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Pulmonary vein isolation

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https://www.readbyqxmd.com/read/28523369/-new-strategies-and-technologies-for-ablation-of-atrial-fibrillation-where-do-we-go
#1
A Metzner, J Riedl, K-H Kuck
Catheter-based ablation is an established treatment option for patients with symptomatic atrial fibrillation (AF). Pulmonary vein isolation is the established cornerstone of all ablation strategies. However, the rate of electrical reconduction of previously isolated pulmonary veins is high and associated with recurrence of AF. Novel and innovative mapping and ablation systems are being developed or are under clinical evaluation aiming for higher durability of pulmonary vein isolation. Additional ablation strategies for patients with recurrence of AF despite persistent isolation of the pulmonary veins are under evaluation...
May 18, 2017: Herz
https://www.readbyqxmd.com/read/28514826/-pulmonary-vein-isolation-in-paroxysmal-atrial-fibrillation-is-still%C3%A2-not-a-primary-therapy-of-paroxysmal-atrial-fibrillation
#2
Johannes Brachmann
No abstract text is available yet for this article.
May 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28514825/-the-pulmonary-vein-isolation-is-the-primary-therapy-for-paroxysmal-atrial-fibrillation
#3
Bernd-Dieter Gonska
No abstract text is available yet for this article.
May 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28514791/impact-of-targeting-adenosine-induced-transient-venous-reconnection-in-patients-undergoing-pulmonary-vein-isolation-for-atrial-fibrillation-a-meta-analysis-of-3524-patients
#4
Alessandro Blandino, Giuseppe Biondi-Zoccai, Alberto Battaglia, Stefano Grossi, Francesca Bianchi, Maria Rosa Conte, Francesco Rametta, Fiorenzo Gaita
AIMS: Atrial fibrillation recurrences after pulmonary vein isolation (PVI) are not uncommon and are frequently related to pulmonary vein reconnection. Adenosine/ATP can reveal dormant pulmonary vein conduction after PVI. Previous studies revealed that adenosine-guided Additional ablation could improve arrhythmia-free survival. We performed a meta-analysis to assess the impact of additional ablation to eliminate adenosine-induced transient pulmonary vein reconnection in terms of atrial fibrillation recurrence at follow-up...
July 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/28513287/contact-force-technology-integrated-with-3d-navigation-system-for-atrial-fibrillation-ablation-improving-results
#5
Roberto Rordorf, Antonio Sanzo, Vincenzo Gionti
Pulmonary veins isolation (PVI) by radiofrequency (RF) ablation is currently an established treatment for symptomatic, drug-resistant paroxysmal atrial fibrillation. Although the effectiveness of the therapy has been clearly demonstrated, success rate after a single procedure is still sub-optimal. The main reason for recurrences after PVI is electrical pulmonary vein-atrium reconnection. In order to increase the likelihood of permanent PVI, the creation of a transmural, durable lesion is mandatory. The main determinants of lesion size and transmurality are power, stability, duration and contact-force during RF application...
May 17, 2017: Expert Review of Medical Devices
https://www.readbyqxmd.com/read/28513211/image-quality-of-low-radiation-dose-left-atrial-ct-using-filtered-back-projection-and-an-iterative-reconstruction-algorithm-intra-individual-comparison-in-unselected-patients-undergoing-pulmonary-vein-isolation
#6
Ute Lina Fahlenkamp, Ivan Diaz Ramirez, Moritz Wagner, Carsten Schwenke, Alexander Huppertz, Bernd Hamm, Alexander Lembcke
Background Computed tomography (CT) of the left atrium (LA) is performed prior to pulmonary vein isolation (PVI) to improve success of circumferential ablation for atrial fibrillation. The ablation procedure itself exposes patients to substantial radiation doses, therefore radiation dose reduction in pre-ablational imaging is of concern. Purpose To assess and compare diagnostic performance of low-radiation dose preprocedural CT in patients scheduled for PVI using two types of reconstruction algorithms. Material and Methods Forty-six patients (61 ± 10 years) scheduled for PVI were enrolled in this study irrespective of body-mass-index or cardiac rhythm at examination...
