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Electrophysiology, Cath Lab

Umberto Barbero, Federico Ferraris, Milena Muro, Carlo Budano, Matteo Anselmino, Fiorenzo Gaita
: Supportive care for pain relief and back discomfort during electrophysiology interventions is usually needed in the electrophysiology lab, especially in long-lasting procedures like atrial fibrillation ablation. Although this is usually achieved with conventional pharmacologic anesthesia, hypnosis has recently aroused interest as a reliable tool to complement and possibly enhance conscious sedation. We collected five case of percutaneous arrhythmia ablation in which, after informed consent, hypnosis was performed by nurse anesthetists in the cath lab...
January 2018: Journal of Cardiovascular Medicine
Laura Cercenelli, Barbara Bortolani, Emanuela Marcelli
Several remote catheter navigation systems have been developed and are now commercially available. However, these systems typically require specialized catheters or equipment, as well as time-consuming operations for the system set-up. In this paper, we present CathROB, a highly compact and versatile robotic system for remote navigation of standard tip-steerable electrophysiology (EP) catheters. Key features of CathROB include an extremely compact design that minimizes encumbrance and time for system set-up in a standard cath lab, a force-sensing mechanism, an intuitive command interface, and functions for automatic catheter navigation and repositioning...
2017: Applied Bionics and Biomechanics
Sebastian Hilbert, Philipp Sommer, Matthias Gutberlet, Thomas Gaspar, Borek Foldyna, Christopher Piorkowski, Steffen Weiss, Thomas Lloyd, Bernhard Schnackenburg, Sascha Krueger, Christian Fleiter, Ingo Paetsch, Cosima Jahnke, Gerhard Hindricks, Matthias Grothoff
AIMS: Recently cardiac magnetic resonance (CMR) imaging has been found feasible for the visualization of the underlying substrate for cardiac arrhythmias as well as for the visualization of cardiac catheters for diagnostic and ablation procedures. Real-time CMR-guided cavotricuspid isthmus ablation was performed in a series of six patients using a combination of active catheter tracking and catheter visualization using real-time MR imaging. METHODS AND RESULTS: Cardiac magnetic resonance utilizing a 1...
April 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Philipp Sommer, Simon Kircher, Sascha Rolf, Sergio Richter, Micha Doering, Arash Arya, Andreas Bollmann, Gerhard Hindricks
A technological platform (MediGuide) has been recently introduced for non-fluoroscopic catheter tracking. In several studies, we have demonstrated that the application of this non-fluoroscopic catheter visualization system (NFCV) reduces fluoroscopy time and dose by 90-95% in a variety of electrophysiology (EP) procedures. This can be of relevance not only to the patients, but also to the nurses and physicians working in the EP lab. Furthermore, in a subset of indications such as supraventricular tachycardias, NFCV enables a fully non-fluoroscopic procedure and allows the lab staff to work without wearing lead aprons...
2015: Journal of Visualized Experiments: JoVE
Alexander J C Mittnacht, Srinivas Dukkipati, Aman Mahajan
Percutaneous catheter ablation is being increasingly performed in patients with recurrent ventricular tachycardia (VT) unresponsive to medical treatment. Optimal management of patients requires careful consideration of the severity of the underlying cardiac disease, the anesthetic drug interactions, and the procedural technique during VT mapping and ablation. The goal is to choose an anesthetic technique that has the least effect on arrhythmogenicity, allowing reproducibility of the VT in the electrophysiology laboratory...
April 2015: Anesthesia and Analgesia
Moussa Mansour, Muhammad R Afzal, Sampath Gunda, Jayasree Pillarisetti, Kevin Heist, Moshe Rav Acha, Michael Heard, Jeremy Ruskin, Dhanunjaya Lakkireddy
BACKGROUND: Radiation exposure in the electrophysiology lab is a major occupational hazard to the electrophysiologists. A catheter localization system (MediGuide Technology, St. Jude Medical Inc., St. Paul, MN, USA) allows the integration of electroanatomical mapping and x-ray imaging, and has been shown to be effective in reducing radiation exposure during several electrophysiological procedures. We intended to evaluate the feasibility of this catheter tracking system to guide transseptal (TS) access...
July 2015: Pacing and Clinical Electrophysiology: PACE
Daniel Sohinki, Owen A Obel
BACKGROUND: Supraventricular tachycardia (SVT) is a general term describing a group of arrhythmias whose mechanism involves or is above the atrioventricular node. The mechanisms of most forms of SVT have been elucidated, and pharmacologic and invasive therapies have evolved simultaneously. METHODS: We provide a brief overview of the mechanisms, classifications, and electrocardiographic characteristics of different SVTs and describe current trends in noninvasive and invasive therapies...
