than antiarrhythmic medication in patients with paroxysmal atrial fibrillation: On-treatment analysis of the randomized controlled MANTRA-PAF trial.

    Science.gov (United States)

    Raatikainen, M J Pekka; Hakalahti, Antti; Uusimaa, Paavo; Nielsen, Jens Cosedis; Johannessen, Arne; Hindricks, Gerhard; Walfridsson, Håkan; Pehrson, Steen; Englund, Anders; Hartikainen, Juha; Kongstad, Ole; Mortensen, Leif Spange; Hansen, Peter Steen

    2015-11-01

    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 to eliminate the clouding effect of crossover we performed an on-treatment analysis of the data. Patients (n=294) were divided into three groups: those receiving only the assigned therapy (RFA and AAD groups) and those receiving both therapies (crossover group). The primary end points were AF burden in 7-day Holter recordings at 3, 6, 12, 18, and 24 months and cumulative AF burden in all recordings. At 24 months, AF burden was significantly lower in the RFA (n=110) than in the AAD (n=92) and the crossover (n=84) groups (90th percentile 1% vs. 10% vs. 16%, P=0.007), and more patients were free from any AF (89% vs. 73% vs. 74%, P=0.006). In the RFA, AAD and the crossover groups 63%, 59% and 21% (PPAF long-term efficacy of RFA was superior to AAD therapy. Thus, it is reasonable to offer RFA as first-line treatment for highly symptomatic patients who accept the risks of the procedure and are aware of frequent need for reablation(s). Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Noninvasive prediction of catheter ablation acute outcome in persistent atrial fibrillation based on logistic regression of ECG fibrillatory wave amplitude and spatio-temporal variability.

    Science.gov (United States)

    Meo, Marianna; Zarzoso, Vicente; Meste, Olivier; Latcu, Decebal G; Saoudi, Nadir

    2013-01-01

    Catheter ablation (CA) is increasingly employed to treat persistent atrial fibrillation (AF), yet assessment of procedural AF termination is still a subject of debate in the medical community. This has motivated the development of different criteria based on the standard electrocardiogram (ECG) to characterize ablation immediate effectiveness. However, most of conventional descriptors are merely computed in one ECG lead, thus neglecting significant information provided by the other leads. The present study proposes a novel predictor of CA outcome by exploiting a subset of the 12 leads in the standard ECG. Our method predicts the need for electrical cardioversion subsequent to CA by suitably combining two sets of multilead features, namely, a measure of fibrillatory wave amplitude and an index of AF spatio-temporal variability per lead. These features are obtained on a reduced-rank approximation determined by principal component analysis emphasizing the highest-variance components in the multilead atrial activity signal, and are then combined by logistic regression. On a database of over 50 persistent AF patients, our method provides reliable predictive measures and proves more robust and informative than classical AF descriptors.

  7. Heart-type fatty acid binding protein is an early marker of myocardial damage after radiofrequency catheter ablation.

    Science.gov (United States)

    Giannessi, Daniela; Piacenti, Marcello; Maltinti, Maristella; Rossi, Andrea; Di Cecco, Pietro; Startari, Umberto; Cabiati, Manuela; Panchetti, Luca; Del Ry, Silvia; Morales, Maria-Aurora

    2010-10-01

    Radiofrequency (RF) ablation of arrhythmias induces myocardial damage and release of biomarkers. This study aimed to assess the kinetics of heart-type fatty acid-binding protein (h-FABP), a cytosolic protein released after myocardial injury incurred by both atrial and ventricular RF ablation, compared to other markers of myocardial injury. h-FABP, cTnI, CK-MB(mass) and myoglobin were evaluated in 30 patients with atrial or ventricular tachyarrhythmias before, immediately after and at 3, 6 and 24h after the procedure. h-FABP increased immediately after the procedure in all subjects (6.6 ± 1.2 μg/L vs 2.7 ± 0.3, pvalues of time for mean power of RF application in both the entire patient cohort and in ventricular ablations. h-FABP may be an early parameter for monitoring RF-induced lesions and the site of ablation was relevant for biomarker increase. Copyright © 2010 Elsevier Inc. All rights reserved.

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

    International Nuclear Information System (INIS)

    Blasco-Gimenez, Ramón; Lequerica, Juan L; Herrero, Maria; Hornero, Fernando; Berjano, Enrique J

    2010-01-01

    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)

  9. Catheter ablation of paroxysmal atrial fibrillation in patients with previous amiodarone-induced hyperthyroidism: a case-control study.

    Science.gov (United States)

    Mikhaylov, Evgeny N; Orshanskaya, Viktorya S; Lebedev, Alexander D; Szili-Torok, Tamas; Lebedev, Dmitry S

    2013-08-01

    Many patients with atrial fibrillation (AF) receive amiodarone. Amiodarone-induced hyperthyroidism (AIH) may develop as a complication. We hypothesized that pulmonary vein (PV) isolation in patients with paroxysmal AF and history of AIH may yield a lower success rate. Among 704 patients who underwent AF ablation in our center between 2007 and 2010, we identified 20 patients (mean age 58.3 ± 5.0 years; 11 males) with paroxysmal AF and overt AIH in the past. The control group consisted of 40 patients with amiodarone-refractory AF and no thyroid dysfunction. All patients underwent circumferential PV isolation. During redo procedures all tachycardias were targeted for ablation. During a 12-month follow-up, in the AIH group 6 (30%) patients were arrhythmia free after a single procedure, in comparison to 25 (62.5%) controls (P = 0.01). Atrial tachycardia (AT) was registered in 7 (35%) AIH patients and in 1 (2.5%) control patient (P = 0.001). AF recurred in 10 (50%) AIH versus 15 (37.5%) control patients (P = 0.2). Redo ablation was performed in 7 (35%) AIH patients and in 3 (7.5%) non-AIH patients (P = 0.01). During a redo procedure a PV-unrelated tachycardia was diagnosed in 5 (25%) AIH patients (vs 0 in the controls, P = 0.003). After the last performed ablation, 12 (60%) AIH patients and 28 (70%) controls had no recurrence, P = 0.56. AIH was an independent predictor of ATs. PV isolation alone has a lower efficacy for preventing recurrence in paroxysmal AF in AIH patients. After repeat ablations, overall freedom from tachyarrhythmias is similar to patients with no history of thyroid dysfunction. © 2013 Wiley Periodicals, Inc.

  10. Assessing arrhythmia burden after catheter ablation of atrial fibrillation using an implantable loop recorder: the ABACUS study.

    Science.gov (United States)

    Kapa, Suraj; Epstein, Andrew E; Callans, David J; Garcia, Fermin C; Lin, David; Bala, Rupa; Riley, Michael P; Hutchinson, Mathew D; Gerstenfeld, Edward P; Tzou, Wendy; Marchlinski, Francis E; Frankel, David S; Cooper, Joshua M; Supple, Gregory; Deo, Rajat; Verdino, Ralph J; Patel, Vickas V; Dixit, Sanjay

    2013-08-01

    Arrhythmia monitoring in patients undergoing atrial fibrillation (AF) ablation is challenging. Transtelephonic monitors (TTMs) are cumbersome to use and provide limited temporal assessment. Implantable loop recorders (ILRs) may overcome these limitations. We sought to evaluate the utility of ILRs versus conventional monitoring (CM) in patients undergoing AF ablation. Forty-four patients undergoing AF ablation received ILRs and CM (30-day TTM at discharge and months 5 and 11 postablation). Over the initial 6 months, clinical decisions were made based on CM. Subjects were then randomized for the remaining 6 months to arrhythmia assessment and management by ILR versus CM. The primary endpoint was arrhythmia recurrence. The secondary endpoint was actionable clinical events (change of antiarrhythmic drugs [AADs], anticoagulation, non-AF arrhythmia events, etc.) due to either monitoring strategy. Over the study period, 6 patients withdrew. In the first 6 months, AF recurred in 18 patients (7 noted by CM, 18 by ILR; P = 0.002). Five patients in the CM (28%) and 5 in the ILR arm (25%; P = NS) had AF recurrence during the latter 6 months. AF was falsely diagnosed frequently by ILR (730 of 1,421 episodes; 51%). In more patients in the ILR compared with the CM arm, rate control agents (60% vs 39%, P = 0.02) and AADs (71% vs 44%, P = 0.04) were discontinued. In AF ablation patients, ILR can detect more arrhythmias than CM. However, false detection remains a challenge. With adequate oversight, ILRs may be useful in monitoring these patients after ablation. © 2013 Wiley Periodicals, Inc.

  11. 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)....

  12. Improvement in estimated glomerular filtration rate in patients with chronic kidney disease undergoing catheter ablation for atrial fibrillation.

    Science.gov (United States)

    Navaravong, Leenhapong; Barakat, Michel; Burgon, Nathan; Mahnkopf, Christian; Koopmann, Matthias; Ranjan, Ravi; Kholmovski, Eugene; Marrouche, Nassir; Akoum, Nazem

    2015-01-01

    Chronic kidney disease (CKD) and atrial fibrillation (AF) often coexist. We studied the association of CKD with atrial fibrosis and the effect of AF ablation on kidney function. AF patients who had a pre- and postablation serum creatinine and who completed a late gadolinium enhancement cardiac magnetic resonance imaging (MRI; LGE-MRI) prior to ablation were included. Estimated glomerular filtration rate (eGFR) was calculated and CKD was staged using the National Kidney Foundation guidelines. Patients with eGFR disease. Atrial fibrosis was not significant different between included CKD stages: 15.8 ± 8.8%, 16.6 ± 12.1%, 17.1 ± 10.4%, and 16.5 ± 8.4% for CKD stage 1, 2, 3A, and 3B, respectively (P = 0.476). At a median of 115 days following ablation, eGFR increased significantly in CKD stage 2 (74 ± 9 to 80 ± 23; P = 0.04), 3A (53 ± 5 to 69 ± 24; P chronic kidney disease. © 2014 Wiley Periodicals, Inc.

  13. Comparison of health-related quality of life in patients with atrial fibrillation treated with catheter ablation or antiarrhythmic drug therapy: a systematic review and meta-analysis protocol

    OpenAIRE

    Allan, Katherine S; Henry, Shaunattonie; Aves, Theresa; Banfield, Laura; Victor, J Charles; Dorian, Paul; Healey, Jeff S; Andrade, Jason; Carroll, Sandra; McGillion, Michael

    2017-01-01

    Introduction Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and causes patients considerable burden; symptoms such as palpitations and dyspnoea are common, leading to frequent emergency room visits. Patients with AF report reduced health-related quality of life (HQOL) compared with the general population; thus, treatments focus on the restoration of sinus rhythm to improve symptoms. Catheter ablation (CA) is a primary treatment strategy to treat AF-related burden in select ...

  14. Predictive capability of left atrial size measured by CT, TEE, and TTE for recurrence of atrial fibrillation following radiofrequency catheter ablation.

    Science.gov (United States)

    Parikh, Sachin S; Jons, Christian; McNitt, Scott; Daubert, James P; Schwarz, Karl Q; Hall, Burr

    2010-05-01

    Recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) has been well established and is in part related to left atrial (LA) size. The purpose of this study was to assess the predictive capability of LA diameter (LAD) and LA volume (LAV) by echocardiography and computed tomography (CT) to determine success in patients undergoing RFCA of AF. Eighty-eight patients with paroxysmal or persistent AF who had undergone RFCA and had a prior transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), and CT were enrolled in the study. TTE LADs and LV ejection fraction as well as TEE LADs and LAVs in three views were recorded. CT LAVs were also recorded. Clinical parameters prior to ablation as well as at 1-year follow-up were assessed. A total of 40 (45%) patients with paroxysmal AF and 48 (55%) patients with persistent AF were analyzed. Paroxysmal AF patients had a RFCA success rate of 88% at 1 year with persistent AF patients having a 52% success rate (P or= 117 cc was associated with an odds ratio (OR) for recurrence of 4.8 (95% confidence interval [CI]=[1.4-16.4], P = 0.01) while a LAV >or=130 cc was associated with an OR for recurrence of 22.0 (95% CI =[2.5-191.0], P = 0.005) after adjustment for persistent AF. LA dimensions and AF type are highly predictive of AF recurrence following RFCA. LAV by CT has significant predictive benefit over standard LADs in severely enlarged atria even after adjustment for AF type.

  15. 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.

  16. Catheter Angiography

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    Full Text Available ... News Physician Resources Professions Site Index A-Z Catheter Angiography Catheter angiography uses a catheter, x-ray ... are the limitations of Catheter Angiography? What is Catheter Angiography? Angiography is a minimally invasive medical test ...

  17. WE-EF-BRA-03: Catheter- Free Ablation with External Photon Radiation: Treatment Planning, Delivery Considerations, and Correlation of Effects with Delivered Dose

    Energy Technology Data Exchange (ETDEWEB)

    Deisher, A; Anderson, S; Cusma, J; Herman, M; Johnson, S; Lehmann, H; Packer, D; Parker, K; Song, L; Takami, M; Kruse, J [Mayo Clinic, Rochester, MN (United States)

    2015-06-15

    Purpose: To plan, target, and calculate delivered dose in atrioventricular node (AVN) ablation with volume-modulated arc therapy (VMAT) in an intact porcine model. Methods: Seven pigs underwent AVN irradiation, with prescription doses ranging between 25 and 55Gy in a single fraction. Cardiac CT scans were acquired at expiration. Two physicians contoured AVN targets on 10 phases, providing estimates of target motion and inter-physician variability. Treatment planning was conducted on a static phase-averaged CT. The volume designated to receive prescription dose covered the full extent of AVN cardiac motion, expanded by 4mm for setup uncertainty. Optimization limited doses to risk structures according to single-fraction tumor treatment protocols. Orthogonal kV images were used to align bony anatomy at time of treatment. Localization was further refined with respiratory-gated cone-beam CT, and range of cardiac motion was verified under fluoroscopy. Beam delivery was respiratory-gated for expiration with a mean efficiency of 60%. Deformable registration of the 10 cardiac CT phases was used to calculate actual delivered dose for comparison to electro-anatomical and visually evident lesions. Results: The mean [minimum,maximum] amplitude of AVN cardiac motion was LR 2.9 [1.7,3.9]mm, AP 6.6 [4.4,10.4]mm, and SI 5.6 [2.0,9.9]mm. Incorporating cardiac motion into the dose calculation showed the volume receiving full dose was 40–80% of the volume indicated on the static planning image, although the contoured AVN target received full dose in all animals. Initial results suggest the dimensions of the electro-anatomical lesion are correlated with the 40Gy isodose volume. Conclusion: Image-guidance techniques allow for accurate and precise delivery of VMAT for catheter-free arrhythmia ablation. An arsenal of advanced radiation planning, dose optimization, and image-guided delivery techniques was employed to assess and mitigate effects of cardiac and respiratory motion

  18. 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.

  19. Catheter Angiography

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    Full Text Available ... Videos About Us News Physician Resources Professions Site Index A-Z Catheter Angiography Catheter angiography uses a ... few millimeters) in the skin where the catheter can be inserted into an artery. The catheter is ...

  20. 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

    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...... was defined as noninducibility of any sustained monophasic VT at the end of the procedure. Long-term analysis addressed VT recurrence, ICD therapies and all-cause death. ES was acutely suppressed by ablation in all patients. RESULTS: Acute ablation success was obtained in 32 of 40 (80%) patients...

  1. 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......) ablation time, fluoroscopy time, radiation dose, and complications were assessed. Stepwise regression was used to predict which variable could best predict acute restoration from AF to SR by ablation. RESULTS: Compared to PsAF, procedure time and RF ablation time were significantly increased in patients...

  2. Optothermal profile of an ablation catheter with integrated microcoil for MR-thermometry during Nd:YAG laser interstitial thermal therapies of the liver—an in-vitro experimental and theoretical study.

    Science.gov (United States)

    Kardoulaki, Evdokia M; Syms, Richard R A; Young, Ian R; Choonee, Kaushal; Rea, Marc; Gedroyc, Wladyslaw M W

    2015-03-01

    Flexible microcoils integrated with ablation catheters can improve the temperature accuracy during local MR-thermometry in Nd:YAG laser interstitial thermal therapies. Here, the authors are concerned with obtaining a preliminary confirmation of the clinical utility of the modified catheter. They investigate whether the thin-film substrate and copper tracks of the printed coil inductor affect the symmetry of the thermal profile, and hence of the lesion produced. Transmission spectroscopy in the near infrared was performed to test for the attenuation at 1064 nm through the 25 μm thick Kapton substrate of the microcoil. The radial transmission profile of an infrared high-power, light emitting diode with >80% normalized power at 1064 nm was measured through a cross section of the modified applicator to assess the impact of the copper inductor on the optical profile. The measurements were performed in air, as well as with the applicator surrounded by two types of scattering media; crystals of NaCl and a layer of liver-mimicking gel phantom. A numerical model based on Huygens-Fresnel principle and finite element simulations, using a commercially available package (COMSOL Multiphysics), were employed to compare with the optical measurements. The impact of the modified optical profile on the thermal symmetry was assessed by examining the high resolution microcoil derived thermal maps from a Nd:YAG laser ablation performed on a liver-mimicking gel phantom. Less than 30% attenuation through the Kapton film was verified. Shadowing behind the copper tracks was observed in air and the measured radial irradiation correlated well with the diffraction pattern calculated numerically using the Huygens-Fresnel principle. Both optical experiments and simulations, demonstrate that shadowing is mitigated by the scattering properties of a turbid medium. The microcoil derived thermal maps at the end of a Nd:YAG laser ablation performed on a gel phantom in a 3 T scanner confirm that the

  3. Catheter Ablation of Ventricular Tachycardia

    Science.gov (United States)

    ... Noel G. Boyle , Kalyanam Shivkumar Download PDF https://doi.org/10.1161/CIRCULATIONAHA.110.963371 Circulation. 2010; 122: ... e389-e391 , originally published July 19, 2010 https://doi.org/10.1161/CIRCULATIONAHA.110.963371 Citation Manager Formats ...

  4. Catheter Angiography

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    Full Text Available ... using: x-rays with catheters computed tomography (CT) magnetic resonance imaging (MRI) In catheter angiography, a thin ... called superselective angiography. Unlike computed tomography (CT) or magnetic resonance (MR) angiography , use of a catheter makes ...

  5. Catheter Angiography

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    Full Text Available ... x-rays with catheters computed tomography (CT) magnetic resonance imaging (MRI) In catheter angiography, a thin plastic ... superselective angiography. Unlike computed tomography (CT) or magnetic resonance (MR) angiography , use of a catheter makes it ...

  6. Catheter Angiography

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    Full Text Available ... risks? What are the limitations of Catheter Angiography? What is Catheter Angiography? Angiography is a minimally invasive ... of ionizing radiation ( x-rays ). top of page What are some common uses of the procedure? Catheter ...

  7. Catheter Angiography

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    Full Text Available ... use of a catheter makes it possible to combine diagnosis and treatment in a single procedure. Catheter ... use of a catheter makes it possible to combine diagnosis and treatment in a single procedure. An ...

  8. Catheter Angiography

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    Full Text Available ... of a catheter makes it possible to combine diagnosis and treatment in a single procedure. Catheter angiography ... of a catheter makes it possible to combine diagnosis and treatment in a single procedure. An example ...

  9. Urinary catheters

    Science.gov (United States)

    ... indwelling catheter, clean the area where the catheter exits your body and the catheter itself with soap ... DO, urologist with the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. ...

  10. Catheter Angiography

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    Full Text Available ... resonance imaging (MRI) In catheter angiography, a thin plastic tube, called a catheter , is inserted into an ... The catheter used in angiography is a long plastic tube about as thick as a strand of ...

  11. Patients treated with catheter ablation for ventricular tachycardia after an ICD shock have lower long-term rates of death and heart failure hospitalization than do patients treated with medical management only.

    Science.gov (United States)

    Bunch, T Jared; Weiss, J Peter; Crandall, Brian G; Day, John D; May, Heidi T; Bair, Tami L; Osborn, Jeffrey S; Mallender, Charles; Fischer, Avi; Brunner, Kyle J; Mahapatra, Srijoy

    2014-04-01

    Ventricular arrhythmias in patients with implantable cardioverter-defibrillators (ICDs) adversely affect outcomes. Antiarrhythmic approaches to ventricular tachycardia (VT) have variable efficacy and may increase risk of ventricular arrhythmias, worsening cardiomyopathy, and death. Comparatively, VT ablation is an alternative approach that may favorably affect outcomes. To further explore the effect on long-term outcomes after catheter ablation of VT, we compared patients with history of ICD shocks who did not undergo ablation, patients with a history of ICD shocks that underwent ablation, and patients with ICDs who had no history of ICD shocks. A total of 102 consecutive patients with structural heart disease who underwent VT ablation for recurrent ICD shocks were compared with 2088 patients with ICDs and no history of appropriate shocks and 817 patients with ICDs and a history of appropriate shocks for VT or ventricular fibrillation. Outcomes considered were mortality, heart failure hospitalization, atrial fibrillation, and stroke/transient ischemic attack. The mean age of 3007 patients was 65.4 ± 13.9 years. Over long-term follow-up, 866 (28.8%) died, 681 (22.7%) had a heart failure admission, 706 (23.5%) developed new-onset atrial fibrillation, and 224 (7.5%) had a stroke. The multivariate-adjusted risks of deaths and heart failure hospitalizations were higher in patients with history of ICD shocks who were treated medically than in patients with ICDs and no history of shock (hazard ratio [HR] 1.45; P hospitalization rates similar to those of patients with no shock (HR 0.89; P = .58 vs HR 1.38; P = .09, respectively). A similar nonsignificant trend was seen with stroke/transient ischemic attack. Patients treated with VT ablation after an ICD shock have a significantly lower risk of death and heart failure hospitalization than did patients managed medically only. The adverse event rates after VT ablation were similar to those of patients with ICDs but without

  12. Catheter-Based Renal Nerve Ablation and Centrally Generated Sympathetic Activity in Difficult-to-Control Hypertensive Patients: Prospective Case Series

    NARCIS (Netherlands)

    Brinkmann, J.; Heusser, K.; Schmidt, B.M.; Menne, J.; Klein, G.; Bauersachs, J.; Haller, H.; Sweep, F.C.; Diedrich, A.; Jordan, J.; Tank, J.

    2012-01-01

    Endovascular renal nerve ablation has been developed to treat resistant hypertension. In addition to lowering efferent renal sympathetic activation, the intervention may attenuate central sympathetic outflow through decreased renal afferent nerve traffic, as evidenced by a recent case report. We

  13. Catheter Angiography

    Medline Plus

    Full Text Available ... Z Catheter Angiography Catheter angiography uses a catheter, x-ray imaging guidance and an injection of contrast material ... vessels in the body. Angiography is performed using: x-rays with catheters computed tomography (CT) magnetic resonance imaging ( ...

  14. Signal-Averaged Electrocardiography as a Noninvasive Tool for Evaluating the Outcomes After Radiofrequency Catheter Ablation of Ventricular Tachycardia in Patients With Ischemic Heart Disease: Reassessment of an Old Tool.

    Science.gov (United States)

    Dinov, Borislav; Bode, Kerstin; Koenig, Sebastian; Oebel, Sabrina; Sommer, Philipp; Bollmann, Andreas; Hindricks, Gerhard; Arya, Arash

    2016-09-01

    Inducibility of ventricular tachycardia (VT) has limited ability to predict recurrent VT after catheter ablation (CA). We sought to correlate the signal-averaged ECG (SAECG) with the endocardial scar characteristics in patients with ischemic VTs. We suggest that successful CA can result in normalization of the SAECG. Fifty patients (42 male; aged 67±10 years, ejection fraction 34±12%) with ischemic VTs were prospectively enrolled. SAECG was performed before and after CA. Patients with at least 2 abnormal criteria (filtered QRS ≥114 ms; root mean square 40 38 ms) were defined as having positive SAECG. There was a linear correlation between endocardial scar area (<1.5 mV) and filtered QRS (r=0.414; P=0.003). CA resulted in normalization of the SAECG in 6 patients. In patients with filtered QRS ≤120 ms, 13 (40.6%) patients had normal SAECG after CA compared with 7 (21.9%) before ablation (P=0.034). Patients with normal or normalized SAECG after CA had better VT-free survival compared with those whose SAECG remained abnormal. Abnormal SAECG after CA was a predictor for VT recurrence: hazard ratio=3.64; P=0.039 for the overall population, and hazard ratio=5.80; P=0.022 for patients having QRS ≤120 ms. There is a significant correlation between the surface SAECG and endocardial scar size in patients with ischemic VTs. A successful CA can result in normalization of SAECG that is associated with more favorable long-term outcomes. SAECG can be useful to assess the procedural success of VT ablation. © 2016 American Heart Association, Inc.

  15. Executive summary: Diagnosis and Treatment of Catheter-Related Bloodstream Infection: Clinical Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) and the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC).

    Science.gov (United States)

    Chaves, Fernando; Garnacho-Montero, José; Del Pozo, José Luis; Bouza, Emilio; Capdevila, José Antonio; de Cueto, Marina; Domínguez, M Ángeles; Esteban, Jaime; Fernández-Hidalgo, Nuria; Fernández Sampedro, Marta; Fortún, Jesús; Guembe, María; Lorente, Leonardo; Paño, Jose Ramón; Ramírez, Paula; Salavert, Miguel; Sánchez, Miguel; Vallés, Jordi

    2018-02-01

    Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Sthaphylococcus aureus, Enterococcus spp, Gram-negative bacilli, and Candida spp), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  16. Catheter Angiography

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    Full Text Available ... the body for abnormalities such as aneurysms and disease such as atherosclerosis (plaque). The use of a catheter makes it possible to combine diagnosis and treatment in a single procedure. Catheter angiography ...

  17. Catheter Angiography

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    Full Text Available ... anxiety during the procedure. The area of the groin or arm where the catheter will be inserted ... it will make the rest of the procedure pain-free. You will not feel the catheter in ...

  18. Catheter Angiography

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    Full Text Available ... Angiography is performed using: x-rays with catheters computed tomography (CT) magnetic resonance imaging (MRI) In catheter angiography, ... a tumor; this is called superselective angiography. Unlike computed tomography (CT) or magnetic resonance (MR) angiography , use of ...

  19. Catheter Angiography

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    Full Text Available ... it will make the rest of the procedure pain-free. You will not feel the catheter in ... nurse if you notice any bleeding, swelling or pain at the site where the catheter entered the ...

  20. Catheter Angiography

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    Full Text Available ... should inform the nurse if you notice any bleeding, swelling or pain at the site where the ... Rarely, the catheter punctures the artery, causing internal bleeding. It also is possible that the catheter tip ...

  1. Catheter Angiography

    Medline Plus

    Full Text Available ... or other procedures such as chemoembolization or selective internal radiation therapy. identify dissection or splitting in the ... days. Rarely, the catheter punctures the artery, causing internal bleeding. It also is possible that the catheter ...

  2. Catheter Angiography

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    Full Text Available ... incision in the skin. Once the catheter is guided to the area being examined, a contrast material ... inserted into an artery. The catheter is then guided through the arteries to the area to be ...

  3. Catheter Angiography

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    Full Text Available ... of a catheter makes it possible to combine diagnosis and treatment in a single procedure. Catheter angiography produces very ... of a catheter makes it possible to combine diagnosis and treatment in a single procedure. An example is finding ...

  4. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation

    DEFF Research Database (Denmark)

    Cosedis Nielsen, Jens; Johannessen, Arne; Raatikainen, Pekka

    2012-01-01

    There are limited data comparing radiofrequency catheter ablation with antiarrhythmic drug therapy as first-line treatment in patients with paroxysmal atrial fibrillation.......There are limited data comparing radiofrequency catheter ablation with antiarrhythmic drug therapy as first-line treatment in patients with paroxysmal atrial fibrillation....

  5. Experimental, Pathologic, and Clinical Findings of Radiofrequency Catheter Ablation of Para-Hisian Region From the Right Ventricle in Dogs and Humans.

    Science.gov (United States)

    Xue, Yumei; Zhan, Xianzhang; Wu, Shulin; Wang, Hongyue; Liu, Yang; Liao, Zili; Deng, Hai; Duan, Xuejing; Zeng, Shaoying; Liang, Dongpo; Elvan, Arif; Fang, Xianhong; Liao, Hongtao; Ramdat Misier, Anand R; Smit, Jaap Jan J; Metzner, Andreas; Heeger, Christian-Hendrik; Liu, Fangzhou; Wang, Feng; Zhang, Zhiwei; Kuck, Karl-Heinz; Yen Ho, Siew; Ouyang, Feifan

    2017-06-01

    Ablation of para-Hisian accessory pathway (AP) poses high risks of atrioventricular block. We developed a pacing technique to differentiate the near-field (NF) from far-field His activations to avoid the complication. Three-dimensional mapping of the right ventricle was performed in 15 mongrel dogs and 23 patients with para-Hisian AP. Using different pacing outputs, the NF- and far-field His activation was identified on the ventricular aspect. Radiofrequency application was delivered at the NF His site in 8 (group 1) and the far-field His site in 7 dogs (group 2), followed by pathologic examination after 14 days. NF His activation was captured with 5 mA/1 ms in 10 and 10 mA/1 ms in 5 dogs. In group 1, radiofrequency delivery resulted in complete atrioventricular block in 3, right bundle branch block with HV (His-to-ventricular) interval prolongation in 1, and only right bundle branch block in 2 dogs, whereas no changes occurred in group 2. Pathologic examination in group-1 dogs showed complete or partial necrosis of the His bundle in 4 and complete necrosis of the right bundle branch in 5 dogs. In group 2, partial necrosis in the right bundle branch was found only in 1 dog. Using this pacing technique, the APs were 5.7±1.2 mm away from the His bundle located superiorly in 20 or inferiorly in 3 patients. All APs were successfully eliminated with 1 to 3 radiofrequency applications. No complications and recurrence occurred during a follow-up of 11.8±1.4 months. Differentiating the NF His from far-field His activations led to a high ablation success without atrioventricular block in para-Hisian AP patients. © 2017 American Heart Association, Inc.

  6. Features of intrinsic ganglionated plexi in both atria after extensive pulmonary isolation and their clinical significance after catheter ablation in patients with atrial fibrillation.

    Science.gov (United States)

    Kurotobi, Toshiya; Shimada, Yoshihisa; Kino, Naoto; Ito, Kazato; Tonomura, Daisuke; Yano, Kentaro; Tanaka, Chiharu; Yoshida, Masataka; Tsuchida, Takao; Fukumoto, Hitoshi

    2015-03-01

    The features of intrinsic ganglionated plexi (GP) in both atria after extensive pulmonary vein isolation (PVI) and their clinical implications have not been clarified in patients with atrial fibrillation (AF). The purpose of this study was to assess the features of GP response after extensive PVI and to evaluate the relationship between GP responses and subsequent AF episodes. The study population consisted of 216 consecutive AF patients (104 persistent AF) who underwent an initial ablation. We searched for the GP sites in both atria after an extensive PVI. GP responses were determined in 186 of 216 patients (85.6%). In the left atrium, GP responses were observed around the right inferior GP in 116 of 216 patients (53.7%) and around the left inferior GP in 57 of 216 (26.4%). In the right atrium, GP responses were observed around the posteroseptal area: inside the CS in 64 of 216 patients (29.6%), at the CS ostium in 150 of 216 (69.4%), and in the lower right atrium in 45 of 216 (20.8%). The presence of a positive GP response was an independent risk factor for AF recurrence (hazard ratio 4.04, confidence interval 1.48-11.0) in patients with paroxysmal, but not persistent, AF. The incidence of recurrent atrial tachyarrhythmias in patients with paroxysmal AF with a positive GP response was 51% vs 8% in those without a GP response (P = .002). The presence of GP responses after extensive PVI was significantly associated with increased AF recurrence after ablation in patients with paroxysmal AF. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  7. Catheter Angiography

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician Resources Professions Site Index A-Z Catheter Angiography Catheter angiography ...

  8. Catheter Angiography

    Medline Plus

    Full Text Available ... imaging technologies and, in most cases, a contrast material injection is needed to produce pictures of blood vessels in the body. Angiography is performed using: x-rays with catheters computed tomography (CT) magnetic resonance imaging (MRI) In catheter angiography, a thin ...

  9. Catheter Angiography

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    Full Text Available ... injected through the catheter and reaches the blood vessels being studied, several sets of x-rays are taken. Then the catheter is removed and the incision site is closed by applying pressure on the area for approximately 10 to 20 ...

  10. Catheter Angiography

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    Full Text Available ... is injected through the catheter and reaches the blood vessels being studied, several sets of x-rays are taken. Then the catheter is removed and the incision site is closed by applying pressure on the area for approximately 10 to 20 ...

  11. Urinary catheter - infants

    Science.gov (United States)

    Bladder catheter - infants; Foley catheter - infants; Urinary catheter - neonatal ... A urinary catheter is a small, soft tube placed in the bladder. This article addresses urinary catheters in babies. WHY IS ...

  12. Catheter Ablation of a Complex Atrial Tachycardia after Surgical Repair of Tetralogy of Fallot Guided by Combined Noncontact and Contact Mapping

    Directory of Open Access Journals (Sweden)

    Eitaro Fujii, MD

    2010-01-01

    Full Text Available A 34-year-old man with a surgically repaired Tetralogy of Fallot complained of palpitation, fatigue, and presyncope. A 12-lead ECG showed atrial tachycardia with a cycle length of 250 ms and a P wave morphology positive in leads II, III and aVF, and negative in lead V1. Although the EnSite system (version 6.OJ made use of noncontact mapping to delineate the counterclockwise reentry around the crista tenninalis, it was difficult to rule out the incisional atrial reentry because the location of the surgical incision was far from the multi-electrode array. Since the bipolar contact mapping of the EnSite system revealed the location of the atriotomy incision, entrainment mapping during the tachycardia demonstrated the critical reentry circuit around the crista terminalis. Radiofrequency ablation targeting the critical isthmus from the lower position of the crista terminalis to the posterior dense scar which was continuous with the inferior vena cava, and to the atriotomy scar, eliminated the tachycardia.

  13. Usefulness of remote magnetic navigation for ablation of ventricular arrhythmias originating from outflow regions

    NARCIS (Netherlands)

    B. Schwagten (Bruno); T. Szili-Torok (Tamas); M. Rivero-Ayerza (Maximo); E. Jessurun; S.D.A. Valk (Suzanne); L.J.L.M. Jordaens (Luc)

    2009-01-01

    textabstractMonomorphic ventricular tachycardia (VT) and symptomatic monomorphic PVCs originating from the region of the right and left outflow tracts are increasingly treated by radiofrequency (RF) catheter ablation. Technical difficulties in catheter manipulation to access these outflow tract

  14. Katetrová ablace pro fibrilaci síní a spektrální analýza variability srdeční frekvence Catheter ablation for atrial fibrillation and spectral analysis of heart rate variability

    Directory of Open Access Journals (Sweden)

    Esseid Gaddur

    2005-02-01

    Full Text Available Cílem studie bylo zkoumání vlivu katetrové ablace na parametry spektrální analýzy (SA variability srdeční frekvence (HRV. Krátkodobý záznam SA HRV byl snímán u skupiny 22 pacientů s paroxysmální fibrilací síní (FS ve věku 53,69 ± 11,95 let (20 mužů a 2 ženy, u kterých byla provedena cirkumferenční katetrová ablace (KA. Měření probíhalo ve třech polohách (leh-stoj-leh, za standardizovaných podmínek, ráno před KA a jeden den po KA. K vyhodnocení výsledků byla použita jak standardní, tak nová metodika hodnocení SA HRV pomocí komplexních ukazatelů. Po KA pro FS došlo ke zvýšení srdeční frekvence (SF a zhoršení většiny jednotlivých i komplexních ukazatelů. Tento nález svědčí o redukci aktivity obou větví autonomního nervového systému. Protože snížení aktivity vagu je výraznější, posouvá se sympatovagová rovnováha mírně směrem k sympatiku. The results of a short term recording of spectral analysis (SA of heart rate variability (HRV in 22 patients with paroxysmal atrial fibrillation (aged 53.69 ± 11.95; 20 male and 2 female in whom circumferential catheter ablation (CA was done are presented in this article. Measurement was done in the morning before CA and one day after CA. A standard orthoclinostatic test in three positions (supine–standing–supine was used. The influence of catheter ablation on SA HRV was identified by standard and complex parameters (Stejskal, Šlachta, Elfmark, Salinger, &Gaul-Aláčová, 2002. After CA, heart rate increased and almost all individual and complex indexes decreased. This finding gives evidence of reduction of activity in both branches of the autonomous nervous system. Vagal activity reduction was larger, so the sympathovagal balance shifts towards sympathicus.

  15. Catheter Angiography

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    Full Text Available ... machine produces a small burst of radiation that passes through the body, recording an image on photographic ... By selecting the arteries through which the catheter passes, it is possible to assess vessels in several ...

  16. Catheter Angiography

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    Full Text Available ... spaghetti. top of page How does the procedure work? Catheter angiography works much the same as a ... and x-rays. Manufacturers of intravenous contrast indicate mothers should not breastfeed their babies for 24-48 ...

  17. Catheter Angiography

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    Full Text Available ... prick when the needle is inserted into your vein for the intravenous line (IV). Injecting a local anesthetic at the site where the catheter is inserted may sting briefly, but it will ...

  18. Catheter Angiography

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    Full Text Available ... examine blood vessels in key areas of the body for abnormalities such as aneurysms and disease such ... to produce pictures of blood vessels in the body. Angiography is performed using: x-rays with catheters ...

  19. Catheter Angiography

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    Full Text Available ... story about radiology? Share your patient story here Images × Image Gallery Interventional radiologist performing an angiography exam View ... ray, Interventional Radiology and Nuclear Medicine Radiation Safety Images related to Catheter Angiography Sponsored by Please note ...

  20. Catheter Angiography

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    Full Text Available ... dose of ionizing radiation ( x-rays ). top of page What are some common uses of the procedure? Catheter ... live more than an hour away. top of page What does the equipment look like? The equipment typically ...

  1. Catheter Angiography

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    Full Text Available ... the body absorb the x-rays in varying degrees. Dense bone absorbs much of the radiation while ... by angioplasty and placement of a stent . The degree of detail displayed by catheter angiography may not ...

  2. Catheter Angiography

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    Full Text Available ... rays ). top of page What are some common uses of the procedure? Catheter angiography is used to ... Society of Urogenital Radiology note that the available data suggest that it is safe to continue breastfeeding ...

  3. Catheter Angiography

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    Full Text Available ... will make the rest of the procedure pain-free. You will not feel the catheter in your ... of North America, Inc. (RSNA). To help ensure current and accurate information, we do not permit copying ...

  4. Catheter Angiography

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    Full Text Available ... tube, called a catheter , is inserted into an artery through a small incision in the skin. Once ... in the chest and abdomen, or in other arteries. detect atherosclerotic (plaque) disease in the carotid artery ...

  5. Catheter Angiography

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    Full Text Available ... spaghetti. top of page How does the procedure work? Catheter angiography works much the same as a ... material injection, you should immediately inform the technologist. Women should always inform their physician or x-ray ...

  6. Catheter Angiography

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    Full Text Available ... such as aneurysms and disease such as atherosclerosis (plaque). The use of a catheter makes it possible ... and abdomen, or in other arteries. detect atherosclerotic (plaque) disease in the carotid artery of the neck, ...

  7. Catheter Angiography

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    Full Text Available ... you are pregnant and discuss any recent illnesses, medical conditions, medications you're taking and allergies, especially ... is Catheter Angiography? Angiography is a minimally invasive medical test that helps physicians diagnose and treat medical ...

  8. Catheter Angiography

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    Full Text Available ... diagnosis and treatment in a single procedure. An example is finding an area of severe arterial narrowing, ... contrast material, your radiologist may advise that you take special medication for 24 hours before catheter angiography ...

  9. Catheter Angiography

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    Full Text Available ... disease). evaluate obstructions of vessels. top of page How should I prepare? You should inform your physician ... as a strand of spaghetti. top of page How does the procedure work? Catheter angiography works much ...

  10. Catheter Angiography

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    Full Text Available ... of page What are some common uses of the procedure? Catheter angiography is used to examine blood ... an hour away. top of page What does the equipment look like? The equipment typically used for ...

  11. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  13. OCCASIONAL REVIEW 'Map and zap' - electrode catheter ...

    African Journals Online (AJOL)

    Where does this leave surgical treatment of WPW syndrome? Despite the high success rates reported, ·it is acknowledged that not all patients can be successfully treated by catheter ablation. The treatment of those with multiple accessory pathways and associated defects such as Ebstein's anomaly of the tricuspid valve is ...

  14. Catheter Angiography

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    Full Text Available ... or other procedures such as chemoembolization or selective internal radiation therapy. identify dissection or splitting in the aorta in the chest or abdomen or its major branches. show the extent and severity of ... the artery, causing internal bleeding. It also is possible that the catheter ...

  15. Catheter Angiography

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician ... Catheter Angiography? Angiography is a minimally invasive medical test that helps physicians diagnose and treat medical conditions. ...

