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Pulmonary vein isolation

Patrycja Pruszkowska, Radosław Lenarczyk, Jakub Gumprecht, Ewa Jedrzejczyk-Patej, Michał Mazurek, Oskar Kowalski, Adam Sokal, Tomasz Podolecki, Stanisław Morawski, Witold Streb, Katarzyna Mitręga, Zbigniew Kalarus
BACKGROUND: Pulmonary vein isolation with cryobaloon catheter ablation (CCB) is an effective method oftreatment in patients with atrial fibrillation (AF) but in patients with heart failure (HF) therole of CCB remains unknown. AIMS: To assess feasibility, effectiveness and safety of CCB in patients with HF and cardiac electronic devices (CIED), the impact of the procedure on symptoms and echocardiographic parameters. METHODS: Thirty consecutive HF patients with left ventricular ejection fraction (EF)≤40% and CIED, referred for CCB of AF were included...
March 12, 2018: Kardiologia Polska
Yoshinari Enomoto, Go Hashimoto, Naohiko Sahara, Hikari Hashimoto, Hiroki Niikura, Keijiro Nakamura, Raisuke Iijima, Hidehiko Hara, Makoto Suzuki, Mahito Noro, Masao Moroi, Kaoru Sugi, Masato Nakamura
A 70-years-old male with a history of hypertension and drug resistant paroxysmal atrial fibrillation (AF) presented to our hospital for catheter ablation to his symptomatic AF. He had no prior surgical or percutaneous procedure to close or exclude the left atrial appendage (LAA). A transesophageal echocardiography (TEE) was performed to rule out intra-cardiac thrombus prior to the ablation procedure. Although the TEE imaging at multiple acquisition angles was obtained, the LAA could not be visualized and an absence of the LAA was suspected...
March 12, 2018: International Heart Journal
Aleksandr Voskoboinik, Paul B Sparks, Joseph B Morton, Geoffrey Lee, Stephen A Joseph, Joshua J Hawson, Peter M Kistler, Jonathan M Kalman
BACKGROUND: Despite technological advances, studies continue to report high complication rates for atrial fibrillation (AF) ablation. We sought to review complication rates for AF ablation at a high-volume centre over a 14-year period and identify predictors of complications. METHODS: We reviewed prospectively collected data from 2750 consecutive AF ablation procedures at our institution using radiofrequency energy (RF) between January 2004 and May 2017. All cases were performed under general anaesthetic with transoesophageal echocardiography (TEE), 3D-mapping and an irrigated ablation catheter...
February 3, 2018: Heart, Lung & Circulation
Grzegorz Suwalski, Robert Emery, Jakub Mróz, Kamil Kaczejko, Leszek Gryszko, Andrzej Cwetsch, Andrzej Skrobowski
OBJECTIVES: In patients undergoing cardiac surgical procedures, pulmonary vein isolation may be easily accomplished, and it is important to achieve bidirectional conduction block across created lesions. The primary aim of this study was to assess the risk of pulmonary vein stenosis (PVS) after multiple applications of epicardial bipolar radiofrequency energy. METHODS: Thirty-five consecutive patients who were referred for off-pump coronary revascularization with concomitant pulmonary vein isolation and left atrial appendage occlusion were prospectively included in the study...
March 7, 2018: Interactive Cardiovascular and Thoracic Surgery
Xiang-Yong Liu, Hai-Xiao Xu, Jian-Kui Li, Dong Zhang, Xiao-Hong Ma, Li-Na Huang, Jun-Hong Lü, Xiao-Zhi Wang
Damage to the endothelial glycocalyx is a critical factor in increased pulmonary vascular permeability, which is the basic pathological feature of acute respiratory distress syndrome (ARDS). Neferine (Nef), a bisbenzylisoquinoline alkaloid isolated from green seed embryos of Nelumbo nucifera Gaertn , has extensive pharmacological activity. In this study, we showed that Nef reduced lung-capillary permeability, down-regulated the production of cytokines (IL-1β, IL-6, TNF-α, and IL-10) and inhibited the activation of the NF-κB signaling pathway in mice with lipopolysaccharide (LPS)-induced ARDS...
2018: Frontiers in Physiology
Ruben R De With, Ernaldo G Marcos, Isabelle C Van Gelder, Michiel Rienstra
Aims: Clinicians increasingly encounter patients with young-onset atrial fibrillation (AF). Aim is to study clinical profile, AF progression, and outcome of patients with young-onset AF. Methods and results: A total of 468 patients with paroxysmal or persistent AF starting <60 years of age were included. Clinical profile, AF progression, defined as development of permanent AF, and cardiovascular events were prospectively collected. Onset of AF was at 46 ± 10 years, 354 (76%) were men, 329 (70%) had paroxysmal AF, 50 (11%) had AF without risk factors or comorbidities, and 118 (25%) had familial AF...