January 1, 2017: Acta Radiologica
https://www.readbyqxmd.com/read/28508944/suppressive-effects-of-zingerone-on-tgfbip-mediated-septic-responses
#7
Gahee Min, Sae-Kwang Ku, Taeho Lee, Jong-Sup Bae
Zingerone (ZGR), a phenolic alkanone isolated from ginger, has been reported to possess various pharmacological activities. Transforming growth factor β-induced protein (TGFBIp) is an extracellular matrix protein whose expression in several cell types is greatly increased by TGF-β. TGFBIp is released by human umbilical vein endothelial cells and functions as a mediator of experimental sepsis. We hypothesized that ZGR could reduce TGFBIp-mediated severe inflammatory responses in human endothelial cells and mice...
May 16, 2017: Archives of Pharmacal Research
https://www.readbyqxmd.com/read/28506919/novel-dye-less-and-fluoro-less-approach-to-cryoballoon-pulmonary-vein-occlusion-assessment
#8
Boaz Avitall, Arthur Kalinski, G Stephen Kocheril, Timothy G Laske, Nicolas Coulombe
BACKGROUND: Occlusion of pulmonary veins is essential for PV isolation using the Cryo balloon. Currently occlusion is arbitrarily determined using fluoroscopy and contrast media. This study aimed to create an objective measure without utilizing excessive fluoroscopy and no contrast media. OBJECTIVE: Ensure PV occlusion without fluoroscopy and contrast dye. METHODS: In 4 in vivo hearts 113 PV occlusions were tested with a 50% cold dye saline mix at 4°C...
May 8, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28506548/antiarrhythmic-medication-is-superior-to-catheter-ablation-in-suppressing-supraventricular-ectopic-complexes-in-patients-with-atrial-fibrillation
#9
Christina Alhede, Trine K Lauridsen, Arne Johannessen, Ulrik Dixen, Jan S Jensen, Pekka Raatikainen, Gerhard Hindricks, Haakan Walfridsson, Ole Kongstad, Steen Pehrson, Anders Englund, Juha Hartikainen, Peter S Hansen, Jens C Nielsen, Christian Jons
BACKGROUND: Supraventricular ectopic complexes (SVEC) originating in the pulmonary veins are known triggers of atrial fibrillation (AF) which led to the development of pulmonary vein isolation for AF. However, the long-term prevalence of SVEC after catheter ablation (CA) as compared to antiarrhythmic medication (AAD) is unknown. Our aims were to compare the prevalence of SVEC after AAD and CA and to estimate the association between baseline SVEC burden and AF burden during 24months of follow-up...
May 10, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28501100/comparison-of-direct-current-synchronized-cardioversion-to-ibutilide-guided-catheter-ablation-for-long-term-sinus-rhythm-maintenance-after-isolated-pulmonary-vein-isolation-of-persistent-atrial-fibrillation
#10
Maojing Wang, Qing Zhao, Wei Ding, Shanglang Cai
Use of the antiarrhythmic ibutilide after isolated pulmonary vein isolation (PVI) might distinguish atrial remodeling severity and cases requiring further substrate modification, thereby improving efficacy of persistent atrial fibrillation (AF) treatment. Ninety-six consecutive patients with persistent AF were randomized after PVI to either direct current synchronized cardioversion (DCC group, n = 48) or 1 mg of intravenous ibutilide (ibutilide group, n = 48) followed by no further intervention if AF converted to sinus rhythm (SR) within 30 minutes (ibutilide conversion subgroup) or by complex fractionated atrial electrogram (CFAE) ablation until SR recovery or complete CFAE elimination (ibutilide nonconversion subgroup)...
March 29, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28500480/-pulmonary-vein-isolation-for-atrial-fibrillation-findings-from-long-term-follow-up
#11
C-H Heeger, K-H Kuck, F Ouyang
Atrial fibrillation is by far the most common cardiac arrhythmia in humans. The incidence of atrial fibrillation increases with age and will increase even more in the future due to the demographic changes in the population. Therefore, this arrhythmia will have a growing clinical and socioeconomic impact. Although there are established pharmaceutical treatment options, atrial fibrillation is one of the major causes of stroke, heart failure and cardiovascular morbidity and mortality. The latest guidelines recommend the invasive procedure of circumferential pulmonary vein isolation (PVI) as an effective treatment of paroxysmal and persistent atrial fibrillation...