  16. Catheter Angiography

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    Full Text Available ... the equipment look like? How does the procedure work? How is the procedure performed? What will I experience during and after the procedure? Who interprets the results and how do I get them? What are the benefits vs. risks? What are the limitations of Catheter Angiography? What ...

  17. Catheter Angiography

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    Full Text Available ... spaghetti. top of page How does the procedure work? Catheter angiography works much the same as a regular x-ray ... any possibility that they are pregnant. See the Safety page for more information about pregnancy and x- ...

  18. Comparison of health-related quality of life in patients with atrial fibrillation treated with catheter ablation or antiarrhythmic drug therapy: a systematic review and meta-analysis protocol

    Science.gov (United States)

    Henry, Shaunattonie; Aves, Theresa; Banfield, Laura; Victor, J Charles; Dorian, Paul; Healey, Jeff S; Andrade, Jason; Carroll, Sandra; McGillion, Michael

    2017-01-01

    Introduction Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and causes patients considerable burden; symptoms such as palpitations and dyspnoea are common, leading to frequent emergency room visits. Patients with AF report reduced health-related quality of life (HQOL) compared with the general population; thus, treatments focus on the restoration of sinus rhythm to improve symptoms. Catheter ablation (CA) is a primary treatment strategy to treat AF-related burden in select patient populations; however, repeat procedures are often needed, there is a risk of major complications and the procedure is quite costly in comparison to medical therapy. As the outcomes after CA are mixed, an updated review that synthesises the available literature, on outcomes that matter to patients, is needed so that patients and their healthcare providers can make quality treatment decisions. The purpose of this review protocol is to extend previous findings by systematically analysing randomised controlled trials (RCTs) of CA in patients with AF and using meta-analytic techniques to identify the benefits and risks of CA with respect to HQOL and AF-related symptoms. Methods and analysis We will include all RCTs that compare CA with antiarrhythmic drugs, or radiofrequency CA with cryoballoon CA, in patients with paroxysmal or persistent AF. To locate studies we will perform comprehensive electronic database searches from database inception to 4 April 2017, with no language restrictions. We will conduct a quantitative synthesis of the effect of CA on HQOL as well as AF-related symptoms and the number of CA procedures needed for success, using meta-analytic techniques. Ethics and dissemination No ethical issues are foreseen and ethical approval is not required given that this is a protocol. The findings of the study will be reported at national and international conferences, and in a peer-reviewed journal using the Preferred Reporting Items for Systematic Reviews and Meta

  19. 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

  20. Uninterrupted Dabigatran versus Warfarin for Ablation in Atrial Fibrillation

    NARCIS (Netherlands)

    Calkins, Hugh; Willems, Stephan; Gerstenfeld, Edward P.; Verma, Atul; Schilling, Richard; Hohnloser, Stefan H.; Okumura, Ken; Serota, Harvey; Nordaby, Matias; Guiver, Kelly; Biss, Branislav; Brouwer, Marc A.; Grimaldi, Massimo; de Asmundis, Carlo; Debruyne, Philippe; Pierard, Luc; Scavé e, Christophe; Schwagten, Bruno; van Acker, Hannes; van Heuverswyn, Frank; Ayala-Paredes, Felix; Lane, Christopher; Lockwood, Evan; Michael, Kevin; Morillo, Carlos; O’ Hara, Gilles; Cebron, Jean-Pierre; Chevalier, Philippe; DeChillou, Christian; Defaye, Pascal; Deharo, Jean-Claude; Duthoit, Guillaume; Marijon, Eloi; Mechulan, Alexis; Sacher, Fré dé ric; Bonnemeier, Hendrik; Dahme, Tillmann; Ince, H.ü seyin; Neumann, Thomas; Steven, Daniel; Ü cer, Ekrem; Zabel, Markus; Calo, Leonardo; Cireddu, Manuela; Menardi, Endrju; Themistoclakis, Sakis; Tondo, Claudio; Fujii, Kenshi; Iwasa, Atsushi; Inden, Yasuya; Kimura, Masaomi; Murakami, Masato; Murakami, Yoshimasa; Satomi, Kazuhiro; Shimizu, Wataru; Watarai, Masato; Yoshida, Yukihiko; Merino, José -Luí s; Mitjans, Angel Moya; Mont, Lluí s; Asensi, Joaquí n Osca; Pedrote Martí nez, Á ngel Alonso; Teijeira-Ferná ndez, Elvis; Allaart, Cornelis P.; de Jong, Jonas S. G.; Folkeringa, Richard J.; Simmers, Tim A.; Barbarash, Olga L.; Kuznetsov, Vadim; Nedoshivin, Aleksandr; Novikova, Tatiana; Revishvili, Amiran S.; Staroverov, Ilya; Agarwal, Sharad; Betts, Timothy; Connelly, Derek; Hobson, Neil; Leong, Fong; McCready, James; Paisey, John; Tayebjee, Muzahir; Thornley, Andrew; Ahmed, Jameel; Beck, Hiroko; Beinart, Sean; Bindra, Sanjay; Chae, Sanders; Cheng, Jie; Eldadah, Zayd; Feigenblum, David; Fuenzalida, Charles; Gandhavadi, Maheer; Garabelli, Paul; Gerstenfeld, Edward; Gonzalez, Mario; Hurwitz, Jodie; Johnson, Colleen; Kabra, Rajesh; Kowalski, Marcin; Kulkarni, Gurudutt; Marrouche, Nassir; Miller, John; Mounsey, Paul; Norris, Blake; O’ Neill, Gearoid; Roukoz, Henri; Srivatsa, Uma; Talano, James; Vora, Aaditya; Wong, Brian; Camm, John; Cappato, Riccardo; Crijns, Harry; Kenigsberg, David; Tijssen, Jan G. P.; Januzzi, James; Garasic, Joe; Pehrson, Steen; Kolansky, Daniel; McDonald, Michael; van Tosh, Andrew; Sturm, Jonathan; Peeters, André ; Hirsch, Karen

    2017-01-01

    BACKGROUND Catheter ablation of atrial fibrillation is typically performed with uninterrupted anticoagulation with warfarin or interrupted non-vitamin K antagonist oral anticoagulant therapy. Uninterrupted anticoagulation with a non-vitamin K antagonist oral anticoagulant, such as dabigatran, may be

  1. Indwelling catheter care

    Science.gov (United States)

    Foley catheter ... You will need to make sure your indwelling catheter is working properly. You will also need to ... not get an infection or skin irritation. Make catheter and skin care part of your daily routine. ...

  2. Anatomic Twist to a Straightforward Ablation

    Directory of Open Access Journals (Sweden)

    Mandeep Singh Randhawa, MD

    2013-03-01

    Full Text Available Atrioventricular (AV junction ablation for treatment of refractory atrial fibrillation is a well defined, standardized procedure and the simplest of commonly performed radiofrequency ablations in the field of cardiac electrophysiology. We report successful AV junction ablation using an inferior approach in a case of inferior vena cava interruption. Inability during the procedure to initially pass the ablation catheter into the right ventricle, combined with low amplitude electrograms, led to suspicion of an anatomic abnormality. This was determined to be a heterotaxy syndrome with inferior vena cava interruption and azygos continuation, draining in turn into the superior vena cava. Advancing Schwartz right 0 (SRO sheath through the venous abnormality into the right atrium allowed adequate catheter stability to successfully induce complete AV block with radiofrequency energy.

  3. Ganglion Plexus Ablation in Advanced Atrial Fibrillation: The AFACT Study

    NARCIS (Netherlands)

    Driessen, Antoine H. G.; Berger, Wouter R.; Krul, Sébastien P. J.; van den Berg, Nicoline W. E.; Neefs, Jolien; Piersma, Femke R.; Chan Pin Yin, Dean R. P. P.; de Jong, Jonas S. S. G.; van Boven, WimJan P.; de Groot, Joris R.

    2016-01-01

    Patients with long duration of atrial fibrillation (AF), enlarged atria, or failed catheter ablation have advanced AF and may require more extensive treatment than pulmonary vein isolation. The aim of this study was to investigate the efficacy and safety of additional ganglion plexus (GP) ablation

  4. Spectroscopic photoacoustic imaging of radiofrequency ablation in the left atrium

    NARCIS (Netherlands)

    S. Iskander-Rizk (Sophinese); P. Kruizinga (Pieter); A.F.W. van der Steen (Ton); G. van Soest (Gijs)

    2018-01-01

    textabstractCatheter-based radiofrequency ablation for atrial fibrillation has long-term success in 60-70% of cases. A better assessment of lesion quality, depth, and continuity could improve the procedure’s outcome. We investigate here photoacoustic contrast between ablated and healthy atrial-wall

  5. Transcatheter ablation of cardiac tissue: advantages and disadvantages of different ablative techniques.

    Science.gov (United States)

    Shenasa, M; Willems, S; Chen, X; Fromer, M; Borggrefe, M

    1992-06-01

    Transcatheter ablation techniques are emerging as an alternative therapeutical tool in the management of cardiac arrhythmias. Catheter ablation was initially introduced as the last resort to ablate the atrioventricular nodal conduction in patients with atrial fibrillation and uncontrolled ventricular response and in patients with drug refractory ventricular tachycardias. Direct current energy was used as the sole source of energy, but because of potential significant complications and early and late mortality, presumably mostly due to ventricular tachyarrhythmias, other sources of energy were sought. Radiofrequency current which does not produce barotrauma and does not require general anesthesia rapidly replaced direct current ablation in many centers. Early results with radiofrequency current ablation of the atrioventricular node and accessory atrioventricular pathways are very encouraging. The results of radiofrequency as well as direct current ablation for atrial flutter, atrial tachycardia and ventricular tachycardia, where the components of reentry circuit are less defined, are not as favorable as those of AV junctional tachycardias. However, improvement of catheter and generatory technology and better understanding of the mechanisms of ventricular tachycardias and characteristics of the target site will enhance the results of catheter ablation in ventricular tachcardias. The procedures are still considered investigational, and mostly done by very experienced groups at tertiary referral hospitals with surgical teams available in case of serious complications. Larger patient populations and longer follow-up periods are required before these techniques expand to community hospitals and to patients with minimal symptoms or asymptomatic individuals as a prophylaxis therapy.

  6. 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

  7. Cost-effectiveness of using recombinant human thyroid-stimulating hormone before radioiodine ablation for thyroid cancer treatment in Spanish hospitals.

    Science.gov (United States)

    Vallejo, J A; Muros, M A

    In thyroid cancer treatment, the thyroid-stimulating hormone (TSH) must be elevated before radioiodine ablation, either by exogenous (with recombinant human thyrotropin [rhTSH]) or endogenous stimulation by thyroid hormone withdrawal (THW). The use of rhTSH avoids hypothyroidism and favours the subsequent elimination of radioiodine, but involves the cost of the product. For this reason, a cost-effectiveness analysis was performed, taking into account all costs involved and the benefits associated with the use of this therapy. Using a Markov modelling with two analysis arms (rhTSH and THW), stratified into high (100mCi/3700 MBq) and low (30mCi/1110 MBq) radioiodine doses, and using 17 weekly cycles, the incremental cost per quality-adjusted life-year (QALY) related to the use of rhTSH was determined. The clinical inputs included in the model were based on published studies and in a treatment survey conducted in Spain. Radioablation preparation with rhTSH is superior to THW, showing additional benefits (0.048 AVAC), as well as cost savings (-€614.16), with an incremental cost-effectiveness rate (ICER) of -€12,795/QALY. The univariate and multivariate sensitivity analyses showed the result to be robust. The use of rhTSH previous to radioablation in Spain has cost savings, as well as a series of health benefits for the patient, making it highly cost-effective. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  8. Percutaneous thermal ablation of renal neoplasms

    International Nuclear Information System (INIS)

    Tacke, J.; Mahnken, A.H.; Guenther, R.W.

    2005-01-01

    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

  9. 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)....

  10. Cryo-balloon catheter position planning using AFiT

    Science.gov (United States)

    Kleinoeder, Andreas; Brost, Alexander; Bourier, Felix; Koch, Martin; Kurzidim, Klaus; Hornegger, Joachim; Strobel, Norbert

    2012-02-01

    Atrial fibrillation (AFib) is the most common heart arrhythmia. In certain situations, it can result in life-threatening complications such as stroke and heart failure. For paroxsysmal AFib, pulmonary vein isolation (PVI) by catheter ablation is the recommended choice of treatment if drug therapy fails. During minimally invasive procedures, electrically active tissue around the pulmonary veins is destroyed by either applying heat or cryothermal energy to the tissue. The procedure is usually performed in electrophysiology labs under fluoroscopic guidance. Besides radio-frequency catheter ablation devices, so-called single-shot devices, e.g., the cryothermal balloon catheters, are receiving more and more interest in the electrophysiology (EP) community. Single-shot devices may be advantageous for certain cases, since they can simplify the creation of contiguous (gapless) lesion sets around the pulmonary vein which is needed to achieve PVI. In many cases, a 3-D (CT, MRI, or C-arm CT) image of a patient's left atrium is available. This data can then be used for planning purposes and for supporting catheter navigation during the procedure. Cryo-thermal balloon catheters are commercially available in two different sizes. We propose the Atrial Fibrillation Planning Tool (AFiT), which visualizes the segmented left atrium as well as multiple cryo-balloon catheters within a virtual reality, to find out how well cryo-balloons fit to the anatomy of a patient's left atrium. First evaluations have shown that AFiT helps physicians in two ways. First, they can better assess whether cryoballoon ablation or RF ablation is the treatment of choice at all. Second, they can select the proper-size cryo-balloon catheter with more confidence.

  11. 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

  12. Long-term outcome of ablative therapy of postoperative supraventricular tachycardias in patients with univentricular heart: a European multicenter study

    NARCIS (Netherlands)

    de Groot, Natasja M. S.; Lukac, Peter; Blom, Nico A.; van Kuijk, Jan Peter; Pedersen, Anders K.; Hansen, Peter S.; Delacretaz, Etienne; Schalij, Martin J.

    2009-01-01

    BACKGROUND: Catheter ablation has evolved as a possible curative treatment modality for supraventricular tachycardias (SVT) in patients with univentricular heart. However, the long-term outcome of ablation procedures is unknown. We evaluated the procedural and long-term outcome of ablative therapy

  13. 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

  14. Ventricular Tachycardia with ICD Shocks: When to Medicate and When to Ablate.

    Science.gov (United States)

    AbdelWahab, Amir; Sapp, John

    2017-09-13

    Ventricular tachycardia occurrence in implantable cardioverter defibrillator (ICD) patients may result in shock delivery and is associated with increased morbidity and mortality. In addition, shocks may have deleterious mechanical and psychological effects. Prevention of ventricular tachycardia (VT) recurrence with the use of antiarrhythmic drugs or catheter ablation may be warranted. Antiarrhythmic drugs are limited by incomplete efficacy and an unfavorable adverse effect profile. Catheter ablation can be effective but acute complications and long-term VT recurrence risk necessitating repeat ablation should be recognized. A shared clinical decision process accounting for patients' cardiac status, comorbidities, and goals of care is often required. There are four published randomized trials of catheter ablation for sustained monomorphic VT (SMVT) in the setting of ischemic heart disease; there are no randomized studies for non-ischemic ventricular substrates. The most recent trial is the VANISH trial which randomly allocated patients with ICD, prior infarction, and SMVT despite first-line antiarrhythmic drug therapy to catheter ablation or more aggressive antiarrhythmic drug therapy. During 28 months of follow-up, catheter ablation resulted in a 28% relative risk reduction in the composite endpoint of death, VT storm, and appropriate ICD shock (p = 0.04). In a subgroup analysis, patients having VT despite amiodarone had better outcomes with ablation as compared to increasing amiodarone dose or adding mexiletine. There is evidence for the effectiveness of both catheter ablation and antiarrhythmic drug therapy for patients with myocardial infarction, an implantable defibrillator, and VT. If sotalol is ineffective in suppressing VT, either catheter ablation or initiation of amiodarone is a reasonable option. If VT occurs despite amiodarone therapy, there is evidence that catheter ablation is superior to administration of more aggressive antiarrhythmic drug therapy

  15. 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.

  16. 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.

  17. Phrenic nerve protection via packing of gauze into the pericardial space during ablation of cristal atrial tachycardia in a child.

    Science.gov (United States)

    Takahashi, Kazuhiro; Fuchigami, Tai; Nabeshima, Taisuke; Sashinami, Arata; Nakayashiro, Mami

    2016-03-01

    The success of catheter ablation of focal atrial tachycardia is limited by possible collateral damage to the phrenic nerve. Protection of the phrenic nerve is required. Here we present a case of a 9-year-old girl having a history of an unsuccessful catheter ablation of a focal atrial tachycardia near the crista terminalis (because of proximity of the phrenic nerve) who underwent a successful ablation by means of a novel technique for phrenic nerve protection: packing of gauze into the pericardial space. This method is a viable approach for patients with a failed endocardial ablation due to the proximity of the phrenic nerve.

  18. Improvements In AF Ablation Outcome Will Be Based More On Technological Advancement Versus Mechanistic Understanding.

    Science.gov (United States)

    Jiang Md, Chen-Yang; Jiang Ms, Ru-Hong

    2014-01-01

    Atrial fibrillation (AF) is one of the most common cardiac arrhythmias. Catheter ablation has proven more effective than antiarrhythmic drugs in preventing clinical recurrence of AF, however long-term outcome remains unsatisfactory. Ablation strategies have evolved based on progress in mechanistic understanding, and technologies have advanced continuously. This article reviews current mechanistic concepts and technological advancements in AF treatment, and summarizes their impact on improvement of AF ablation outcome.

  19. 2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adults

    Directory of Open Access Journals (Sweden)

    Josep A. Capdevila

    2016-07-01

    Full Text Available The use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. The short-term use of peripheral catheters has been found to be associated with the risk of nosocomial bacteraemia, resulting in morbidity and mortality. Staphylococcus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been prepared by a panel of experts of the Spanish Society of Cardiovascular Infections, in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy, and the Spanish Society of Thoracic-Cardiovascular Surgery, and aims to define and establish guidelines for the management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance, registering, diagnosis and treatment of infection, indications for removal, as well as placing an emphasis on continuous education as a drive toward quality. Implementation of these guidelines will allow uniformity in use, thus minimizing the risk of infections and their complications.

  20. 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...

  1. Is Cryoballoon Ablation Preferable to Radiofrequency Ablation for Treatment of Atrial Fibrillation by Pulmonary Vein Isolation? A Meta-Analysis

    Science.gov (United States)

    Xu, Junxia; Huang, Yingqun; Cai, Hongbin; Qi, Yue; Jia, Nan; Shen, Weifeng; Lin, Jinxiu; Peng, Feng; Niu, Wenquan

    2014-01-01

    Objective Currently radiofrequency and cryoballoon ablations are the two standard ablation systems used for catheter ablation of atrial fibrillation; however, there is no universal consensus on which ablation is the optimal choice. We therefore sought to undertake a meta-analysis with special emphases on comparing the efficacy and safety between cryoballoon and radiofrequency ablations by synthesizing published clinical trials. Methods and Results Articles were identified by searching the MEDLINE and EMBASE databases before September 2013, by reviewing the bibliographies of eligible reports, and by consulting with experts in this field. Data were extracted independently and in duplicate. There were respectively 469 and 635 patients referred for cryoballoon and radiofrequency ablations from 14 qualified clinical trials. Overall analyses indicated that cryoballoon ablation significantly reduced fluoroscopic time and total procedure time by a weighted mean of 14.13 (95% confidence interval [95% CI]: 2.82 to 25.45; P = 0.014) minutes and 29.65 (95% CI: 8.54 to 50.77; P = 0.006) minutes compared with radiofrequency ablation, respectively, whereas ablation time in cryoballoon ablation was nonsignificantly elongated by a weighted mean of 11.66 (95% CI: −10.71 to 34.04; P = 0.307) minutes. Patients referred for cryoballoon ablation had a high yet nonsignificant success rate of catheter ablation compared with cryoballoon ablation (odds ratio; 95% CI; P: 1.34; 0.53 to 3.36; 0.538), and cryoballoon ablation was also found to be associated with the relatively low risk of having recurrent atrial fibrillation (0.75; 0.3 to 1.88; 0.538) and major complications (0.46; 0.11 to 1.83; 0.269). There was strong evidence of heterogeneity and low probability of publication bias. Conclusion Our findings demonstrate greater improvement in fluoroscopic time and total procedure duration for atrial fibrillation patients referred for cryoballoon ablation than those for

  2. Anatomical and procedural determinants of catheter-based renal denervation.

    Science.gov (United States)

    Ewen, Sebastian; Ukena, Christian; Lüscher, Thomas Felix; Bergmann, Martin; Blankestijn, Peter J; Blessing, Erwin; Cremers, Bodo; Dörr, Oliver; Hering, Dagmara; Kaiser, Lukas; Nef, Holger; Noory, Elias; Schlaich, Markus; Sharif, Faisal; Sudano, Isabella; Vogel, Britta; Voskuil, Michiel; Zeller, Thomas; Tzafriri, Abraham R; Edelman, Elazer R; Lauder, Lucas; Scheller, Bruno; Böhm, Michael; Mahfoud, Felix

    Catheter-based renal sympathetic denervation (RDN) can reduce blood pressure (BP) and sympathetic activity in certain patients with uncontrolled hypertension. Less is known about the impact of renal anatomy and procedural parameters on subsequent BP response. A total of 564 patients with resistant hypertension underwent bilateral RDN in 9 centers in Europe and Australia using a mono-electrode radiofrequency catheter (Symplicity Flex, Medtronic). Anatomical criteria such as prevalence of accessory renal arteries (ARA), presence of renal artery disease (RAD), length, and diameter were analyzed blinded to patient's characteristics. ARA was present in 171 patients (30%), and RAD was documented in 71 patients (13%). On average 11±2.7 complete 120-s ablations were performed, equally distributed on both sides. After 6months, BP was reduced by 19/8mmHg (p4mm (-29 vs. -26 vs. -17mmHg; p<0.001). Neither the length of the renal artery nor the number of RF ablations influenced BP reduction after 6months. The diameter of renal arteries correlated with SBP change after RDN at 6-month follow-up. Change of SBP was not related to the lengths of the renal artery, presence of ARA, RAD, or the number of RF ablations delivered by a mono-electrode catheter. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. 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

  4. Spanish I

    CERN Document Server

    Rodriguez, Jill

    2001-01-01

    CliffsQuickReview course guides cover the essentials of your toughest classes. Get a firm grip on core concepts and key material, and test your newfound knowledge with review questions. CliffsQuickReview Spanish I is meant to provide all the foundations of basic Spanish pronunciation, spelling, and sentence construction. Spanish grammar is systematically explained in its most simplistic way, so there's no need for any prerequisite before beginning this ""review"" of the equivalent of two years of high school Spanish. As you work your way through this review, you'll be ready to tackle such conc

  5. 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.

  6. Bladder Morphology Using 2 Different Catheter Designs

    Science.gov (United States)

    2017-04-10

    Urologic Injuries; Urologic Diseases; Bladder Infection; Urinary Tract Infections; Mucosal Inflammation; Mucosal Infection; Bladder Injury; Catheter-Related Infections; Catheter Complications; Catheter; Infection (Indwelling Catheter); Pelvic Floor Disorders; Urinary Incontinence

  7. Real-Time MRI-Guided Cardiac Cryo-Ablation: A Feasibility Study.

    Science.gov (United States)

    Kholmovski, Eugene G; Coulombe, Nicolas; Silvernagel, Joshua; Angel, Nathan; Parker, Dennis; Macleod, Rob; Marrouche, Nassir; Ranjan, Ravi

    2016-05-01

    MRI-based ablation provides an attractive capability of seeing ablation-related tissue changes in real time. Here we describe a real-time MRI-based cardiac cryo-ablation system. Studies were performed in canine model (n = 4) using MR-compatible cryo-ablation devices built for animal use: focal cryo-catheter with 8 mm tip and 28 mm diameter cryo-balloon. The main steps of MRI-guided cardiac cryo-ablation procedure (real-time navigation, confirmation of tip-tissue contact, confirmation of vessel occlusion, real-time monitoring of a freeze zone formation, and intra-procedural assessment of lesions) were validated in a 3 Tesla clinical MRI scanner. The MRI compatible cryo-devices were advanced to the right atrium (RA) and right ventricle (RV) and their position was confirmed by real-time MRI. Specifically, contact between catheter tip and myocardium and occlusion of superior vena cava (SVC) by the balloon was visually validated. Focal cryo-lesions were created in the RV septum. Circumferential ablation of SVC-RA junction with no gaps was achieved using the cryo-balloon. Real-time visualization of freeze zone formation was achieved in all studies when lesions were successfully created. The ablations and presence of collateral damage were confirmed by T1-weighted and late gadolinium enhancement MRI and gross pathological examination. This study confirms the feasibility of a MRI-based cryo-ablation system in performing cardiac ablation procedures. The system allows real-time catheter navigation, confirmation of catheter tip-tissue contact, validation of vessel occlusion by cryo-balloon, real-time monitoring of a freeze zone formation, and intra-procedural assessment of ablations including collateral damage. © 2016 Wiley Periodicals, Inc.

  8. 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.)

  9. Epicardial Adipose Tissue Thickness and Ablation Outcome of Atrial Fibrillation

    Science.gov (United States)

    Tsao, Hsuan-Ming; Lin, Yenn-Jiang; Yun, Chun-Ho; Lai, Yau-Huei; Chang, Shih-Lin; Lo, Li-Wei; Hu, Yu-Feng; Tuan, Ta-Chuan; Chang, Hung-Yu; Kuo, Jen-Yuan; Yeh, Hung-I; Wu, Tsu-Juey; Hsieh, Ming-Hsiung; Yu, Wen-Chung; Chen, Shih-Ann

    2013-01-01

    Objectives Epicardial fat was closely related to atrial fibrillation (AF). Transthoracic echocardiography (TTE) has been proposed to be a convenient imaging tool in assessing epicardial adipose tissue (EAT). The goal of the present study was to investigate whether the EAT thickness measured on TTE was a useful parameter in predicting procedural outcomes of AF ablations. Methods and Results A total of 227 paroxysmal AF (PAF) and 56 non-paroxysmal AF (non-PAF) patients receiving catheter ablations from 2008-2010 were enrolled. Echocardiography-derived regional EAT thickness from parasternal long-axis view was quantified for each patient. Free of recurrence was defined as the absence of atrial arrhythmias without using antiarrhythmic agents after ablations. The mean EAT thickness of the study population was 6.1 ± 0.8 mm. Non-PAF patients had a thicker EAT than that of PAF patients (7.0 ± 0.7 mm versus 5.9 ± 0.7 mm, p value EAT thickness were independent predictors of recurrence after catheter ablations. At a cutoff value of 6 mm for PAF and 6.9 mm for non-PAF, the measurement of EAT thickness could help us to identify patients at risk of recurrences. Conclusions EAT thickness may serve as a useful parameter in predicting recurrences after AF ablations. Compared to other imaging modalities, TTE can be an alternative choice with less cost and time in assessing the effects of EAT on ablation outcomes. PMID:24066158

  10. Magnetic resonance imaging guided transatrial electrophysiological studies in swine using active catheter tracking - experience with 14 cases

    Energy Technology Data Exchange (ETDEWEB)

    Grothoff, Matthias; Gutberlet, Matthias [University of Leipzig - Heart Center, Department of Radiology, Leipzig (Germany); Hindricks, Gerhard; Sommer, Philipp; Hilbert, Sebastian [University of Leipzig - Heart Center, Department of Electrophysiology, Leipzig (Germany); Fleiter, Christian [Helios Klinikum Berlin-Buch, Department of Orthopaedic Surgery, Berlin (Germany); Schnackenburg, Bernhard [Philips Healthcare, Hamburg (Germany); Weiss, Steffen; Krueger, Sascha [Philips Innovative Technologies, Hamburg (Germany); Piorkowski, Christopher; Gaspar, Thomas [University of Dresden - Heart Center, Department of Electrophysiology, Dresden (Germany); Wedan, Steve; Lloyd, Thomas [Imricor Medical Systems, Burnsville, MN (United States)

    2017-05-15

    To evaluate the feasibility of performing comprehensive Cardiac Magnetic resonance (CMR) guided electrophysiological (EP) interventions in a porcine model encompassing left atrial access. After introduction of two femoral sheaths 14 swine (41 ± 3.6 kg) were transferred to a 1.5 T MR scanner. A three-dimensional whole-heart sequence was acquired followed by segmentation and the visualization of all heart chambers using an image-guidance platform. Two MR conditional catheters were inserted. The interventional protocol consisted of intubation of the coronary sinus, activation mapping, transseptal left atrial access (n = 4), generation of ablation lesions and eventually ablation of the atrioventricular (AV) node. For visualization of the catheter tip active tracking was used. Catheter positions were confirmed by passive real-time imaging. Total procedure time was 169 ± 51 minutes. The protocol could be completed in 12 swine. Two swine died from AV-ablation induced ventricular fibrillation. Catheters could be visualized and navigated under active tracking almost exclusively. The position of the catheter tips as visualized by active tracking could reliably be confirmed with passive catheter imaging. Comprehensive CMR-guided EP interventions including left atrial access are feasible in swine using active catheter tracking. (orig.)

  11. Ultrafast laser ablation for targeted atherosclerotic plaque removal

    Science.gov (United States)

    Lanvin, Thomas; Conkey, Donald B.; Descloux, Laurent; Frobert, Aurelien; Valentin, Jeremy; Goy, Jean-Jacques; Cook, Stéphane; Giraud, Marie-Noelle; Psaltis, Demetri

    2015-07-01

    Coronary artery disease, the main cause of heart disease, develops as immune cells and lipids accumulate into plaques within the coronary arterial wall. As a plaque grows, the tissue layer (fibrous cap) separating it from the blood flow becomes thinner and increasingly susceptible to rupturing and causing a potentially lethal thrombosis. The stabilization and/or treatment of atherosclerotic plaque is required to prevent rupturing and remains an unsolved medical problem. Here we show for the first time targeted, subsurface ablation of atherosclerotic plaque using ultrafast laser pulses. Excised atherosclerotic mouse aortas were ablated with ultrafast near-infrared (NIR) laser pulses. The physical damage was characterized with histological sections of the ablated atherosclerotic arteries from six different mice. The ultrafast ablation system was integrated with optical coherence tomography (OCT) imaging for plaque-specific targeting and monitoring of the resulting ablation volume. We find that ultrafast ablation of plaque just below the surface is possible without causing damage to the fibrous cap, which indicates the potential use of ultrafast ablation for subsurface atherosclerotic plaque removal. We further demonstrate ex vivo subsurface ablation of a plaque volume through a catheter device with the high-energy ultrafast pulse delivered via hollow-core photonic crystal fiber.

  12. Catheter-related bloodstream infection.

    Science.gov (United States)

    Goede, Matthew R; Coopersmith, Craig M

    2009-04-01

    Catheter-related bloodstream infections (CR-BSIs) are a common, frequently preventable complication of central venous catheterization. CR-BSIs can be prevented by strict attention to insertion and maintenance of central venous catheters and removing unneeded catheters as soon as possible. Antiseptic- or antibiotic-impregnated catheters are also an effective tool to prevent infections. The diagnosis of CR-BSI is made largely based on culture results. CR-BSIs should always be treated with antibiotics, and except in rare circumstances the infected catheter needs to be removed.

  13. Spanish Football

    OpenAIRE

    Gagnepain, Philippe; Ascari, Guido

    2006-01-01

    The authors analyze the financial situation of the Spanish football industry. They first argue that a relevant analysis of the industry's financial results relies on a careful description of how historical and cultural factors have influenced its organization. Moreover, they stress the important relationship between the industry and television. The authors suggest that the situation of the Spanish football industry suffers from some structural weaknesses in its accounts. However, the situatio...

  14. Catheter Ablation for Long-Standing Persistent Atrial Fibrillation

    OpenAIRE

    Romero, Jorge; Gianni, Carola; Di Biase, Luigi; Natale, Andrea

    2015-01-01

    Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and represents a major burden to health care systems. Atrial fibrillation is associated with a 4- to 5-fold increased risk of thromboembolic stroke. The pulmonary veins have been identified as major sources of atrial triggers for AF. This is particularly true in patients with paroxysmal AF but not always the case for those with long-standing persistent AF (LSPAF), in which other locations for ectopic beats have been we...

  15. REAL TIME MRI GUIDED RADIOFREQUENCY ATRIAL ABLATION AND VISUALIZATION OF LESION FORMATION AT 3-TESLA

    Science.gov (United States)

    Vergara, Gaston R.; Vijayakumar, Sathya; Kholmovski, Eugene G.; Blauer, Joshua J.E.; Guttman, Mike A.; Gloschat, Christopher; Payne, Gene; Vij, Kamal; Akoum, Nazem W.; Daccarett, Marcos; McGann, Christopher J.; MacLeod, Rob S.; Marrouche, Nassir F.

    2011-01-01

    Background MRI allows visualization of location and extent of RF ablation lesion, myocardial scar formation, and real-time (RT) assessment of lesion formation. In this study, we report a novel 3-Tesla RT-MRI based porcine RF ablation model and visualization of lesion formation in the atrium during RF energy delivery. Objective To develop of a 3-Tesla RT-MRI based catheter ablation and lesion visualization system. Methods RF energy was delivered to six pigs under RT-MRI guidance. A novel MRI compatible mapping and ablation catheter was used. Under RT-MRI this catheter was safely guided and positioned within either the left or right atrium. Unipolar and bi-polar electrograms were recorded. The catheter tip-tissue interface was visualized with a T1-weighted gradient echo sequence. RF energy was then delivered in a power-controlled fashion. Myocardial changes and lesion formation were visualized with a T2-weighted (T2w) HASTE sequence during ablation. Results Real-time visualization of lesion formation was achieved in 30% of the ablations performed. In the other cases, either the lesion was formed outside the imaged region (25%) or lesion was not created (45%) presumably due to poor tissue-catheter tip contact. The presence of lesions was confirmed by late gadolinium enhancement (LGE) MRI and macroscopic tissue examination. Conclusion MRI compatible catheters can be navigated and RF energy safely delivered under 3-Tesla RT-MRI guidance. It is also feasible to record electrograms during RT imaging. Real-time visualization of lesion as it forms during delivery of RF energy is possible and was demonstrated using T2w HASTE imaging. PMID:21034854

  16. Combination of Hansen Robotic system with cryocatheter in a challenging parahisian accessory pathway ablation

    Directory of Open Access Journals (Sweden)

    Moisés Rodríguez-Mañero

    2015-11-01

    Full Text Available A perceived distinctive feature of cryoablation is the stability (cryoadherence of the catheter tip during cold temperatures at the desired location, even during tachycardia. We report the case report of a young patient with a parahisian accessory pathway where stability of the ablation catheter was not achieved despite using the cryocatheter with a steerable sheath. Ultimately, stability at the desired location was achieved robotically by means of Hansen system (Hansen Medical, Mountain View, CA, USA.

  17. 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.

  18. Inadvertent puncture of the aortic noncoronary cusp during postoperative left atrial tachycardia ablation

    Directory of Open Access Journals (Sweden)

    Dursun Aras, MD

    2015-08-01

    Full Text Available Transseptal catheterization has become part of the interventional electrophysiologist׳s technical armamentarium since the development of left atrial catheter ablation and percutaneous technologies for treating mitral and aortic valve disease. Although frequently performed, the procedure׳s most feared complication is aortic root penetration. Focal atrial tachycardia has been described as the most common late sequela of surgical valve replacements. We present a complicated case involving the inadvertent delivery of an 8 French sheath across the noncoronary cusp during radiofrequency catheter ablation for left atrial tachycardia originating from the mitral annulus in a patient with prior mitral valve replacement.

  19. Intravascular (catheter) MR imaging

    International Nuclear Information System (INIS)

    Cohen, A.M.; Hurst, G.C.; Katz, D.E.; Dverk, J.L.; Wiesen, E.J.; Czerski, L.W.; Malaya, R.; Bellon, E.M.

    1989-01-01

    Intravascular MR probes allow excellent spatial resolution and have the potential to detect arterial wall microstructure. Ultrasonic intravascular probes suggest that detailed morphologic information can assist clinical decision making. Catheter MR probes of 2--7 mm outside diameter (OD) were built of copper wire, Teflon, and parts from standard commercial catheters. The probes were connected to the surface coil receiver input of our Picker VISTA 2055HP 1.5-T imaging system. The extant (linear) body coil was used for transmit. Phantoms were constructed of coaxial glass MR tubes, filled with doped water. Watanabe rabbit aorta and human autopsy iliac artery specimens were examined within 4 hours of excision or stored by freezing. In vivo iliac arteries in dogs under general anesthesia were imaged, with percutaneous placement of the probe. Results are presented

  20. Ablation of supraventricular arrhythmias in adult congenital heart disease: A contemporary review.

    Science.gov (United States)

    Combes, Nicolas; Derval, Nicolas; Hascoët, Sebastien; Zhao, Alexandre; Amet, Denis; Le Bloa, Mathieu; Maltret, Alice; Heitz, François; Thambo, Jean-Benoit; Marijon, Eloi

    2017-05-01

    Supraventricular arrhythmias are an important and increasing cause of morbidity in adults with congenital heart disease, requiring specific management strategies. Pharmacological treatment has limited efficacy, and is often associated with some side-effects. Major improvements in catheter ablation techniques have opened new opportunities to better understand underlying mechanisms of supraventricular arrhythmias, offer better therapy, and eventually improve symptoms and quality of life in these patients. An array of tools and techniques are necessary to access relevant anatomical areas to address the arrhythmogenic substrate. The mechanism of these arrhythmias is mostly related to macroreentry around surgical scars or cavotricuspid isthmus-dependent flutter. The efficacy of catheter ablation is mainly dependent on the underlying congenital heart condition, with the most complex cases typically being associated with atrial switch and Fontan surgeries. Although relatively high rates of recurrence are seen after a single procedure, additional attempts are often helpful to decrease recurrences and improve symptoms. Catheter ablation in such patients continues to present many unique challenges that are best addressed by experienced multidisciplinary teams, at centres equipped with the proper catheters, imaging capabilities, mapping systems and support staff needed to maximize safety and success. Consensus indications have emerged that often support ablation as first-line therapy in these patients. In this comprehensive review, we aim to describe the specific issues associated with ablation of supraventricular arrhythmias in adult congenital heart disease, assess the results in contemporary practice and, finally, review the current indications. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  1. Comparison of microbubble presence in the right heart during mechanochemical and radiofrequency ablation for varicose veins.

    Science.gov (United States)

    Moon, K H; Dharmarajah, B; Bootun, R; Lim, C S; Lane, Tra; Moore, H M; Sritharan, K; Davies, A H

    2017-07-01

    Objective Mechanochemical ablation is a novel technique for ablation of varicose veins utilising a rotating catheter and liquid sclerosant. Mechanochemical ablation and radiofrequency ablation have no reported neurological side-effect but the rotating mechanism of mechanochemical ablation may produce microbubbles. Air emboli have been implicated as a cause of cerebrovascular events during ultrasound-guided foam sclerotherapy and microbubbles in the heart during ultrasound-guided foam sclerotherapy have been demonstrated. This study investigated the presence of microbubbles in the right heart during varicose vein ablation by mechanochemical abaltion and radiofrequency abaltion. Methods Patients undergoing great saphenous vein ablation by mechanochemical abaltion or radiofrequency ablation were recruited. During the ablative procedure, the presence of microbubbles was assessed using transthoracic echocardiogram. Offline blinded image quantification was performed using International Consensus Criteria grading guidelines. Results From 32 recruited patients, 28 data sets were analysed. Eleven underwent mechanochemical abaltion and 17 underwent radiofrequency abaltion. There were no neurological complications. In total, 39% (11/28) of patients had grade 1 or 2 microbubbles detected. Thirty-six percent (4/11) of mechanochemical abaltion patients and 29% (5/17) of radiofrequency ablation patients had microbubbles with no significant difference between the groups ( p=0.8065). Conclusion A comparable prevalence of microbubbles between mechanochemical abaltion and radiofrequency ablation both of which are lower than that previously reported for ultrasound-guided foam sclerotherapy suggests that mechanochemical abaltion may not confer the same risk of neurological events as ultrasound-guided foam sclerotherapy for treatment of varicose veins.

  2. Noninvasive Assessment of Tissue Heating During Cardiac Radiofrequency Ablation Using MRI Thermography

    Science.gov (United States)

    Kolandaivelu, Aravindan; Zviman, Menekhem M.; Castro, Valeria; Lardo, Albert C.; Berger, Ronald D.; Halperin, Henry R.