March 6, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
João Mesquita, Diogo Cavaco, António Miguel Ferreira, Francisco Moscoso Costa, Pedro Carmo, Francisco Morgado, Miguel Mendes, Pedro Adragão
BACKGROUND: Pulmonary vein isolation (PVI) is the cornerstone of AF ablation, but its long-term clinical outcomes, predictors of relapse, and optimal pharmacological treatment remain controversial. OBJECTIVE: The objectives of this paper were to (1) assess very long-term AF recurrence, (2) identify predictors of relapse, and (3) evaluate the impact of continued antiarrhythmic drug (AAD) treatment after ablation. METHODS: Multicenter observational registry including all consecutive patients with drug-resistant AF who underwent a first PVI between 2006 and 2008 (n = 253 (age 55 years (IQR 48-63)), 80% males, 64% with paroxysmal AF...
March 6, 2018: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Thomas J Buist, Ahmet Adiyaman, Jaap Jan J Smit, Anand R Ramdat Misier, Arif Elvan
The name of the author Jaap Jan J. Smit was rendered wrongly in the original publication. The original article has been corrected.
March 6, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Albert C Lin, Bradley P Knight
Interventional catheter ablation approaches to the rhythm control of atrial fibrillation (AF) have advanced significantly in the past decade. The foundation of the catheter ablation in AF is electrical isolation of the pulmonary veins (PVI). However, PVI only in more advanced stages of AF (persistent AF) has only modest to poor success rates prompting a search for alternative and adjunctive procedures to improve the outcomes of ablation in persistent AF. The left atrial appendage (LAA) is well understood to be a primary source of emboli in AF but less well known be a trigger or driver for AF...
March 6, 2018: Current Treatment Options in Cardiovascular Medicine
Masaharu Masuda, Masashi Fujita, Osamu Iida, Shin Okamoto, Takayuki Ishihara, Kiyonori Nanto, Takashi Kanda, Takuya Tsujimura, Yasuhiro Matsuda, Shota Okuno, Takuya Ohashi, Aki Tsuji, Toshiaki Mano
BACKGROUND: Association between the presence of left atrial low-voltage areas and atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) has been shown mainly in persistent AF patients. We sought to compare the AF recurrence rate in paroxysmal AF patients with and without left atrial low-voltage areas. METHODS: This prospective observational study included 147 consecutive patients undergoing initial ablation for paroxysmal AF. Voltage mapping was performed after PVI during sinus rhythm, and low-voltage areas were defined as regions where bipolar peak-to-peak voltage was <0...
April 15, 2018: International Journal of Cardiology
Xue Sun, Wenjia Lei, Yu Wang, Faiza Amber Siddiqui, Ying Zhang
Partial anomalous pulmonary venous connection (PAPVC) is a rare malformation. We describe a case of PAPVC, in which the left pulmonary veins coursed to the left innominate vein through a vertical vein and finally drained into the right superior vena cava; the right pulmonary veins were connected to the left atrium. Tracing the origin and destination of abnormal vessels presented at the three-vessel and trachea view is useful for the diagnosis. Four-dimensional echocardiography with high-definition flow imaging and spatiotemporal image correlation facilitates the identification of the drainage of fetal pulmonary veins, which should be considered as a complementary modality in obstetric ultrasonic examination when cardiac abnormalities are suspected...
March 5, 2018: Echocardiography
Ping Lü, Qibin Jiao, Daisuke Shimura, Yoichiro Kusakari, Fang Liu, Susumu Minamisawa
BACKGROUND: Previous research has revealed that patent vein grafts lose their venous identity Eph-B4 but not gain arterial identity Ephrin-B2 during adaptation to the arterial circulation, and vascular identity marker, e.g., the Eph-B4 signaling is a critical determinant of venous wall thickness of vein grafts. But what is the remodeling pattern, especially the remodeling pattern of vascular identity in the venous segment of arteriovenous shunt at a late stage post-operation has not been fully explored...
March 1, 2018: Annals of Vascular Surgery
Sandeep Prabhu, Manish Kalla, Kah Y Peck, Aleksandr Voskoboinik, Alex Ja McLellan, Bupesh Pathik, Chrishan J Nalliah, Geoff R Wong, Hariharan Sugumar, Sonia M Azzopardi, Geoffrey Lee, Liang-Han Ling, Jonathan M Kalman, Peter M Kistler
BACKGROUND: Pulmonary vein isolation (PVI) remains the cornerstone of catheter ablation (CA) in persistent AF (PeAF) although less successful than for PAF. Whether rapid or fibrillatory (PVAF) PV firing may identify PeAF patients more likely to benefit from a PV based approach, is unclear. OBJECTIVE: To determine the relationship between PV cycle length (PVCL) and PVAF outcome post CA. METHODS: Before ablation, the multipolar catheter was placed in each PV and the left atrial appendage (LAA) for 100 consecutive cycles...