May 12, 2017: Herz
https://www.readbyqxmd.com/read/28500479/-catheter-ablation-of-persistent-atrial-fibrillation-where-do-we-go
#12
C Lemeš, K-H Kuck, S Mathew
Despite the very promising initial results of clinical studies, catheter ablation of persistent atrial fibrillation (AF) remains a challenge in modern electrophysiology. On the basis of the hypothesized pathophysiological mechanisms, a variety of ablation strategies have been developed over the course of time. The current ablation strategies range from pulmonary vein isolation (PVI) alone as first-line therapy, through ablation of multiple linear lesions, ablation of complex fractionated atrial electrograms (CFAE), rotor ablation, isolation of fibrotic and scar tissue up to isolation of the left atrial appendage (LAA); however, it is unclear even to the present day whether these complex and time-consuming strategies actually improve the success rate of ablation therapy...
May 12, 2017: Herz
https://www.readbyqxmd.com/read/28500420/purification-biochemical-and-structural-characterization-of-a-novel-fibrinolytic-enzyme-from-mucor-subtilissimus-ucp-1262
#13
Thiago Pajeú Nascimento, Amanda Emmanuelle Sales, Tatiana Souza Porto, Romero Marcos Pedrosa Brandão Costa, Leonid Breydo, Vladimir N Uversky, Ana Lúcia Figueiredo Porto, Attilio Converti
Fibrinolytic proteases are enzymes that degrade fibrin. They provide a promising alternative to existing drugs for thrombolytic therapy. A protease isolated from the filamentous fungus Mucor subtilissimus UCP 1262 was purified in three steps by ammonium sulfate fractionation, ion exchange, and molecular exclusion chromatographies, and characterized biochemically and structurally. The purified protease exhibited a molecular mass of 20 kDa, an apparent isoelectric point of 4.94 and a secondary structure composed mainly of α-helices...
May 12, 2017: Bioprocess and Biosystems Engineering
https://www.readbyqxmd.com/read/28497857/validation-of-electrical-ostial-pulmonary-vein-isolation-verified-with-a-spiral-inner-lumen-mapping-catheter-during-second-generation-cryoballoon-ablation
#14
Shinsuke Miyazaki, Takatsugu Kajiyama, Tomonori Watanabe, Hiroshi Taniguchi, Hiroaki Nakamura, Rikuta Hamaya, Shigeki Kusa, Miyako Igarashi, Hitoshi Hachiya, Kenzo Hirao, Yoshito Iesaka
BACKGROUND: Achieve catheters are cryoballoon guidewires that enable pulmonary vein (PV) potential mapping. The single catheter approach in conjunction with the Achieve catheter is currently standard practice in second-generation cryoballoon ablation, yet circumferential mapping catheters are the gold standard for evaluating PV isolation (PVI). The study sought to validate the ostial PVI verified by an Achieve catheter alone. METHODS: One-hundred fifty-one paroxysmal atrial fibrillation patients undergoing PVI using exclusively 28-mm second-generation cryoballoons were enrolled...
May 12, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28496936/strategies-to-improve-safety-and-efficacy-of-atrial-fibrillation-ablation-using-electrode-multipolar-phased-rf-pvac%C3%A2-catheter-a-case-report
#15
Fabio Dorfman, Cristiano Dietrich, Paulo Costa, Evandro Sbaraini, Rafael Abt, Dalmo Moreira, Cézar Mesas
Phased radiofrequency ablation with a single catheter technique, using a 9-electrode circumferential catheter, is a viable approach to pulmonary vein isolation for the treatment of atrial fibrillation. However, creating effective transmural lesions with such technique, while avoiding serious complications like atrioesophageal fistula, can be difficult. This case illustrates a challenging scenario, where catheter maneuvers fail to allow safe radiofrequency delivery, due to esophageal temperature rise, despite extensive navigating maneuvers...