    2010-01-01

    Background Failure to achieve properly localized, permanent tissue destruction is a common cause of arrhythmia recurrence after cardiac ablation. Current methods of assessing lesion size and location during cardiac radiofrequency ablation are unreliable or not suited for repeated assessment during the procedure. MRI thermography could be used to delineate permanent ablation lesions because tissue heating above 50°C is the cause of permanent tissue destruction during radiofrequency ablation. However, image artifacts caused by cardiac motion, the ablation electrode, and radiofrequency ablation currently pose a challenge to MRI thermography in the heart. In the current study, we sought to demonstrate the feasibility of MRI thermography during cardiac ablation. Methods and Results An MRI-compatible electrophysiology catheter and filtered radiofrequency ablation system was used to perform ablation in the left ventricle of 6 mongrel dogs in a 1.5-T MRI system. Fast gradient-echo imaging was performed before and during radiofrequency ablation, and thermography images were derived from the preheating and postheating images. Lesion extent by thermography was within 20% of the gross pathology lesion. Conclusions MR thermography appears to be a promising technique for monitoring lesion formation and may allow for more accurate placement and titration of ablation, possibly reducing arrhythmia recurrences. PMID:20657028

  3. Multielectrode phased radiofrequency ablation compared with point-by-point ablation for pulmonary vein isolation – outcomes in 539 patients

    Directory of Open Access Journals (Sweden)

    Spitzer SG

    2014-01-01

    Full Text Available Stefan G Spitzer,1 Laszlo Karolyi,1 Thomas Weinmann,1 Frank Scharfe,1 Carola Rämmler,1 Tobias Otto,1 Friedrich Jung,2 Clemens T Kadalie11Praxisklinik Herz und Gefäße, Akademische Lehrpraxisklinik der TU Dresden, Dresden, Germany; 2Saarland University, Homburg, Saar, GermanyPurpose: To provide data on acute and long-term outcomes from pulmonary vein isolation with the pulmonary vein ablation catheter (PVAC in patients with paroxysmal or persistent atrial fibrillation (AF.Methods: This was a single-center, retrospective, nonrandomized, case control study. Patients with documented symptomatic paroxysmal or persistent AF were treated with PVAC or with point-by-point radiofrequency ablation guided by the NavX™ mapping system. All follow-up visits were conducted in our center at 1 month, 3 months, and 6 months, and then at 6-month intervals. Electrocardiography and 24-hour Holter monitoring were performed at each follow-up visit. The endpoints included procedure times, acute and 24-month outcomes, and complications.Results: Of the 539 patients that were enrolled consecutively, 388 were ablated using PVAC and 151 using radiofrequency ablation. More patients with paroxysmal AF were treated with PVAC than with radiofrequency ablation. Acute success rates were >99% with both methods. Procedure duration and fluoroscopy times were significantly (P<0.001 shorter with PVAC than with point-by-point ablation. Rates of freedom from AF at all follow-up times available (up to 24 months were significantly higher after PVAC ablation than with radiofrequency ablation (64.2% versus 48.2% at 24 months. With both ablation strategies, the rates of freedom from AF were higher in patients with paroxysmal AF than for persistent AF. Two posterior cerebral infarcts occurred in the PVAC group within 2 days of the procedure. No phrenic nerve injuries and no esophageal injuries were recorded. Data on embolic lesions were not collected.Conclusion: PVAC ablation achieved

  4. Right atrial mass following transcatheter radiofrequency ablation for recurrent atrial fibrillation: thrombus, endocarditis or mixoma?

    Science.gov (United States)

    Ancona, Roberta; Comenale Pinto, Salvatore; Caso, Pio; Di Palma, Vito; Pisacane, Francesca; Martiniello, Alfonso Roberto; Quarto, Cesare; De Rosa, Nicla; Pisacane, Carlo; Calabrò, Raffaele

    2009-03-01

    We report a case of an asymptomatic patient in whom a right atrial mass was fortuitously documented by echocardiography few months after a transcatheter radiofrequency catheter ablation for recurrent AF. No masses were seen in the cardiac chambers before the ablative procedure, raising important diagnostic and decision-making issues. The patient was referred to the surgeon and a diagnosis of right atrial myxoma was made.

  5. Role of ventricular tachycardia ablation in arrhythmogenic right ventricular cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Alberto Cipriani

    2017-11-01

    Full Text Available Arrhythmogenic right ventricular cardiomyopathy (ARVC is characterized by progressive fibro-fatty replacement of the myocardium that represents the substrate for recurrent sustained ventricular tachycardia (VT. These arrhythmias characterize the clinical course of a sizeable proportion of patients and have significant implications for their quality of life and long-term prognosis. Antiarrhythmic drugs are often poorly tolerated and usually provide incomplete control of arrhythmia relapses. Catheter ablation is a potentially effective strategy to treat frequent VT episodes and ICD shocks in ARVC patients. The aims of this review are to discuss the electrophysiological and electroanatomic substrates of ventricular tachycardia in patients with ARVC and to analyze the role of catheter ablation in their management with particular reference to selection of patients, technical issues, potential complications and outcomes.

  6. Protection of the coronary arteries during epicardial radiofrequency ablation with intracoronary chilled saline irrigation: assessment in an in vitro model.

    Science.gov (United States)

    Thyer, Isaac A; Kovoor, Pramesh; Barry, Michael A; Pouliopoulos, Jim; Ross, David L; Thiagalingam, Aravinda

    2006-05-01

    The coronary arteries can be damaged during epicardial radiofrequency ablation (RFA) procedures. We hypothesized that intracoronary irrigation with chilled saline may be a useful technique for minimizing heat-induced damage to the coronary artery endothelium during this procedure. Twenty-nine ablation procedures were performed on 17 freshly excised ovine hearts. Radiofrequency current was delivered through an internally cooled, 4-mm-tip ablation catheter placed directly over the coronary artery (24 applications) and over noncoronary epicardium (5 applications). An Amplatz coronary catheter was used to internally irrigate the coronary artery with either 37 degrees C or 5 degrees C 0.9% saline (12 ablations each group). Fluroptic temperature probes were placed within the artery lumen under the ablation site and 15 mm distal from the ablation site. The peak intracoronary temperature directly under the ablation catheter was significantly lower (P = 0.001) in the chilled than in the nonchilled saline irrigation group (23.6 degrees C, interquartile range [IQR] 15.7-39.8 vs 54.6 degrees C, IQR 48.9-58.6). Blue tetrazolium stained lesion sections showed that the median distance between the ablation lesion and the artery wall was significantly higher (P = 0.004) for the chilled versus the nonchilled saline irrigation group (0.42 mm, IQR 0.25-0.70 vs 0.00 mm, IQR 0.00-0.28). Intracoronary irrigation with chilled saline may protect the coronary artery endothelium from heat-induced damage during epicardial RFA.

  7. Tissue ablation and gas formation of two excimer laser systems: an in vitro evaluation on porcine aorta.

    Science.gov (United States)

    Appelman, Y E; Piek, J J; Verhoofstad, G G; Gijsbers, G H; Van Gemert, M J

    1996-01-01

    The relationship between tissue ablation volume and the formation of insoluble gas of the currently available excimer laser systems is unknown. This aspect was evaluated in two excimer laser systems. We measured tissue ablation volume and gas production of two excimer laser systems (308 nm) on porcine aortic tissue immersed in saline (the CVX-300 using 1.4 and 1.7 mm laser catheters and the Dymer 200 + using 1.3, 1.3z and 1.6 mm laser catheters). Tissue ablation volume and gas production increased proportionally with the applied energy fluence, ranging from 30-60 mJ/mm2. The gas production per unit of ablated tissue volume of the 1.4 mm laser catheter was significantly higher than the 1.3 mm laser catheter (mean difference +117%, 95% CI from +64% till +188%, PCVX-300 laser system results in significantly higher gas production than the Dymer 200+ laser system, which can be markedly reduced by lowering the applied energy fluence. The 1.3z laser catheter constitutes an exception, showing similar characteristics as the CVX-300 laser catheters.

  8. 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

    BACKGROUND: During radiofrequency ablation of arrhythmias tissue heating and hence lesion size depend on electrode-tissue contact and cooling of the electrode tip caused by cavitary blood flow. These factors are unique and unknown for each catheter placement in the beating heart. A tool for asses......BACKGROUND: During radiofrequency ablation of arrhythmias tissue heating and hence lesion size depend on electrode-tissue contact and cooling of the electrode tip caused by cavitary blood flow. These factors are unique and unknown for each catheter placement in the beating heart. A tool...... 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

  9. Ablation effect indicated by impedance fall is correlated with contact force level during ablation for atrial fibrillation.

    Science.gov (United States)

    De Bortoli, Alessandro; Sun, Li-Zhi; Solheim, Eivind; Hoff, Per Ivar; Schuster, Peter; Ohm, Ole-Jørgen; Chen, Jian

    2013-11-01

    Previous studies have validated the use of impedance fall as a measure of the effects of ablation. We investigated whether catheter-to-tissue contact force correlated with impedance fall during atrial fibrillation ablation. A total of 394 ablation points from 35 patients who underwent atrial fibrillation ablation were selected and analyzed in terms of the presence of stable catheter contact in non-ablated areas in the left atrium. A fixed power output (30 W) was applied for 60 seconds. Contact force, impedance fall, and force-direction angle were retrieved and exported for off-line analysis. Qualified points were divided into 5 groups according to the level of contact force (1-5 g, 6-10 g, 11-15 g, 16-20 g, and >20 g). An acute impedance fall was observed in the first 10 seconds followed by a plateau in group I and by a further fall in the other groups. Group V showed a rise in impedance during the last 20 seconds of ablation. Levels of impedance fall at each time point were significantly different among all the groups (Pcontact force and maximum impedance fall (rho = 0.54, Pangle of 0-30° had significantly lower contact force and maximum impedance fall than those with angles of 30-60° and 60-135° (Pcontact force correlates with impedance fall during 60 seconds of ablation. Contact force exceeding 5 g produces greater impedance fall, which probably indicates adequate lesion formation. A contact force greater than 20 g may lead to late tissue overheating. © 2013 Wiley Periodicals, Inc.

  10. Pulmonary vein isolation using the Rhythmia mapping system: Verification of intracardiac signals using the Orion mini-basket catheter.

    Science.gov (United States)

    Anter, Elad; Tschabrunn, Cory M; Contreras-Valdes, Fernando M; Li, Jianqing; Josephson, Mark E

    2015-09-01

    During pulmonary vein isolation (PVI), a circular lasso catheter is positioned at the junction between the left atrium (LA) and the pulmonary vein (PV) to confirm PVI. The Rhythmia mapping system uses the Orion mini-basket catheter with 64 electrodes instead of the lasso catheter. However, its feasibility to determine PVI has not been studied. The purpose of this study was to compare signals between the mini-basket and lasso catheters at the LA-PV junction. In 12 patients undergoing PVI using Rhythmia, the mini-basket and lasso catheters were placed simultaneously at the LA-PV junction for baseline and post-PVI signal assessment. Pacing from both catheters was performed to examine the presence of exit block. At baseline, recordings of LA and PV potentials were concordant in all PVs. However, after PVI, concordance between the catheters was only 68%. Discordance in all cases resulted from loss of PV potentials on the lasso catheter with persistence of PV potentials on the mini-basket catheter. In 9 of 13 PVs (69%), these potentials represented true PV potentials that were exclusively recorded with the smaller and closely spaced mini-basket electrodes. In the other 4 PVs (31%), these potentials originated from neighboring structures and resulted in underestimation of PVI. The use of the mini-basket catheter alone is sufficient to determine PVI. While it improves recording of PV potentials after incomplete ablation, it is also associated with frequent recording of "PV-like" potentials originating from neighboring structures. In these cases, pacing maneuvers are helpful to determine PVI and avoid excessive ablation. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  11. Agile and Bright Intracardiac Catheters

    NARCIS (Netherlands)

    M. Pekař (Martin)

    2017-01-01

    markdownabstractIntracardiac imaging catheters represent unique instruments to diagnose and treat a diseased heart. While there are imminent advances in medical innovation, many of the commercially available imaging catheters are outdated. Some of them have been designed more than 20 years and

  12. Radiofrequency Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC).

    Science.gov (United States)

    Romero, Jorge; Grushko, Michael; Briceño, David F; Natale, Andrea; Di Biase, Luigi

    2017-09-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heritable form of cardiomyopathy, typically with autosomal dominant transmission, shown to be a defect in the cardiac desmosomes, with distinct regional and histopathological features. Clinically, this can ultimately result in bi-ventricular failure and/or malignant ventricular tachycardia (VT) via reentrant circuits created by patchy scar formation. We sought to review the current treatment for ventricular arrhythmias in the setting of ARVC, with particular attention to radiofrequency (RF) ablation and its varied techniques, along with potential therapies in the ablation spectrum. There is underwhelming data on the effectiveness of medical therapy for ARVC-related VT, including beta-blockers and antiarrhythmic medication. Primary and secondary prophylactic implantable-cardioverter defibrillator (ICD) implantation in higher-risk patients is recommended. More recently, RF ablation has been used for ARVC-related VT. Endocardial VT ablation in this setting can produce acute success, though recurrence rate is quite high, which may be explained by the more epicardial and patchy nature of the disease. Combined endocardial-epicardial ablation has since been shown to be feasible, safe, and with significantly better acute and long-term success, particularly when combined with scar dechanneling or homogenization of the scar. However, recurrence rates are not insignificant, and ablation does not eliminate the need for ICD placement. Medical therapy for ARVC-related VT is suboptimal. RF ablation techniques including endocardial and epicardial approaches appear to have the highest success rates for ARVC-related VT. Catheter ablation of VT in ARVC patients should be considered a potentially effective strategy for eliminating frequent VT episodes and ICD shocks rather than a curative therapeutic approach, until long-term efficacy has been consistently documented. Research into the optimal mapping and ablation techniques

  13. Skin colonisation at the catheter exit site is strongly associated with catheter colonisation and catheter-related sepsis.

    Science.gov (United States)

    Ponnusamy, Vennila; Perperoglou, Aris; Venkatesh, Vidheya; Curley, Anna; Brown, Nicholas; Tremlett, Catherine; Clarke, Paul

    2014-12-01

    The commonest mode of catheter colonisation is via the extraluminal route with skin bacteria. Catheter-related sepsis causes significant mortality and morbidity in neonates. Our aim was to study the relationships between culture-positive catheter exit site skin swabs, percutaneous central venous catheter segments and blood to determine the magnitude of associations between exit site skin colonisation, catheter colonisation and catheter-related sepsis. In a prospective study, an exit site skin swab and three formerly in vivo catheter segments (proximal, middle and tip) were taken for culture at catheter removal. In those neonates who were clinically unwell at catheter removal, a peripheral blood culture was also collected. Univariate and multivariate analyses were used to study associations. Skin swabs were culture positive in 39 (21%) of 187 catheter removals. With a culture-positive skin swab, the risk of associated catheter colonisation was nearly eight times higher (OR: 7.84, 95% CI: 3.59-17.15) and the risk of definite catheter-related sepsis with the same organism was nearly 10 times higher (OR 9.86, 95% CI: 3.13-31.00). Culture-positive skin swabs from the catheter exit site were strongly associated with catheter colonisation and with definite catheter-related sepsis with the same organism. These data provide further evidence supporting catheter colonisation via the extraluminal route and highlight the importance of optimising skin disinfection before catheter insertion. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  14. Cryoballoon ablation for paroxysmal atrial fibrillation in the presence of an Amplatzer Septal Occluder device

    Directory of Open Access Journals (Sweden)

    Jubran A. Rind

    2016-09-01

    Full Text Available Cryoballoon ablation of the pulmonary veins (CAPV has been demonstrated to be non-inferior to radiofrequency (RF ablation for paroxysmal atrial fibrillation (AFib. As CAPV requires a larger transseptal sheath than RF ablation, it can be challenging in the presence of an Amplatzer™ Septal Occluder (ASO device. Real-time three-dimensional transesophageal echocardiography (RT3DTEE provides enhanced visualization of various complex cardiac defects and has revolutionized interventional procedures by guiding catheter positioning. We describe successful RT3DTEE guided transseptal puncture for CAPV of paroxysmal AFib in the presence of an ASO in a 53-year-old male.

  15. 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.

  16. Could successful cryoballoon ablation of paroxysmal atrial fibrillation prevent progressive left atrial remodeling?

    Science.gov (United States)

    Erdei, Tamás; Dénes, Mónika; Kardos, Attila; Mihálcz, Attila; Földesi, Csaba; Temesvári, András; Lengyel, Mária

    2012-03-19

    Radiofrequency catheter ablation of atrial fibrillation (AF) has been proved to be effective and to prevent progressive left atrial (LA) remodeling. Cryoballoon catheter ablation (CCA), using a different energy source, was developed to simplify the ablation procedure. Our hypothesis was that successful CCA can also prevent progressive LA remodeling. 36 patients selected for their first CCA because of nonvalvular paroxysmal AF had echocardiography before and 3, 6 and 12 months after CCA. LA diameters, volumes (LAV) and LA volume index (LAVI) were evaluated. LA function was assessed by: early diastolic velocities of the mitral annulus (Aa(sept), Aa(lat)), LA filling fraction (LAFF), LA emptying fraction (LAEF) and the systolic fraction of pulmonary venous flow (PVSF). Detailed left ventricular diastolic function assessment was also performed. Excluding recurrences in the first 3-month blanking period, the clinical success rate was 64%. During one-year of follow-up, recurrent atrial arrhythmia was found in 21 patients (58%). In the recurrent group at 12 months after ablation, minimal LAV (38 ± 19 to 44 ± 20 ml; p < 0.05), maximal LAV (73 ± 23 to 81 ± 24 ml; p < 0.05), LAVI (35 ± 10 to 39 ± 11 ml/m2; p = 0.01) and the maximal LA longitudinal diameter (55 ± 5 to 59 ± 6 mm; p < 0.01) had all increased. PVSF (58 ± 9 to 50 ± 10%; p = 0.01) and LAFF (36 ± 7 to 33 ± 8%; p = 0.03) had decreased. In contrast, after successful cryoballoon ablation LA size had not increased and LA function had not declined. In the recurrent group LAEF was significantly lower at baseline and at follow-up visits. In patients whose paroxysmal atrial fibrillation recurred within one year after cryoballoon catheter ablation left atrial size had increased and left atrial function had declined. In contrast, successful cryoballoon catheter ablation prevented progressive left atrial remodeling.

  17. Could successful cryoballoon ablation of paroxysmal atrial fibrillation prevent progressive left atrial remodeling?

    Directory of Open Access Journals (Sweden)

    Erdei Tamás

    2012-03-01

    Full Text Available Abstract Background Radiofrequency catheter ablation of atrial fibrillation (AF has been proved to be effective and to prevent progressive left atrial (LA remodeling. Cryoballoon catheter ablation (CCA, using a different energy source, was developed to simplify the ablation procedure. Our hypothesis was that successful CCA can also prevent progressive LA remodeling. Methods 36 patients selected for their first CCA because of nonvalvular paroxysmal AF had echocardiography before and 3, 6 and 12 months after CCA. LA diameters, volumes (LAV and LA volume index (LAVI were evaluated. LA function was assessed by: early diastolic velocities of the mitral annulus (Aasept, Aalat, LA filling fraction (LAFF, LA emptying fraction (LAEF and the systolic fraction of pulmonary venous flow (PVSF. Detailed left ventricular diastolic function assessment was also performed. Results Excluding recurrences in the first 3-month blanking period, the clinical success rate was 64%. During one-year of follow-up, recurrent atrial arrhythmia was found in 21 patients (58%. In the recurrent group at 12 months after ablation, minimal LAV (38 ± 19 to 44 ± 20 ml; p p 2; p = 0.01 and the maximal LA longitudinal diameter (55 ± 5 to 59 ± 6 mm; p p = 0.01 and LAFF (36 ± 7 to 33 ± 8%; p = 0.03 had decreased. In contrast, after successful cryoballoon ablation LA size had not increased and LA function had not declined. In the recurrent group LAEF was significantly lower at baseline and at follow-up visits. Conclusions In patients whose paroxysmal atrial fibrillation recurred within one year after cryoballoon catheter ablation left atrial size had increased and left atrial function had declined. In contrast, successful cryoballoon catheter ablation prevented progressive left atrial remodeling.

  18. Pulmonary ablation: a primer.

    Science.gov (United States)

    Roberton, Benjamin J; Liu, David; Power, Mark; Wan, John M C; Stuart, Sam; Klass, Darren; Yee, John

    2014-05-01

    Percutaneous image-guided thermal ablation is safe and efficacious in achieving local control and improving outcome in the treatment of both early stage non-small-cell lung cancer and pulmonary metastatic disease, in which surgical treatment is precluded by comorbidity, poor cardiorespiratory reserve, or unfavorable disease distribution. Radiofrequency ablation is the most established technology, but new thermal ablation technologies such as microwave ablation and cryoablation may offer some advantages. The use of advanced techniques, such as induced pneumothorax and the popsicle stick technique, or combining thermal ablation with radiotherapy, widens the treatment options available to the multidisciplinary team. The intent of this article is to provide the reader with a practical knowledge base of pulmonary ablation by concentrating on indications, techniques, and follow-up. Copyright © 2014 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

  19. Spanish Visit

    CERN Multimedia

    2004-01-01

    On 23 January, CERN welcomed a visit by Pedro Morenés Eulate, Spanish Secretary of State for Scientific and Technological Policy. He was taken on a tour of the LHC Superconducting test facility, the CMS magnet assembly hall and the civil engineering works at Point 5. After a brief presentation on the AMS (Alpha Magnetic Spectrometer) experiment, delivered by Sam Ting, and lunch hosted by Director General Robert Aymar, he continued his tour of the ATLAS assembly hall and the ISOLDE experimental hall. Pedro Morenés finished his visit by meeting with the Spanish scientific community working at CERN. From left to right: Juan-Antonio Rubio, CERN, Responsible for the Education & Communication, Technology transfer and Scientific Information groups; Gonzalo León, General Secretary of the Spanish Ministry; Joaquín Pérez-Villanueva y Tovar, Ambassador, Permanent Representative of Spain to the United Nations Office; Robert Aymar, CERN Director General; Maria-José Garcia-Borge, ISOLDE and NTOF, CSIC Madrid Tea...

  20. Laser ablation of a biliary duct for treatment of a persistent biliary-cutaneous fistula.

    Science.gov (United States)

    Eicher, Chad A; Adelson, Anthony B; Himmelberg, Jeffrey A; Chintalapudi, Udaya

    2008-02-01

    A persistent biliary-cutaneous fistula detected after biliary drainage catheter removal could not be resolved with diversionary techniques and Gelfoam and fibrin glue administration in the fistulous tract. As an alternative approach for treatment of the fistula, obliteration of the contributing bile duct with laser ablation was performed.

  1. Efficacy and Safety of Atrial Fibrillation Ablation Using Remote Magnetic Navigation

    DEFF Research Database (Denmark)

    Jin, Q I; Pehrson, Steen; Jacobsen, Peter Karl

    2016-01-01

    BACKGROUND: The objective of this study was to assess the procedural outcomes of catheter ablation guided by remote magnetic navigation (RMN) in a large cohort of patients with paroxysmal trial fibrillation (PAF) and persistent AF (PerAF). METHODS: A total of 726 patients (547 male, age: 58.5 ± 10...

  2. Thulium fiber laser recanalization of occluded ventricular catheters in an ex vivo tissue model

    Science.gov (United States)

    Hutchens, Thomas C.; Gonzalez, David A.; Hardy, Luke A.; McLanahan, C. Scott; Fried, Nathaniel M.

    2017-04-01

    Hydrocephalus is a chronic medical condition that occurs in individuals who are unable to reabsorb cerebrospinal fluid (CSF) created within the ventricles of the brain. Treatment requires excess CSF to be diverted from the ventricles to another part of the body, where it can be returned to the vascular system via a shunt system beginning with a catheter within the ventricle. Catheter failures due to occlusion by brain tissues commonly occur and require surgical replacement of the catheter. In this preliminary study, minimally invasive clearance of occlusions is explored using an experimental thulium fiber laser (TFL), with comparison to a conventional holmium: yttrium aluminium garnet (YAG) laser. The TFL utilizes smaller optical fibers (450-μm OD), providing critical extra cross-sectional space within the 1.2-mm-inner-diameter ventricular catheter for simultaneous application of an endoscope for image guidance and a saline irrigation tube for visibility and safety. TFL ablation rates using 100-μm core fiber, 33-mJ pulse energy, 500-μs pulse duration, and 20- to 200-Hz pulse rates were compared to holmium laser using a 270-μm core fiber, 325-mJ, 300-μs, and 10 Hz. A tissue occluded catheter model was prepared using coagulated egg white within clear silicone tubing. An optimal TFL pulse rate of 50 Hz was determined, with an ablation rate of 150 μm/s and temperature rise outside the catheter of ˜10°C. High-speed camera images were used to explore the mechanism for removal of occlusions. Image guidance using a miniature, 0.7-mm outer diameter, 10,000 pixel endoscope was explored to improve procedure safety. With further development, simultaneous application of TFL with small fibers, miniature endoscope for image guidance, and irrigation tube for removal of tissue debris may provide a safe, efficient, and minimally invasive method of clearing occluded catheters in the treatment of hydrocephalus.

  3. 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.

  4. Real-time magnetic resonance imaging-guided radiofrequency atrial ablation and visualization of lesion formation at 3 Tesla.

    Science.gov (United States)

    Vergara, Gaston R; Vijayakumar, Sathya; Kholmovski, Eugene G; Blauer, Joshua J E; Guttman, Mike A; Gloschat, Christopher; Payne, Gene; Vij, Kamal; Akoum, Nazem W; Daccarett, Marcos; McGann, Christopher J; Macleod, Rob S; Marrouche, Nassir F

    2011-02-01

    Magnetic resonance imaging (MRI) allows visualization of location and extent of radiofrequency (RF) ablation lesion, myocardial scar formation, and real-time (RT) assessment of lesion formation. In this study, we report a novel 3-Tesla RT -RI based porcine RF ablation model and visualization of lesion formation in the atrium during RF energy delivery. The purpose of this study was to develop a 3-Tesla RT MRI-based catheter ablation and lesion visualization system. RF energy was delivered to six pigs under RT MRI guidance. A novel MRI-compatible mapping and ablation catheter was used. Under RT MRI, this catheter was safely guided and positioned within either the left or right atrium. Unipolar and bipolar electrograms were recorded. The catheter tip-tissue interface was visualized with a T1-weighted gradient echo sequence. RF energy was then delivered in a power-controlled fashion. Myocardial changes and lesion formation were visualized with a T2-weighted (T2W) half Fourier acquisition with single-shot turbo spin echo (HASTE) sequence during ablation. RT visualization of lesion formation was achieved in 30% of the ablations performed. In the other cases, either the lesion was formed outside the imaged region (25%) or the lesion was not created (45%) presumably due to poor tissue-catheter tip contact. The presence of lesions was confirmed by late gadolinium enhancement MRI and macroscopic tissue examination. MRI-compatible catheters can be navigated and RF energy safely delivered under 3-Tesla RT MRI guidance. Recording electrograms during RT imaging also is feasible. RT visualization of lesion as it forms during RF energy delivery is possible and was demonstrated using T2W HASTE imaging. Copyright © 2011 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  5. Novel Mapping Strategies for Ventricular Tachycardia Ablation.

    Science.gov (United States)

    Aziz, Zaid; Tung, Roderick

    2018-03-23

    Despite advances in antiarrhythmic and device therapy, ventricular tachycardia (VT) continues to be a major cause of increased morbidity and mortality. During scar-mediated monomorphic ventricular tachycardia ablation, the search for critical isthmus sites continues to be the primary goal during successful ablative procedures. However, given the overwhelming hemodynamic instability of most ventricular arrhythmias (> 70%), VT ablation is increasingly performed during sinus rhythm. This technique requires either a greater reliance on isthmus surrogates, or more extensive ablation techniques and is a more probabilistic approach to substrate modification. We believe that a better understanding of scar physiology and activation during sinus rhythm has important implications for clinical workflow and mechanistic improvements with current ablation strategies. With advancements in high-density mapping and multi-electrode catheter technology, mapping of VT substrates is performed with higher resolution, with improved visualization of local abnormal ventricular activities (LAVA), and with a more nuanced functional understanding of late potentials. As a prerequisite, our practice for VT ablation starts with a high-density structural map to identify voltage abnormalities as well as an isochronal functional map of sinus rhythm activation to identify region of discontinuous wavefront propagation. As the era of increased automation has emerged, there continues to be vast array of customizable features, and we have adopted the use of multiple wavefront mapping to further elucidate possible arrhythmogenic substrate. Our emerging understanding of how scar propagation patterns relate to areas of abnormal signals and critical isthmuses may greatly improve the ability to identify surrogates during sinus rhythm and help localize the most arrhythmogenic regions within a given scar. In the hemodynamically unstable patients, we routinely integrate isochronal late activation mapping (ILAM

  6. Colonization of peripheral intravascular catheters with biofilm ...

    African Journals Online (AJOL)

    Background: Biofilms often colonize catheters and contribute to catheter-related septicemia. However, predictors of catheter colonization by biofilms remain poorly defined. The aim of this study was to evaluate clinical factors that may be associated with biofilm colonization of catheters. Materials and Methods: A total of 54 ...

  7. Optimization of the generator settings for endobiliary radiofrequency ablation.

    Science.gov (United States)

    Barret, Maximilien; Leblanc, Sarah; Vienne, Ariane; Rouquette, Alexandre; Beuvon, Frederic; Chaussade, Stanislas; Prat, Frederic

    2015-11-10

    To determine the optimal generator settings for endobiliary radiofrequency ablation. 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. 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). 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.

  8. Ablation lesions in Koch's triangle assessed by three-dimensional myocardial contrast echocardiography

    Directory of Open Access Journals (Sweden)

    Cate Folkert

    2004-12-01

    Full Text Available Abstract Background Myocardial contrast echocardiography (MCE allows visualization of radiofrequency (RF ablation lesions in the left ventricle in an animal model. Aim: To test whether MCE allows visualization of RF and cryo ablation lesions in the human right atrium using three-dimensional echocardiography. Methods 18 patients underwent catheter ablation of a supraventricular tachycardia and were included in this prospective single-blind study. Twelve patients were ablated inside Koch's triangle and 6, who served as controls, outside this area. Three-dimensional echocardiography of Koch's triangle was performed before and after the ablation procedure in all patients, using respiration and ECG gated pullback of a 9 MHz ICE transducer, with and without continuous intravenous echocontrast infusion (SonoVue, Bracco. Two independent observers analyzed the data off-line. Results MCE identified ablation lesions as a low contrast area within the normal atrial myocardial tissue. Craters on the endocardial surface were seen in 10 (83% patients after ablation. Lesions were identified in 11 out of 12 patients (92%. None of the control patients were recognized as having been ablated. The confidence score of the independent echo reviewer tended to be higher when the number of applications increased. Conclusions 1. MCE allows direct visualization of ablation lesions in the human atrial myocardium. 2. Both RF and cryo energy lesions can be identified using MCE.

  9. Novel automated point collection software facilitates rapid, high-density electroanatomical mapping with multiple catheter types.

    Science.gov (United States)

    Ptaszek, Leon M; Moon, Boyce; Rozen, Guy; Mahapatra, Srijoy; Mansour, Moussa

    2018-01-01

    Manual, point-by-point electroanatomical mapping requires the operator to directly evaluate each point during map construction. Consequently, point collection can be a slow process. An automated 3D mapping system was developed with the goal of improving key mapping metrics, including map completion time and point density. Automated 3D mapping software that includes morphology and cycle length discrimination functions for surface and intracardiac electrograms was developed. In five swine, electroanatomical maps (EAMs) of all four cardiac chambers were generated in sinus rhythm. Four catheters were used: two different four-pole ablation catheters, a 20-pole circular catheter, and a 64-pole basket catheter. Automated and manual 3D mapping were compared for 12 different catheter-chamber combinations (paired sets of 10 maps for most combinations, for a total of 156 maps). Automated 3D mapping produced more than twofold increase in the number of points per map, as compared with manual 3D mapping (P ≤0.007 for all catheter-chamber combinations tested). Automated 3D mapping also reduced map completion time by an average of 29% (P software described in this study is significantly faster than manual, point-by-point 3D mapping. This resulted in shorter mapping time and higher point density. The morphology discrimination functions effectively excluded ectopic beats during mapping in sinus rhythm and allowed for rapid mapping of intermittent ventricular ectopic beats. © 2017 Wiley Periodicals, Inc.

  10. Peripherally inserted central catheter - insertion

    Science.gov (United States)

    PICC - insertion ... A PICC is a long, thin tube (called a catheter) that goes into your body through a vein in ... into a large vein near your heart. The PICC helps carry nutrients and medicines into your body. ...

  11. Percutaneously inserted central catheter - infants

    Science.gov (United States)

    PICC - infants; PQC - infants; Pic line - infants; Per-Q cath - infants ... A percutaneously inserted central catheter (PICC) is a long, very thin, soft plastic tube that is put into a small blood vessel. This article addresses PICCs in ...

  12. Endovascular Radiofrequency Ablation for Varicose Veins

    Science.gov (United States)

    2011-01-01

    or worse as other chronic diseases such as back pain and arthritis. Lower limb VV is a very common disease affecting adults – estimated to be the 7th most common reason for physician referral in the US. There is a very strong familial predisposition to VV. The risk in offspring is 90% if both parents affected, 20% when neither affected and 45% (25% boys, 62% girls) if one parent affected. The prevalence of VV worldwide ranges from 5% to 15% among men and 3% to 29% among women varying by the age, gender and ethnicity of the study population, survey methods and disease definition and measurement. The annual incidence of VV estimated from the Framingham Study was reported to be 2.6% among women and 1.9% among men and did not vary within the age range (40-89 years) studied. Approximately 1% of the adult population has a stasis ulcer of venous origin at any one time with 4% at risk. The majority of leg ulcer patients are elderly with simple superficial vein reflux. Stasis ulcers are often lengthy medical problems and can last for several years and, despite effective compression therapy and multilayer bandaging are associated with high recurrence rates. Recent trials involving surgical treatment of superficial vein reflux have resulted in healing and significantly reduced recurrence rates. Endovascular Radiofrequency Ablation for Varicose Veins RFA is an image-guided minimally invasive treatment alternative to surgical stripping of superficial venous reflux. RFA does not require an operating room or general anaesthesia and has been performed in an outpatient setting by a variety of medical specialties including surgeons and interventional radiologists. Rather than surgically removing the vein, RFA works by destroying or ablating the refluxing vein segment using thermal energy delivered through a radiofrequency catheter. Prior to performing RFA, color-flow Doppler ultrasonography is used to confirm and map all areas of venous reflux to devise a safe and effective

  13. Safety and efficacy of pulmonary vein isolation using a surround flow catheter with contact force measurement capabilities: A multicenter registry.

    Science.gov (United States)

    Stabile, Giuseppe; Di Donna, Paolo; Schillaci, Vincenzo; Di Monaco, Antonio; Iuliano, Assunta; Caponi, Domenico; Urraro, Francesco; Solimene, Francesco; Grimaldi, Massimo; Scaglione, Marco

    2017-07-01

    Pulmonary vein (PV) isolation is the cornerstone of catheter ablation in patients with atrial fibrillation (AF). Surround flow and contact force (CF) measurement capabilities might enhance procedure efficacy and safety. We report on the safety and midterm efficacy of a novel ablation catheter for PV isolation in patients with AF. Two hundred thirty-three consecutive patients (57 ± 11 years, 76% males, 51% with structural heart disease), referred for paroxysmal (157) or persistent (76) AF, underwent PV isolation by a surround flow catheter with CF measurement capability in four centers. Ablation was guided by electroanatomic mapping allowing radiofrequency (RF) energy delivery in the antral region aiming at PV isolation. Mean overall procedure time was 100 ± 42 minutes with a mean fluoroscopy time of 6 ± 5 minutes. Mean ablation time was 31±15 minutes; 99% of the targeted veins were isolated. The mean CF value during ablation was 13 ± 4 g. Intraprocedural early (30 minutes) PV reconnection occurred in 12% PVs, and all PVs were effectively reisolated. One pericardial effusion and five groin hematomas were reported. During a mean follow-up of 12 ± 6 months, 30 (12.9%) (10% paroxysmal AF vs. 18% persistent AF, P = 0.07) patients had an atrial arrhythmias recurrence. In this multicenter registry, RF ablation using a new surround flow catheter, with CF sensor, resulted as feasible, achieving a high rate of isolated PVs. Procedural and fluoroscopy times and success rates were comparable with other techniques with a low complication rate. © 2017 Wiley Periodicals, Inc.

  14. Orthogonal electrode catheter array for mapping of endocardial focal site of ventricular activation

    Energy Technology Data Exchange (ETDEWEB)

    Desai, J.M.; Nyo, H.; Vera, Z.; Seibert, J.A.; Vogelsang, P.J. (Division of Cardiovascular Medicine, University of California, School of Medicine, Davis (USA))

    1991-04-01

    Precise location of the endocardial site of origin of ventricular tachycardia may facilitate surgical and catheter ablation of this arrhythmia. The endocardial catheter mapping technique can locate the site of ventricular tachycardia within 4-8 cm2 of the earliest site recorded by the catheter. This report describes an orthogonal electrode catheter array (OECA) for mapping and radiofrequency ablation (RFA) of endocardial focal site of origin of a plunge electrode paced model of ventricular activation in dogs. The OECA is an 8 F five pole catheter with four peripheral electrodes and one central electrode (total surface area 0.8 cm{sup 2}). In eight mongrel dogs, mapping was performed by arbitrarily dividing the left ventricle (LV) into four segments. Each segment was mapped with OECA to find the earliest segment. Bipolar and unipolar electrograms were obtained. The plunge electrode (not visible on fluoroscopy) site was identified by the earliest wave front arrival times of -30 msec or earlier at two or more electrodes (unipolar electrograms) with reference to the earliest recorded surface ECG (I, AVF, and V1). Validation of the proximity of the five electrodes of the OECA to the plunge electrode was performed by digital radiography and RFA. Pathological examination was performed to document the proximity of the OECA to the plunge electrode and also for the width, depth, and microscopic changes of the ablation. To find the segment with the earliest LV activation a total of 10 {plus minus} 3 (mean {plus minus} SD) positions were mapped. Mean arrival times at the two earlier electrodes were -39 {plus minus} 4 msec and -35 {plus minus} 3 msec. Digital radiography showed the plunge electrode to be within the area covered by all five electrodes in all eight dogs. The plunge electrode was within 1 cm2 area of the region of RFA in all eight dogs.

  15. 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.

  16. Counterclockwise heart rotation affects variation in successful ablation line position in common atrial flutter.

    Science.gov (United States)

    Machino, Takeshi; Tada, Hiroshi; Sekiguchi, Yukio; Naruse, Yoshihisa; Kuroki, Kenji; Yamasaki, Hiro; Igarashi, Miyako; Yoshida, Kentaro; Nogami, Akihiko; Aonuma, Kazutaka

    2014-01-01

     Linear ablation of atrial flutter usually targets a 6 o'clock position on the cavotricuspid isthmus on left anterior oblique view, but the difficulty of the ablation often requires a variation in successful ablation line position from 5 to 7 o'clock.  This study included 94 patients without structural heart disease. A linear lesion was created in turn at the 6, 7, and 5 o'clock positions until bidirectional block of the isthmus was completed; the final lesion was defined as the successful ablation line. The degree of counterclockwise heart rotation (CCW-HR) was evaluated in a blinded fashion according to the angle between the vertical line crossing the His bundle catheter and the line connecting the His bundle catheter and coronary sinus ostium. Successful ablation lines were obtained at the 6 o'clock position in 59 patients (63%); the 7 o'clock position in 19 patients (20%; the oldest group with a moderate radiofrequency burden); and the 5 o'clock position in the remaining 16 (17%; the youngest group with the largest radiofrequency burden). Age-related increase in CCW-HR was the only independent predictor of a more septal successful ablation line (OR, 7.1; 95% CI: 3.3-14.3; Paffected by age-related CCW-HR; its evaluation might reduce radiofrequency burden, especially in the young and elderly.  

  17. Intracorporeal knotting of a femoral nerve catheter

    Directory of Open Access Journals (Sweden)

    Ghanem, Mohamed

    2015-01-01

    Full Text Available Peripheral nerve catheters are effective and well-established tools to provide postoperative analgesia to patients undergoing orthopedic surgery. The performance of these techniques is usually considered safe. However, placement of nerve catheters may be associated with a considerable number of side effects and major complications have repeatedly been published. In this work, we report on a patient who underwent total knee replacement with spinal anesthesia and preoperative insertion of femoral and sciatic nerve catheters for postoperative analgesia. During insertion of the femoral catheter, significant resistance was encountered upon retracting the catheter. This occurred due to knotting of the catheter. The catheter had to be removed by operative intervention which has to be considered a major complication. The postoperative course was uneventful. The principles for removal of entrapped peripheral catheters are not well established, may differ from those for neuroaxial catheters, and range from cautious manipulation up to surgical intervention.