March 1, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Guy O Furniss, Dimitrios Panagopoulos, Sadeek Kanoun, Edward J Davies, David R Tomlinson, Guy A Haywood
BACKGROUND: A reduction in surface electrocardiogram (ECG) P wave duration and dispersion is associated with improved outcomes in atrial fibrillation ablation. We investigated the effects of different ablation strategies on P wave duration and dispersion, hypothesising that extensive left atrial (LA) ablation with left atrial posterior wall isolation would give a greater reduction in P wave duration than more limited ablation techniques. METHODS: A retrospective analysis of ECGs from patients who have undergone atrial fibrillation (AF) ablation was performed and pre-procedural sinus rhythm ECGs were compared with the post procedure ECGs...
February 14, 2018: Heart, Lung & Circulation
Benjamin Schaeffer, Stephan Willems, Christian Meyer, Jakob Lüker, Ruken Ö Akbulak, Julia Moser, Mario Jularic, Christian Eickholt, Jana M Schwarzl, Melanie Gunawardene, Pawel Kuklik, Arian Sultan, Boris A Hoffmann, Daniel Steven
AIMS: Contact force (CF) catheters provide catheter-tissue contact information to improve outcome of pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (PAF). We evaluated different target-CF values for achievement of the additional endpoint of an unexcitable ablation line. METHODS: A total of 106 patients undergoing PVI were randomized into three groups (G) (G1: target-CF 15 g, G2: target-CF 10 g, G3: CF concealed from operator). The PVI encircling line was divided into predefined sections...
March 2, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Kaoru Okishige, Hideshi Aoyagi, Takurou Nishimura, Takatoshi Shigeta, Tomofumi Nakamura, Yasuteru Yamauchi, Takehiko Keida, Tetsuo Sasano, Kenzo Hirao
BACKGROUND: Adenosine triphosphate (ATP) can provoke acute reconnections after pulmonary vein isolation (PVI). This study aimed to investigate dormant conduction (DC) after ablation with second-generation cryoballoon (CB). METHODS: Two hundred sixteen patients (148 male; age 64±9 years) with atrial fibrillation (AF) were included. After a successful PVI with the CB, 20mg of ATP was administered. All patients were followed up for 425±56 days. RESULTS: Seven hundred ninety-five out of 864 (92%) PVs were successfully isolated solely by the CB...
February 26, 2018: Journal of Cardiology
Waleed Sadiq, Madeeha Subhan
Pulmonary embolism (PE) with isolated homocysteinemia is a rare disease. The diagnosis demands a proper clinical workup. Timely diagnosis can prevent complications and provide a better quality of life for the patient. We present a young man with homocysteinemia with deep vein thrombosis (DVT), pulmonary embolism, and normal vitamin B12 and folate levels despite being treated with rivaroxaban.
December 22, 2017: Curēus
Mark R de Jong, Annemiek F Hoogerwaard, Ahmet Adiyaman, Jaap Jan J Smit, Anand R Ramdat Misier, Jan-Evert Heeg, Boudewijn A A M van Hasselt, Isabelle C Van Gelder, Harry J G M Crijns, Ignacio Fernández Lozano, Jorge E Toquero Ramos, F Javier Alzueta, Borja Ibañez, José M Rubio, Fernando Arribas, José M Porres Aracama, Josep Brugada, Lluís Mont, Arif Elvan
BACKGROUND: Hypertension is an important, modifiable risk factor for the development of atrial fibrillation (AF). Even after pulmonary vein isolation (PVI), 20-40% experience recurrent AF. Animal studies have shown that renal denervation (RDN) reduces AF inducibility. One clinical study with important limitations suggested that RDN additional to PVI could reduce recurrent AF. OBJECTIVE: The goal of this multicenter randomized controlled study is to investigate whether RDN added to PVI reduces AF recurrence...
February 27, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Samir Omar Saleh, Mauro Figueiredo Carvalho de Andrade, Guilherme de Arruda Cuadrado, Kassem Samir Saleh, Flávia Emi Akamatsu, Alfredo Luiz Jacomo
BACKGROUND: Aneurysms of the deep veins of the lower limbs are rare and often asymptomatic. Although natural history is unclear, these aneurysms have been associated with deep venous thrombosis and fatal pulmonary embolism events. To our knowledge, this case represents the fifth patient with isolated aneurysm of a calf vein described in the literature and the second one affecting the fibular vein. CASE PRESENTATION: We report the case of a 20-year-old white man with an aneurysm of the fibular vein that we believe is the second case in the literature...
February 23, 2018: Annals of Vascular Surgery
Wilber Su, G Joseph Orme, Robert Hoyt, James Baker, Steven Compton, Christopher Fellows, John Harding, J Thomas Svinarich, Marcin Kowalski, Bryan Piedad, David Kenigsberg, John Seger, Zeshan K Ahmad, Paul Wang
BACKGROUND: Pulmonary vein isolation (PVI) via catheter ablation is an approved therapy for patients with drug-refractory and symptomatic atrial fibrillation (AF). Furthermore, cryoballoon is now considered to be as effective as focal radiofrequency catheter ablation. This study examines the second-generation cryoballoon performance in a US multicenter review of real-world practices. METHODS: By retrospective chart collections, the long-term efficacy and safety of the cryoballoon procedure were assessed in 15 US centers...
February 24, 2018: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
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