October 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/28496923/emergency-covered-stent-implantation-for-rupture-of-a-pulmonary-vein-after-balloon-angioplasty-for-postinterventional-pulmonary-vein-stenosis
#16
Sebastian Hilbert, Silke John, Frank-Thomas Riede, Arash Arya, Ingo Paetsch, Cosima Jahnke, Gerhard Hindricks, Andreas Bollmann
Pulmonary vein (PV) stenosis is a known complication of PV isolation procedures for atrial fibrillation. We describe in this report a case of emergency covered stent implantation for rupture of a PV after balloon angioplasty for postinterventional PV stenosis occlusion. Focus is on stent implantation and on a novel aspect of magnetic resonance imaging for postprocedural outcome evaluation. A focused review of the current literature regarding ongoing limitations of PV stenosis treatment is provided.
October 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/28495652/acute-efficacy-safety-and-long-term-clinical-outcomes-utilizing-the-second-generation-cryoballoon-for-pulmonary-vein-isolation-in-patients-with-a-left-common-pulmonary-vein-a-multicenter-study
#17
Christian-Hendrik Heeger, Verena Tscholl, Erik Wissner, Thomas Fink, Laura Rottner, Peter Wohlmuth, Barbara Bellmann, Mattias Roser, Shibu Mathew, Christian Sohns, Bruno Reißmann, Christine Lemeš, Tilman Maurer, Francesco Santoro, Johannes Riedl, Britta Goldmann, Ulf Landmesser, Feifan Ouyang, Karl-Heinz Kuck, Andreas Rillig, Andreas Metzner
BACKGROUND: Second-generation cryoballoon (CB2)-based pulmonary vein isolation (PVI) has demonstrated encouraging clinical results in the treatment of paroxysmal (PAF) and persistent atrial fibrillation (PersAF). However, the CB2 features a maximal diameter of 28mm and its adaptability to anatomical variations of the pulmonary veins (PVs) might be challenging. OBJECTIVE: To assess acute efficacy, safety and long-term clinical results of CB2-based PVI in patients with a left common PV (LCPV)...
May 8, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28492985/catheter-ablation-of-paroxysmal-atrial-fibrillation-circumferential-pulmonary-vein-ablation-success-rates-with-and-without-exclusion-of-areas-adjacent-to-the-esophagus
#18
Klaus Kettering, Dag-Hau Yim, Alexander Benz, Felix Gramley
BACKGROUND: Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory paroxysmal atrial fibrillation. Circumferential pulmonary vein ablation is still the standard approach in these patients. The occurrence of an atrioesophageal fistula is a rare but life-threatening complication after such ablation procedures. This is due to the fact that the esophagus does frequently have a very close anatomical relationship to the left or right pulmonary vein ostia...
May 10, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/28491757/successful-use-of-bivalirudin-in-place-of-heparin-infusion-for-pulmonary-vein-isolation-using-a-cryoballoon-catheter-in-a-patient-with-heparin-allergy
#19
Ethan R Ellis
No abstract text is available yet for this article.
January 2017: HeartRhythm Case Reports
https://www.readbyqxmd.com/read/28487347/acute-and-long-term-effects-of-full-power-electroporation-ablation-directly-on-the-porcine-esophagus
#20
Kars Neven, René van Es, Vincent van Driel, Harry van Wessel, Herma Fidder, Aryan Vink, Pieter Doevendans, Fred Wittkampf
BACKGROUND: Esophageal ulceration and fistula are complications of pulmonary vein isolation using thermal energy sources. Irreversible electroporation is a novel, nonthermal ablation modality for pulmonary vein isolation. A single 200 J application can create deep myocardial lesions. Acute and chronic effects of this new energy source on the esophagus are unknown. METHODS AND RESULTS: In 8 pigs (±70 kg), the suprasternal esophagus was surgically exposed. A linear suction device with a single 35-mm long and 6-mm wide protruding linear electrode inside a plastic suction cup was used for ablation...
May 2017: Circulation. Arrhythmia and Electrophysiology
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