  18. Atrial Fibrillation Ablation Guided by a Novel Nonfluoroscopic Navigation System.

    Science.gov (United States)

    Ballesteros, Gabriel; Ramos, Pablo; Neglia, Renzo; Menéndez, Diego; García-Bolao, Ignacio

    2017-09-01

    Rhythmia is a new nonfluoroscopic navigation system that is able to create high-density electroanatomic maps. The aim of this study was to describe the acute outcomes of atrial fibrillation (AF) ablation guided by this system, to analyze the volume provided by its electroanatomic map, and to describe its ability to locate pulmonary vein (PV) reconnection gaps in redo procedures. This observational study included 62 patients who underwent AF ablation with Rhythmia compared with a retrospective cohort who underwent AF ablation with a conventional nonfluoroscopic navigation system (Ensite Velocity). The number of surface electrograms per map was significantly higher in Rhythmia procedures (12 125 ± 2826 vs 133 ± 21 with Velocity; P < .001), with no significant differences in the total procedure time. The Orion catheter was placed for mapping in 99.5% of PV (95.61% in the control group with a conventional circular mapping catheter; P = .04). There were no significant differences in the percentage of PV isolation between the 2 groups. In redo procedures, an ablation gap could be identified on the activation map in 67% of the reconnected PV (40% in the control group; P = .042). The measured left atrial volume was lower than that calculated by computed tomography (109.3 v 15.2 and 129.9 ± 13.2 mL, respectively; P < .001). There were no significant differences in the number of complications. The Rhythmia system is effective for AF ablation procedures, with procedure times and safety profiles similar to conventional nonfluoroscopic navigation systems. In redo procedures, it appears to be more effective in identifying reconnected PV conduction gaps. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  19. Lesion size in relation to ablation site during radiofrequency ablation

    DEFF Research Database (Denmark)

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

    1998-01-01

    This study was designed to investigate the effect of the convective cooling of the tip of the ablation electrode during temperature controlled radiofrequency ablation. In vivo two different application sites in the left ventricle of anaesthetised pigs were ablated and in vitro ablation was perfor......This study was designed to investigate the effect of the convective cooling of the tip of the ablation electrode during temperature controlled radiofrequency ablation. In vivo two different application sites in the left ventricle of anaesthetised pigs were ablated and in vitro ablation.......61 in vitro). We conclude that during temperature controlled radiofrequency ablation lesion size differs for septal and apical left ventricular applications. Differences in convective cooling might play an important role in this respect. This is supported by our in vitro experiments, where increased...

  20. Temperature Controlled Radiofrequency Ablation

    Directory of Open Access Journals (Sweden)

    Olaf J. Eick

    2002-07-01

    Full Text Available Since its introduction in 1987, radiofrequency (RF ablation has developed to become the treatment of choice for symptoms caused by atrio ventricular (AV reentrant tachycardia, isthmus related atrial flutter, AV-nodal reentrant tachycardia and to some extent also for certain types of ventricular tachycardias. The introduction of new cardiac activation mapping systems has further contributed to the successful and safe application of RF ablation for various tachyarrhythmias.

  1. Malfunctioning and infected tunneled infusion catheters: over-the-wire catheter exchange versus catheter removal and replacement.

    Science.gov (United States)

    Guttmann, David M; Trerotola, Scott O; Clark, Timothy W; Dagli, Mandeep; Shlansky-Goldberg, Richard D; Itkin, Maxim; Soulen, Michael C; Mondschein, Jeffrey I; Stavropoulos, S William

    2011-05-01

    To compare the safety and effectiveness of over-the-wire catheter exchange (catheter-exchange) with catheter removal and replacement (removal-replacement) at a new site for infected or malfunctioning tunneled infusion catheters. Using a quality assurance database, 61 patients with tunneled infusion catheters placed during the period July 2001 to June 2009 were included in this study. Patients receiving hemodialysis catheters were excluded. Catheter-exchange was performed in 25 patients, and same-day removal-replacement was performed in 36 patients. Data collected included demographic information, indication for initial catheter placement and replacement, dwell time for the new catheter, and ultimate fate of the new device. Statistical comparisons between the two cohorts were analyzed using the Kaplan-Meier technique and Fisher exact test. Catheters exchanged over the wire remained functional without infection for a median of 102 days (range, 2-570 days), whereas catheters removed and replaced were functional for a median 238 days (range, 1-292 days, P = .12). After catheter replacement, there were 11 instances of subsequent infection in the catheter-exchange group and 7 instances in the removal-replacement cohort, accounting for infection rates of 4.4 and 2.3 per 1,000 catheter days (P = .049). Patients in the catheter-exchange group had 3.2 greater odds of infection compared with patients in the removal-replacement group. Five malfunction events occurred in each group, accounting for 2.0 and 1.7 malfunctions per 1,000 catheter days in the catheter-exchange and removal-replacement groups (P = .73). Catheter-exchange of tunneled infusion catheters results in a higher infection rate compared with removal-replacement at a new site. The rate of catheter malfunction is not significantly different between the two groups. Catheter-exchange is an alternative for patients with tunneled infusion catheters who have limited venous access, but this technique should not be

  2. Is a project needed to prevent urinary tract infection in patients admitted to spanish ICUs?

    Science.gov (United States)

    Álvarez Lerma, F; Olaechea Astigarraga, P; Nuvials, X; Gimeno, R; Catalán, M; Gracia Arnillas, M P; Seijas Betolaza, I; Palomar Martínez, M

    2018-02-06

    To analyze epidemiological data of catheter-associated urinary tract infection (CAUTI) in critically ill patients admitted to Spanish ICUs in order to assess the need of implementing a nationwide intervention program to reduce these infections. Non-intervention retrospective annual period prevalence analysis. Participating ICUs in the ENVIN-UCI multicenter registry between the years 2007-2016. Critically ill patients admitted to the ICU with catheter-associated urinary tract infection (CAUTI). Incidence rates per 1,000 catheter-days; urinary catheter utilization ratio; proportion of CAUTIs in relation to total health care-associated infections (HAIs). A total of 187,100 patients, 137,654 (73.6%) of whom had a urinary catheter in place during 1,215,673 days (84% of days of ICU stay) were included. In 4,539 (3.3%) patients with urinary catheter, 4,977 CAUTIs were diagnosed (3.6 episodes per 100 patients with urinary catheter). The CAUTI incidence rate showed a 19% decrease between 2007 and 2016 (4.69 to 3.8 episodes per 1,000 catheter-days), although a sustained urinary catheter utilization ratio was observed (0.84 [0.82-0.86]). The proportion of CAUTI increased from 23.3% to 31.9% of all HAIs controlled in the ICU. Although CAUTI rates have declined in recent years, these infections have become proportionally the first HAIs in the ICU. The urinary catheter utilization ratio remains high in Spanish ICUs. There is room for improvement, so that a CAUTI-ZERO project in our country could be useful. Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  3. Translumbar aortography by catheter technique

    International Nuclear Information System (INIS)

    Hagen, B.; Honemeyer, U.; Meier-Duis, H.

    1982-01-01

    400 examinations performed during the last three years by TLA (only catheter technique) were subjected to critical analysis and studied particularly in respect to the rate of complications. We observed 13 complications (3.25%) of moderate severity, including 3 large hematomas (documented by CT), 3 paravasations and 7 dissections, but no fatal complication. Two (0.5%) of these complications had clinical evidence. The advantages of the catheter technique of TLA are described. Injections through rigid metal cannula should be avoided because of the high incidence of complications (mainly the increased risk of dissection). Downstream injection resulted in excellent visualization of peripheral occluding vascular disease. Upstream injection should be preferred to demonstrate the major abdominal arteries as well as supraceliac collateral circulation in the case of high Leriche syndrome. The low or intermediate puncture of the aorta is preferable to facilitate caudad direction of the catheter and to diminish the risk of damaging other vessels or puncturing an organ. (orig.) [de

  4. FACTORS AND COMPLICATIONS AFFECTING CATHETER AND TECHNIQUE SURVIVAL WITH PERMANENT SINGLE-LUMEN DIALYSIS CATHETERS

    NARCIS (Netherlands)

    DEMEESTER, J; VANHOLDER, R; DEROOSE, J; RINGOIR, S

    1994-01-01

    This long-term study on the outcome of permanent silicone single-lumen dialysis catheters consisted of 43 surgically inserted catheters in 33 patients. All catheters were attached to a pressure-pressure single-cannula dialysis system. Technique and catheter survival were 80 and 59% at 1 year, and 63

  5. Comparison of transcatheter laser and direct-current shock ablation of endocardium near tricuspid anulus

    Science.gov (United States)

    Zhang, Yu-Zhen; Wang, Shi-Wen; Li, Junheng

    1993-03-01

    Forty to eighty percent of the patients with accessory pathways (APs) manifest themselves by tachyarrhythmias. Many of these patients needed either life-long medical therapy or surgery. In order to avoid the discomfort and expenses in surgical procedures, closed chest percutaneous catheter ablation of APs became a potentially desirable therapeutic approach. Many investigations indicated that ablation of right APs by transcatheter direct current (dc) shock could cause life-threatening arrhythmias, right coronary arterical (RCA) spasm, etc. With the development of transcatheter laser technique, it has been used in drug-incurable arrhythmias. The results show that laser ablation is much safer than surgery and electric shock therapy. The purpose of this study is to explore the effectiveness, advantages, and complications with transcatheter Nd:YAG laser and dc shock in the ablation of right atrioventricular accessory pathways in the atrium near the tricuspid annulus (TA) in 20 dogs.

  6. Tracking the position and rotational orientation of a catheter using a transmit array system.

    Science.gov (United States)

    Celik, Haydar; Mahcicek, Davut I; Senel, Oytun K; Wright, Graham A; Atalar, Ergin

    2013-04-01

    A new method for detecting the rotational orientation and tracking the position of an inductively coupled radio frequency (ICRF) coil using a transmit array system is proposed. The method employs a conventional body birdcage coil, but the quadrature hybrid is eliminated so that the two excitation channels can be used separately. The transmit array system provides RF excitations such that the body birdcage coil creates linearly polarized and changing RF pulses instead of a conventional rotational forward-polarized excitation. The receive coils and their operations are not modified. Inductively coupled RF coils are constructed on catheters for detecting rotational orientation and for tracking purposes. Signals from the anatomy and from tissue close to the ICRF coil are different due to the new RF excitation scheme: the ICRF coil can be separated from the anatomy in real time, and after doing so, a color-coded image is reconstructed. More importantly, this novel method enables a real-time calculation of the absolute rotational orientation of an ICRF coil constructed on a catheter. Modified FLASH and TrueFISP sequences are used for the experiments. The acquired images from this technique show the feasibility of different applications, such as catheter tracking. Furthermore, applications where knowledge of the rotational orientation of the catheter is important, such as magnetic resonance-guided endoluminal-focused ultrasound, RF ablation, side-looking optical imaging, and catheters with side ports for needles, become feasible with this method.

  7. 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.

  8. Seeing the Invisible: Revealing Atrial Ablation Lesions Using Hyperspectral Imaging Approach.

    Science.gov (United States)

    Muselimyan, Narine; Swift, Luther M; Asfour, Huda; Chahbazian, Tigran; Mazhari, Ramesh; Mercader, Marco A; Sarvazyan, Narine A

    2016-01-01

    Currently, there are limited means for high-resolution monitoring of tissue injury during radiofrequency ablation procedures. To develop the next generation of visualization catheters that can reveal irreversible atrial muscle damage caused by ablation and identify viability gaps between the lesions. Radiofrequency lesions were placed on the endocardial surfaces of excised human and bovine atria and left ventricles of blood perfused rat hearts. Tissue was illuminated with 365nm light and a series of images were acquired from individual spectral bands within 420-720nm range. By extracting spectral profiles of individual pixels and spectral unmixing, the relative contribution of ablated and unablated spectra to each pixel was then displayed. Results of spectral unmixing were compared to lesion pathology. RF ablation caused significant changes in the tissue autofluorescence profile. The magnitude of these spectral changes in human left atrium was relatively small (gaps at clinically relevant locations. Data supports the possibility for developing percutaneous hyperspectral catheters for high-resolution ablation guidance.

  9. 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...

  10. Button self-retaining drainage catheter

    International Nuclear Information System (INIS)

    Caridi, James G.; Hawkins, Irvin F.; Akins, E. William; Young, Ronald S.

    1997-01-01

    To help improve patient acceptance of long-term internal/external catheter access to the biliary tract in those with benign biliary obstruction, a simple design allows the catheter end to remain flush with the skin. It consists of a clothes button affixed to the drainage catheter with a wood screw after the catheter has been cut off at the skin exit. This button/screw device has been used successfully in 22 patients over the last 10 years; catheter exchanges were easily accomplished

  11. Robotic positioning of standard electrophysiology catheters: a novel approach to catheter robotics.

    Science.gov (United States)

    Knight, Bradley; Ayers, Gregory M; Cohen, Todd J

    2008-05-01

    Robotic systems have been developed to manipulate and position electrophysiology (EP) catheters remotely. One limitation of existing systems is their requirement for specialized catheters or sheaths. We evaluated a system (Catheter Robotics Remote Catheter Manipulation System [RCMS], Catheter Robotics, Inc., Budd Lake, New Jersey) that manipulates conventional EP catheters placed through standard introducer sheaths. The remote controller functions much like the EP catheter handle, and the system permits repeated catheter disengagement for manual manipulation without requiring removal of the catheter from the body. This study tested the hypothesis that the RCMS would be able to safely and effectively position catheters at various intracardiac sites and obtain thresholds and electrograms similar to those obtained with manual catheter manipulation. Two identical 7 Fr catheters (Blazer II; Boston Scientific Corp., Natick, Massachusetts) were inserted into the right femoral veins of 6 mongrel dogs through separate, standard 7 Fr sheaths. The first catheter was manually placed at a right ventricular endocardial site. The second catheter handle was placed in the mating holder of the RCMS and moved to approximately the same site as the first catheter using the Catheter Robotics RCMS. The pacing threshold was determined for each catheter. This sequence was performed at 2 right atrial and 2 right ventricular sites. The distance between the manually and robotically placed catheters tips was measured, and pacing thresholds and His-bundle recordings were compared. The heart was inspected at necropsy for signs of cardiac perforation or injury. Compared to manual positioning, remote catheter placement produced the same pacing threshold at 7/24 sites, a lower threshold at 11/24 sites, and a higher threshold at only 6/24 sites (p > 0.05). The average distance between catheter tips was 0.46 +/- 0.32 cm (median 0.32, range 0.13-1.16 cm). There was no difference between right atrial

  12. For Spanish Readers.

    Science.gov (United States)

    Rivas, Yolanda

    1980-01-01

    Lists and annotates four picture books (three by classic Russian poets) that have been translated from Russian into Spanish, and two nonfiction books about handicapped children that have been translated from English to Spanish. (GT)

  13. Ablating the ventricular insertion of atrio-fascicular Mahaim fiber: what selection criteria should we use?

    Science.gov (United States)

    Ducceschi, Valentino; Vitale, Raffaele; Ottaviano, Luca; Sokola, Ewa Anna; Sangiuolo, Raffaele; Gregorio, Giovanni

    2009-09-01

    We reported a patient who underwent RF ablation of the distal insertion of an atrio-fascicular accessory pathway with decremental properties because of inability to map a suitable potential alongside the tricuspid annulus. Small, discrete potentials resembling those of purkinje fiber were found at right ventricular apex, all these potentials showed early activation during tachycardia preceding the QRS onset of various degrees. Pace mapping helped to localize the presumed main distal insertion of the atrio-fascicular AP in a region where a damage of the His-purkinje system may ensue. This case report describes catheter ablation of an atriofascicular accessory pathway by targeting its distal (ventricular) insertion site.

  14. Ablating the ventricular insertion of atrio-fascicular mahaim fiber: could be performed safely?

    Science.gov (United States)

    Ducceschi, Valentino; Vitale, Raffaele; Sokola, Ewa Anna; Ottaviano, Luca; Sangiuolo, Raffaele; Gregorio, Giovanni

    2009-01-01

    We report a patient who underwent radiofrequency ablation of the distal insertion of an atrio-fascicular accessory pathway with decremental properties because of inability to map a suitable potential alongside the tricuspid annulus. Small, discrete potentials resembling those of Purkinje fiber were found at right ventricular apex. All these potentials showed early activation during tachycardia preceding the QRS onset of various degree. Pace mapping helped to localize the presumed main distal insertion of the atrio-fascicular accessory pathway in a region where damage of the His-purkinje system may ensue. This case report describes catheter ablation of an atriofascicular accessory pathway by targeting its distal (ventricular) insertion site.

  15. Totally implantable catheter embolism: two related cases

    Directory of Open Access Journals (Sweden)

    Rodrigo Chaves Ribeiro

    Full Text Available CONTEXT AND OBJECTIVE: Long-term totally implantable catheters (e.g. Port-a-Cath® are frequently used for long-term venous access in children with cancer. The use of this type of catheter is associated with complications such as infection, extrusion, extravasation and thrombosis. Embolism of catheter fragments is a rare complication, but has potential for morbidity. The aim here was to report on two cases in which embolism of fragments of a long-term totally implantable catheter occurred. DESIGN AND SETTING: Case series study at Hospital do Servidor Público Estadual, São Paulo. METHODS: Retrospective review of catheter embolism in oncological pediatric patients with long-term totally implantable catheters. RESULTS: The first patient was a 3-year-old girl diagnosed with stage IV Wilms' tumor. Treatment was started with the introduction of a totally implantable catheter through the subclavian vein. At the time of removal, it was realized that the catheter had fractured inside the heart. An endovascular procedure was necessary to remove the fragment. The second case was a boy diagnosed with stage II Wilms' tumor at the age of two years. At the time of removal, it was noticed that the catheter had disconnected from the reservoir and an endovascular procedure was also necessary to remove the embolized catheter. CONCLUSION: Embolism of fragments of totally implantable catheters is a rare complication that needs to be recognized even in asymptomatic patients.

  16. Ablation of hypertrophic septum using radiofrequency energy: an alternative for gradient reduction in patient with hypertrophic obstructive cardiomyopathy?

    Science.gov (United States)

    Riedlbauchová, Lucie; Janoušek, Jan; Veselka, Josef

    2013-06-01

    Alcohol septal ablation and surgical myectomy represent accepted therapeutic options for treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy. Long-term experience with radiofrequency ablation of arrhythmogenic substrates raised a question if this technique might be effective for left ventricular outflow tract (LVOT) gradient reduction. We report on a 63-year-old patient with recurrence of symptoms 1 year after alcohol septal ablation (ASA) leading originally to a significant reduction of both symptoms and gradient. Due to a new increase of gradient in the LVOT up to 200 mm Hg with corresponding worsening of symptoms and due to refusal of surgical myectomy by the patient, endocardial radiofrequency ablation of the septal hypertrophy (ERASH) was indicated. Radiofrequency ablation was performed in the LVOT using irrigated-tip ablation catheter; the target site was identified using intracardiac echocardiography and electroanatomical CARTO mapping. ERASH caused an immediate gradient reduction due to hypokinesis of the ablated septum. At 2-month follow-up exam, significant clinical improvement was observed, together with persistent gradient reduction assessed with Doppler echocardiography. Echocardiography and magnetic resonance revealed persistent septal hypokinesis and slight thinning of the ablated region. Septal ablation using radiofrequency energy may be a promising alternative or adjunct to the treatment of hypertrophic obstructive cardiomyopathy. Intracardiac echocardiography and electroanatomical CARTO mapping enable exact lesion placement and preservation of atrioventricular conduction.

  17. Spanish nuclear industry

    International Nuclear Information System (INIS)

    1994-01-01

    In this book published to commemorate the twentieth anniversary of the Spanish Nuclear Society, it is included a report on the Spanish Nuclear Industry. The Spanish Companies and Organizations in nuclear world are: CIEMAT, Empresarios Agrupados, ENRESA, ENUSA, ENDESA, Grupo Iberdrola, LAINSA, INITEC AND TECNATOM. Activities, history and research programs of each of them are included

  18. Mortality, stroke, and heart failure in atrial fibrillation cohorts after ablation versus propensity-matched cohorts.

    Science.gov (United States)

    Jarman, Julian We; Hunter, Tina D; Hussain, Wajid; March, Jamie L; Wong, Tom; Markides, Vias

    2017-01-01

    We sought to determine from key clinical outcomes whether catheter ablation of atrial fibrillation (AF) is associated with increased survival. Using routinely collected hospital data, ablation patients were matched to two control cohorts using direct and propensity score methodology. Four thousand nine hundred ninety-one ablation patients were matched 1:1 with general AF controls without ablation. Five thousand four hundred seven ablation patients were similarly matched to controls who underwent cardioversion. We examined the rates of ischemic stroke or transient ischemic attack (stroke/TIA), heart failure hospitalization, and death. Matched populations had very similar comorbidity profiles, including nearly identical CHA 2 DS 2 -VASc risk distribution ( p =0.6948 and p =0.8152 vs general AF and cardioversion cohorts). Kaplan-Meier models showed increased survival after ablation for all outcomes compared with both control cohorts ( p vs general AF, p =0.0087 for stroke/TIA, p vs cardioversion). Cox regression models also showed improved survival after ablation for all outcomes compared with the general AF cohort (hazard ratio [HR]=0.4, 95% confidence interval [95% CI]: 0.3-0.6, p stroke/TIA; HR=0.4, 95% CI: 0.2-0.6, p stroke/TIA; HR=0.4, 95% CI: 0.3-0.6, p stroke/TIA, and heart failure compared with a matched general AF population and a matched population who underwent cardioversion. Potential confounding of outcomes was minimized by very tight cohort matching.

  19. Collateral findings during computed tomography scan for atrial fibrillation ablation: Let's take a look around.

    Science.gov (United States)

    Perna, Francesco; Casella, Michela; Narducci, Maria Lucia; Dello Russo, Antonio; Bencardino, Gianluigi; Pontone, Gianluca; Pelargonio, Gemma; Andreini, Daniele; Vitulano, Nicola; Pizzamiglio, Francesca; Conte, Edoardo; Crea, Filippo; Tondo, Claudio

    2016-04-26

    The growing number of atrial fibrillation catheter ablation procedures warranted the development of advanced cardiac mapping techniques, such as image integration between electroanatomical map and cardiac computed tomography. While scanning the chest before catheter ablation, it is frequent to detect cardiac and extracardiac collateral findings. Most collateral findings are promptly recognized as benign and do not require further attention. However, sometimes clinically relevant collateral findings are detected, which often warrant extra diagnostic examinations or even invasive procedure, and sometimes need to be followed-up over time. Even though reporting and further investigating collateral findings has not shown a clear survival benefit, almost all the working groups providing data on collateral findings reported some collateral findings eventually coming out to be malignancies, sometimes at an early stage. Therefore, there is currently no clear agreement about the right strategy to be followed.

  20. Seeing the Invisible: Revealing Atrial Ablation Lesions Using Hyperspectral Imaging Approach.

    Directory of Open Access Journals (Sweden)

    Narine Muselimyan

    Full Text Available Currently, there are limited means for high-resolution monitoring of tissue injury during radiofrequency ablation procedures.To develop the next generation of visualization catheters that can reveal irreversible atrial muscle damage caused by ablation and identify viability gaps between the lesions.Radiofrequency lesions were placed on the endocardial surfaces of excised human and bovine atria and left ventricles of blood perfused rat hearts. Tissue was illuminated with 365nm light and a series of images were acquired from individual spectral bands within 420-720nm range. By extracting spectral profiles of individual pixels and spectral unmixing, the relative contribution of ablated and unablated spectra to each pixel was then displayed. Results of spectral unmixing were compared to lesion pathology.RF ablation caused significant changes in the tissue autofluorescence profile. The magnitude of these spectral changes in human left atrium was relatively small (< 10% of peak fluorescence value, yet highly significant. Spectral unmixing of hyperspectral datasets enabled high spatial resolution, in-situ delineation of radiofrequency lesion boundaries without the need for exogenous markers. Lesion dimensions derived from hyperspectral imaging approach strongly correlated with histological outcomes. Presence of blood within the myocardium decreased the amplitude of the autofluorescence spectra while having minimal effect on their overall shapes. As a result, the ability of hyperspectral imaging to delineate ablation lesions in vivo was not affected.Hyperspectral imaging greatly increases the contrast between ablated and unablated tissue enabling visualization of viability gaps at clinically relevant locations. Data supports the possibility for developing percutaneous hyperspectral catheters for high-resolution ablation guidance.

  1. 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.

  2. A systematical analysis of in vivo contact forces on virtual catheter tip/tissue surface contact during cardiac mapping and intervention.

    Science.gov (United States)

    Okumura, Yasuo; Johnson, Susan B; Bunch, T Jared; Henz, Benhur D; O'Brien, Christine J; Packer, Douglas L

    2008-06-01

    While catheter tip/tissue contact has been shown to be an important determinant of ablative lesions in in vitro studies, the impact of contact on the outcomes of mapping and ablation in the intact heart has not been evaluated. Twelve dogs underwent atrial ablation guided by the Senesitrade mark robotic catheter remote control system. After intracardiac ultrasound (ICE) validation of contact force measured by an in-line mechanical sensor, the relationship between contact force and individual lesion formation was established during irrigated-tipped ablation (flow 17 mL/sec) at 15 watts for 30 seconds. Minimal contact by ICE correlated with force of 4.7 +/- 5.8 grams, consistent contact 9.9 +/- 8.6 grams and tissue tenting produced 25.0 +/- 14.0 grams. Conversely, catheter tip/tissue contact by ICE was predicted by contact force. A contact force of 10-20 and > or =20 grams generated full-thickness, larger volume ablative lesions than that created with <10 grams (98 +/- 69 and 89 +/- 70 mm(3) vs 40 +/- 42 mm(3), P < 0.05). Moderate (10 grams) and marked contact (15-20 grams) application produced 1.5 X greater electroanatomic map volumes that were seen with minimal contact (5 grams) (26 +/- 3 cm(3) vs 33 +/- 6, 39 +/- 3 cm(3), P < 0.05). The electroanatomic map/CT merge process was also more distorted when mapping was generated at moderate to marked contact force. This study shows that mapping and ablation using a robotic sheath guidance system are critically dependent on generated force. These findings suggest that ablative lesion size is optimized by the application of 10-20 grams of contact force, although mapping requires lower-force application to avoid image distortions.

  3. Fiberoptic Contact-Force Sensing Electrophysiological Catheters: How Precise Is the Technology?

    Science.gov (United States)

    Bourier, Felix; Gianni, Carola; Dare, Matthew; Deisenhofer, Isabel; Hessling, Gabriele; Reents, Tilko; Mohanty, Sanghamitra; Trivedi, Chintan; Natale, Andrea; Al-Ahmad, Amin

    2017-01-01

    Contact-force (CF) sensing catheters are increasingly used in electrophysiological procedures due to their efficacy and safety profile. As data about the accuracy of fiberoptic CF technology are scarce, we sought to quantify it using in vitro experiments. A force sensor was built with a flexible membrane to allow exact reference force measurements for each set of experiments. A TactiCath Quartz (TCQ) ablation catheter was brought in contact with the force sensor membrane in order to compare the TCQ force measurements to sensor reference force measurements. Measurements were performed at different tip angles (0°/perpendicular contact, 45°, 90°/parallel contact), with fluid irrigation, different degrees of catheter deflection, and using a sheath. The accuracy of the TCQ force measurements was 0.9 ± 0.9 g (0°), 0.8 ± 0.8 g (45°) and 1.2 ± 1.3 g (90°), 0.8 ± 0.7 g (irrigation), 0.8 ± 0.8 g (deflection), and 0.8 ± 0.9 g (sheath); this was not significantly different among all experimental conditions. The precision was ≤3.8%. CF measurements using a fiberoptic sensing technology show a high level of accuracy and precision, without being significantly influenced by tip angle, fluid irrigation, catheter deflection or use of a sheath. © 2016 Wiley Periodicals, Inc.

  4. Malposition of catheters during voiding cystourethrography

    Energy Technology Data Exchange (ETDEWEB)

    Rathaus, V.; Konen, O.; Shapiro, M. [Dept. of Diagnostic Imaging Sapir Medical Center, Kfar-Saba and Sackler Medical School, Tel Aviv University (Israel); Grunebaum, M. [Veteran Pediatric Radiologist, Kfar Saba (Israel)

    2001-04-01

    The aim of this study was to report catheter malposition during voiding cystourethrography. Eight hundred forty-three voiding cystourethrography (265 males and 578 females, aged 1 week to 12 years, mean age 2 years) were performed during a period of 4 years. The conventional standard procedure was applied. In 3 cases with passed history of urinary tract infection the catheter entered directly into the ureter. In all these cases the uretero-vesical reflux was present on the same side where the catheter entered. It appears that insertion of a catheter into the ureter is possible only in the presence of an anomaly or pathology at the vesicoureteric junction. (orig.)

  5. Impact of Voltage Mapping to Guide Whether to Perform Ablation of the Posterior Wall in Patients With Persistent Atrial Fibrillation.

    Science.gov (United States)

    Cutler, Michael J; Johnson, Jeremy; Abozguia, Khalid; Rowan, Shane; Lewis, William; Costantini, Otto; Natale, Andrea; Ziv, Ohad

    2016-01-01

    Fibrosis as a substrate for atrial fibrillation (AF) has been shown in numerous preclinical models. Voltage mapping enables in vivo assessment of scar in the left atrium (LA), which can be targeted with catheter ablation. We hypothesized that using the presence or absence of low voltage to guide ablation beyond pulmonary vein antral isolation (PVAI) will improve atrial arrhythmia (AF/AT)-free survival in persistent AF. Single-center retrospective analysis of 2 AF ablation strategies: (1) standard ablation (SA) versus (2) voltage-guided ablation (VGA). PVAI was performed in both groups. With SA, additional lesions beyond PVAI were performed at the discretion of the operator. With VGA, additional lesions to isolate the LA posterior wall were performed if voltage mapping of this region in sinus rhythm showed scar (LA voltage atrial size. Posterior wall ablation was performed in 57% of patient with SA compared to 42% with VGA. VGA ablation increased 1-year AF-/AT-free survival in patients when compared to SA (80% vs. 57%; P = 0.005). In a multivariate analysis, VGA was the only independent predictor of AF-/AT-free survival (hazard ratio of 0.30; P = 0.002). The presence of LA posterior wall scar may be an important ablation target in persistent AF. A prospective randomized trial is needed to confirm these data. © 2015 Wiley Periodicals, Inc.

  6. Spanish dialects: phonetic transcription

    OpenAIRE

    Moreno Bilbao, M. Asunción; Mariño Acebal, José Bernardo

    1998-01-01

    It is well known that canonical Spanish, the dialectal variant `central' of Spain, so called Castilian, can be transcribed by rules. This paper deals with the automatic grapheme to phoneme transcription rules in several Spanish dialects from Latin America. Spanish is a language spoken by more than 300 million people, has an important geographical dispersion compared among other languages and has been historically influenced by many native languages. In this paper authors expand the Castilian ...

  7. Field enhancement induced laser ablation

    DEFF Research Database (Denmark)

    Fiutowski, Jacek; Maibohm, Christian; Kjelstrup-Hansen, Jakob

    Sub-diffraction spatially resolved, quantitative mapping of strongly localized field intensity enhancement on gold nanostructures via laser ablation of polymer thin films is reported. Illumination using a femtosecond laser scanning microscope excites surface plasmons in the nanostructures....... The accompanying field enhancement substantially lowers the ablation threshold of the polymer film and thus creates local ablation spots and corresponding topographic modifications of the polymer film. Such modifications are quantified straightforwardly via scanning electron and atomic force microscopy. Thickness...

  8. 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.

  9. Pulmonary vein ostium shape and orientation as possible predictors of occlusion in patients with drug-refractory paroxysmal atrial fibrillation undergoing cryoballoon ablation

    NARCIS (Netherlands)

    Sorgente, A.; Chierchia, G.B.; Asmundis, C. de; Sarkozy, A.; Namdar, M.; Capulzini, L.; Yazaki, Y.; Muller-Burri, S.A.; Bayrak, F.; Brugada, P.

    2011-01-01

    AIMS: No specific data are available on the influence of pulmonary vein (PV) anatomy and shape on cryoballoon ablation (CA) catheter efficacy in delivering cryothermal energy and, consequently, in obtaining PV isolation. METHODS AND RESULTS: Among a larger series of patients (68) with

  10. What Is the Appropriate Lesion Set for Ablation in Patients with Persistent Atrial Fibrillation?

    Science.gov (United States)

    Romero, Jorge; Gianni, Carola; Natale, Andrea; Di Biase, Luigi

    2017-05-01

    Special attention must be paid to detect, diagnose, and optimize management of reversible or treatable causes of long-standing persistent atrial fibrillation (LSPAF) such as obesity, obstructive sleep apnea (OSA), hypertension, hypo or hyperthyroidism, inflammatory and infectious diseases, and stress. Though, we strongly believe that the role of the pulmonary veins (PVs) is more pronounced in paroxysmal atrial fibrillation (AF) than in persistent AF, performing an adequate pulmonary vein isolation is still key in LSPAF. Patients with LSPAF will frequently require a more aggressive mapping and ablative approach. We do not encourage the use of empiric lines or complex fractionated atrial electrograms. Ablation of sites associated with non-PV triggers such as the entire posterior wall, the roof, the anterior part of the left atrium septum, left atrial appendage (LAA), the CS and SVC has been shown to improve the freedom from AF at follow-up when combined with PVs isolation. During the isoproterenol challenge, non-PV triggers are detected in most patients with AF. Mapping non-PV triggers is guided by multiple catheters positioned along both the right and left atriums: a 10-pole circular mapping catheter in the left superior PV recording the far-field LAA activity, the ablation catheter in the right superior PV that records the far-field interatrial septum and a 20-pole catheter with electrodes spanning from the SVC to the CS. With this simple catheter setup, when focal ectopic atrial activity is observed (a single ectopic beat is enough) their activation sequence is compared to that of sinus rhythm, allowing to quickly identify their area of origin. For significant non-PV triggers (repetitive isolated beats, focal atrial tachycardias or beats triggering AF/atrial flutter, a more detailed activation mapping is performed in the area of origin. They are subsequently targeted with focal ablation, exception being the triggers originating from the SVC, LAA or CS, in which

  11. Standardizing umbilical catheter usage in preterm infants.

    Science.gov (United States)

    Shahid, Shaneela; Dutta, Sourabh; Symington, Amanda; Shivananda, Sandesh

    2014-06-01

    Absence of guidelines on umbilical arterial catheter (UAC) and umbilical venous catheter (UVC) use and inability to predict the hospital course may sway the frontline staff to overuse umbilical catheters in preterm infants. Our objective was to evaluate the feasibility of implementing guidelines standardizing the use of umbilical catheters and its impact on the incidence of sepsis and resource use. All inborn infants delivered at <33 weeks' gestation and admitted to the NICU were included in this quality improvement study. The primary outcome was proportion of infants receiving umbilical catheters. Secondary outcomes were central venous catheter (CVC) use and central line-associated bloodstream infection (CLABSI). The proportion of infants receiving UACs and UVCs was significantly lower in postintervention (sustainment) phase than in the preintervention phase (93 [42.3%] vs 52 [23.6%], P = .0001) and (137 [62.6%] vs 93 [42.3%], P = .0001), respectively. There was no corresponding increase in the proportion of infants receiving peripherally inserted central catheters (PICCs) or surgical CVCs (SCVCs) during the sustainment phase. There was a significant reduction in the proportion of infants receiving CVCs (UVC, PICC, and SCVC) in the sustainment phase. The incidence of CLABSI was similar in the preintervention and sustainment phases. Implementation of guidelines standardizing the use of umbilical catheters in the NICU is feasible. Fewer infants were exposed to the risk of UVC or UAC, and fewer resources were used. Copyright © 2014 by the American Academy of Pediatrics.

  12. Urethral catheters: can we reduce use?

    NARCIS (Netherlands)

    Broek, P.J. van den; Wille, J.C.; Benthem, B.H.B. van; Perenboom, R.J.M.; Akker-van Marle, M.E. van den; Nielen, A.M.A.

    2011-01-01

    Indwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection. The efficacy of an intervention programme to improve adherence to

  13. 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.

  14. The efficacy of noble metal alloy urinary catheters in reducing catheter-associated urinary tract infection

    Directory of Open Access Journals (Sweden)

    Alanood Ahmed Aljohi

    2016-01-01

    Results: A 90% relative risk reduction in the rate of CAUTI was observed with the noble metal alloy catheter compared to the standard catheter (10 vs. 1 cases, P = 0.006. When considering both catheter-associated asymptomatic bacteriuria and CAUTI, the relative risk reduction was 83% (12 vs. 2 cases, P = 0.005. In addition to CAUTI, the risk of acquiring secondary bacteremia was lower (100% for the patients using noble metal alloy catheters (3 cases in the standard group vs. 0 case in the noble metal alloy catheter group, P = 0.24. No adverse events related to any of the used catheters were recorded. Conclusion: Results from this study revealed that noble metal alloy catheters are safe to use and significantly reduce CAUTI rate in ICU patients after 3 days of use.

  15. Bladder catheter protocol: technical modification for the change of Long-Term bladder catheters

    Directory of Open Access Journals (Sweden)

    Susana Rueda Pérez

    2013-09-01

    Full Text Available The replacement of urinary catheters is a common practice in chronic patients for both outpatients and inpatients. This action involves a large number of nursing interventions either planned or caused by emergency (obstruction, incorrect implantation, etc.... This modification of the catheter technique tries to improve the patient’s quality of life by minimizing the stress produced by urethral catheter replacements and reducing malpractice risks. This change in the urinary catheter technique also intends to alleviate some of the side effects of permanent urethral catheterization. By filling the bladder with saline prior to the change of catheter, it is possible to get a quick and safe implantation, dragging possible sediment and microorganisms and thereby reducing the number of nursing actions related to the process of the urinary catheter replacement (obstruction or incorrect catheter implantations etc.

  16. Microbial contamination of haemodialysis catheter connections.

    Science.gov (United States)

    Gorke, A

    2005-01-01

    Bacterial contamination and colonisation of the haemodialysis catheter is a reason for infection in dialysis patients. One reason for contamination may be frequent routine connections at the beginning, during and end of dialysis. Higher infection rates observed with double lumen catheters may be due to the absence of the sterile, disposable device that is fitted between the blood tubing and the catheter hubs with single lumen catheters. A sterile, disposable extension was implemented at the author's unit for use in dialysis with double lumen catheters. The proximal and distal ends of the extension were assessed for microbial contamination after standard dialysis. Results show microbial contamination in almost 30% of the samples retrieved from the extensions. Experiences in PD and the behaviour of skin bacteria on polymers, suggest that disposable extensions might have the potential to serve as a barrier or absorber for bacterial contamination.

  17. Effect of Catheter Gauge on the Success of Intravenous Catheter Placement by Veterinary Students.

    Science.gov (United States)

    Hofmeister, Erik H; Quandt, Jane

    2017-11-03

    The purposes of this study were to determine if senior veterinary students find it easier to place a smaller-bore catheter, and to relate patient variables with student success in catheter placement. For dogs between 10 kg and 20 kg, the catheter size options were 20 gauge or 22 gauge. For dogs larger than 20 kg, the catheter size options were 18 gauge or 20 gauge. Variables recorded included time for catheter placement, number of catheterization attempts, number of catheters used, number of legs used, difficulty of catheterization, student success, and patient characteristics including signalment, weight, body condition score, premedication drugs given, tentative diagnosis, and procedure. If the student could not place an IV catheter after three attempts, it was graded as a student catheter placement failure. For the 55 students participating in the study over 28 months, we recorded 192 individual catheterization attempts. In small patients, students were successful in 19/20 attempts with 22-gauge catheters and in 24/30 with 20-gauge catheters. In large patients, students were successful in 59/68 attempts with 20-gauge catheters and 61/74 with 18-gauge catheters. The overall success rate was 164/192 (85%). Students were more likely to be successful when attempting placement in those dogs receiving acepromazine than in those not receiving acepromazine (p=.02). There were no significant differences among any of the other variables for difficulty, placement time, number of attempts, or student success. Clinicians and educators may select a size catheter for the patient without concern for the effects on student catheter placement success.

  18. Cardiogenic Shock, Acute Severe Mitral Regurgitation and Complete Heart Block After Cavo-Tricuspid Isthmus Atrial Flutter Ablation.

    Science.gov (United States)

    Aung, Thein Tun; Roberto, Edward Samuel; Kravitz, Kevin D

    2017-04-01

    Radiofrequency (RF) ablation is the first-line management of cavo-tricuspid isthmus dependent atrial flutter. It has been performed with 95% success rate. Adverse events are very rare. We report the first case of acute severe mitral regurgitation (MR) and complete heart block developed after successful atrial flutter ablation. A 62-year-old female with mild MR presented with palpitations. Surface electrocardiogram was suggestive of isthmus dependent atrial flutter. A duodecapolar mapping catheter showed an atrial flutter with cycle length of 280 ms. An 8 mm tipped Thermistor RF ablation catheter was placed at the cavo-tricuspid isthmus. RF energy was delivered as the catheter was dragged to the inferior vena cava. Temperature limit was 60 °C; the power output limit was 60 W. The patient converted to sinus rhythm with the first ablation line. Bi-directional block was recorded. Two additional ablation lines lasting 60 - 120 s were delivered. The patient started having chest pain and developed complete heart block with no escape rhythm. She became hypotensive and was immediately paced from the right ventricle. There were no signs of pericardial tamponade. Emergent bedside echo demonstrated severe MR with a retracted posteromedial mitral valve leaflet. She was 100% paced and EKG changes could not be assessed. Based on the sudden onset chest pain, hypotension, complete heart block and acute severe MR after ablation, the right coronary artery occlusion was suspected. She was immediately transferred to the catheterization laboratory. Coronary angiography revealed a total occlusion of the posterolateral branch from the right coronary artery. Balloon angioplasty and coronary artery stenting was performed. Complete heart block subsequently resolved. Subsequent bedside echocardiogram showed marked improvement of the MR. Patients with smaller body size have smaller hearts and more likely to have injury from RF current. Higher energy penetrates deeper and causes more tissue

  19. Teaching Spoken Spanish

    Science.gov (United States)

    Lipski, John M.

    1976-01-01

    The need to teach students speaking skills in Spanish, and to choose among the many standard dialects spoken in the Hispanic world (as well as literary and colloquial speech), presents a challenge to the Spanish teacher. Some phonetic considerations helpful in solving these problems are offered. (CHK)

  20. Radiofrequency ablation of osteoid osteoma

    NARCIS (Netherlands)

    Vanderschueren, Geert Maria Joris Michael

    2009-01-01

    The main purpose of this thesis was to evaluate the effectiveness and safety of CT-guided radiofrequency ablation for the treatment of spinal and non-spinal osteoid osteomas. Furthermore, the technical requirements needed for safe radiofrequency ablation and the clinical outcome after radiofrequency

  1. Radiological Interventions for Correction of Central Venous Port Catheter Migrations

    International Nuclear Information System (INIS)

    Gebauer, Bernhard; Teichgraeber, Ulf Karl; Podrabsky, Petr; Werk, Michael; Haenninen, Enrique Lopez; Felix, Roland

    2007-01-01

    The purpose of the study is to evaluate radiological-interventional central venous port catheter corrections in migrated/malpositioned catheter tips. Thirty patients with migrated/malpositioned port catheter tips were included in this retrospective analysis. To visualize the catheter patency, a contrast-enhanced port catheter series was performed, followed by transfemoral port catheter correction with various 5F angiographic catheters (pigtail, Sos Omni), goose-neck snare, or combinations thereof. One patient showed spontaneous reposition of the catheter tip. In 27 of 29 patients (93%), radiological-interventional port catheter correction was successful. In two patients, port catheter malposition correction was not possible because of the inability to catch either the catheter tip or the catheter in its course, possibly due to fibrin sheath formation with attachment of the catheter to the vessel wall. No disconnection or port catheter dysfunction was observed after correction. In migrated catheter tips, radiological-interventional port catheter correction is a minimally invasive alternative to port extraction and reimplantation. In patients with a fibrin sheath and/or thrombosis, port catheter correction is often more challenging

  2. Outcome of Radiologically Placed Tunneled Haemodialysis Catheters

    International Nuclear Information System (INIS)

    Sayani, R.; Anwar, M.; Haq, T.U.; Qamari, N.A.; Bilal, M.A.

    2013-01-01

    Objective: To study the outcome of radiologically placed double lumen tunneled haemodialysis catheters for the management of renal failure. Study Design: Case series. Place and Duration of Study: Interventional Suite of Radiology Department at the Aga Khan University Hospital, Karachi, from April 2010 to June 2011. Methodology: All consecutive patients who were referred to the department of radiology by the nephrologists for double lumen tunneled haemodialysis catheter (Permacath) placement during the study period were included. Patients with septicemia, those for whom follow-up was not available, those coming for catheter exchange or who died due to a noncatheter related condition were excluded. A radio-opaque, soft silicone double lumen catheter was inserted through a subcutaneous tunnel created over the anterior chest wall. The catheter tip was placed in the right atrium via the internal jugular vein. Ultrasound guidance was used for initial venous puncture. The rest of the procedure was carried out under fluoroscopic guidance. Technical success, catheter related bacteremia rates, adequacy of dialysis, patency, and adverse events were analyzed. Results: Overall 88 tunneled haemodialysis catheters were placed in 87 patients. Patients were followed-up for duration of 1 - 307 days with mean follow-up period of 4 months. Immediate technical success was 100%. The procedural complication rate was 5.6% (5 catheters). Eight patients died during the study period, seven from causes unrelated to the procedure. One patient died due to septicemia secondary to catheter related infection. Of the remaining 69 patients, 50 (72.4%) predominantly had uneventful course during the study period. Twelve patients developed infection (17.3%); two were successfully treated conservatively while in 10 patients catheter had to be removed. Seven catheters (10.1%) failed due to mechanical problems. In 3 patients the internal jugular veins got partially thrombosed. One catheter was

  3. Impact of cavotricuspid isthmus morphology in CRYO versus radiofrequency ablation of typical atrial flutter.

    Science.gov (United States)

    Saygi, Serkan; Bastani, Hamid; Drca, Nikola; Insulander, Per; Wredlert, Christer; Schwieler, Jonas; Jensen-Urstad, Mats

    2017-04-01

    Cryoablation (CRYO) is an alternative to radiofrequency (RF) for catheter ablation of cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL). We aimed to study whether different CTI morphologies had different impacts on procedural success for CRYO and RF. This study randomized 153 patients with CTI-dependent AFL (median age 65 years; range 34-82) to RF or CRYO (78 CRYO; 75 RF). Biplane angiography (RAO 30° and LAO 60°) was done before the ablation procedure and isthmuses were classified as straight (n = 81), concave (n = 43) or pouch-like (n = 29). RF was performed with a 3.5-mm open-irrigated tip catheter and CRYO was performed with a 9 F, 8-mm tip catheter. The ablation endpoint was bidirectional block of CTI. Acute procedural success was achieved in 70/75 patients in the RF group and in 72/78 patients in the CRYO group. With regard to CRYO or RF, acute procedural success rates were similar between the three isthmus types: straight: CRYO (92%) and RF (96%); concave: CRYO (92%) and RF (94%); and pouch-like: CRYO (94%) and RF (85%). There were no significant differences regarding success rate between the different morphologies in the CRYO or the RF group. The CTI was longer in patients with acute failure compared to the patients with acute success (38 ± 7 mm versus 33 ± 6 mm, p = 0.045). The CTI morphology did not influence the acute success rate for either the CRYO or the RF ablation of CTI-dependent AFL. A longer CTI was associated with a lower success rate regardless of energy source.

  4. Evaluation of the Achieve Mapping Catheter in cryoablation for atrial fibrillation: a prospective randomized trial.

    Science.gov (United States)

    Gang, Yi; Gonna, Hanney; Domenichini, Giulia; Sampson, Michael; Aryan, Niloufar; Norman, Mark; Behr, Elijah R; Zuberi, Zia; Dhillon, Paramdeep; Gallagher, Mark M

    2016-03-01

    The purpose of this study is to establish the role of Achieve Mapping Catheter in cryoablation for paroxysmal atrial fibrillation (PAF) in a randomized trial. A total of 102 patients undergoing their first ablation for PAF were randomized at 2:1 to an Achieve- or Lasso-guided procedure. Study patients were systematically followed up for 12 months with Holter monitoring. Primary study endpoint was acute procedure success. Secondary endpoint was clinical outcomes assessed by AF free at 6 and 12 months after the procedure. Of 102 participants, 99 % of acute procedure success was achieved. Significantly shorter procedure duration with the Achieve-guided group than with the Lasso-guided group (118 ± 18 vs. 129 ± 21 min, p < 0.05) was observed as was the duration of fluoroscopy (17 ± 5 vs. 20 ± 7 min, p < 0.05) by subgroup analysis focused on procedures performed by experienced operators. In the whole study patients, procedure and fluoroscopic durations were similar in the Achieve- (n = 68) and Lasso-guided groups (n = 34). Transient phrenic nerve weakening was equally prevalent with the Achieve and Lasso. No association was found between clinical outcomes and the mapping catheter used. The use of second-generation cryoballoon (n = 68) reduced procedure time significantly compared to the first-generation balloon (n = 34); more patients were free of AF in the former than the latter group during follow-up. The use of the Achieve Mapping Catheter can reduce procedure and fluoroscopic durations compared with Lasso catheters in cryoablation for PAF after operators gained sufficient experience. The type of mapping catheter used does not affect procedure efficiency and safety by models of cryoballoon.

  5. 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.

  6. Laboratory Simulations of Micrometeoroid Ablation

    Science.gov (United States)

    Thomas, Evan Williamson

    Each day, several tons of meteoric material enters Earth's atmosphere, the majority of which consist of small dust particles (micrometeoroids) that completely ablate at high altitudes. The dust input has been suggested to play a role in a variety of phenomena including: layers of metal atoms and ions, nucleation of noctilucent clouds, effects on stratospheric aerosols and ozone chemistry, and the fertilization of the ocean with bio-available iron. Furthermore, a correct understanding of the dust input to the Earth provides constraints on inner solar system dust models. Various methods are used to measure the dust input to the Earth including satellite detectors, radar, lidar, rocket-borne detectors, ice core and deep-sea sediment analysis. However, the best way to interpret each of these measurements is uncertain, which leads to large uncertainties in the total dust input. To better understand the ablation process, and thereby reduce uncertainties in micrometeoroid ablation measurements, a facility has been developed to simulate the ablation of micrometeoroids in laboratory conditions. An electrostatic dust accelerator is used to accelerate iron particles to relevant meteoric velocities (10-70 km/s). The particles are then introduced into a chamber pressurized with a target gas, and they partially or completely ablate over a short distance. An array of diagnostics then measure, with timing and spatial resolution, the charge and light that is generated in the ablation process. In this thesis, we present results from the newly developed ablation facility. The ionization coefficient, an important parameter for interpreting meteor radar measurements, is measured for various target gases. Furthermore, experimental ablation measurements are compared to predictions from commonly used ablation models. In light of these measurements, implications to the broader context of meteor ablation are discussed.

  7. Efficacy comparison between cryoablation and radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter: a meta-analysis

    Science.gov (United States)

    Chen, Yi-He; Lin, Hui; Xie, Cheng-Long; Zhang, Xiao-Ting; Li, Yi-Gang

    2015-01-01

    We perform this meta-analysis to compare the efficacy and safety of cryoablation versus radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter. By searching EMBASE, MEDLINE, PubMed and Cochrane electronic databases from March 1986 to September 2014, 7 randomized clinical trials were included. Acute (risk ratio[RR]: 0.93; P = 0.14) and long-term (RR: 0.94; P = 0.08) success rate were slightly lower in cryoablation group than in radiofrequency ablation group, but the difference was not statistically significant. Additionally, the fluoroscopy time was nonsignificantly reduced (weighted mean difference[WMD]: −2.83; P = 0.29), whereas procedure time was significantly longer (WMD: 25.95; P = 0.01) in cryoablation group compared with radiofrequency ablation group. Furthermore, Pain perception during the catheter ablation was substantially less in cryoabaltion group than in radiofrequency ablation group (standardized mean difference[SMD]: −2.36; P radiofrequency ablation produce comparable acute and long-term success rate for patients with cavotricuspid valve isthmus dependent atrial flutter. Meanwhile, cryoablation ablation tends to reduce the fluoroscopy time and significantly reduce pain perception in cost of significantly prolonged procedure time. PMID:26039980

  8. Retained Fractured Fragment of A Central Venous Catheter: A ...

    African Journals Online (AJOL)

    BACKGROUND: Complication following fracture of a central venous catheter can be catastrophic to both the patient and the attending doctor. Catheter fracture has been attributed to several factors namely prolong mechanical force acting on the catheter, and forceful removal or insertion of the catheter. CASE DETAILS: In ...

  9. 21 CFR 870.1290 - Steerable catheter control system.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Steerable catheter control system. 870.1290... catheter control system. (a) Identification. A steerable catheter control system is a device that is connected to the proximal end of a steerable guide wire that controls the motion of the steerable catheter...

  10. Prolonged use of indwelling urinary catheter following acute urinary ...

    African Journals Online (AJOL)

    J.O. Bello

    duration of catheter use and median out-of-pocket payment per catheter change was 65 years (range 20–90 years), 12 months (range .... pocket payments per catheter change and reasons for prolonged catheter use was collected. ... ing almost half (44.7%) of the average annual income of an adult in the study region of ...

  11. The Spanish gas industry

    International Nuclear Information System (INIS)

    Anon.

    1993-01-01

    The spanish gas industry has become one of the major actors in the gas sector of the European Economic Community. This paper pictures the spanish gas industry on the basis of a study by Sedigas, the spanish member of the International Gas Union (IGU). The main subjects described are structure of gas companies, natural gas supply, transport and storage, natural gas distribution networks, statistical data on natural gas consumption, manufactured gas and Liquefied Petroleum Gases (LPG) production-consumption in Spain. 7 figs., 10 tabs

  12. Central venous catheters: the role of radiology

    International Nuclear Information System (INIS)

    Tan, P.L.; Gibson, M.

    2006-01-01

    The insertion and management of long-term venous catheters have long been the province of anaesthetists, intensive care physicians and surgeons. Radiologists are taking an increasing role in the insertion of central venous catheters (CVCs) because of their familiarity with the imaging equipment and their ability to manipulate catheters and guide-wires. The radiological management of the complications of CVCs has also expanded as a result. This article reviews the role of radiology in central venous access, covering the detection and management of their complications

  13. Percutaneous catheter dilatation of carotid stenoses

    International Nuclear Information System (INIS)

    Mathias, K.; Mittermayer, C.; Ensinger, H.; Neff, W.

    1980-01-01

    Thirty-one carotid artery stenoses were produced in thirty dogs by three different techniques. Twenty-three of these could be cured by transfemoral percutaneous catheter dilatation. High grade tight stenoses may present resistance which cannot be overcome by the catheter. Histological examination of the dilated vessels showed circumscribed changes in the vessel wall, with destruction of elastic membranes. From our experience of catheter dilatation of pelvic and lower limb arteries and of renal arteries, we consider it feasible to use this technique in selected patients with carotid stenosis. (orig.) [de

  14. Teaching L2 Spanish Stress

    Science.gov (United States)

    Saalfeld, Anita K.

    2012-01-01

    The present study investigated the effects of training on the perception of Spanish stress, an important feature in the Spanish verbal morphology system. Participants were two intact classes of native English speakers enrolled in a six-week session of second-semester Spanish, as well as native English and native Spanish control groups. During the…

  15. Outcomes after cardioversion and atrial fibrillation ablation in patients treated with rivaroxaban and warfarin in the ROCKET AF trial.

    Science.gov (United States)

    Piccini, Jonathan P; Stevens, Susanna R; Lokhnygina, Yuliya; Patel, Manesh R; Halperin, Jonathan L; Singer, Daniel E; Hankey, Graeme J; Hacke, Werner; Becker, Richard C; Nessel, Christopher C; Mahaffey, Kenneth W; Fox, Keith A A; Califf, Robert M; Breithardt, Günter

    2013-05-14

    This study sought to investigate the outcomes following cardioversion or catheter ablation in patients with atrial fibrillation (AF) treated with warfarin or rivaroxaban. There are limited data on outcomes following cardioversion or catheter ablation in AF patients treated with factor Xa inhibitors. We compared the incidence of electrical cardioversion (ECV), pharmacologic cardioversion (PCV), or AF ablation and subsequent outcomes in patients in a post hoc analysis of the ROCKET AF (Efficacy and Safety Study of Rivaroxaban With Warfarin for the Prevention of Stroke and Non-Central Nervous System Systemic Embolism in Patients With Non-Valvular Atrial Fibrillation) trial. Over a median follow-up of 2.1 years, 143 patients underwent ECV, 142 underwent PCV, and 79 underwent catheter ablation. The overall incidence of ECV, PCV, or AF ablation was 1.45 per 100 patient-years (n = 321; 1.44 [n = 161] in the warfarin arm, 1.46 [n = 160] in the rivaroxaban arm). The crude rates of stroke and death increased in the first 30 days after cardioversion or ablation. After adjustment for baseline differences, the long-term incidence of stroke or systemic embolism (hazard ratio [HR]: 1.38; 95% confidence interval [CI]: 0.61 to 3.11), cardiovascular death (HR: 1.57; 95% CI: 0.69 to 3.55), and death from all causes (HR: 1.75; 95% CI: 0.90 to 3.42) were not different before and after cardioversion or AF ablation. Hospitalization increased after cardioversion or AF ablation (HR: 2.01; 95% CI: 1.51 to 2.68), but there was no evidence of a differential effect by randomized treatment (p value for interaction = 0.58). The incidence of stroke or systemic embolism (1.88% vs. 1.86%) and death (1.88% vs. 3.73%) were similar in the rivaroxaban-treated and warfarin-treated groups. Despite an increase in hospitalization, there were no differences in long-term stroke rates or survival following cardioversion or AF ablation. Outcomes were similar in patients treated with rivaroxaban or warfarin

  16. Fractional ablative erbium YAG laser

    DEFF Research Database (Denmark)

    Taudorf, Elisabeth H; Haak, Christina S; Erlendsson, Andrés M

    2014-01-01

    BACKGROUND AND OBJECTIVES: Treatment of a variety of skin disorders with ablative fractional lasers (AFXL) is driving the development of portable AFXLs. This study measures micropore dimensions produced by a small 2,940 nm AFXL using a variety of stacked pulses, and determines a model correlating...... energies of 2.3-12.8 mJ/microbeam and total energy levels of 4.6-640 mJ/microchannel. Histological endpoints were ablation depth (AD), coagulation zone (CZ) and ablation width (AW). Data were logarithmically transformed if required prior to linear regression analyses. Results for histological endpoints...

  17. 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

    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

  18. 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.

  19. Catheter visualisation in MR tomography: first animal experimental experiences with field inhomogeneity catheters

    International Nuclear Information System (INIS)

    Adam, G.; Glowinski, A.; Neuerburg, J.; Buecker, A.; Vaals, J.J. van; Hurtak, W.; Guenther, R.W.

    1997-01-01

    Purpose: To assess the feasibility of a new developed field inhomogeneity catheter for interventional MR imaging in vivo. Materials and methods: Three different prototypes of a field inhomogeneity catheter were investigated in 6 pigs. The catheters were introduced in Seldinger technique via the femoral vessels over a guide wire on an interventional MR system (Philips Gyroscan NT combined with a C-arm fluoroscopy unit [Philips BV 212[). Catheters were placed in veins and arteries. The catheter position was controlled by a fast gradient echo sequence (Turbo Field Echo [TEF[). Results: Catheters were introduced over a guide wire without complications in all cases. Using the field inhomogeneity concept, catheters were easily visualised in the inferior vena cava and the aorta by the fast gradient echo technique on MR in all cases. Although aortic branches were successfully cannulated, the catheters were not displayed by the TFE technique due to the complex and tortuous anatomy. All animals survived the experiments without complications. Conclusion: MR guided visualisation of a field inhomogeneity catheter is a simple concept which can be realised on each MR scanner and may allow intravascular MR guided interventions in future. (orig.) [de

  20. Intravascular catheter-related bloodstream infection.

    Science.gov (United States)

    Shah, Harshal; Bosch, Wendelyn; Thompson, Kristine M; Hellinger, Walter C

    2013-07-01

    Intravascular catheters required for the care of many hospitalized patients can give rise to bloodstream infection, a complication of care that has occurred most frequently in intensive care unit (ICU) settings. Elucidation of the pathogenesis of catheter-related bloodstream infections (CRBSIs) has guided development of effective diagnostic, management, and prevention strategies. When CRBSIs occur in the ICU, physicians must be prepared to recognize and treat them. Prevention of these infections requires careful attention to optimal catheter selection, insertion and maintenance, and to removal of catheters when they are no longer needed. This review provides a succinct summary of the epidemiology, pathogenesis, and microbiology of CRBSIs and a review of current guidance for the diagnosis, management, and prevention of these infections.

  1. Catheter-Associated Urinary Tract Infections

    Science.gov (United States)

    ... Vaccine Safety Frequently Asked Questions about Catheter-associated Urinary Tract Infections Recommend on Facebook Tweet Share Compartir What is ... an incision above the pubis. What is a urinary tract infection? A urinary tract infection (UTI) is an infection ...

  2. Peripherally inserted central catheter - dressing change

    Science.gov (United States)

    PICC - dressing change ... You have a peripherally inserted central catheter (PICC). This is a tube that goes into a vein in your arm. It carries nutrients and medicines into your body. It may also ...

  3. Persistent left superior vena cava with thrombus formed in the catheter lumen 4 h after dialysis catheter placed.

    Science.gov (United States)

    Kawasaki, Tomoki; Tanaka, Hiroyuki; Oba, Miki; Takada, Megumi; Tanaka, Haruna; Suda, Shin

    2018-02-17

    Persistent left superior vena cava (PLSVC) is one of the most common thoracic venous anomaly and rarely noticed, because it is asymptomatic. However, for nephrologists, it is frequent enough to be encountered while placing hemodialysis catheters through the jugular vein. We report the case of 66-year-old patient with PLSVC presenting intrinsic thrombosis formation 4 h after dialysis catheter placed. Dialysis catheter was placed in the left internal jugular vein without resistance and any complication. PLSVC was detected after dialysis catheter insertion. We decided to remove the catheter, because the patient has other veins in which the catheter can be placed. When it was removed 4 h after catheter placing, thrombus was recognized in the catheter lumen. Transesophageal echocardiography was performed and no thrombus formation was observed in the heart chamber. For patients with PLSVC, if there were other veins in which the catheter can be placed, catheter replacement should be considered.

  4. School of Spanish

    Directory of Open Access Journals (Sweden)

    Valerii A. Iovenko

    2014-01-01

    Full Text Available Spanish language was among foreign languages, studied at MGIMO from its inception. Maria Luisa Gonzalez Vincens was at the origin of the establishment of the School of Spanish language at MGIMO. She as a philologist, belonging to humanitarian tradition. She studied at the University of Madrid with Luis Bunuel, Federico Garcia Lorca and Salvador Dali, and communicated with people who later became the glory and pride of the world culture. The increased role of the Spanish language in international contacts required the creation of the separate Department of Spanish Language at MGIMO. Since 2002, the Department of Spanish Language separated from the Department of Roman Languages and is teaching students of all Departments and at all stages of educating at MGIMO, including almost all masters programs. It is hard to imagine successful language learning without the understanding of a broad cultural context. This is why the Department supports the Spanish theater for more than 20 years. Currently, the Department is headed by of professor, Doctor of Philology Valery Iovenko. The Department staff includes more than 45 teachers who successfully address new educational and scientific objectives, creating teaching materials, fully adapted to the new educational standards.

  5. Spanish Visit to CERN

    CERN Multimedia

    2002-01-01

    Last week CERN was visited by the Spanish Minister of Science and Technology, Josep Piqué i Camps. While here, he was able to visit the ATLAS assembly hall where many items of equipment are being built in collaboration with Spanish academic institutions or firms. These include the vacuum vessels for the ATLAS barrel toroid magnets supplied by the Spanish firm Felguera Construcciones Mechanics. Similarly, the Universidad Autónoma de Madrid is participating in the manufacture of the electromagnetic calorimeter endcaps, while the Barcelona Institute for High Energy Physics and the Valencia IFIC (Instituto de Física Corpuscular) are highly involved in the production of barrel modules for the tile calorimeter. The delegation, accompanied by Spanish scientists at CERN, also visited the LHC superconducting magnet test hall (photo). From left to right: Felix Rodriguez Mateos of CERN LHC Division, Josep Piqué i Camps, Spanish Minister of Science and Technology, César Dopazo, Director-General of CIEMAT (Spanish ...

  6. Risk of Ionizing Radiation in Women of Childbearing Age undergoing Radiofrequency Ablation

    Energy Technology Data Exchange (ETDEWEB)

    Lima, Gustavo Glotz de, E-mail: gglima.pesquisa@gmail.com; Gomes, Daniel Garcia; Gensas, Caroline Saltz; Simão, Mariana Fernandez; Rios, Matheus N.; Pires, Leonardo Martins; Kruse, Marcelo Lapa; Leiria, Tiago Luiz Luz [Instituto de Cardiologia, Fundação Universitária de Cardiologia, Porto Alegre, RS (Brazil)

    2013-11-15

    The International Commission of Radiology recommends a pregnancy screening test to all female patients of childbearing age who will undergo a radiological study. Radiation is known to be teratogenic and its effect is cumulative. The teratogenic potential starts at doses close to those used during these procedures. The prevalence of positive pregnancy tests in patients undergoing electrophysiological studies and/or catheter ablation in our midst is unknown. To evaluate the prevalence of positive pregnancy tests in female patients referred for electrophysiological study and/or radiofrequency ablation. Cross-sectional study analyzing 2,966 patients undergoing electrophysiological study and/or catheter ablation, from June 1997 to February 2013, in the Institute of Cardiology of Rio Grande do Sul. A total of 1490 procedures were performed in women, of whom 769 were of childbearing age. All patients were screened with a pregnancy test on the day before the procedure. Three patients tested positive, and were therefore unable to undergo the procedure. The prevalence observed was 3.9 cases per 1,000 women of childbearing age. Because of their safety and low cost, pregnancy screening tests are indicated for all women of childbearing age undergoing radiological studies, since the degree of ionizing radiation needed for these procedures is very close to the threshold for teratogenicity, especially in the first trimester, when the signs of pregnancy are not evident.

  7. Percutaneous ultrasonographically guided radiofrequency heat ablation for treatment of primary hyperparathyroidism in dogs.

    Science.gov (United States)

    Pollard, R E; Long, C D; Nelson, R W; Hornof, W J; Feldman, E C

    2001-04-01

    To evaluate the efficacy and safety of ultrasonographically guided radiofrequency heat ablation of parathyroid masses in dogs with primary hyperparathyroidism. Clinical trial. 11 dogs. In all dogs, either 1 or 2 parathyroid masses were evident ultrasonographically. Dogs were anesthetized, and a 20-gauge over-the-needle catheter was directed into the parathyroid mass via ultrasonographic guidance. Radiofrequency heat was applied to the stylet of the catheter until there was sonographically apparent change to the entire parenchyma of the mass. Serum total and ionized calcium and parathyroid hormone concentrations were monitored daily for 5 days after the ablation procedure and again at 1, 2, and 3-month intervals, if possible. Dogs were monitored for adverse effects. One treatment was required in 6 dogs, 2 treatments were required in 2 dogs, and treatment was unsuccessful in 3 dogs. Serum total and ionized calcium concentrations were within reference ranges within 2 days of the last procedure in all 8 successfully treated dogs. Serum parathyroid hormone concentration was decreased 24 hours after treatment in all 8 dogs. Hypocalcemia developed in 5 of the 8 successfully treated dogs, all of which required treatment. One dog had a transient voice change. Other adverse effects were not reported. Ultrasonographically guided radiofrequency heat ablation of parathyroid masses is a safe and effective alternative to surgery in dogs with primary hyperparathyroidism.

  8. HRV changes before and after radiofrequency ablation in patients with different origin of right ventricular outflow tract ventricular premature contraction

    Directory of Open Access Journals (Sweden)

    Yi-Ming Ma

    2017-04-01

    Full Text Available Objective: To observe the HRV changes before and after the radiofrequency current catheter ablationventricular premature beats originated from different site of right ventricular outflow tract. Methods: A total of 102 patients with frequent RVOT-VPC admitted to our hospital were accepted radiofrequency current catheter ablation (RF. According to the origin of RVOT-VPC, it was divided into 2 groups, one is from ventricular septum, and the other one is from free wall, and in each group, male and female are observed separately. Results: (1 HRV before RF ablation: 1 rMSSD in the female patients with RVOT-VPC from free wall was significantly lower than those from septum; 2 frequency domain index (W, LF were higher than normal range, and in male patients, LF/HF1. (2 HRV after RF ablation: 1 Significant changes were found in female patients with RVOT-VPC from septum, rMSSD, PNN50, HF and LF decreased; 2 In female patients with RVOT-VPC from free wall, rMSSD decreased; 3 In male patients, there were no significant HRV changes found before and after RF ablation. (3 Heart rate changes: 1 In female patients with RVOT-VPC from septum, heart rate decreased significantly [(76.47±9.47 bpm vs (69.29±14.59 bpm]. 2 No significant changes were found in male patients. Conclusion: In patients with RVOT-PVC sympathetic and vagus excitability increased, and after catheter ablation, in female patients with RVOT-PVC originated from septum, the HRV index relating to sympathetic and vagus excitability significantly decreased.

  9. Magnetic resonance imaging guidance for the optimization of ventricular tachycardia ablation.

    Science.gov (United States)

    Mukherjee, Rahul K; Whitaker, John; Williams, Steven E; Razavi, Reza; O'Neill, Mark D

    2018-03-23

    Catheter ablation has an important role in the management of patients with ventricular tachycardia (VT) but is limited by modest long-term success rates. Magnetic resonance imaging (MRI) can provide valuable anatomic and functional information as well as potentially improve identification of target sites for ablation. A major limitation of current MRI protocols is the spatial resolution required to identify the areas of tissue responsible for VT but recent developments have led to new strategies which may improve substrate assessment. Potential ways in which detailed information gained from MRI may be utilized during electrophysiology procedures include image integration or performing a procedure under real-time MRI guidance. Image integration allows pre-procedural magnetic resonance (MR) images to be registered with electroanatomical maps to help guide VT ablation and has shown promise in preliminary studies. However, multiple errors can arise during this process due to the registration technique used, changes in ventricular geometry between the time of MRI and the ablation procedure, respiratory and cardiac motion. As isthmus sites may only be a few millimetres wide, reducing these errors may be critical to improve outcomes in VT ablation. Real-time MR-guided intervention has emerged as an alternative solution to address the limitations of pre-acquired imaging to guide ablation. There is now a growing body of literature describing the feasibility, techniques, and potential applications of real-time MR-guided electrophysiology. We review whether real-time MR-guided intervention could be applied in the setting of VT ablation and the potential challenges that need to be overcome.

  10. Peritoneal catheter fixation combined with straight upward tunnel and low implant position to prevent catheter malfunction.

    Science.gov (United States)

    Zhang, Qingyan; Jiang, Chunming; Zhu, Wei; Sun, Cheng; Xia, Yangyang; Tang, Tianfeng; Wan, Cheng; Shao, Qiuyuan; Liu, Jing; Jin, Bo; Zhang, Miao

    2018-03-01

    Catheter malfunction is the main reason for early peritoneal dialysis (PD) technique failure. This study aimed to evaluate the effect of a new surgery technique with catheter fixation to the lower abdominal wall combined with straight upward tunnel and low implant position in reducing catheter malfunction. Patients with end stage renal disease who received PD in our centre from January 2013 to December 2015 were involved in this study. They were randomly divided into three groups according to surgical technique: traditional open surgery group, modified open surgery group and modified open surgery with catheter fixation group. All patients were followed up for six months after surgery. Catheter- related complications were analyzed. A total of 152 patients were involved. Among them, 49 received traditional open surgery (TOS group), 49 received modified open surgery (MOS group), and 54 received modified open surgery with catheter fixation (MOS-F group). During follow-up, no patients (0%) in MOS-F group developed catheter malfunction which was significantly lower than that of the TOS group (0 vs 16.33%, P = 0.002). Although not statistically significant, the incidence of catheter malfunction was lower in MOS-F group than that in MOS group (0 vs 4.08%, P = 0.134). No significant difference was observed in the episodes of infection, bleeding, leakage, inflow or outflow pain, hernia and delayed wound healing among the three groups (all P > 0.05). Catheter fixation combined with straight upward tunnel and low implant position can effectively prevent catheter malfunction in PD catheter placement. © 2016 Asian Pacific Society of Nephrology.

  11. Water spray assisted ultrashort laser pulse ablation

    International Nuclear Information System (INIS)

    Silvennoinen, M.; Kaakkunen, J.J.J.; Paivasaari, K.; Vahimaa, P.

    2013-01-01

    Highlights: ► We show the novel method to use multibeam processing with ultrashort pulses efficiently. ► Sprayed thin water layer on ablation zone enhances ablation rate and quality. ► In some cases this method also enables ablation of the deeper and straighter holes compared to ones made without the water layer. ► Method also makes possible to directly write features without the self-organizing structures. - Abstract: We have studied femtosecond ablation under sprayed thin water film and its influence and benefits compared with ablation in the air atmosphere. These have been studied in case of the hole and the groove ablation using IR femtosecond laser. Water enhances the ablation rate and in some situations it makes possible to ablate the holes with a higher aspect ratio. While ablating the grooves, the water spray allows using the high fluences without the generation of the self-organized structures.

  12. Clinical usefulness of catheter-drawn blood samples and catheter tip cultures for the diagnosis of catheter-related bloodstream infections in neonatology: A systematic review.

    Science.gov (United States)

    Ferreira, Janita; Camargos, Paulo Augusto Moreira; Clemente, Wanessa Trindade; Romanelli, Roberta Maia de Castro

    2018-01-01

    Neonatal sepsis is the most frequent health care-associated infection in neonatal units. This study aimed to analyze articles on the clinical usefulness of catheter-drawn blood samples and catheter tip cultures for the diagnosis of intravascular catheter-related bloodstream infection (CRBSI) in neonates. A systematic search was performed for studies published from 1987-2017, without language restriction. Observational studies carried out in neonates with CRBSI diagnosed using catheter-drawn blood samples or catheter tip cultures were included. A total of 412 articles were identified in the databases and 10 articles were included. The 7 studies that evaluated central venous catheter tip cultures and cultures of catheter fragments presented sensitivities ranging from 58.5%-100% and specificities ranging from 60%-95.7%. Three studies that evaluated catheter-drawn blood cultures, paired with peripheral blood cultures, reported sensitivity and specificity of 94% and 71% when evaluated for the differential time to positivity. When quantitative evaluation was performed, the sensitivity and specificity were 80% and 99.4%. Most of the studies analyzed cultures from the central venous catheter tip and catheter fragments for the diagnosis of CRBSI in neonatal populations. The results of this review suggest that the analysis of the catheter-drawn blood samples and catheter tip cultures, paired with peripheral blood cultures, are efficient methods for the diagnosis of CRBSI in neonates. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  13. A Three-Dimensional Shape-Based Force and Stiffness-Sensing Platform for Tendon-Driven Catheters.

    Science.gov (United States)

    Kouh Soltani, Minou; Khanmohammadi, Sohrab; Ghalichi, Farzan

    2016-06-28

    This paper presents an efficient shape-based three-axial force and stiffness estimator for active catheters commonly implemented in cardiac ablation. The force-sensing capability provides important feedback for catheterization procedures including real-time control and catheter steering in autonomous navigation systems. The proposed platform is based on the introduced accurate and computationally efficient Cosserat rod model for tendon-driven catheters. The proposed nonlinear Kalman filter formulation for contact force estimation along with the developed catheter model provides a real-time force observer robust to nonlinearities and noise covariance uncertainties. Furthermore, the proposed platform enables stiffness estimation in addition to tip contact force sensing in different operational circumstances. The approach incorporates pose measurements which can be achieved using currently developed pose-sensing systems or imaging techniques. The method makes the approach compatible with the range of forces applied in clinical applications. The simulation and experimental results verify the viability of the introduced force and stiffness-sensing technique.

  14. A Three-Dimensional Shape-Based Force and Stiffness-Sensing Platform for Tendon-Driven Catheters

    Directory of Open Access Journals (Sweden)

    Minou Kouh Soltani

    2016-06-01

    Full Text Available This paper presents an efficient shape-based three-axial force and stiffness estimator for active catheters commonly implemented in cardiac ablation. The force-sensing capability provides important feedback for catheterization procedures including real-time control and catheter steering in autonomous navigation systems. The proposed platform is based on the introduced accurate and computationally efficient Cosserat rod model for tendon-driven catheters. The proposed nonlinear Kalman filter formulation for contact force estimation along with the developed catheter model provides a real-time force observer robust to nonlinearities and noise covariance uncertainties. Furthermore, the proposed platform enables stiffness estimation in addition to tip contact force sensing in different operational circumstances. The approach incorporates pose measurements which can be achieved using currently developed pose-sensing systems or imaging techniques. The method makes the approach compatible with the range of forces applied in clinical applications. The simulation and experimental results verify the viability of the introduced force and stiffness-sensing technique.

  15. Radiofrequency Thermal Ablation Heat Energy Transfer in anEx-VivoModel.

    Science.gov (United States)

    Thakur, Shivani; Lavito, Sandi; Grobner, Elizabeth; Grobner, Mark

    2017-12-01

    Little work has been done to consider the temperature changes and energy transfer that occur in the tissue outside the vein with ultrasound-guided vein ablation therapy. In this experiment, a Ex-Vivo model of the human calf was used to analyze heat transfer and energy degradation in tissue surrounding the vein during endovascular radiofrequency ablation (RFA). A clinical vein ablation protocol was used to determine the tissue temperature distribution in 10 per cent agar gel. Heat energy from the radiofrequency catheter was measured for 140 seconds at fixed points by four thermometer probes placed equidistant radially at 0.0025, 0.005, and 0.01 m away from the RFA catheter. The temperature rose 1.5°C at 0.0025 m, 0.6°C at 0.005 m, and 0.0°C at 0.01 m from the RFA catheter. There was a clinically insignificant heat transfer at the distances evaluated, 1.4 ± 0.2 J/s at 0.0025 m, 0.7 ± 0.3 J/s at 0.0050 m, and 0.3 ± 0.0 J/s at 0.01 m. Heat degradation occurred rapidly: 4.5 ± 0.5 J (at 0.0025 m), 4.0 ± 1.6 J (at 0.0050 m), and 3.9 ± 3.6 J (at 0.01 m). Tumescent anesthesia injected one centimeter around the vein would act as a heat sink to absorb the energy transferred outside the vein to minimize tissue and nerve damage and will help phlebologists strategize options for minimizing damage.

  16. Ablation of Solid Hydrogen in a Plasma

    DEFF Research Database (Denmark)

    Jørgensen, L. W.; Sillesen, Alfred Hegaard

    1979-01-01

    Several hydrogen pellet ablation models based on the formation of a shielding neutral cloud have been reported by different authors. The predicted ablation rates are shown to follow almost the same scaling law and this is used to explain the authors' ablation experiment.......Several hydrogen pellet ablation models based on the formation of a shielding neutral cloud have been reported by different authors. The predicted ablation rates are shown to follow almost the same scaling law and this is used to explain the authors' ablation experiment....

  17. Spanish? What Spanish? The Search for a 'Caribbean Standard.'

    Science.gov (United States)

    Hollingsworth, C.

    1978-01-01

    Variations in lexicon, phonology, morphology, and syntax of Spanish as spoken in Venezuela, Cuba, Mexico, and Castile have led to a diversity in the types of Spanish taught in Caribbean schools. The Programa Interamericano de Linguistica y Ensenanza de Idiomas is conducting a survey which will provide authoritative standards for Spanish teachers.…

  18. [Value of two left atrium and pulmonary vein stereoscopic imaging reconstruction methods on guiding radiofrequency ablation for atrial fibrillation].

    Science.gov (United States)

    Tian, Y; Zhou, S; Yin, Y H; Zheng, Y X; Wang, R P; Liu, X Q; Liu, Z Q; Liu, Q F; Liu, W; Pang, J; Jiang, Z; Tian, L H; Huang, J; Yang, L

    2017-11-24

    Objective: To compare the value of two 3D imaging reconstruction methods for left atria and pulmonary vein on guiding the catheter ablation for atrial fibrillation (AF). Methods: From January 2014 to January 2017, a total of 100 drug refractory paroxysmal AF patients were divided into left atria direct angiography group ( n =50), and indirect angiography group ( n =50). 3D CARTO system was applied for mapping and guiding the ablation procedure. Patients assigned to direct angiography group were treated as follows: intraoperative puncture of atrial septum, inject contrast agent directly into the left atrium, conduct left atrial and pulmonary venous rotation angiography, reconstruct three-dimensional image, integrate the image into real-time X-ray system to facilitate circumferential pulmonary vein isolation. Patients assigned into the indirect angiography group were treated as follows: inject contrast agent through the right ventricle, conduct delayed rotation angiography of the left atria and pulmonary vein to guide circumferential pulmonary vein fixation and ablation. The left atrial and pulmonary venous image acquisition, the operation and X-ray exposure time, the success rate and the incidence of complication of the two groups were compared. The patients were followed up for 3-6 months. Results: General clinical characteristics of the two groups were similar(all P >0.05). Ablation was successful in all 100 patients. The operation time[(112.0±21.4)min vs. (134.0±24.3)min]and X-ray exposure time((10.7±4.7)min vs. (15.8±5.2)min)were significantly lower in direct angiography group than in indirect angiography group (both P guide the radiofrequency catheter ablation of paroxysmal atrial fibrillation by reconstruction 3D image of left atrium and pulmonary vein. Compared with indirect angiography group, direct angiography group can improve the imaging quality of left atrium and pulmonary vein, decrease the X-ray exposure time of the ablation procedure.

  19. Image-guided radiofrequency ablation (RFA) of spinal tumors

    Energy Technology Data Exchange (ETDEWEB)

    Gevargez, Athour [Groenemeyer Institute of MicroTherapy, Bochum (Germany); Department of Radiology and Microtherapy, University of Witten/Herdecke, Bochum (Germany)], E-mail: gevargez@microtherapy.de; Groenemeyer, Dietrich H.W. [Groenemeyer Institute of MicroTherapy, Bochum (Germany); Department of Radiology and Microtherapy, University of Witten/Herdecke, Bochum (Germany)

    2008-02-15

    Purpose: To evaluate retrospectively the efficacy and safety of radiofrequency ablation (RFA) in patients with spinal tumors. Materials and methods: Forty-one patients (25 men, 16 women; age range, 46-82 years) with nonresectable primary or secondary tumor involvement of the spine unresponsive to chemo- and radiotherapy received RFA treatment. Two radiofrequency ablation systems, one with a cool-tip electrode and one with an expandable electrode catheter, were used. Both systems work impedance controlled with a power output of 150- 200 W. Each coagulation cycle lasted 12-15 min depending on tumor impedance. Several single RFA cycles of 15 min each were used for overlapping RFAs in tumors with diameters of more than 3 cm. Temperature was kept between 50 deg. C and 120 deg. C and was chosen according to spinal cord distance and patient heat tolerance during the ablation. Multi-slice computed tomography (CT) combined with C-arm fluoroscopy guided the intervention. Efficacy outcomes were assessed after about 6 weeks, 6 months, and more than 6 months using standardized questionnaires and indices regarding tumor pain, pain disability, functional activities, quality of life, neurological status, and tumor progression. Results: RFA significantly reduced tumor-induced pain within 6 weeks, improved daily activities, and maintained quality of life. Mean time to tumor progression was 730 {+-} 54 days (Kaplan-Meier estimate). No RFA-associated complications were reported. Conclusion: RFA of primary and secondary spinal tumors, which were unresponsive to chemo- and radiotherapy and prone to progression, is a safe, resource-saving, and highly effective percutaneous technique in patients with nonresectable spinal tumors.

  20. Successful Non-fluoroscopic Radiofrequency Ablation of Incessant Atrial Tachycardia in a High Risk Twin Pregnancy

    Directory of Open Access Journals (Sweden)

    Dr Zia Zuberi, BSc PhD MRCP

    2014-01-01

    Full Text Available We describe a patient presenting with incessant ectopic atrial tachycardia during a high risk twin pregnancy. Tachycardia was resistant to escalating doses of beta-blockade with digoxin. Because of increasing left ventricular dysfunction early in the third trimester, catheter ablation was performed successfully at 30 weeks gestation. Electro-anatomic mapping permitted the entire procedure to be conducted without the use of ionizing radiation. The pregnancy proceeded to successful delivery near term and after three years the patient remains recurrence free with normal left ventricular function, off all medication.

  1. Ablation of an atriofascicular accessory pathway with a zero-fluoroscopy procedure

    Directory of Open Access Journals (Sweden)

    Riccardo Proietti, MD, PhD

    2015-10-01

    Full Text Available A 16-year-old patient with recurrent palpitations and documented left bundle branch block superior axis wide complex tachycardia underwent an electrophysiological study and ablation with a zero-fluoroscopy procedure. The electrophysiological study showed a decremental antegrade conducting atriofascicular pathway. Three-dimensional CARTO-guided mapping of the tricuspid annulus in sinus rhythm was performed, and a distinct signal corresponding to the accessory pathway potential of the atriofascicular pathway was found in the posterolateral region. By using an SR0 sheath and a 4-mm-tip catheter, radiofrequency application was delivered at this point on the annulus and successfully eliminated conduction through the accessory pathway.

  2. Reduction of radiation exposure during atrial fibrillation ablation using a novel fluoroscopy image integrated 3-dimensional electroanatomic mapping system: A prospective, randomized, single-blind, and controlled study.

    Science.gov (United States)

    Huo, Yan; Christoph, Marian; Forkmann, Mathias; Pohl, Matthias; Mayer, Julia; Salmas, Jozef; Sitzy, Judith; Wunderlich, Carsten; Piorkowski, Christopher; Gaspar, Thomas

    2015-09-01

    We explored whether the use of a novel fluoroscopy image integrated 3-dimensional electroanatomic mapping (F-EAM) system could result in a reduction of overall fluoroscopy time and radiation doses during the whole procedure of atrial fibrillation (AF) ablation. Eighty patients (44 men (55%); mean age 63 ± 10 years) who underwent catheter ablation due to paroxysmal AF were recruited consecutively in the present study. Patients were randomized (1:1) into 2 arms for AF ablation: one using a conventional 3-dimensional electroanatomical mapping (EAM) system and the other using the F-EAM system. Fluoroscopy time (10:42 [interquartile range {IQR} 8:45-12:46] minutes:seconds vs 1:45 [IQR 1:05-2:22] minutes:seconds; P fluoroscopy time and 73% of radiation doses have been reduced during the AF ablation procedure using the F-EAM system compared to using the conventional EAM system. However, procedure time did not differ significantly (1:39 [IQR 1:18-2:10] hours:minutes vs 1:37 [IQR 1:17-1:50] hours:minutes; P = .362). During follow-up (5.9 ± 1.3 months), 61 patients (76.3%) had no recurrence of atrial arrhythmias. The recurrence rate between the 2 groups did not differ. AF catheter ablation using the F-EAM system was safe and resulted in a significant reduction of radiation exposure to patients and staff without complicating the workflow of the procedure. A near-zero fluoroscopic catheter ablation procedure could be performed without compromising acute/mid-term efficacy and safety. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  3. Cultural Understanding: Spanish Level 1.

    Science.gov (United States)

    Scott, Reid

    The teacher's attention is focused on selected elements of Spanish culture which may be taught integrally with instructional materials found in the first-year Spanish texts "Entender y Hablar", "La Familia Fernandez", and "A-LM Spanish, Level One". Items are cross-referenced for 42 cultural concepts ranging from nicknames to streets, roads, and…

  4. [The role of the uretral catheter in the development of catheter- related urinary tract infection].

    Science.gov (United States)

    Vasilyev, A O; Govorov, A V; Shiryaev, A A; Pushkar, D Yu

    2017-12-01

    The most common source of nosocomial infection is the urinary tract, especially if they it is drained with a urethral catheter. Catheter-associated urinary tract infections account for at least 80% of all complicated urinary tract infections and are the most common type of hospital-acquired infection. Intestinal microflora plays the leading role in the pathogenesis of catheter-associated urinary tract infections, whereas the most important risk factor for their development is the long duration of urinary catheter drainage. In the case of short-term and intermittent catheterization, routine antibiotic prophylaxis is not required, but if a patient develops clinically significant infection, antibiotic therapy is required followed by definitive therapy based on culture. Urethral catheters coated with antimicrobial substances and anti-inflammatory agents can significantly reduce the adhesion and migration of bacteria, thereby reducing the incidence of urinary tract infections. Despite this, the incidence of catheter-associated infection remains high. We have reviewed recent literature related to catheter-associated urinary tract infections and the best means of preventing this condition.

  5. In Vivo Evaluations of a Phased Ultrasound Array for Transesophageal Cardiac Ablation

    Science.gov (United States)

    Jaiswal, Devina; Werner, Jacob; Park, Eun-Joo; Francischelli, David; Smith, Nadine Barrie

    2010-03-01

    Atrial fibrillation is one of the most common arrhythmias that affects over 2.2 million Americans each year. Catheter ablation, one of the effective treatments, has shown high rate of success in treating paroxysmal atrial fibrillation. Currently, radiofrequency which is being used for catheter ablation is an invasive procedure. Measurable morbidity and significant costs and time are associated with this modality of treatment of permanent or persistent atrial fibrillation. In order to address these issues, a transesophageal ultrasound applicator for noninvasive cardiac ablation was designed, developed and evaluated. The ultrasound energy delivered by the phased array was used to create a lesion in the myocardial tissue. Various factors, simulation results of transducer arrays, current transesophageal medical devices, and throat anatomy, were considered while designing a phased ultrasound transducer that can be inserted into the esophagus. For this research, a two-dimensional sparse phased array with flat tapered elements was fabricated and evaluated in in vivo experiments. Five pigs were anesthetized; the array was passed transesophagealy and positioned over the heart. An operating frequency of 1.6 MHz and 8˜15 minutes of array operation resulted in both single and multiple lesions on atrial and ventricular myocardium. The average size of lesions was 5.1±2.1 mm in diameter and 7.8±2.5 mm in length. Experimental results indicate that the array delivered sufficient power to produce ablation at the focal point while not grossly damaging the tissue surrounding the area of interest. These results demonstrate a potential application of the ultrasound applicator for noninvasive transesophageal cardiac surgery in atrial fibrillation treatment.

  6. Spanish Consensus Statement

    Science.gov (United States)

    Rey, Guillermo Álvarez; Cuesta, Jordi Ardevol; Loureda, Rafael Arriaza; España, Fernando Ávila; Matas, Ramón Balius; Pazos, Fernando Baró; de Dios Beas Jiménez, Juan; Rosell, Jorge Candel; Fernandez, César Cobián; Ros, Francisco Esparza; Colmenero, Josefina Espejo; de Prado, Jorge Fernández; Cota, Juan José García; González, Jose Ignacio Garrido; Santander, Manuela González; Munilla, Miguel Ángel Herrador; Ruiz, Francisco Ivorra; Díaz, Fernando Jiménez; Marqueta, Pedro Manonelles; Fernandez, Antonio Maestro; Benito, Juan José Muñoz; Vilás, Ramón Olivé; Teres, Xavier Peirau; Amaro, José Peña; Roque, Juan Pérez San; Parenteu, Christophe Ramírez; Serna, Juan Ribas; Álvarez, Mikel Sánchez; Marchori, Carlos Sanchez; Soto, Miguel del Valle; Alonso, José María Villalón; García, Pedro Guillen; de la Iglesia, Nicolas Hugo; Alcorocho, Juan Manuel Lopez

    2015-01-01

    On the 21st of March, 2015, experts met at Clínica CEMTRO in Madrid, Spain, under the patronage of The Spanish Society for Sports Traumatology (SETRADE), The Spanish Federation of Sports Medicine (FEMEDE), The Spanish Association of Medical Services for Football Clubs (AEMEF), and The Spanish Association of Medical Services for Basketball Clubs (AEMB) with the aim of establishing a round table that would allow specialists to consider the most appropriate current general actions to be taken when treating muscle tears in sport, based on proven scientific data described in the medical literature. Each expert received a questionnaire prior to the aforementioned meeting comprising a set of questions concerning therapeutic indications generally applied in the different stages present during muscle repair. The present Consensus Document is the result of the answers to the questionnaire and resulting discussion and consensus over which are the best current indications in the treatment of muscle tears in sport. Avoiding immobilization, not taking nonsteroidal anti-inflammatory drugs (NSAIDs) randomly, fostering early mobilization, increasing vascularization of injured, site and regulating inflammatory mechanisms—without inhibiting these from the early stages of the recovery period—all stood out as main points of the Consensus Document. Additionally, there is controversy concerning cell stimulation techniques and the use of growth factors or cell inhibitors. The decision concerning discharge was unanimous, as was the criteria considered when it came to performing sport techniques without pain. PMID:27213161

  7. Introductory Spanish: Part 2.

    Science.gov (United States)

    Dade County Public Schools, Miami, FL.

    This course is intended for students who have had some experience in the formal study of Spanish. Performance objectives emphasize development of listening, speaking, and reading skills. Conversation is directed to everyday teenage interests: school, friends, soccer, and clothes. Grammar exercises treating "ser" and "estar"…

  8. I Can Learn Spanish.

    Science.gov (United States)

    La Rocca, Samuel J.

    This set of materials for Spanish second language instruction was designed for students who can be taught most effectively through a functional, conversational approach. It is intended as a supplement to the regular course of study so that all students, regardless of ability level, can be provided with an effective instructional program. It…

  9. Femtosecond laser ablation of dentin

    Science.gov (United States)

    Alves, S.; Oliveira, V.; Vilar, R.

    2012-06-01

    The surface morphology, structure and composition of human dentin treated with a femtosecond infrared laser (pulse duration 500 fs, wavelength 1030 nm, fluences ranging from 1 to 3 J cm-2) was studied by scanning electron microscopy, x-ray diffraction, x-ray photoelectron spectroscopy and Fourier transform infrared spectroscopy. The average dentin ablation threshold under these conditions was 0.6 ± 0.2 J cm-2 and the ablation rate achieved in the range 1 to 2 µm/pulse for an average fluence of 3 J cm-2. The ablation surfaces present an irregular and rugged appearance, with no significant traces of melting, deformation, cracking or carbonization. The smear layer was entirely removed by the laser treatment. For fluences only slightly higher than the ablation threshold the morphology of the laser-treated surfaces was very similar to the dentin fracture surfaces and the dentinal tubules remained open. For higher fluences, the surface was more porous and the dentin structure was partially concealed by ablation debris and a few resolidified droplets. Independently on the laser processing parameters and laser processing method used no sub-superficial cracking was observed. The dentin constitution and chemical composition was not significantly modified by the laser treatment in the processing parameter range used. In particular, the organic matter is not preferentially removed from the surface and no traces of high temperature phosphates, such as the β-tricalcium phosphate, were observed. The achieved results are compatible with an electrostatic ablation mechanism. In conclusion, the high beam quality and short pulse duration of the ultrafast laser used should allow the accurate preparation of cavities, with negligible damage of the underlying material.

  10. Femtosecond laser ablation of dentin

    International Nuclear Information System (INIS)

    Alves, S; Vilar, R; Oliveira, V

    2012-01-01

    The surface morphology, structure and composition of human dentin treated with a femtosecond infrared laser (pulse duration 500 fs, wavelength 1030 nm, fluences ranging from 1 to 3 J cm -2 ) was studied by scanning electron microscopy, x-ray diffraction, x-ray photoelectron spectroscopy and Fourier transform infrared spectroscopy. The average dentin ablation threshold under these conditions was 0.6 ± 0.2 J cm -2 and the ablation rate achieved in the range 1 to 2 µm/pulse for an average fluence of 3 J cm -2 . The ablation surfaces present an irregular and rugged appearance, with no significant traces of melting, deformation, cracking or carbonization. The smear layer was entirely removed by the laser treatment. For fluences only slightly higher than the ablation threshold the morphology of the laser-treated surfaces was very similar to the dentin fracture surfaces and the dentinal tubules remained open. For higher fluences, the surface was more porous and the dentin structure was partially concealed by ablation debris and a few resolidified droplets. Independently on the laser processing parameters and laser processing method used no sub-superficial cracking was observed. The dentin constitution and chemical composition was not significantly modified by the laser treatment in the processing parameter range used. In particular, the organic matter is not preferentially removed from the surface and no traces of high temperature phosphates, such as the β-tricalcium phosphate, were observed. The achieved results are compatible with an electrostatic ablation mechanism. In conclusion, the high beam quality and short pulse duration of the ultrafast laser used should allow the accurate preparation of cavities, with negligible damage of the underlying material. (paper)

  11. Vascular access in neonatology: peripherally inserted central catheter and peripheral venous catheter

    Directory of Open Access Journals (Sweden)

    Marcia Lienemann

    2014-04-01

    The objective of this paper is to present aspects of peripherally inserted central catheter and peripheral venous catheter, highlighting important points in choosing the type of access. For the passage of peripherally inserted central catheter is previously performing specific course necessary, while the primary indication occurs when it is necessary to access the patient's stay for a long period of time. Whereas peripheral venipuncture is the most appropriate in cases of needing an IV line quickly and safely, for the administration of fluids, blood collection, blood transfusion and other.

  12. Percutaneous Intraductal Radiofrequency Ablation is a Safe Treatment for Malignant Biliary Obstruction: Feasibility and Early Results

    Energy Technology Data Exchange (ETDEWEB)

    Mizandari, Malkhaz [Tbilisi State Medical University, Department of Radiology (Georgia); Pai, Madhava, E-mail: madhava.pai@imperial.ac.uk; Xi Feng [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom); Valek, Vlastimil; Tomas, Andrasina [University Hospital Brno Bohunice, Department of Radiology (Czech Republic); Quaretti, Pietro [IRCCS Policlinico San Matteo, Department of Radiology (Italy); Golfieri, Rita; Mosconi, Cristina [University of Bologna, Department of Radiology, Policlinico S. Orsola-Malpighi (Italy); Ao Guokun [The 309 Hospital of Chinese PLA, Department of Radiology (China); Kyriakides, Charis [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom); Dickinson, Robert [Imperial College London, Department of Bioengineering (United Kingdom); Nicholls, Joanna; Habib, Nagy, E-mail: nagy.habib@imperial.ac.uk [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom)

    2013-06-15

    Purpose. Previous clinical studies have shown the safety and efficacy of this novel radiofrequency ablation catheter when used for endoscopic palliative procedures. We report a retrospective study with the results of first in man percutaneous intraductal radiofrequency ablation in patients with malignant biliary obstruction. Methods. Thirty-nine patients with inoperable malignant biliary obstruction were included. These patients underwent intraductal biliary radiofrequency ablation of their malignant biliary strictures following external biliary decompression with an internal-external biliary drainage. Following ablation, they had a metal stent inserted. Results. Following this intervention, there were no 30-day mortality, hemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the 39 patients, 28 are alive and 10 patients are dead with a median survival of 89.5 (range 14-260) days and median stent patency of 84.5 (range 14-260) days. One patient was lost to follow-up. All but one patient had their stent patent at the time of last follow-up or death. One patient with stent blockage at 42 days postprocedure underwent percutaneous transhepatic drain insertion and restenting. Among the patients who are alive (n = 28) the median stent patency was 92 (range 14-260) days, whereas the patients who died (n = 10) had a median stent patency of 62.5 (range 38-210) days. Conclusions. In this group of patients, it appears that this new approach is feasible and safe. Efficacy remains to be proven in future, randomized, prospective studies.

  13. Alternative approach for management of an electrical storm in Brugada syndrome:Importance of primary ablation within a narrow time window

    Directory of Open Access Journals (Sweden)

    Ahmed Karim Talib, MD, PhD

    2016-06-01

    Full Text Available Placement of an implantable cardioverter–defibrillator (ICD is the only powerful treatment modality for Brugada syndrome in patients presenting with ventricular fibrillation (VF. For those whose first presentation is an electrical storm, pharmacologic therapy is typically used to control VF followed by ICD implantation. We report an alternative approach whereby, before ICD implantation, emergency catheter ablation of the VF-triggering premature ventricular contraction (PVC resulted in long-term VF-free survival. The results suggest that, because VF triggers appear in a narrow time window, ablation of the culprit PVCs that initiate VF before the index PVCs subside is a reasonable alternative approach.

  14. Low-energy radiofrequency catheter ablation as therapy for supraventricular tachycardia in a premature neonate

    NARCIS (Netherlands)

    Kolditz, Denise P.; Blom, Nico A.; Bökenkamp, Regina; Schalij, Martin J.

    2005-01-01

    A premature neonate with hydrops was born at 32 weeks of gestation after successful direct fetal amiodarone therapy via cordocentesis for incessant supraventricular tachycardia. After birth the tachycardia could not be controlled despite high doses of amiodarone and flecainide and the patient

  15. Cardiac rehabilitation versus usual care for patients treated with catheter ablation for atrial fibrillation

    DEFF Research Database (Denmark)

    Risom, Signe S; Zwisler, Ann-Dorthe; Rasmussen, Trine Bernholdt

    2016-01-01

    ) versus 20.7mL kg(-1) min(-1), p of main effect=0.003, p of interaction between time and intervention=0.020). No significant difference between groups on Short Form-36 was found (53.8 versus 51.9 points, P=.20). Two serious adverse events (atrial fibrillation in relation to physical exercise and death...... unrelated to rehabilitation) occurred in the cardiac rehabilitation group versus one in the usual care group (death unrelated to intervention) (P=.56). In the cardiac rehabilitation group 16 patients versus 7 in the usual care group reported non-serious adverse events (P=.047). CONCLUSION: Comprehensive...

  16. "Cardio-Neuromodulation" With a Multielectrode Irrigated Catheter: A Potential New Approach for Patients With Cardio-Inhibitory Syncope.

    Science.gov (United States)

    Debruyne, Philippe

    2016-09-01

    Syncope is frequently neurally mediated and can seriously affect quality of life. Different ablation strategies have been successfully performed. These approaches have not gained wide acceptance and are quite extensive and complex, exposing patients to significant risks. This article reports the case of a 16-year-old girl who was severely affected by frequent and prolonged episodes of syncope and was treated by tailored ablation of the anterior right ganglionated plexus with a multielectrode irrigated catheter. She had fainted >30 times in the 5 years preceding treatment, experiencing approximately 10 severe episodes of syncope in the previous 12 months. After 3 minutes of ablation, the P-P interval was reduced by >400 milliseconds. Syncope disappeared and the patient has remained completely asymptomatic over a follow-up of 22 months. The "reset" basal P-P interval has remained unchanged (follow-up electrocardiogram at 16 months). At 6 months, there was no residual heart rate activity 16,000 beats. We believe that this case report is original for several reasons: the unusual clinical presentation; the unique structure targeted; the very limited ablation, implying much lower risks for the patient; the anatomical approach; and the different endpoint. This new "cardio-neuromodulation" approach could be useful for the treatment of patients with neurally mediated syncope. © 2016 Wiley Periodicals, Inc.

  17. Urinary catheterization diary – A useful tool in tracking causes of non-deflating Foley catheter

    Directory of Open Access Journals (Sweden)

    C.O. Okorie

    2015-06-01

    Conclusions: Most urinary catheters marketed in developing countries are unidentifiable after unpacking. A catheterization diary is a useful tool for solving catheter-related problems, and its application in health-care facilities should be encouraged. Companies marketing Foley catheters should print the catheter name on both the catheter packaging and on the catheter itself.

  18. TU-AB-201-06: Evaluation of Electromagnetically Guided High- Dose Rate Brachytherapy for Ablative Treatment of Lung Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Pinkham, D.W.; Shultz, D.; Loo, B.W.; Sung, A.; Diehn, M.; Fahimian, B.P. [Stanford University, Stanford, CA (United States)

    2015-06-15

    Purpose: The advent of electromagnetic navigation bronchoscopy has enabled minimally invasive access to peripheral lung tumors previously inaccessible by optical bronchoscopes. As an adjunct to Stereotactic Ablative Radiosurgery (SABR), implantation of HDR catheters can provide focal treatments for multiple metastases and sites of retreatments. The authors evaluate a procedure to deliver ablative doses via Electromagnetically-Guided HDR (EMG-HDR) to lung metastases, quantify the resulting dosimetry, and assess its role in the comprehensive treatment of lung cancer. Methods: A retrospective study was conducted on ten patients, who, from 2009 to 2011, received a hypo-fractionated SABR regimen with 6MV VMAT to lesions in various lobes ranging from 1.5 to 20 cc in volume. A CT visible pathway was delineated for EM guided placement of an HDR applicator (catheter) and dwell times were optimized to ensure at least 98% prescription dose coverage of the GTV. Normal tissue doses were calculated using inhomogeneity corrections via a grid-based Boltzmann solver (Acuros-BV-1.5.0). Results: With EMG-HDR, an average of 83% (+/−9% standard deviation) of each patient’s GTV received over 200% of the prescription dose, as compared to SABR where the patients received an average maximum dose of 125% (+/−5%). EMG-HDR enabled a 59% (+/−12%) decrease in the aorta maximum dose, a 63% (+/−26%) decrease in the spinal cord max dose, and 57% (+/−23%) and 70% (+/−17%) decreases in the volume of the body receiving over 50% and 25% of the prescription dose, respectively. Conclusion: EMG-HDR enables delivery of higher ablative doses to the GTV, while concurrently reducing surrounding normal tissue doses. The single catheter approach shown here is limited to targets smaller than 20 cc. As such, the technique enables ablation of small lesions and a potentially safe and effective retreatment option in situations where external beam utility is limited by normal tissue constraints.

  19. Accidental Breakage of Lumbar Epidural Catheter - Case report ...

    African Journals Online (AJOL)

    Breakage of epidural catheter is a rare occurrence with only isolated reports. Though insertion of epidural catheter is generally considered a safe procedure, breakage during removal leaving a segment in the patient's back can occur. There are many factors associated with breakage of an epidural catheter, such as the ...

  20. Misplaced left internal jugular venous catheter with an exceptional ...

    African Journals Online (AJOL)

    Large numbers of central venous catheters (CVCs) are placed each year in the intensive care units and misplacement occurs frequently. Many critically ill patients require central venous catheterization for multiple and varied reasons. Internal jugular vein (IJV) catheter is one of the most frequent central venous catheters in ...

  1. 21 CFR 868.5120 - Anesthesia conduction catheter.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Anesthesia conduction catheter. 868.5120 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5120 Anesthesia conduction catheter. (a) Identification. An anesthesia conduction catheter is a flexible tubular device used to inject...

  2. FAQs about Catheter-Associated Urinary Tract Infection

    Science.gov (United States)

    ... the bladder. What are the symptoms of a urinary tract infection? Some of the common symptoms of a urinary tract infection are: • Burning or ... catheter is removed. Sometimes people with catheter-associated urinary tract ... these symptoms of infection. Can catheter-associated urinary tract infections ...

  3. 21 CFR 884.6110 - Assisted reproduction catheters.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproduction catheters. 884.6110 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6110 Assisted reproduction catheters. (a) Identification. Assisted reproduction catheters are devices used in in...

  4. Intravascular catheter related infections in children admitted on the ...

    African Journals Online (AJOL)

    peripheral venous intravascular catheters uncoated with no antibiotic or antiseptic, was done. Social demographic characteristics, anthropometry, clinical examination including the catheter site were determined at enrollment. The children had their blood, catheter tip and hub samples taken off for culture and sensitivity as ...

  5. Catheter associated urinary tract infection: Aetiologic agents and ...

    African Journals Online (AJOL)

    The objective of this study was to identify microbial pathogens associated with bacteriuria and UTI in patients with indwelling urethral catheters and determine their susceptibility patterns to commonly used antimicrobial agents in our institution. Catheter urine and catheter tip specimens of all the patients were analyzed by ...

  6. Severe Tricuspid Valve Endocarditis Related to Tunneled Catheters ...

    African Journals Online (AJOL)

    The patient improved after catheter removal and treatment with ceftazidime, vancomycin and amikacin. Another patient who was maintained on chronic HD through a tunneled catheter in the right internal jugular vein presented with a limited infection in the sub-cutaneous tunnel of the catheter that improved after treatment ...

  7. Management of Non- Deflating Foley Suprapubic Catheters - A ...

    African Journals Online (AJOL)

    The procedure described uses a 10 ml syringe and needle passed through the lumen of the catheter to puncture the inner surface of the catheter balloon and thus deflate it. Because the catheter balloon does not burst in this procedure there is no risk of balloon fragmentation or subsequent stone formation. The technique is ...

  8. Dislodgment of Port-A-Cath Catheters in Children

    Directory of Open Access Journals (Sweden)

    Chi-Lin Ho

    2008-10-01

    Conclusion: The dislodgment rate of port-a-cath catheters in children in our series was 4.1%. Most (83% catheters were broken at the site of anastomosis to the port. All dislodged catheters could be successfully retrieved by transcatheter retrieval using a gooseneck snare.

  9. Catheter Removal versus Retention in the Management of Catheter-Associated Enterococcal Bloodstream Infections

    Directory of Open Access Journals (Sweden)

    Jonas Marschall

    2013-01-01

    Full Text Available BACKGROUND: Enterococci are an important cause of central venous catheter (CVC-associated bloodstream infections (CA-BSI. It is unclear whether CVC removal is necessary to successfully manage enterococcal CA-BSI.

  10. Feasibility and safety of transradial coronary interventions using a 6.5-F sheathless guiding catheter in patients with small radial arteries.

    Science.gov (United States)

    Cheaito, Radi; Benamer, Hakim; Hovasse, Thomas; Tritar, Amine; Hage, Fouad; Garot, Philippe; Lefèvre, Thierry; Unterseeh, Thierry; Chevalier, Bernard; Morice, Marie-Claude; Louvard, Yves

    2015-07-01

    This study investigated the feasibility and the safety of using a 6.5-French sheathless guide catheter in patients with small radial arteries. The small size of radial arteries is a limitation of transradial coronary intervention. A new sheathless guiding catheter with a diameter almost 2-Fr smaller than conventional sheaths and a full-length hydrophilic coating has been introduced. A total of 148 patients from three French hospitals were consecutively enrolled from March 2009 to February 2012. They underwent transradial approach (TRA) for percutaneous coronary interventions (PCI) using the 6.5-F ASAHI sheathless Eaucath guiding catheter system. Among the 148 patients enrolled, 95 were females (64%), and 183 lesions were treated. Procedural success rate was 100%. Thirteen patients (9%) underwent same-procedure multivessel interventions for the right and left coronary artery. Among the group of 46 patients undergoing bifurcation PCI, 35 (76%) bifurcated lesions were treated with a kissing balloon technique, one patient had a saphenous vein bypass graft lesion requiring filter wire placement prior to intervention, nine (6.1%) patients required rotational atherectomy, thrombus-aspiration catheters were used in 19 (12.8%) patients, fractional flow reserve (FFR)-guided PCI in 10 (6.7%) patients, alcohol septal ablation in three (2%) patients. Ten (6.7%) cases of chronic total occlusion were successfully treated in nine (6.1%) patients using the hydrophilic catheter. No radial artery site complications was noted. The use of sheathless guiding catheters is a safe, effective method for PCI via TRA in small radial arteries without catheter-related complications. © 2015 Wiley Periodicals, Inc.

  11. electrode catheter techniques for treattnent of supraventricular ...

    African Journals Online (AJOL)

    damaged by radiofrequency energy (RP) delivered via catheters insened percutaneously without general anaes- thesia. The technique and results of its use were the main topics of interest at the 9th World Symposium on. Cardiac Pacing and Electrophysiology held in. Washington, DC, in June 1991. Effective cure of WPW.

  12. Percutaneous Placement of Peritoneal Dialysis Catheters in ...

    African Journals Online (AJOL)

    Background: The percutaneous placement of peritoneal dialysis (PD) catheters using conscious sedation with ultrasound and fluoroscopic guidance is underutilised and hasseveral advantages over the open surgical and laparoscopic placement methods, especially in the resource-limited developing world. Objectives: To ...

  13. Ultraminiature manometer-tipped cardiac catheter

    Science.gov (United States)

    Coon, G. W.

    1967-01-01

    Miniature diaphragm-type capacitance transducer capable of being mounted on the end of a cardiac catheter has been developed for measurement of intravascular pressures. The transducer can be inserted in small ducts /arteries and veins/ without disturbing the flow characteristics. It is very useful for making measurements in babies.

  14. Concurrent use of pigtail and loop snare catheters for percutaneous retrieval of dislodged central venous port catheter

    Directory of Open Access Journals (Sweden)

    Ming-Tsung Chuang

    2011-11-01

    Full Text Available The purpose of this study was to report our experience of percutaneous retrieval of dislodged port catheters with concurrent use of pigtail and loop snare catheters. During a 5-year period at our institute (June 2005 to July 2010, a total of 23 dislodged port catheters were retrieved. The interval between port catheter implantation and dislodged catheter retrieval ranged from 43 days to 1,414 days (mean 586.7 days. The time of delayed retrieval ranged from 1 day to 45 days (mean 4.6 days. All dislodged catheters were retrieved with the concurrent use of pigtail and loop snare catheters via femoral venous route. The prevalence of port catheter dislodgement at our institute was 3.4%. All dislodged port catheters were removed successfully with pigtail and loop snare catheters together. No procedure-related complications were encountered, except for transient arrhythmia in two patients, which required no medication. In conclusion, the concurrent use of pigtail and loop snare catheters is a feasible and easy way for percutaneous retrieval of a dislodged central venous port catheter.

  15. Radiofrequency ablation of liver metastases

    International Nuclear Information System (INIS)

    Pereira, P.L.; Clasen, S.; Schmidt, D.; Wiskirchen, J.; Tepe, G.; Claussen, C.D.; Boss, A.; Gouttefangeas, C.; Burkart, C.

    2004-01-01

    The liver is the second only to lymph nodes as the most common site of metastatic disease irrespective of the primary tumor. Up to 50% of all patients with malignant diseases will develop liver metastases with a significant morbidity and mortality. Although the surgical resection leads to an improvement of the survival time, only approximately 20% of the patients are eligible for surgical intervention. Radiofrequency (RF) ablation represents one of the most important alternatives as well as complementary methods for the therapy of liver metastases. RF ablation can lead in a selected patient group to a palliation or to an increased life expectancy. RF ablation appears either safer (vs. cryotherapy) or easier (vs. laser) or more effective (percutaneous ethanol instillation [PEI]), transarterial chemoembolisation [TACE] in comparison with other minimal invasive procedures. RF ablation can be performed percutaneously, laparoscopically or intraoperatively and may be combined with chemotherapy as well as with surgical resection. Permanent technical improvements of RF systems, a better understanding of the underlying electrophysiological principles and an interdisciplinary approach will lead to a prognosis improvement in patients with liver metastases. (orig.) [de

  16. [Radiofrequency ablation of liver metastases].

    Science.gov (United States)

    Pereira, P L; Clasen, S; Boss, A; Schmidt, D; Gouttefangeas, C; Burkart, C; Wiskirchen, J; Tepe, G; Claussen, C D

    2004-04-01

    The liver is the second only to lymph nodes as the most common site of metastatic disease irrespective of the primary tumor. Up to 50% of all patients with malignant diseases will develop liver metastases with a significant morbidity and mortality. Although the surgical resection leads to an improvement of the survival time, only approximately 20% of the patients are eligible for surgical intervention. Radiofrequency (RF) ablation represents one of the most important alternatives as well as complementary methods for the therapy of liver metastases. RF ablation can lead in a selected patient group to a palliation or to an increased life expectancy. RF ablation appears either safer (vs. cryotherapy) or easier (vs. laser) or more effective (percutaneous ethanol instillation [PEI], transarterial chemoembolisation [TACE]) in comparison with other minimal invasive procedures. RF ablation can be performed percutaneously, laparoscopically or intraoperatively and may be combined with chemotherapy as well as with surgical resection. Permanent technical improvements of RF systems, a better understanding of the underlying electrophysiological principles and an interdisciplinary approach will lead to a prognosis improvement in patients with liver metastases.

  17. Endometrial ablation with paracervical block

    NARCIS (Netherlands)

    Penninx, Josien P. M.; Mol, Ben Willem; Bongers, Marlies Y.

    2009-01-01

    OBJECTIVE: To evaluate the safety, feasibility and efficacy of endometrial ablation under local anesthesia. STUDY DESIGN: A prospective cohort study was performed at the gynecology department of a large teaching hospital. Women with dysfunctional uterine bleeding were included to undergo NovaSure

  18. Placement issues of hemodialysis catheters with pre-existing central lines and catheters.

    Science.gov (United States)

    Aurshina, Afsha; Hingorani, Anil; Alsheekh, Ahmad; Kibrik, Pavel; Marks, Natalie; Ascher, Enrico

    2018-03-01

    It has been a widely accepted practice that a previous placed pacemaker, automatic implantable cardioverter defibrillators, or central line can be a contraindication to placing a hemodialysis catheter in the ipsilateral jugular vein. Fear of dislodging pacing wires, tunneling close to the battery site or causing venous obstruction has been a concern for surgeons and interventionalists alike. We suggest that this phobia may be unfounded. A retrospective review was conducted of patients in whom hemodialysis catheters were placed over a period of 10 years. For each hemodialysis catheter that was placed, perioperative chest X-ray performed was used to evaluate for pre-existing pacemakers and central lines. The position and laterality of placement of the hemodialysis catheter along with presence of arteriovenous fistula with functional capacity for access were noted. A total of 600 hemodialysis catheters were placed in patients over the period of 10 years. The mean age of the patients was 73.6 ± 12 years with a median age of 76 years. We found 20 pacemakers or automatic implantable cardioverter defibrillators and 19 central lines on the same side of the neck as the hemodialysis catheter that was placed in the ipsilateral jugular vein. No patient exhibited malfunction or dislodgment of the central line, the pacemaker, or automatic implantable cardioverter defibrillator or evidence of upper extremity venous obstruction based upon signs symptoms or duplex exams. Based on our experience, we suggest that placement of hemodialysis catheter in the internal jugular vein ipsilateral to the pre-existing catheter/leads is safe and spares the contralateral limb for arteriovenous fistula creation.

  19. Hydrodynamic instabilities in an ablation front

    Energy Technology Data Exchange (ETDEWEB)

    Piriz, A R; Portugues, R F [E.T.S.I. Industriales, Universidad de Castilla-La Mancha, 13071 Ciudad Real (Spain)

    2004-06-01

    The hydrodynamic stability of an ablation front is studied for situations in which the wavelength of the perturbations is larger than the distance to the critical surface where the driving radiation is absorbed. An analytical model is presented, and it shows that under conditions in which the thermal flux is limited within the supercritical region of the ablative corona, the front may behave like a flame or like an ablation front, depending on the perturbation wavelength. For relatively long wavelengths the critical and ablation surfaces practically lump together into a unique surface and the front behaves like a flame, whereas for the shortest wavelengths the ablation front substructure is resolved.

  20. Urethral catheters: can we reduce use?

    Directory of Open Access Journals (Sweden)

    van den Akker-van Marle M Elske

    2011-05-01

    Full Text Available Abstract Background Indwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection. Methods The efficacy of an intervention programme to improve adherence to recommendations to reduce the use of urethral catheters was studied in a before-after comparison in ten Dutch hospitals. The programme detected barriers and facilitators and each individual facility was supported with developing their own intervention strategy. Outcome was evaluated by the prevalence of catheters, alternatives such as diapers, numbers of urinary tract infections, the percentage of correct indications and the duration of catheterization. The costs of the implementation as well as the catheterization were evaluated. Results Of a population of 16,495 hospitalized patients 3335 patients of whom 2943 were evaluable for the study, had a urethral catheter. The prevalence of urethral catheters decreased insignificantly in neurology (OR 0.93; 95% CI 0.77 - 1.13 and internal medicine wards (OR 0.97; 95% CI 0.83 - 1.13, decreased significantly in surgical wards (OR 0.84; 95% CI 0.75 - 0.96, but increased significantly in intensive care (IC and coronary care (CC units (OR 1.48; 95% CI 1.01 - 2.17. The use of alternatives was limited and remained so after the intervention. Duration of catheterization decreased insignificantly in IC/CC units (ratio after/before 0.95; 95% CI 0.78 - 1.16 and neurology (ratio 0.97; 95% CI 0.80 - 1.18 and significantly in internal medicine (ratio 0.81; 95% CI 0.69 - 0.96 and surgery wards (ratio 0.80; 95% CI 0.71 - 0.90. The percentage of correct indications on the day of inclusion increased from 50 to 67% (p Conclusion Targeted implementation of recommendations from an existing guideline can lead to better adherence and cost savings. Especially, hospitals which use a lot of urethral catheters or

  1. Causes and nursing countermeasures in pediatric PICC catheter complications.

    Science.gov (United States)

    Xiang, Mingli; Li, Na; Yi, Lan; Liu, Bin

    2016-01-01

    To analyze the complications and nursing countermeasures of PICC (Peripherally Inserted Central Catheter) catheters using children PICC catheter technique 40 cases, complications were observed, and analyze the original causes, in order to propose a solution. There were 10 cases of catheter blockage, 5 cases of catheter infection, 6 cases of phlebitis, 5 cases of puncture difficulties, 2 cases of poor feeding tube, 2 cases of bleeding puncture site with the continuous exploration and research of nursing intervention, the production of clinical complications from PICC has been used in children were greatly reduced.

  2. Indwelling Urinary Catheter-Related Problems After Laparoscopic Radical Prostatectomy.

    Science.gov (United States)

    Reuvers, Sarah; Zonneveld, Willemijn; Meiland-van Bakel, Marja; Putter, Hein; Nicolai, Melianthe; Pelger, Rob; Elzevier, Henk

    2016-01-01

    The purpose of this study was to determine occurrence rates of catheter-related problems and their association to pertinent clinical characteristics in men with indwelling urinary catheters following laparoscopic radical prostatectomy. Descriptive, correlational study. One hundred twelve men who underwent laparoscopic radical prostatectomy between December 2010 and December 2012 at the Leiden University Medical Centre in the Netherlands were included in this study. After surgery, a Charriere 20 (20F) silicone catheter was left indwelling for 1 week. Data were gathered from 2 sources; we reviewed participants' medical records, and participants completed a questionnaire designed for this study. Pearson χ tests were used to analyze associations between dichotomous and ordinal variables and catheter-related problems. Univariate logistic regression analyses were used to analyze the relationships between continuous factors and catheter-related problems. Seventy-five percent of participants reported at least 1 catheter-related problem. Univariate regression analyses revealed correlations between body weight and experiencing catheter-related problems (odds ratio [OR] = 1.050; P = .028) and between body mass index and experiencing catheter-related problems (OR = 1.159; P = .049). Indwelling catheter-related problems after laparoscopic radical prostatectomy are prevalent, and they may occur at any time during the entire period of catheter use. High body mass index and high body weight were associated with an increased likelihood of catheter-related problems following radical prostatectomy.

  3. Radiologically placed tunneled peritoneal catheter in palliation of malignant ascites

    Energy Technology Data Exchange (ETDEWEB)

    Akinci, Devrim; Erol, Bekir; Ciftci, Tuerkmen T. [Hacettepe University, Faculty of Medicine, Department of Radiology, 06100 Ankara (Turkey); Akhan, Okan, E-mail: akhano@tr.net [Hacettepe University, Faculty of Medicine, Department of Radiology, 06100 Ankara (Turkey)

    2011-11-15

    The purpose of this study was to evaluate retrospectively the safety and effectiveness of radiologically placed tunneled peritoneal catheter in palliation of malignant ascites. Between July 2005 and June 2009, 41 tunneled peritoneal catheters were placed under ultrasonographic and fluoroscopic guidance in 40 patients (mean age, 55 years; 22 women) who had symptomatic malignant ascites. No procedure related mortality was observed. Major complication occurred in one patient (2.5%) in the form of serious bacterial peritonitis that necessitated catheter removal. Minor complications such as minor bacterial peritonitis, catheter dislodgement, tunnel infection, and catheter blockage occurred in 11 patients (27.5%). The mean duration of survival after catheter placement was 11.8 weeks. All patients expired of their primary malignancies in the follow-up. Radiologically placed tunneled peritoneal catheter is safe and effective in palliation of symptomatic malignant ascites.

  4. A Novel Catheter-Guidance Algorithm for Localization of Atrial Fibrillation Rotor and Focal Sources

    Science.gov (United States)

    Salmin, Anthony J.; Ganesan, Prasanth; Shillieto, Kristina E.; Cherry, Elizabeth M.; Huang, David T.; Pertsov, Arkady M.; Ghoraani, Behnaz

    2018-01-01

    Locating atrial fibrillation (AF) focal and rotor sources can help improve target ablation therapy for AF. However, it remains unclear how to use the information provided by multi-polar diagnostic catheters (MPDC) to locate AF sources. Our aim was to develop a catheter-guidance algorithm to locate AF focal and rotor sources using a conventional MPDC. We simulated a 10 cm x 10 cm atrial tissue with focal and rotor sources using the Nygren et al. ionic model. We modeled a Lasso MPDC with 20-unipole electrodes placed with a spacing of 4.5-1-4.5 mm (diameter, d=15 mm) along a circle to obtain 10-bipole electrograms. Staring from an initial location, the algorithm, which was blinded to the location and type of the AF source, iteratively advanced the MPDC by moving its center to the location of the first activated bipole (FAB). The algorithm located an AF source if a stopping condition for either source was satisfied using bipole electrogram characteristics extracted from the MPDC placement. We tested the algorithm for a single rotor and focal source for all possible initial positions on the simulated tissue and repeated it for a random placement with a maximum of 20 possible placements at every trial. The algorithm located the AF source for 100% of trials and on average required 5.99 ± 1.92 placements to an AF source. This algorithm may be used to iteratively direct an MPDC towards an AF source and allow the AF source to be localized for customized AF ablation. PMID:28268380

  5. 7 CFR 51.2734 - Spanish type.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Spanish type. 51.2734 Section 51.2734 Agriculture... Standards for Grades of Shelled Spanish Type Peanuts Definitions § 51.2734 Spanish type. Spanish type means peanuts of varieties which belong to the Spanish classification group and which are free from kernels of...

  6. Durable lesion formation while avoiding esophageal injury during ablation of atrial fibrillation: Lessons learned from late gadolinium MR imaging.

    Science.gov (United States)

    Chelu, Mihail G; Morris, Alan K; Kholmovski, Eugene G; King, Jordan B; Kaur, Gagandeep; Silver, Michelle A; Cates, Joshua E; Han, Frederick T; Marrouche, Nassir F

    2018-03-01

    Adequate catheter/atrial tissue contact is critical for lesion formation during radiofrequency (RF) ablation of atrial fibrillation (AF). Late gadolinium enhancement magnetic resonance imaging (LGE-MRI) is a unique tool for the evaluation of lesion formation and detection of acute esophageal injury. LGE-MRIs were obtained prior, within 24 hours of, and at 115 ± 62 days after first AF ablation in 36 patients. The Visitag module of CARTO3 was used to collect contact force (CF) and duration from a CF sensing ablation catheter for each registered ablation point. The minimum CF resulting in permanent lesions was determined. Esophageal enhancement detected by acute LGE-MRI was classified as mild, moderate, and severe. The CF resulting in esophageal enhancement was determined. A total of 4,642 registered ablation tags at 50 W power were analyzed. The mean RF duration (5.9 ± 3.7 vs. 5.6 ± 3.2 seconds, P < 0.05), CF (11.5 ± 5.6 vs. 10.9 ± 5.4 g, P < 0.001), and force time integral (FTI) (67.3 ± 54.5 vs. 62.2 ± 52.7 gs, P < 0.01) were significantly higher between ablation tags with and without associated LGE-MRI detected scar. The mean CF (15.7 ± 6.1 vs. 12.6 ± 5.9 g, P < 0.05, n  =  17 patients) in areas of esophageal enhancement was greater than areas without. Left atrial short duration ablation lesions with a CF greater than 12 g are more likely to be associated with permanent lesion formation. Ablating on top of the esophagus, CF less than 15 g would help minimize esophageal wall injury. © 2018 Wiley Periodicals, Inc.

  7. In vitro analysis of balloon cuffing phenomenon: inherent biophysical properties of catheter material or mechanics of catheter balloon deflation?

    Science.gov (United States)

    Chung, Eric; So, Karina

    2012-06-01

    To investigates the different methods of balloon deflation, types of urinary catheters and exposure to urine media in catheter balloon cuffing. Bardex®, Bard-Lubri-Sil®, Argyle®, Releen® and Biocath® were tested in sterile and E.Coli inoculated urine at 0, 14 and 28 days. Catheter deflation was performed with active deflation; passive deflation; passive auto-deflation; and excision of the balloon inflow channel. Balloon cuffing was assessed objectively by running the deflated balloon over a plate of agar and subjectively by 3 independent observers. Bardex®, Argyle® and Biocath® showed greater degree of catheter balloon cuffing (p deflation was the worst method (p 0.05). Linear regression model analysis confirmed time as the most significant factor. The duration of catheters exposure, different deflation methods and types of catheters tested contributed significantly to catheter balloon cuffing (p < 0.01).

  8. The Spanish Language in Ireland

    OpenAIRE

    Barnwell, David

    2008-01-01

    This article provides an overview of the situation of Spanish in the Irish educational system and in wider society. Spain enjoys positive attitudes among Irish people, helped by the considerable amount of property in that country purchased by Irish during the past few years. The Spanish language has over the years experienced mixed fortunes as regards its place in Irish education. Recently, however, there has been a moderate increase in the numbers studying Spanish across all sectors...

  9. Exploring relationships of catheter-associated urinary tract infection and blockage in people with long-term indwelling urinary catheters.

    Science.gov (United States)

    Wilde, Mary H; McMahon, James M; Crean, Hugh F; Brasch, Judith

    2017-09-01

    To describe and explore relationships among catheter problems in long-term indwelling urinary catheter users, including excess healthcare use for treating catheter problems. Long-term urinary catheter users experience repeated problems with catheter-related urinary tract infection and blockage of the device, yet little has been reported of the patterns and relationships among relevant catheter variables. Secondary data analysis was conducted from a sample in a randomised clinical trial, using data from the entire sample of 202 persons over 12 months' participation. Descriptive statistics were used to characterise the sample over time. Zero-inflated negative binomial models were employed for logistic regressions to evaluate predictor variables of the presence/absence and frequencies of catheter-related urinary tract infection and blockage. Catheter-related urinary tract infection was marginally associated with catheter blockage. Problems reported at least once per person in the 12 months were as follows: catheter-related urinary tract infection 57%, blockage 34%, accidental dislodgment 28%, sediment 87%, leakage (bypassing) 67%, bladder spasms 59%, kinks/twists 42% and catheter pain 49%. Regression analysis demonstrated that bladder spasms were significantly related to catheter-related urinary tract infection and sediment amount, and catheter leakages were marginally significantly and positively related to catheter-related urinary tract infection. Frequencies of higher levels of sediment and catheter leakage were significantly associated with higher levels of blockage, and being female was associated with fewer blockages. Persons who need help with eating (more disabled) were also more likely to have blockages. Catheter-related urinary tract infection and blockage appear to be related and both are associated with additional healthcare expenditures. More research is needed to better understand how to prevent adverse catheter outcomes and patterns of problems in

  10. Transvenous Radiofrequency Ablation Therapy in the Treatment of Arrhythmias: A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Tayyar Gökdeniz

    2013-03-01

    Full Text Available Introduction: Radiofrequency ablation of tachyarrhythmia is effective in the treatment of tachycardia. In this study, we evaluated the results of radiofrequency catheter ablation of tachyarrhythmia.Patients and Methods: From December 2010 to January 2012, 114 consecutive patients with symptomatic drug-resistant typical slow-fast atrioventricular nodal reentrant tachycardia, 17 patients with atrioventricular reentrant tachycardia (five Wolf Parkinson White syndrome, eight patients with atrial tachycardia, seven patients with atrial flutter, five patients with right ventricular outflow tract tachycardia and three patients with atrial fibrillation underwent an invasive electrophysiology study and radiofrequency ablation. Results: The 154 patients (age: 39.1 ± 17.2 years, body mass index: 24.3 ± 5.2 kg/m2, waist/hip ratio: 0.88 ± 5.2, systolic blood pressure: 128.3 ± 22.4 mmHg, diastolic blood pressure: 75.30 ± 9.0 mmHg, resting heart rate: 76.10 ± 8.2 beat/minute with tachycardia (89 women, 65 men were ablated. Procedure and fluoroscopy times were 57.5 ± 19.0 and 14.4 ± 4.1 minute respectively. The mean follow up period was 10.2 ± 4.3 months. During follow up period three patients with atrioventricular nodal reentrant tachycardia, two patients with atrioventricular reentrant tachycardia, one patient with right ventricular outflow tract tachycardia and one patient with atrial fibrillation had recurrence.Conclusion: The transvenous radiofrequency ablation therapy is a safe and effective approach for the treatment of tachyarrhythmia under experienced hands.

  11. Percutaneous ablation of pancreatic cancer

    Science.gov (United States)

    D’Onofrio, Mirko; Ciaravino, Valentina; De Robertis, Riccardo; Barbi, Emilio; Salvia, Roberto; Girelli, Roberto; Paiella, Salvatore; Gasparini, Camilla; Cardobi, Nicolò; Bassi, Claudio

    2016-01-01

    Pancreatic ductal adenocarcinoma is a highly aggressive tumor with an overall 5-year survival rate of less than 5%. Prognosis and treatment depend on whether the tumor is resectable or not, which mostly depends on how quickly the diagnosis is made. Chemotherapy and radiotherapy can be both used in cases of non-resectable pancreatic cancer. In cases of pancreatic neoplasm that is locally advanced, non-resectable, but non-metastatic, it is possible to apply percutaneous treatments that are able to induce tumor cytoreduction. The aim of this article will be to describe the multiple currently available treatment techniques (radiofrequency ablation, microwave ablation, cryoablation, and irreversible electroporation), their results, and their possible complications, with the aid of a literature review. PMID:27956791

  12. Laser Ablation for Medical Applications

    Science.gov (United States)

    Hayashi, Ken-Ichi

    Medical applications of laser are measurement, laser surgery, in-situ monitoring, and processing of medical devices. In this paper, author briefly reviews the trends of medical applications, describes some new applications, and then discuss about the future trends and problems of medical applications. At present, the domestic market of laser equipment for medical applications is nearly 1/10 of that for industrial applications, which has registered significant growth continuously. Laser surgery as a minimum invasive surgery under arthroscope is expected to decrease the pain of patients. Precise processing such as cutting and welding is suitable for manufacturing medical devices. Pulsed laser deposition has been successfully applied to the thin film coating. The corneal refractive surgery by ArF excimer laser has been widely accepted for its highly safe operation. Laser ablation for retinal implant in the visual prosthesis is one of the promising applications of laser ablation in medicine. New applications with femtosecond laser are expected in the near future.

  13. Retrograde epidural catheter relieves intractable sacral pain

    Directory of Open Access Journals (Sweden)

    Ruchir Gupta

    2016-01-01

    Full Text Available Pain caused by tumor infiltration of the sacral area remains a major clinical challenge. Patients with poor pain control despite comprehensive medical management may be treated with neuraxial techniques such as continuous epidural or spinal anesthetic. We report a case in which a patient with metastatic breast cancer experienced inadequate pain relief after multiple intravenous pain management regimens as well as intrathecal (IT drug delivery. The concentration of local anesthetics delivered via the IT catheter was limited due to the patient's baseline motor weakness which would be exacerbated with higher concentrations of local anesthetics. Thus, a decision was made to insert an epidural catheter via a retrograde technique to provide the patient with a “band of anesthesia” which would provide profound sensory blockade without concomitant motor weakness. Pain refractory to other modalities of pain control was successfully treated with the epidural technique.

  14. Percutaneous catheter drainage of tuberculous psoas abscesses

    International Nuclear Information System (INIS)

    Pombo, F.; Martin-Egana, R.; Cela, A.; Diaz, J.L.; Linares-Mondejar, P.; Freire, M.

    1993-01-01

    Six patients with 7 tuberculous psoas or ilio-psoas abscesses were treated by CT-guided catheter drainage and chemotherapy. The abscesses (5 unilateral and 1 bilateral) were completely drained using a posterior or lateral approach. The abscess volume was 70 to 700 ml (mean 300 ml) and the duration of drainage 5 to 11 days (mean 7 days). Immediate local symptomatic improvement was achieved in all patients, and there were no procedural complications. CT follow-up at 3 to 9 months showed normalization in 5 patients, 2 of whom are still in medical therapy. One patient, who did not take the medication regularly, had a recurrent abscess requiring new catheter drainage after which the fluid collection disappeared. Percutaneous drainage represents an efficient and attractive alternative to surgical drainage as a supplement to medical therapy in the management of patients with large tuberculous psoas abscesses. (orig.)

  15. Urgent peritoneal dialysis or hemodialysis catheter dialysis.

    Science.gov (United States)

    Lok, Charmaine E

    2016-03-01

    Worldwide, there is a steady incident rate of patients with end-stage kidney disease (ESKD) who require renal replacement therapy. Of these patients, approximately one-third have an "unplanned" or "urgent" start to dialysis. This can be a very challenging situation where patients have either not had adequate time for education and decision making regarding dialysis modality and appropriate dialysis access, or a decision was made and plans were altered due to unforeseen circumstances. Despite such unplanned starts, clinicians must still consider the patient's ESKD "life-plan", which includes the best initial dialysis modality and access to suit the patient's individual goals and their medical, social, logistic, and facility circumstances. This paper will discuss the considerations of peritoneal dialysis and a peritoneal dialysis catheter access and hemodialysis and central venous catheter access in patients who require an urgent start to dialysis.

  16. Inappropriate urinary catheter reinsertion in hospitalized older patients.

    Science.gov (United States)

    Hu, Fang-Wen; Tsai, Chuan-Hsiu; Lin, Huey-Shyan; Chen, Ching-Huey; Chang, Chia-Ming

    2017-01-01

    We investigated the incidence and rationale for inappropriate reinsertion of urinary catheters and elucidated whether reinsertion is an independent predictor of adverse outcomes. A longitudinal study was adopted. Patients aged ≥65 years with urinary catheters placed within 24 hours of hospitalization were enrolled. Data collection, including demographic variables and health conditions, was conducted within 48 hours after admission. Patients with catheters in place were followed-up every day. If the patient had catheter reinsertion, the reinsertion information was reviewed from medical records. Adverse outcomes were collected at discharge. A total of 321 patients were enrolled. Urinary catheters were reinserted in 66 patients (20.6%), with 95 reinsertions; 49.5% of catheter reinsertions were found to be inappropriate. "No evident reason for urinary catheter use" was the most common rationale for inappropriate reinsertion. Inappropriate reinsertion was found to be a significant predictor for prolonged length of hospital stay, development of catheter-associated urinary tract infections and catheter-related complications, and decline in activities of daily living. This study indicates a considerable percentage of inappropriate urinary catheter reinsertions in hospitalized older patients. Inappropriate reinsertion was significantly associated with worsening outcomes. Efforts to improve appropriateness of reinsertion and setting clinical policies for catheterization are necessary to reduce the high rate of inappropriate reinsertion. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  17. Peritoneal dialysis catheter embedment: surgical considerations, expectations, and complications.

    Science.gov (United States)

    Crabtree, John H; Burchette, Raoul J

    2013-10-01

    Peritoneal dialysis catheter embedment consists of implanting the catheter far in advance of anticipated need, with the external tubing buried under the skin. The catheter is externalized when initiation of dialysis is required. Details of the surgical procedure and management of associated complications are generally lacking. A total of 84 catheters including conventional and extended catheters were embedded and externalized during the study period. Factors influencing duration of embedment, functionality upon externalization, and long-term outcomes were analyzed. Mean duration of embedment was 13.9 months (median 9.4; range .5 to 68.5). Immediate function was exhibited in 85.7% of catheters. Employing laparoscopic revision, 98.8% of embedded catheters were successfully used for peritoneal dialysis. Extended catheters and duration of embedment were important determinants of catheter functionality. Catheters can be embedded for prolonged periods and still result in functional dialysis access when needed. Complications are few and easily managed. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Radiologic Placement of Tunneled Central Venous Catheters in Pediatric Patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eun Ji; Song, Soon Young; Cho, On Koo; Koh, Byung Hee; Kim, Yong Soo; Jeong, Woo Kyoung; Lee, Yong Ho [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2010-08-15

    We evaluated the technical success and complication rates associated with the radiological placement of tunneled central venous catheters in pediatric patients. Between May 1, 2005 and March 31, 2008, a total of 46 tunneled central venous catheters were placed in 34 children (M:F = 22:12; mean age, 9.9 years [9 months to 16.8 years]). All procedures were performed under ultrasonographic and fluoroscopic guidance. Follow-up data were obtained through the retrospective review of the medical records. We used the Kaplan-Meier survival method for the evaluation of survival rate of the catheters. All procedures were technically successful. The observed periprocedural complications included hematoma formation in three patients. The mean catheter life was 189.3 days (total, 8710 days; range, 7-810). Catheters were removed due to death (n=9), the end of treatment (n=8), catheter sepsis (n=4), malfunction (n=8), and accidental removal (n=4). The rate of catheter sepsis and malfunction was 0.459 and 0.919 for every 1000 catheter days, respectively. The expected mean catheter life was 479.6 days as per the Kaplan- Meier analysis. The results suggest that the radiologic placement of a tunneled central venous catheter is an effective technique with a high technical success rate and low complication rate.

  19. Recommended Clinical Trial End Points for Dialysis Catheters.

    Science.gov (United States)

    Allon, Michael; Brouwer-Maier, Deborah J; Abreo, Kenneth; Baskin, Kevin M; Bregel, Kay; Chand, Deepa H; Easom, Andrea M; Mermel, Leonard; Mokrzycki, Michele H; Patel, Priti R; Roy-Chaudhury, Prabir; Shenoy, Surendra; Valentini, Rudolph P; Wasse, Haimanot

    2018-03-07

    Central venous catheters are used frequently in patients on hemodialysis as a bridge to a permanent vascular access. They are prone to frequent complications, including catheter-related bloodstream infection, catheter dysfunction, and central vein obstruction. There is a compelling need to develop new drugs or devices to prevent central venous catheter complications. We convened a multidisciplinary panel of experts to propose standardized definitions of catheter end points to guide the design of future clinical trials seeking approval from the Food and Drug Administration. Our workgroup suggests diagnosing catheter-related bloodstream infection in catheter-dependent patients on hemodialysis with a clinical suspicion of infection (fever, rigors, altered mental status, or unexplained hypotension), blood cultures growing the same organism from the catheter hub and a peripheral vein (or the dialysis bloodline), and absence of evidence for an alternative source of infection. Catheter dysfunction is defined as the inability of a central venous catheter to ( 1 ) complete a single dialysis session without triggering recurrent pressure alarms or ( 2 ) reproducibly deliver a mean dialysis blood flow of >300 ml/min (with arterial and venous pressures being within the hemodialysis unit parameters) on two consecutive dialysis sessions or provide a Kt/V≥1.2 in 4 hours or less. Catheter dysfunction is defined only if it persists, despite attempts to reposition the patient, reverse the arterial and venous lines, or forcefully flush the catheter. Central vein obstruction is suspected in patients with >70% stenosis of a central vein by contrast venography or the equivalent, ipsilateral upper extremity edema, and an existing or prior history of a central venous catheter. There is some uncertainty about the specific criteria for these diagnoses, and the workgroup has also proposed future high-priority studies to resolve these questions. Copyright © 2018 by the American Society of

  20. Antimicrobial Agents and Catheter Complications in Outpatient Parenteral Antimicrobial Therapy.

    Science.gov (United States)

    Keller, Sara C; Dzintars, Kathryn; Gorski, Lisa A; Williams, Deborah; Cosgrove, Sara E

    2018-03-01

    Debate about whether certain antimicrobial agents traditionally considered vesicants increase the risk of catheter complications has led to uncertainty in venous catheter placement protocols. To understand whether patients requiring home-based outpatient parenteral antimicrobial therapy (OPAT) should receive peripheral catheters (e.g., midline catheters) versus central venous catheters, and to understand whether certain antimicrobial agents place home-based OPAT patients at higher risk for catheter complications, we investigated associations between antimicrobial agent(s) and catheter complications. We performed a prospective cohort study of patients requiring home-based OPAT discharged from two urban tertiary care academic medical centers, including telephone surveys and chart abstractions. Multivariable Poisson regressions were used to evaluate: (i) associations between antimicrobial agents traditionally considered vesicants, based on pH or osmolarity, and catheter complication rates, and (ii) associations between antimicrobial agent and rates of catheter complications. Vesicant antimicrobials defined using pH or osmolarity criteria were not associated with an increased rate of catheter complications (adjusted incidence rate ratio [aIRR]: 1.63, 95% confidence interval [CI]: 0.89-2.96). Vancomycin was associated with an increased rate of catheter complications, as was daptomycin (aIRR: 2.32 [95% CI: 1.20-4.46] and 4.45 [95% CI: 1.02-19.41], respectively). Staphylococcus aureus infections were also associated with an increased rate of catheter complications (aIRR: 2.13, 95% CI: 1.09-4.19), as were midline catheters (aIRR: 9.44, 95% CI: 2.12-41.97). Our study supports recent guidance identifying vancomycin as a vesicant, among a subset of antimicrobial agents, and removal of pH criteria for identification of vesicants. © 2018 Pharmacotherapy Publications, Inc.

  1. CATHETER DURATION AND THE RISK OF SEPSIS IN PREMATURE BABIES WITH UMBILICAL VEIN CATHETERS

    Directory of Open Access Journals (Sweden)

    Hartojo Hartojo

    2012-01-01

    Full Text Available Umbilical catheters are frequently required in the management of severely ill premature babies. The risk of complications may increase with duration of UVC use. Objective: To determine whether the risk of central line-associated bloodstream infections (CLA-BSIs and sepsis remained constant over the duration of umbilical vein catheters (UVCs in high-risk premature neonates. Methods:retrospective analysis. The data were collected from the medical record of high risk premature neonates who had a UVC placed in neonatal care unit of Husada Utama Hospital between April 1st 2008 to April 30th 2011 with purposive sampling. Catheter duration was observed before and after 14 days on placement. Blood and UVC culture was performed to establish the risk of CLA-BSIs and sepsis. Chi-square and logistic regression analysis were performed in the laboratorium data. Result: A total 44 high risk premature babies with UVCs were enrolled (sepsis group: n = 23 and non sepsis group: n = 21. Baseline demographics were similar between the groups. 15 babies in sepsis group have UVCs duration > 14 days, and 8 babies have UVCs 14 days show blood culture performance in 11 babies with positive evidence, UVCs culture performance is negative in 18 babies (p = 0.456. Burkholderia cepacia and Klebsiella pneumonia mostly appeared in blood culture performance. 25% of UVC culture performance shows Pseudomonas aeroginosa. Conclusions: The catheter duration have no significant difference in risk of sepsis in premature babies with Umbilical Vein Catheters.

  2. Retrograde prostatic urethroplasty with balloon catheter

    International Nuclear Information System (INIS)

    Castaneda, F.; Reddy, P.; Hulbert, J.; Letourneau, J.G.; Hunter, D.W.; Castaneda-Zuniga, W.R.; Amplatz, K.

    1987-01-01

    The authors performed retrograde prostatic urethroplasty in 18 patients using a 25-mm urethroplasty balloon catheter. The procedure was performed on an outpatient basis under local anesthesia. Voiding cystourethrography, retrograde urethrography, rectal US, and MRE imaging were performed before and immediately after the procedure and at 2 weeks and 3, 6, 12, and 18 months. Long-term results at 18 months and possible clinical implications are discussed

  3. Incidence of catheter-related complications in patients with central venous or hemodialysis catheters: a health care claims database analysis.

    Science.gov (United States)

    Napalkov, Pavel; Felici, Diana M; Chu, Laura K; Jacobs, Joan R; Begelman, Susan M

    2013-10-16

    Central venous catheter (CVC) and hemodialysis (HD) catheter usage are associated with complications that occur during catheter insertion, dwell period, and removal. This study aims to identify and describe the incidence rates of catheter-related complications in a large patient population in a United States-based health care claims database after CVC or HD catheter placement. Patients in the i3 InVision DataMart® health care claims database with at least 1 CVC or HD catheter insertion claim were categorized into CVC or HD cohorts using diagnostic and procedural codes from the US Renal Data System, American College of Surgeons, and American Medical Association's Physician Performance Measures. Catheter-related complications were identified using published diagnostic and procedural codes. Incidence rates (IRs)/1000 catheter-days were calculated for complications including catheter-related bloodstream infections (CRBSIs), thrombosis, embolism, intracranial hemorrhage (ICH), major bleeding (MB), and mechanical catheter-related complications (MCRCs). Thirty percent of the CVC cohort and 54% of the HD cohort had catheter placements lasting <90 days. Catheter-related complications occurred most often during the first 90 days of catheter placement. IRs were highest for CRBSIs in both cohorts (4.0 [95% CI, 3.7-4.3] and 5.1 [95% CI, 4.7-5.6], respectively). Other IRs in CVC and HD cohorts, respectively, were thrombosis, 1.3 and 0.8; MCRCs, 0.6 and 0.7; embolism, 0.4 and 0.5; MB, 0.1 and 0.3; and ICH, 0.1 in both cohorts. Patients with cancer at baseline had significantly higher IRs for CRBSIs and thrombosis than non-cancer patients. CVC or HD catheter-related complications were most frequently seen in patients 16 years or younger. The risk of catheter-related complications is highest during the first 90 days of catheter placement in patients with CVCs and HD catheters and in younger patients (≤16 years of age) with HD catheters. Data provided in this study can be applied

  4. Anatomical and procedural determinants of ambulatory blood pressure lowering following catheter-based renal denervation using radiofrequency.

    Science.gov (United States)

    Lauder, Lucas; Ewen, Sebastian; Tzafriri, Abraham R; Edelman, Elazer R; Cremers, Bodo; Kulenthiran, Saarraaken; Ukena, Christian; Linz, Dominik; Kindermann, Ingrid; Tsioufis, Costas; Scheller, Bruno; Böhm, Michael; Mahfoud, Felix

    2018-03-02

    Catheter-based renal sympathetic denervation (RDN) has been introduced to lower blood pressure (BP) and sympathetic activity in patients with uncontrolled hypertension with at best equivocal results. It has been postulated that anatomic and procedural elements introduce unaccounted variability and yet little is known of the impact of renal anatomy and procedural parameters on BP response to RDN. Anatomical parameters such as length and diameter were analyzed by quantitative vascular analysis and the prevalence of accessory renal arteries and renal artery disease were documented in 150 patients with resistant hypertension undergoing bilateral RDN using a mono-electrode radiofrequency catheter (Symplicity Flex, Medtronic). Accessory renal arteries and renal artery disease were present in 56 (37%) and 14 patients (9%), respectively. At 6-months, 24 h-ambulatory BP was reduced by 11/6 mm Hg (p 4 mm (-19 vs. -10 mmHg; p = 0.038). Neither the length of the renal artery nor the number of RF ablations influenced 24 h-ambulatory BP reduction at 6 months. 24 h-ambulatory BP lowering was most pronounced in patients with smaller renal artery diameter but not related to renal artery length, accessory arteries or renal artery disease. Further, there was no dose-response relationship observed with increasing number of ablations. Because little is known of the impact of renal anatomy and procedural parameters on blood pressure (BP) response to renal denervation (RDN), anatomical and procedural data were analyzed in 150 patients undergoing bilateral RDN. BP lowering was most pronounced in patients with smaller renal artery diameter but not related to renal artery length, the presence of renal artery disease or accessory renal arteries. Further, there was no dose-response relationship observed with increasing number of ablations. Copyright © 2018. Published by Elsevier Inc.

  5. Image integration into 3-dimensional-electro-anatomical mapping system facilitates safe ablation of ventricular arrhythmias originating from the aortic root and its vicinity.

    Science.gov (United States)

    Jularic, Mario; Akbulak, Ruken Özge; Schäffer, Benjamin; Moser, Julia; Nuehrich, Jana; Meyer, Christian; Eickholt, Christian; Willems, Stephan; Hoffmann, Boris A

    2018-03-01

    During ablation in the vicinity of the coronary arteries establishing a safe distance from the catheter tip to the relevant vessels is mandatory and usually assessed by fluoroscopy alone. The aim of the study was to investigate the feasibility of an image integration module (IIM) for continuous monitoring of the distance of the ablation catheter tip to the main coronary arteries during ablation of ventricular arrhythmias (VA) originating in the sinus of valsalva (SOV) and the left ventricular summit part of which can be reached via the great cardiac vein (GCV). Of 129 patients undergoing mapping for outflow tract arrhythmias from June 2014 till October 2015, a total of 39 patients (52.4 ± 18.1 years, 17 female) had a source of origin in the SOV or the left ventricular summit. Radiofrequency (RF) ablation was performed when a distance of at least 5 mm could be demonstrated with IIM. A safe distance in at least one angiographic plane could be demonstrated in all patients with a source of origin in the SOV, whereas this was not possible in 50% of patients with earliest activation in the summit area. However, using the IIM a safe position at an adjacent site within the GCV could be obtained in three of these cases and successful RF ablation performed safely without any complications. Ablation was successful in 100% of patients with an origin in the SOV, whereas VAs originating from the left ventricular summit could be abolished completely in only 60% of cases. Image integration combining electroanatomical mapping and fluoroscopy allows assessment of the safety of a potential ablation site by continuous real-time monitoring of the spatial relations of the catheter tip to the coronary vessels prior to RF application. It aids ablation in anatomically complex regions like the SOV or the ventricular summit providing biplane angiograms merged into the three-dimensional electroanatomical map. Published on behalf of the European Society of Cardiology. All rights reserved.

  6. Radiofrequency Ablation of Hepatic Cysts : Case Report

    International Nuclear Information System (INIS)

    Lee, Ye Ri; Kim, Pyo Nyun

    2005-01-01

    Radiofrequency ablation has been frequently performed on intra-hepatic solid tumor, namely, hepatocellular carcinoma, metastatic tumor and cholangio carcinoma, for take the cure. But, the reports of radiofrequency ablation for intrahepatic simple cysts are few. In vitro experiment of animal and in vivo treatment for intrahepatic cysts of human had been reported in rare cases. We report 4 cases of radiofrequency ablation for symptomatic intrahepatic cysts

  7. [Biodegradable catheters and urinary stents. When?

    Science.gov (United States)

    Soria, F; Morcillo, E; López de Alda, A; Pastor, T; Sánchez-Margallo, F M

    2016-10-01

    One of the main wishes in the field of urinary catheters and stents is to arm them with biodegradable characteristics because we consider a failure of these devices the need for retrieval, the forgotten catheter syndrome as well as the adverse effects permanent devices cause after fulfilling their aim. The efforts focused in new designs, coatings and biomaterials aim to increase the biocompatibility of theses internal devices. Lately, there have been correct advances to answer the main challenges regarding biodegradable ureteral devices. Thus, modulation of the rate of degradation has been achieved thanks to new biomaterials and the use of copolymers that enable to choose the time of permanence as it is programmed with conventional double J catheters. Biocompatibility has improved with the use of new polymers that adapt better to the urine. Finally, one of the main problems is elimination of degraded fragments and experimentally it has be demonstrated that new designs elicit controlled degradation, from distal to proximal; using stranding and combination of copolymers degradation may be caused by dilution, reducing fragmentation to the last stages of life of the prosthesis. Moreover, it has been demonstrated that biodegradable catheters potentially may cause less urinary tract infection, less encrustation and predictably they will diminish catheter morbidity, since their degradation process reduces adverse effects. Regarding the development of biodegradable urethral stents, it is necessary to find biomaterials that enable maintaining their biomechanical properties in the long term, keeping open the urethral lumen both in patients with BPH and urethral stenosis. Modulation of the time of degradation of the prosthesis has been achieved, but the appearance of urothelial hyperplasia is still a constant in the initial phases after implantation. The development of drug eluting stents, anti-proliferative or anti-inflammatory, as well as biodegradable stents biocoated is a

  8. The Spanish flu in Denmark

    DEFF Research Database (Denmark)

    Kolte, Ida Viktoria; Skinhøj, Peter; Keiding, Niels

    2008-01-01

    The spread of H5N1 influenza and the similarity between this avian virus and the Spanish flu virus causes fear of a new influenza pandemic, but data from the Spanish flu may also be of guidance in planning for preventive measures. Using data on influenza cases, influenza deaths and total deaths...

  9. Library Guide: Spanish Literature, 2001.

    Science.gov (United States)

    de Sumar, Juanita Jara, Comp.

    Intended for use by those conducting research in Spanish literature, this guide lists selected reference materials in literature from Spain, in Spanish, Galician, and Catalan languages. Annotations in the guide are divided into the following sections: (1) General Encyclopedias (1 annotation); (2) Guides to the Literature (4 annotations); (3)…

  10. The Spanish Borderlands, Historiography Redux

    Science.gov (United States)

    Weber, David J.

    2005-01-01

    The word "borderlands" has many meanings in North American historiography, but this short overview focuses on the time and place that American historians have long known as the "Spanish Borderlands." Historian Herbert Eugene Bolton, the much-studied father of what came to be known as the "Bolton School," popularized the term "Spanish Borderlands"…

  11. Aprendemos Espanol. (Let's Learn Spanish).

    Science.gov (United States)

    Naranjo, Laura Villagomez; And Others

    A set of Peace Corps materials for introductory Spanish contains 19 units on aspects of Spanish verbs: the verb "estar"; the present tense of regular verbs; the use of "necesitar" and "ir" with infinitives; "querer,""poner,""tener que" and the infinitive; the verb "ser"; the…

  12. Double guiding catheters for complex percutaneous coronary intervention.

    Science.gov (United States)

    Chou, Shing-Hsien; Lin, Chia-Pin; Lin, Yen-Chen; Kuo, Chi-Tai; Lin, Ming-Shyan; Chang, Chi-Jen

    2012-01-01

    A large-lumen guiding catheter is often used for complex percutaneous coronary intervention-particularly when a final kissing-balloon or 2-stent technique is required. However, catheter insertion is sometimes restricted by diseased vascular access sites or a tortuous vascular route.We report 2 cases in which a unique double guiding catheter technique was used to create a lumen of sufficient size for complex percutaneous coronary intervention. In each patient, two 6F guiding catheters were used concurrently to engage the ostium of 1 target vessel. In 1 patient, these catheters were used for the delivery of 2 balloons to complete kissing-balloon dilation after single-stent placement. In the other patient, the catheters were used to deliver 2 stents sequentially to their respective target lesions. The stents were then deployed simultaneously as kissing stents, followed by high-pressure kissing-balloon postdilation.

  13. Balloon catheter versus basket catheter for endoscopic bile duct stone extraction: a multicenter randomized trial.

    Science.gov (United States)

    Ishiwatari, Hirotoshi; Kawakami, Hiroshi; Hisai, Hiroyuki; Yane, Kei; Onodera, Manabu; Eto, Kazunori; Haba, Shin; Okuda, Toshinori; Ihara, Hideyuki; Kukitsu, Takehiro; Matsumoto, Ryusuke; Kitaoka, Keisuke; Sonoda, Tomoko; Hayashi, Tsuyoshi

    2016-04-01

    Endoscopic bile duct stone (BDS) removal is a well-established treatment; however, the preference for basket or balloon catheters for extraction is operator-dependent. We therefore conducted a multicenter prospective randomized trial to compare catheter performance. We enrolled patients with a BDS diameter ≤ 10 mm and common bile duct diameter ≤ 15 mm. Participants were randomly assigned to groups that were treated with basket or balloon catheters between October 2013 and September 2014. The primary endpoint was the rate of complete clearance of the duct; the secondary endpoints were the rate and time to complete clearance in one endoscopic session. We initially enrolled 172 consecutive patients; 14 were excluded after randomization. The complete clearance rates were 92.3 % (72/78) in the balloon group and 80.0 % (64 /80) in the basket group. The difference in the rates between the two groups was 12.3 percentage points, indicating non-inferiority of the balloon method (non-inferiority limit -10 %; P < 0.001 for non-inferiority). Moreover, the balloon was superior to the basket (P = 0.037). The rate of complete clearance in one endoscopic session was 97.4 % using the balloon and 97.5 % using the basket (P = 1.00). The median times to complete clearance in one endoscopic session were 6.0 minutes (1 - 30) and 7.8 minutes (1 - 37) in the balloon and basket groups, respectively (P = 0.15). For extraction of BDSs ≤ 10 mm, complete endoscopic treatment with a single catheter is more likely when choosing a balloon catheter over a basket catheter.University Hospital Medical Information Network Trials Registry: UMIN000011887. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Futurism in Spanish Literature

    Directory of Open Access Journals (Sweden)

    Nur Gülümser İLKER

    2018-01-01

    Full Text Available At the beginning of the 20th century, a group of authors, poets and artists known as “Vanguardistas” (modernists paved the way for modern movements in art and literature in Spain. Inspired by the Italian poet Filippo Tomasso Marinetti, the Futurism movement quickly showed its influence in Spain as well as other countries. It rose to prominence due to its original and dynamic perceptions as well as its appreciation of modernism. As the world is constantly changing, old traditions, lifestyles, outdated ideas as well as previous attitudes, perceptions, styles and movements in literature and art should be abandoned in favor of newer, more original and current ones. This point of view is especially clear in the works of Ramón Gómez de la Serna. Italian Futurism suggests that previous ideas, literary styles and lifestyles cannot have strong links with the present and it is a challenge that makes it difficult to open the doors for the future. Based on this idea and adding different points of view, the Spanish writers aimed at building an original Futurism with its roots in the past but focusing on the future. Spanish intellectuals protested the oppression and censorship of the ruling order in that period, benefiting from the innovative style and perceptions of Futurism in literature.

  15. Thromboembolic and bleeding risks in patients undergoing atrial fibrillation ablation: oral anticoagulation perspectives.

    Science.gov (United States)

    Briceño, David F; Madan, Nidhi; Romero, Jorge; Londoño, Alejandra; Villablanca, Pedro A; Natale, Andrea; Di Biase, Luigi

    2017-07-01

    Atrial fibrillation (AF) is a cause of significant morbidity and mortality. Catheter ablation for AF (CAAF) has emerged as an effective treatment option of rhythm control for patients with symptomatic AF. However, the risk of thromboembolism and bleeding in the periprocedural period represent a worrisome complication of this therapy. The reported incidence of thromboembolic and bleeding events associated with CAAF varies from 0.9% to 5% depending on the CAAF strategy and the anticoagulation regimen used in the periprocedural period. Areas covered: The different anticoagulation regimens used prior to, during, and after CAAF to minimize the risk of thromboembolic and bleeding events are reviewed. The use of uninterrupted oral anticoagulation and appropriate heparin dosing to achieve safe activated clotting time levels are also detailed. A comprehensive approach with assessment of individual risk for thromboembolic and bleeding complications, and understanding the pharmacokinetics of the anticoagulant agents available is also reviewed. Expert opinion: The key advances done in the periprocedural anticoagulation field include the use of uninterrupted anticoagulation strategies in patients undergoing AF ablation and efforts to simplify the selection of patients who need LAA thrombus screening prior to ablation.

  16. Embolization of brain arteriovenous malformations using tracker catheter

    International Nuclear Information System (INIS)

    Kim, Sun Yong; Son, Mi Young; Jang, Jae Chun; Hwang, Mi Soo; Park, Bok Hwan

    1990-01-01

    With the recent advance in micro catheters, steerable guide wires, balloons, embolic materials and digital subtraction angiography (DSA), as well as technical refinements in endovascular surgery, there has been a revolution in therapeutic strategies for cerebral arteriovenous malformations (AVMs). We have performed super selective angiography and embolization with Tracker micro catheter about 12 cases of brain AVMs for therapeutic and preoperative aims. This micro catheter and guide wire provided high selectivity of feeding artery, greater maneuverability and useful for deliver various embolus materials

  17. Clinical features of catheter-related candidemia at disease onset.

    Science.gov (United States)

    Yoshino, Yusuke; Wakabayashi, Yoshitaka; Suzuki, Satoshi; Seo, Kazunori; Koga, Ichiro; Kitazawa, Takatoshi; Okugawa, Shu; Ota, Yasuo

    2014-11-01

    Early detection of catheter-related candidemia is necessary to ensure that patients receive prompt and appropriate treatment. The aim of the present case-control study is to investigate the clinical features of catheter-related candidemia at disease onset, so as to determine the clinical indications for empiric antifungal therapy. All 41 cases of catheter-related candidemia from September 2009 to August 2011 at a teaching hospital were included in the present study. To determine the characteristics that were risk factors for developing catheter-related candidemia, we compared all cases of catheter-related candidemia with all 107 cases of catheter-related blood stream infection (CRBSI) caused by non-Candida spp. In comparison with CRBSI due to non-Candida spp., the duration of catheter use was significantly longer in cases of catheter-related candidemia (13.9 ± 9.0 days vs. 23.2 ± 25.2 days). There was also a significant difference in the frequency of pre-antibiotic treatment between catheter-related candidemia and CRBSI due to non-Candida spp. (97.6% [40/41 cases] vs. 44.9% [48/107 cases]). Patients with catheter-related candidemia also had significantly more severe clinical statuses (measured using the Sepsis-related Organ Failure Assessment score) than patients with CRBSI due to non-Candida spp. (7.63 ± 3.65 vs. 5.92 ± 2.81). When compared to patients with CRBSI caused by non-Candida spp., patients with catheter-related candidemia had significantly more severe clinical backgrounds, longer duration of catheter use and more frequent prior administration of antibiotic agents.

  18. Feasibility of real-time MR thermal dose mapping for predicting radiofrequency ablation outcome in the myocardium in vivo.

    Science.gov (United States)

    Toupin, Solenn; Bour, Pierre; Lepetit-Coiffé, Matthieu; Ozenne, Valéry; Denis de Senneville, Baudouin; Schneider, Rainer; Vaussy, Alexis; Chaumeil, Arnaud; Cochet, Hubert; Sacher, Frédéric; Jaïs, Pierre; Quesson, Bruno

    2017-01-25

    Clinical treatment of cardiac arrhythmia by radiofrequency ablation (RFA) currently lacks quantitative and precise visualization of lesion formation in the myocardium during the procedure. This study aims at evaluating thermal dose (TD) imaging obtained from real-time magnetic resonance (MR) thermometry on the heart as a relevant indicator of the thermal lesion extent. MR temperature mapping based on the Proton Resonance Frequency Shift (PRFS) method was performed at 1.5 T on the heart, with 4 to 5 slices acquired per heartbeat. Respiratory motion was compensated using navigator-based slice tracking. Residual in-plane motion and related magnetic susceptibility artifacts were corrected online. The standard deviation of temperature was measured on healthy volunteers (N = 5) in both ventricles. On animals, the MR-compatible catheter was positioned and visualized in the left ventricle (LV) using a bSSFP pulse sequence with active catheter tracking. Twelve MR-guided RFA were performed on three sheep in vivo at various locations in left ventricle (LV). The dimensions of the thermal lesions measured on thermal dose images, on 3D T1-weighted (T1-w) images acquired immediately after the ablation and at gross pathology were correlated. MR thermometry uncertainty was 1.5 °C on average over more than 96% of the pixels covering the left and right ventricles, on each volunteer. On animals, catheter repositioning in the LV with active slice tracking was successfully performed and each ablation could be monitored in real-time by MR thermometry and thermal dosimetry. Thermal lesion dimensions on TD maps were found to be highly correlated with those observed on post-ablation T1-w images (R = 0.87) that also correlated (R = 0.89) with measurements at gross pathology. Quantitative TD mapping from real-time rapid CMR thermometry during catheter-based RFA is feasible. It provides a direct assessment of the lesion extent in the myocardium with precision in the range of one

  19. Catheter Fracture and Embolization Related to an Arm Venous Port

    Directory of Open Access Journals (Sweden)

    Brent E. Burbridge

    2011-01-01

    Full Text Available This 55-year-old female had a chest X-ray during a follow-up visit for the management of her breast cancer. The chest X-ray demonstrated an embolized venous catheter superimposed upon the mediastinum. It was determined that the catheter of the patient's arm port had fractured and embolized to the pulmonary circulation. The catheter was retrieved, in the interventional radiology suite, under fluoroscopic guidance. The patient suffered no ill effects. Subsequently, one day later, the old vein port was removed and a new arm port and associated catheter were implanted to facilitate the delivery of the patient's ongoing chemotherapy.

  20. Remote control catheter navigation: options for guidance under MRI

    Directory of Open Access Journals (Sweden)

    Muller Leah

    2012-06-01

    Full Text Available Abstract Background Image-guided endovascular interventions have gained increasing popularity in clinical practice, and magnetic resonance imaging (MRI is emerging as an attractive alternative to X-ray fluoroscopy for guiding such interventions. Steering catheters by remote control under MRI guidance offers unique challenges and opportunities. Methods In this review, the benefits and limitations of MRI-guided remote control intervention are addressed, and the tools for guiding such interventions in the magnetic environment are summarized. Designs for remote control catheter guidance include a catheter tip electromagnetic microcoil design, a ferromagnetic sphere-tipped catheter design, smart material-actuated catheters, and hydraulically actuated catheters. Remote control catheter guidance systems were compared and contrasted with respect to visualization, safety, and performance. Performance is characterized by bending angles achievable by the catheter, time to achieve bending, degree of rotation achievable, and miniaturization capacity of the design. Necessary improvements for furthering catheter design, especially for use in the MRI environment, are addressed, as are hurdles that must be overcome in order to make MRI guided endovascular procedures more accessible for regular use in clinical practice. Conclusions MR-guided endovascular interventions under remote control steering are in their infancy due to issues regarding safety and reliability. Additional experimental studies are needed prior to their use in humans.

  1. Analog experiment of transarterial catheter hyperthermic infusion in vitro

    International Nuclear Information System (INIS)

    Fan Shufeng Li Zheng; Gu Weizhong; Ru Fuming

    2006-01-01

    Objective: To investigate the factors related to the heating effect by transarterial catheter hyperthermic infusion with the evaluation of the feasibility in controlling the tumor temperature. Methods: Infusing 55-68 degree C liquid at the speed of 10-40 ml/min through 6F, 5F or 3F catheter with different length respectively under the similar clinical condition. The liquid temperature at the terminal exit of the catheter was measured with a digital thermometer. The factors related to the liquid temperature at the exit of the catheter were analyzed by multiple regression analysis. Results: The infusion temperature , rate and the catheter length were the main related factors to the liquid temperature at the exit of the catheter as the condition similar in clinical use. When 60-65 degree C liquid was infused at the rate of 20-40 ml/min through 5F catheter with length of 80 cm, the mean and 95% confident interval of the liquid temperature at the catheter exit were (47.55±0.44) degree C and 44.61-48.49 degree C respectively. Conclusions: The liquid temperature at the exit of infusion catheter can be regulated and controlled through adjusting the liquid perfusion temperature and speed. (authors)

  2. Laser ablation of paint in nuclear industry

    International Nuclear Information System (INIS)

    Brygo, Francois; Semerok, Alexandre; Weulersse, Jean-Marc; Thro, Pierre-Yves; Oltra, Roland; Decobert, Guy

    2006-01-01

    Nuclear dismantling faces the challenge of paint removal on large surfaces of painted walls. The conventional methods for paint stripping on concrete walls are mainly based on mechanical grinder and lead to an important volume of aerosols and wastes. Laser ablation has been evaluated as a promising method for paint removal with a number of advantages. The method reduces considerably the waste volume as the removal of paint is selective. The ablated matter can be collected by aerosol aspiration/filtration. The automation of the process can provide a higher capacity of paint removal. Laser ablation of paint was under our extensive studies. Laser ablation with different nanosecond repetition rate lasers was comparatively studied to understand the ablation mechanisms, and to obtain the highest efficiency of paint removal. The investigations were made with three Q-Switched Nd:YAG lasers (λ = 532 nm and λ = 1.064 μm). The different pulse durations (5 ns and 100 ns) demonstrated the different ablation regimes. Ablation with long pulses (100 ns) provided the best removal efficiency while the short ones (5 ns) decreased the ablation threshold fluence. It was demonstrated that the pulse repetition rate increasing in the 20 Hz - 10 kHz range induced heat accumulation in the paint. It resulted in ablation efficiency increase with a large decrease in the ablation threshold fluence. Laser ablation in the 0 - 10 J / cm 2 fluence range was investigated. Various paints were under investigation to obtain the maximum efficiency of paint removal for each specific experimental case. The ejected matter recording with a high speed imaging system allows to analyse the laser-matter interaction. (authors)

  3. Gallbladder ablation by radiologic intervention

    International Nuclear Information System (INIS)

    Becker, C.D.; Quenville, N.F.; Burhenne, H.J.

    1988-01-01

    Thirty pigs underwent cystic duct occlusion by means of transcatheter endoluminal bipolar radiofrequency electrocoagulation under fluoroscopic guidance. Twenty animals subsequently underwent gallbladder ablation with alcohol and sotradecol; ten animals served as controls. Serial histologic blocking of the common bile duct, cystic duct, and gallbladder in all animals revealed no adverse effects of the sclerosants on the bile ducts or the structures adjacent to the gallbladder. The combination of 95% alcohol plus 3% sotradecol resulted in necrosis of the gallbladder mucosa within 2 weeks (two of two animals) and complete eradication of the mucosa and fibrotic obliteration of the gallbladder lumen within 8 weeks (six of eight animals)

  4. Fluoroscopy integrated 3D mapping significantly reduces radiation exposure during ablation for a wide spectrum of cardiac arrhythmias.

    Science.gov (United States)

    Christoph, Marian; Wunderlich, Carsten; Moebius, Stefanie; Forkmann, Mathias; Sitzy, Judith; Salmas, Jozef; Mayer, Julia; Huo, Yan; Piorkowski, Christopher; Gaspar, Thomas

    2015-06-01

    Despite the use of established 3D-mapping systems, invasive electrophysiological studies and catheter ablation require high radiation exposure of patients and medical staff. This study investigated whether electroanatomic catheter tracking in prerecorded X-ray images on top of an existing 3D-mapping system has any impact on radiation exposure. Two hundred and ninety-five consecutive patients were either ablated with the guidance of the traditional CARTO-3 system (c3) or with help of the CARTO-UNIVU system (cU): [typical atrial flutter (AFL) n = 58, drug refractory atrial fibrillation (AF) n = 81, ectopic atrial tachycardia (EAT) n = 37, accessory pathways (APs) n = 22, symptomatic, idiopathic premature ventricular complexes (PVCs) n = 56, ventricular tachycardias (VTs) n = 41]. The CARTO-UNIVU allowed a reduction in radiation exposure: fluoroscopy time: AFL c3: 8.6 ± 0.8 min vs. cU: 2.9 ± 0.3 min, P fluoroscopy time the fluoroscopy dose was also reduced significantly. These advantages were not at the cost of increased procedure times, periprocedural complications, or decreased acute ablation success rates. In a wide spectrum of cardiac arrhythmias, and especially in AF and VT ablation, fluoroscopy integrated 3D mapping contributed to a dramatic reduction in radiation exposure without prolonging procedure times and compromising patient's safety. That effect, however, could not be maintained in patients with APs and PVCs. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  5. Spanish clitic clusters

    Directory of Open Access Journals (Sweden)

    María Cristina Cuervo

    2013-11-01

    Full Text Available This paper deals with a small set of data from clusters of three clitics in Spanish that questions the empirical adequacy and scope of previous analyses of clitic clusters in Romance. It is shown that the output of the Spurious se Rule is not identical to genuine se, at some level that is relevant for linearization of clitics within a cluster. A proposal is presented to capture the neglected data, and this is done in a way that illuminates the debate on the division of labour in clitic phenomena between phonology, morphology and syntax. Central questions in morphology, such as ordering of operations, syncretisms, linearization principles and consequences of lexical insertion are addressed and re-examined.

  6. The spanish nuclear choice

    International Nuclear Information System (INIS)

    Martin Blazquez, C.

    1983-12-01

    The aim of this thesis was to examine the present state and projections of the nuclear energy development in Spain, the limits and conditions of this development, as also the industrial and politic-economical stakes resulting. The analysis is considered through the evolution of the energetic balance up to 1990, taking into account the exceptional role of the nuclear energy: description of the various economic and social development plans since 1964, history of the energy consumption in Spain, structures of the nuclear sector (mining, production, and the private industry), importance of the electric energy in the spanish industry, structures of the electric sector in Spain, roles and interventions of the government in the nuclear electric subsector

  7. Managerial style in Spanish

    Directory of Open Access Journals (Sweden)

    Dra. Cristina Etayo Pérez

    2008-01-01

    Full Text Available This paper aims to study the management style of the Spanish advertising agencies. For this purpose, it explores the way in which the dimensions that define the nature of this concept arise in the sector chosen. The analysis begins with the definition of management style as concept followed by an exposition of its main functions and its fundamental dimensions. Then, the paper presents the methodology used to verify how these dimensions appear among managers as well as the results obtained during the fieldwork. Such methodology includes the achievement of in-depth interviews, with the help of a questionnaire of semi-structured questions, and the descriptive analysis of qualitative and quantitative information obtained from those interviews. The revision of these aspects enriches the study of management at the advertising agencies since it contributes to understand why certain actions have as a consequence one particular kind of relationship between directors and collaborators or another.

  8. Hyperkalaemia after radiofrequency ablation of hepatocellular carcinoma

    NARCIS (Netherlands)

    Verhoevena, BH; Haagsma, EB; Appeltans, BMG; Slooff, MJH; de Jong, KP

    Radiofrequency ablation of liver tumours is a useful therapy for otherwise unresectable tumours. The complication rate is said to be low. In this case report we describe hyperkalaemia after radiofrequency ablation of a hepatocellular carcinoma in a patient with end-stage renal insufficiency. (C)

  9. Ablation Techniques for Mahaim Fiber Tachycardia

    Directory of Open Access Journals (Sweden)

    Shomu Bohora

    2009-03-01

    Full Text Available Mahaim fiber exhibits atrio-ventricular node like properties and generally is localized at the lateral aspect of the tricuspid annulus. Of the varying methods for localization, ablation at the site of Mahaim potential is the most accepted and successful method. Radiofrequency ablation of Mahaim fiber has high success rates.

  10. The Atrial Fibrillation Ablation Pilot Study

    DEFF Research Database (Denmark)

    Arbelo, Elena; Brugada, Josep; Hindricks, Gerhard

    2014-01-01

    AIMS: The Atrial Fibrillation Ablation Pilot Study is a prospective registry designed to describe the clinical epidemiology of patients undergoing an atrial fibrillation (AFib) ablation, and the diagnostic/therapeutic processes applied across Europe. The aims of the 1-year follow-up were to analy...

  11. Testing and evaluation of light ablation decontamination

    International Nuclear Information System (INIS)

    Demmer, R.L.; Ferguson, R.L.

    1994-10-01

    This report details the testing and evaluation of light ablation decontamination. It details WINCO contracted research and application of light ablation efforts by Ames Laboratory. Tests were conducted with SIMCON (simulated contamination) coupons and REALCON (actual radioactive metal coupons) under controlled conditions to compare cleaning effectiveness, speed and application to plant process type equipment

  12. Testing and evaluation of light ablation decontamination

    Energy Technology Data Exchange (ETDEWEB)

    Demmer, R.L.; Ferguson, R.L.

    1994-10-01

    This report details the testing and evaluation of light ablation decontamination. It details WINCO contracted research and application of light ablation efforts by Ames Laboratory. Tests were conducted with SIMCON (simulated contamination) coupons and REALCON (actual radioactive metal coupons) under controlled conditions to compare cleaning effectiveness, speed and application to plant process type equipment.

  13. Relationships between cardiac innervation/perfusion imbalance and ventricular arrhythmias: impact on invasive electrophysiological parameters and ablation procedures

    Energy Technology Data Exchange (ETDEWEB)

    Gimelli, Alessia [Fondazione Toscana Gabriele Monasterio, Pisa (Italy); Menichetti, Francesca; Soldati, Ezio; Liga, Riccardo; Vannozzi, Andrea; Bongiorni, Maria Grazia [University Hospital of Pisa, Cardio-Thoracic and Vascular Department, Pisa (Italy); Marzullo, Paolo [Fondazione Toscana Gabriele Monasterio, Pisa (Italy); CNR, Institute of Clinical Physiology, Pisa (Italy)

    2016-12-15

    To assess the relationship between regional myocardial perfusion and sympathetic innervation parameters at myocardial scintigraphy and intra-cavitary electrophysiological data in patients with ventricular arrhythmias (VA) submitted to invasive electrophysiological study and ablation procedure. Sixteen subjects underwent invasive electrophysiological study with electroanatomical mapping (EAM) followed by trans-catheter ablations of VA. Before ablation all patients were studied with a combined evaluation of regional myocardial perfusion and sympathetic innervation by means of tomographic {sup 99m}Tc-tetrofosmin and {sup 123}I- metaiodobenzylguanidine cadmium-zinc-telluride (CZT) scintigraphies, respectively. Off-line spatial co-registration of CZT perfusion and innervation data with the three-dimensional EAM reconstruction was performed in every patient. CZT revealed the presence of myocardial scar in 55 (20 %) segments. Of the viable myocardial segments, 131 (60 %) presented a preserved adrenergic innervation, while 86 (40 %) showed a significantly depressed innervation (i.e. innervation/perfusion mismatch). On EAM, the invasively measured intra-cavitary voltage was significantly lower in scarred segments than in viable ones (1.7 ± 1.5 mV vs. 4.0 ± 2.2 mV, P < 0.001). Interestingly, among the viable segments, those showing an innervation/perfusion mismatch presented a significantly lower intra-cavitary voltage than those with preserved innervation (1.9 ± 2.5 mV vs. 4.7 ± 2.3 mV, P < 0.001). Intra-cardiac ablation was performed in 63 (23 %) segments. On multivariate analysis, after correction for scar burden, the segments showing an innervation/perfusion mismatch remained the most frequent ablation targets (OR 5.6, 95 % CI 1.5-20.8; P = 0.009). In patients with VA, intra-cavitary electrical abnormalities frequently originate at the level of viable myocardial segments with depressed sympathetic innervation that frequently represents the ultimate ablation target

  14. Totally implantable venous catheters for chemotherapy: experience in 500 patients

    Directory of Open Access Journals (Sweden)

    Nelson Wolosker

    Full Text Available CONTEXT: Totally implantable devices are increasingly being utilized for chemotherapy treatment of oncological patients, although few studies have been done in our environment to analyze the results obtained from the implantation and utilization of such catheters. OBJECTIVE: To study the results obtained from the implantation of totally implantable catheters in patients submitted to chemotherapy. TYPE OF STUDY: Prospective. SETTING: Hospital do Câncer A.C. Camargo, São Paulo, Brazil. METHODS: 519 totally implantable catheters were placed in 500 patients submitted to chemotherapy, with preference for the use of the right external jugular vein. Evaluations were made of the early and late-stage complications and patient evolution until removal of the device, death or the end of the treatment. RESULTS: The prospective analysis showed an average duration of 353 days for the catheters. There were 427 (82.2% catheters with no complications. Among the early complications observed, there were 15 pathway hematomas, 8 cases of thrombophlebitis of the distal stump of the external jugular vein and one case of pocket infection. Among the late-stage complications observed, there were 43 infectious complications (0.23/1000 days of catheter use, 11 obstructions (0.06/1000 days of catheter use and 14 cases of deep vein thrombosis (0.07/1000 days of catheter use. Removal of 101 catheters was performed: 35 due to complications and 66 upon terminating the treatment. A total of 240 patients died while the catheter was functioning and 178 patients are still making use of the catheter. CONCLUSION: The low rate of complications obtained in this study confirms the safety and convenience of the use of totally implantable accesses in patients undergoing prolonged chemotherapy regimes.

  15. High Heat Flux Block Ablator-in-Honeycomb Heat Shield Using Ablator/Aerogel-Filled Foam, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — Ultramet and ARA Ablatives Laboratory previously developed and demonstrated advanced foam-reinforced carbon/phenolic ablators that offer substantially increased high...

  16. Advances in laser ablation of materials

    International Nuclear Information System (INIS)

    Singh, R.K.; Lowndes, D.H.; Chrisey, D.B.; Fogarassy, E.; Narayan, J.

    1998-01-01

    The symposium, Advances in Laser Ablation of Materials, was held at the 1998 MRS Spring Meeting in San Francisco, California. The papers in this symposium illustrate the advances in pulsed laser ablation for a wide variety of applications involving semiconductors, superconductors, metals, ceramics, and polymers. In particular, advances in the deposition of oxides and related materials are featured. Papers dealing with both fundamentals and the applications of laser ablation are presented. Topical areas include: fundamentals of ablation and growth; in situ diagnostics and nanoscale synthesis advances in laser ablation techniques; laser surface processing; pulsed laser deposition of ferroelectric, magnetic, superconducting and optoelectronic thin films; and pulsed laser deposition of carbon-based and polymeric materials. Sixty papers have been processed separately for inclusion on the data base

  17. Determinants of Research Productivity in Spanish Academia

    Science.gov (United States)

    Albert, Cecilia; Davia, María A.; Legazpe, Nuria

    2016-01-01

    This article aims to widen the empirical evidence about the determinants of Spanish academics' publication productivity across fields of study. We use the Spanish Survey on Human Resources in Science and Technology addressed to Spanish resident PhDs employed in Spanish universities as academics. Productivity is measured as the total number of…

  18. Adult Second Language Learning of Spanish Vowels

    Science.gov (United States)

    Cobb, Katherine; Simonet, Miquel

    2015-01-01

    The present study reports on the findings of a cross-sectional acoustic study of the production of Spanish vowels by three different groups of speakers: 1) native Spanish speakers; 2) native English intermediate learners of Spanish; and 3) native English advanced learners of Spanish. In particular, we examined the production of the five Spanish…

  19. Gd-EOB-DTPA-enhanced MR guidance in thermal ablation of liver malignancies.

    Directory of Open Access Journals (Sweden)

    Christian Rosenberg

    Full Text Available OBJECTIVE: To evaluate the potency of Gd-EOB-DTPA to support hepatic catheter placement in laser ablation procedures by quantifying time-dependent delineation effects for instrumentation and target tumor within liver parenchyma. Monitoring potential influence on online MR thermometry during the ablation procedure is a secondary aim. MATERIALS AND METHODS: 30 cases of MR-guided laser ablation were performed after i.v. bolus injection of gadoxetic acid (0.025 mmol/Kg Gd-EOB-DTPA; Bayer Healthcare, Berlin, Germany. T1-weighted GRE sequences were used for applicator guidance (FLASH 3D in the catheter placement phase and for therapy monitoring (FLASH 2D in the therapy phase. SNR and consecutive CNR values were measured for elements of interest plotted over time both for catheter placement and therapy phase and compared with a non-contrast control group of 19 earlier cases. Statistical analysis was realized using the paired Wilcoxon test. RESULTS: Sustainable signal elevation of liver parenchyma in the contrast-enhanced group was sufficient to silhouette both target tumor and applicator against the liver. Differences in time dependent CNR alteration were highly significant between contrast-enhanced and non-contrast interventions for parenchyma and target on the one hand (p = 0.020 and parenchyma and instrument on the other hand (p = 0.002. Effects lasted for the whole procedure (monitoring up to 60 min and were specific for the contrast-enhanced group. Contrasting maxima were seen after median 30 (applicator and 38 (tumor minutes, in the potential core time of a multineedle procedure. Contrast influence on T1 thermometry for real-time monitoring of thermal impact was not significant (p = 0.068-0.715. CONCLUSION: Results strongly support anticipated promotive effects of Gd-EOB-DTPA for MR-guided percutaneous liver interventions by proving and quantifying the delineating effects for therapy-relevant elements in the procedure. Time benefit, cost

  20. 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

  1. Prevention of catheter-related blood stream infection.

    Science.gov (United States)

    Byrnes, Matthew C; Coopersmith, Craig M

    2007-08-01

    Catheter-related blood stream infections are a morbid complication of central venous catheters. This review will highlight a comprehensive approach demonstrated to prevent catheter-related blood stream infections. Elements of prevention important to inserting a central venous catheter include proper hand hygiene, use of full barrier precautions, appropriate skin preparation with 2% chlorhexidine, and using the subclavian vein as the preferred anatomic site. Rigorous attention needs to be given to dressing care, and there should be daily assessment of the need for central venous catheters, with prompt removal as soon as is practicable. Healthcare workers should be educated routinely on methods to prevent catheter-related blood stream infections. If rates remain higher than benchmark levels despite proper bedside practice, antiseptic or antibiotic-impregnated catheters can also prevent infections effectively. A recent program utilizing these practices in 103 ICUs in Michigan resulted in a 66% decrease in infection rates. There is increasing recognition that a comprehensive strategy to prevent catheter-related blood stream infections can prevent most infections, if not all. This suggests that thousands of infections can potentially be averted if the simple practices outlined herein are followed.

  2. Safety and efficacy of catheter-directed thrombolysis

    DEFF Research Database (Denmark)

    Bækgaard, N; Klitfod, Lotte; Broholm, R

    2012-01-01

    To describe the background for--and mechanism of--catheter-directed thrombolysis (CDT) for iliofemoral deep venous thrombosis (DVT) accessed via the popliteal vein. Focus is on safety and efficacy.......To describe the background for--and mechanism of--catheter-directed thrombolysis (CDT) for iliofemoral deep venous thrombosis (DVT) accessed via the popliteal vein. Focus is on safety and efficacy....

  3. Diagnosis of intra vascular catheter-related infection.

    Science.gov (United States)

    Cicalini, S; Palmieri, F; Noto, P; Boumis, E; Petrosillo, N

    2002-01-01

    The use of central vascular catheters (CVC) is associated with a substantial number of complications, amongst which infections predominate. A diagnosis of CVC-related infection usually requires catheter removal for culture. Semiquantitative (roll-plate method) and quantitative methods (flush, vortex, centrifugation or sonication methods) are the most reliable diagnostic methodologies requiring catheter removal, because of their greater specificity. The roll-plate method is the simplest and most commonly used technique. This method only samples the external surface of the catheter, and is particularly indicated for recently inserted catheters in which extraluminal colonisation is the primary mechanism of infection. Luminal culture techniques, such as the quantitative methods, may be more relevant for catheters that have been in place for a long period of time. However, in up to 85% of removed CVC the culture is negative, and other diagnostic techniques that do not require catheter removal have been proposed, including paired quantitative blood cultures, endoluminal brushing, and differential time to positivity (DTP) of paired blood cultures. DTP, that compares the time to positivity for qualitative cultures of blood samples simultaneously drawn from the CVC and a peripheral vein, appears to be the most reliable in the routine clinical practice since many hospitals use automatic devices for qualitative blood culture positivity detection. More recently catheter-sparing direct diagnostic methods, which include Gram stain and acridin-orange leucocyte cytospin (AOLC) test, appeared to be especially useful because of the rapidity of results and the ability to distinguish different microorganisms, allowing early targeted antimicrobial therapy.

  4. Risk factors for peritoneal dialysis catheter failure in children ...

    African Journals Online (AJOL)

    Background Peritoneal dialysis catheter (PDC) failure still remains a common clinical problem in pediatric patients despite advancements in catheter placement and dialysis techniques. Our aim was to determine the risk factors that may lead to PDC failure, especially those factors that could be potentially modified to ...

  5. Femoral venous catheters: a safe alternative for delivering parenteral alimentation.

    Science.gov (United States)

    Friedman, B; Kanter, G; Titus, D

    1994-04-01

    Femoral vein catheterization is an alternative method of obtaining central venous access. Placement of femoral venous catheters (FVCs) is possible in the majority of patients, suitable for most indications, and associated with a low complication rate during insertion. We wished to determine the incidence of infections or other complications resulting when parenteral nutrition was delivered through FVCs. Fifty-two patients were followed from a hospital-wide population including patients in the critical care units. Triple-lumen catheters were placed by using the sterile Seldinger technique, and sites were examined daily for inflammation. Bacteriologic surveillance was accomplished by submitting the catheter tip for semiquantitative cultures. If catheter line sepsis was suspected, blood samples for cultures were drawn through the catheter and peripherally. The rate of occurrence of colonized catheters was 9.6% (five of 52), and catheter sepsis was found in one case (1.9%). Other than inflammation at six (11.5%) of 52 catheter sites, noninfectious complications of FVCs were not found. On the basis of these findings, we consider FVC-delivered parenteral alimentation a safe and effective alternative to other forms of central venous access.

  6. Catheter Associated Urinary Tract Infection In A Tetiary Health ...

    African Journals Online (AJOL)

    Background: The use of indwelling catheter creates an inherent risk for infection. Catheter associated urinary tract infections (CAUTIs) comprise perhaps the largest institutional reservoir of nosocomial antibiotic resistant pathogens. This could lead to complications such as pyelonephritis and bacteraemia. Objective: To ...

  7. Cognitive Skills in Catheter-based Cardiovascular Interventions

    NARCIS (Netherlands)

    Jarodzka, Halszka; Boshuizen, Els; Kirschner, Paul A.

    2013-01-01

    Jarodzka, H., Boshuizen, H. P. A., & Kirschner, P. A. (2012). Cognitive skills in catheter-based cardiovascular interventions. In P. Lanzer (Ed.), Catheter-based cardiovascular interventions (pp. 69-86). Berlin, Germany: Springer. doi:10.1007/978-3-642-27676-7_7

  8. Indwelling Urethral Catheter Self-Care Preparedness Among ...

    African Journals Online (AJOL)

    Conclusion: These subjects were not properly assessed and assigned appropriate systems of nursing care. Nurses need to be clear about the content of their patient teaching in catheter care and assume full responsibility in teaching them. Key words: Indwelling urethral catheter, Self-care, Preparedness. [Jnl of College of ...

  9. A prototype catheter designed for ultraviolet C disinfection

    DEFF Research Database (Denmark)

    Bak, Jimmy; Begovic, Tanja

    2013-01-01

    UVC light exposure, sampling and plate counting. Findings Two minutes of UVC exposure was sufficient to obtain 4 log10 disinfection for the full-length prototype catheter. This exposure corresponds to ∼40 mJ/cm2 at the catheter tip and indicates that even shorter exposure times can be achieved...

  10. Encrusted and incarcerated urinary bladder catheter: what are the ...

    African Journals Online (AJOL)

    Urinary bladder catheter encrustations are known complications of long-term urinary catheterisation, which is commonly seen in clinical practice. These encrustations can impede deflation of the balloon and therefore cause problems in the removal of the catheter. The options in managing an encrusted and incarcerated ...

  11. Coronary artery angioplasty with a helical autoperfusion balloon catheter

    NARCIS (Netherlands)

    Gurbel, PA; Anderson, RD; vanBoven, AJ; denHeijer, P

    The initial in-hospital and long-term clinical experience with a helical autoperfusion balloon catheter in the treatment of coronary artery disease is reported, This new catheter design allows blood to flow passively around the inflated balloon through a protected helical channel molded into the

  12. Unusual migration of ventriculo peritoneal distal catheter into vagina

    Directory of Open Access Journals (Sweden)

    Sghavamedin Tavallaee

    2015-04-01

    Full Text Available VP shunt is one of the most popular methods for ICP reduction and treatment of hydrocephalus. Various complications of this method are not uncommon such as shunt malfunction, infection and unusual migration of distal catheter. I present a case of migration of the peritoneal catheter out of the vagina.

  13. Catheter-related bloodstream infections in neonatal intensive care units

    Directory of Open Access Journals (Sweden)

    Jung Hyun Lee

    2011-09-01

    Full Text Available Central venous catheters (CVCs are regularly used in intensive care units, and catheter-related bloodstream infection (CRBSI remains a leading cause of healthcare-associated infections, particularly in preterm infants. Increased survival rate of extremely-low-birth-weight infants can be partly attributed to routine practice of CVC placement. The most common types of CVCs used in neonatal intensive care units (NICUs include umbilical venous catheters, peripherally inserted central catheters, and tunneled catheters. CRBSI is defined as a laboratory-confirmed bloodstream infection (BSI with either a positive catheter tip culture or a positive blood culture drawn from the CVC. BSIs most frequently result from pathogens such as gram-positive cocci, coagulase-negative staphylococci , and sometimes gram-negative organisms. CRBSIs are usually associated with several risk factors, including prolonged catheter placement, femoral access, low birth weight, and young gestational age. Most NICUs have a strategy for catheter insertion and maintenance designed to decrease CRBSIs. Specific interventions slightly differ between NICUs, particularly with regard to the types of disinfectants used for hand hygiene and appropriate skin care for the infant. In conclusion, infection rates can be reduced by the application of strict protocols for the placement and maintenance of CVCs and the education of NICU physicians and nurses.

  14. Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter

    International Nuclear Information System (INIS)

    Oh, Jung Suk; Lee, Hae Giu; Chun, Ho Jong; Choi, Byung Gil; Lee, Sang Hoon; Hahn, Seong Tai; Ohm, Joon Young

    2013-01-01

    Purpose: This study was designed to evaluate retrospectively the safety and efficacy of the percutaneous management of duodenal stump leakage with a Foley catheter after subtotal gastrectomy. Methods: Ten consecutive patients (M:F = 9:1, median age: 64 years) were included in this retrospective study. The duodenal stump leakages were diagnosed in all the patients within a median of 10 days (range, 6–20). At first, the patients underwent percutaneous drainage on the day of or the day after confirmation of the presence of duodenal stump leakage, and then the Foley catheters were replaced at a median of 9 days (range, 6–38) after the percutaneous drainage. Results: Foley catheters were placed successfully in the duodenal lumen of all the patients under a fluoroscopic guide. No complication was observed during and after the procedures in all the patients. All of the patients started a regular diet 1 day after the Foley catheter placement. The patients were discharged at a median of 7 days (range, 5–14) after the Foley catheter placement. The catheters were removed in an outpatient clinic 10–58 days (median, 28) after the Foley catheter placement. Conclusions: Fluoroscopy-guided percutaneous Foley catheter placement may be a safe and effective treatment option for postoperative duodenal stump leakage and may allow for shorter hospital stays, earlier oral intake, and more effective control of leakage sites

  15. The relationship between the S-wave in lead 1 and recurrence of RVOT PVC ablation.

    Science.gov (United States)

    Güneş, Hacı Murat; Demir, Gültekin Günhan; Karaca, Oğuz; Yılmaz, Filiz Kızılırmak; İbişoğlu, Ersin; Gökdeniz, Tayyar; Omaygenç, Mehmet Onur; Güler, Ekrem; Güler, Gamze Babur; Savur, Ümeyir; Çakal, Beytullah; Barutçu, İrfan; Kılıçaslan, Fethi

    2017-12-14

    Radiofrequency catheter ablation (CA) is a common non-pharmacological treatment option for ventricular premature contractions (PVCs) originating from right ventricular outflow tract (RVOT). In this study, we aimed to investigate the relationship between recurrence after CA for RVOT-PVC and S-wave in lead 1 that was shown to be associated with RVOT depolarization. A total of 104 patients who were referred to our clinic for CA for idiopathic RVOT-PVC between 2012 and 2015years were enrolled. All ECG parameters were measured before and after the ablation procedure. Ablation was successful in 100 patients (96,1%). These patients with successful ablation were followed for a mean duration of 1078days. 13 patients (13%) had recurrence. Univariate logistic regression analysis revealed age (odds ratio: 1.916, p:0,012), presence of post-procedural S1 (odds ratio:1.040 p:0,028), post-procedural S1 area (oddsratio:1.023 p:0,041), ΔS1 area (odds ratio:1.242 p:0,004) as predictors for recurrence. Multivariate logistic regression analysis detected age (odds ratio:1.053 p:0,032) and ΔS1 area (odds ratio:0.701 p:0,009) as predictors for recurrence. Radiofrequency CA for RVOT-PVC can be performed with high procedural success and low complication rates. Age and ΔS1 area might be helpful for prediction of recurrence after CA. Copyright © 2017. Published by Elsevier Inc.

  16. [Interventional catheter treatment of tricuspid valve regurgitation].

    Science.gov (United States)

    Wißt, T; Kreidel, F; Schlüter, M; Kuck, K-H; Frerker, C

    2017-11-01

    The tricuspid valve can be considered the "forgotten" valve because in the past hardly any research has been conducted in this field and as a result only few therapeutic options existed. The prognosis of untreated tricuspid regurgitation (TR) is poor and mortality is high for patients with severe TR. Patients frequently return to medical practices and hospitals because of cardiac decompensation, with shortness of breath and leg edema. Recent years have seen more development in catheter-based treatment options. Currently, several devices are in clinical evaluation, which are presented in this article. A web-based literature search was carried out and information was gathered at international cardiology meetings (TCT 2016 in Washington, DGK 2017 in Mannheim, EuroPCR 2017 in Paris). There are various options for interventional catheter procedures for TR, which are being investigated within the scope of clinical studies. Most aim at reducing the tricuspid annular diameter and optimizing leaflet coaptation. Because of these new therapy options patients can now be treated who were considered untreatable in the past because of the high perioperative mortality.

  17. Teaching in Spanish Medical Schools.

    Science.gov (United States)

    Bombi, Josep Antoni

    2003-01-01

    Assesses the current situation of medical teaching, available healthcare facilities, and teaching staff employed at Spanish medical schools. Response rate was 100% from 27 schools surveyed. (Author/NB)

  18. Medical catheters thermally manipulated by fiber optic bundles

    Science.gov (United States)

    Chastagner, P.

    1992-10-06

    A maneuverable medical catheter comprising a flexible tube having a functional tip is described. The catheter is connected to a control source. The functional tip of the catheter carries a plurality of temperature activated elements arranged in parallel and disposed about the functional tip and held in spaced relation at each end. These elements expand when they are heated. A plurality of fiber optic bundles, each bundle having a proximal end attached to the control source and a distal end attached to one of the elements carry light into the elements where the light is absorbed as heat. By varying the optic fiber that is carrying the light and the intensity of the light, the bending of the elements can be controlled and thus the catheter steered. In an alternate embodiment, the catheter carries a medical instrument for gathering a sample of tissue. The instrument may also be deployed and operated by thermal expansion and contraction of its moving parts. 10 figs.

  19. Positioning of nasobiliary tube using magnet-loaded catheters.

    Science.gov (United States)

    Watanabe, Seitaro; Sato, Takamitsu; Kato, Shingo; Hosono, Kunihiro; Kobayashi, Noritoshi; Nakajima, Atsushi; Kubota, Kensuke

    2013-10-01

    In endoscopic nasobiliary drainage (ENBD), repositioning the catheter from the mouth to the nose is complicated. We devised a method using catheters with magnets and verified its utility and safety. We prospectively enrolled 20 patients undergoing ENBD at Yokohama City University Hospital. The procedures were successful in all 20 cases and no case required a change of operators to a senior doctor. The mean time for the procedure was 36.6 seconds. The emetic reflex was induced 0.5 times on average using the magnet method. The mean X-ray exposure time was 29.6 seconds. No complications occurred. The magnet-loaded catheter method for positioning the ENBD catheter before finally leading it through the nose took little time and was performed successfully and safely. Therefore, the magnet method could become the first choice among techniques for ENBD catheter placement. © Georg Thieme Verlag KG Stuttgart · New York.

  20. Dose requirements for UVC disinfection of catheter biofilms

    DEFF Research Database (Denmark)

    Bak, Jimmy; Ladefoged, Søren D.; Tvede, Michael

    2009-01-01

    Bacterial biofilms on permanent catheters are the major sources of infection. Exposure to ultraviolet-C (UVC) light has been proposed as a method for disinfecting the inner surface of catheters. Specification of a UVC-based device for in vivo disinfection is based on the knowledge of the required...... doses to kill catheter biofilm. Given these doses and the power of available UVC light sources, calculation of the necessary treatment times is then possible. To determine the required doses, contaminated urinary catheters were used as test samples and UVC treated in vitro. Patient catheters (n = 67......) were collected and cut into segments of equal size and treated with various UVC doses. After treatment, the biofilm was removed by scraping and quantified by counting colony forming units. Percentage killing rates were determined by calculating ratios between UVC-treated samples and controls (no UVC...