2014: Ochsner Journal
Noboru Ichihara, Shinsuke Miyazaki, Hiroshi Taniguchi, Eisuke Usui, Takamitsu Takagi, Jin Iwasawa, Akio Kuroi, Hiroaki Nakamura, Hitoshi Hachiya, Yoshito Iesaka
BACKGROUND: Deep sedation or general anesthesia is generally used during atrial fibrillation (AF) ablation. The aim of this study was to report the safety and feasibility of minimal sedation during AF ablation. METHODS AND RESULTS: One thousand and fifty-two AF ablation procedures in 819 patients (62 ± 11 years, 621 men, 506 paroxysmal) were included. Boluses of intravenous hydroxyzine pamoate and pentazocine were administered, with a maximal dose of 100 mg of hydroxyzine and 60 mg of pentazocine in response to pain...
2015: Circulation Journal: Official Journal of the Japanese Circulation Society
Cory M Tschabrunn, Francis E Marchlinski
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is primarily believed to be an inherited cardiomyopathy that subsequently results in significant myocardial fibrosis. The arrhythmogenic consequences that result from the development of fibrosis are similar to other nonischemic cardiomyopathies, but the unique endocardial-epicardial disease process of ARVC/D requires a specialized approach for arrhythmia treatment in the electrophysiology laboratory. Although the association between ARVC/D and development of ventricular arrhythmias has become increasingly clear over the last 2 decades, our understanding of the arrhythmia mechanisms, underlying electrophysiologic substrate, and treatment strategies were significantly limited...
September 26, 2014: World Journal of Cardiology
Bernhard Meier
No abstract text is available yet for this article.
September 2014: JACC. Cardiovascular Interventions
Ettore Petrucci, Vruyr Balian, Andrea Bocchieri
OBJECTIVES: This study aimed to determine whether the intracoronary electrograms (IC-EGMs) recorded using a standard percutaneous coronary intervention guidewire could provide myocardial viability information. BACKGROUND: The revascularization of dysfunctional but viable myocardium may confer prognostic benefits compared with medical therapy in patients with post-ischemic heart failure. However, knowledge of myocardial viability is often unavailable at the time of the procedure...
September 2014: JACC. Cardiovascular Interventions
Adam C Kean, Martin J LaPage, Sunkyung Yu, Macdonald Dick, David J Bradley
OBJECTIVE: To identify factors associated with fluoroscopy use in pediatric and congenital heart disease (CHD) patients. DESIGN: Retrospective cohort. SETTING: Pediatric electrophysiology lab in a single tertiary-care children's hospital. PATIENTS: Three hundred eighty-three patients who underwent electrophysiology study and ablation between January 2010 and December 2012. METHODS: Ablation procedures in which nonfluoroscopic navigation was employed were reviewed...
May 2015: Congenital Heart Disease
Seth H Sheldon, Hung-Kei Li, Samuel J Asirvatham, Christopher J McLeod
Several observations and maneuvers in the electrophysiology (EP) laboratory are employed to identify whether retrograde ventriculoatrial conduction is via the atrioventricular (AV) node or an accessory pathway. Parahisian pacing is a unique maneuver where there is no change in the position of the catheter, the position of the stimulating electrode, nor the cycle length for pacing, but rather the pacing output is varied. The primary value for parahisian pacing is to distinguish between a septal accessory pathway and AV nodal conduction...
August 2014: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Heidi L Estner, Jian Chen, Tatjana Potpara, Alessandro Proclemer, Derick Todd, Carina Blomström-Lundqvist
Clinical electrophysiology (EP) and catheter ablation of arrhythmias are rapidly evolving in recent years. More than 50 000 catheter ablations are performed every year in Europe. Emerging indications, an increasing number of procedures, and an expected high quality require national and international standards as well as trained specialists. The purpose of this European Heart Rhythm Association (EHRA) survey was to assess the practice of requirements for EP personnel, equipment, and facilities in Europe. Responses to the questionnaire were received from 52 members of the EHRA research network...
July 2014: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Jayasree Pillarisetti, Arun Kanmanthareddy, Yeruva Madhu Reddy, Dhanunjaya Lakkireddy
Since the introduction of percutaneous intervention in modern medical science, specifically cardiovascular medicine fluoroscopy has remained the gold standard for navigation inside the cardiac structures. As the complexity of the procedures continue to increase with advances in interventional electrophysiology, the procedural times and fluoroscopy times have proportionately increased and the risks of radiation exposure both to the patients as well as the operator continue to rise. 3D electroanatomic mapping systems have to some extent complemented fluoroscopic imaging in improving catheter navigation and forming a solid platform for exploring the electroanatomic details of the target substrate...
September 2014: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Edmund Kenneth Kerut, Curtis Hanawalt, James McKinnie
We describe our first 20 cases of cryoablation of atrial fibrillation (AF) using transesophageal echocardiography (TEE). Continuous procedural monitoring with TEE by a cardiologist and senior sonographer assists the electrophysiologist in performance of the cryoballoon procedure of AF. Previously using intracardiac echocardiography (ICE) we have found TEE to have better overall procedural imaging, and monitoring for pericardial effusion or thrombus formation. We have found TEE monitoring to be helpful with positioning for interatrial septal (IAS) puncture, catheter tip avoidance of the left atrial appendage (LAA), and guidance of the balloon catheter into each pulmonary vein (PV), with proper positioning within each PV orifice, and documentation of PV occlusion for the cryoballoon procedure...
February 2015: Echocardiography
Hein Heidbuchel, Fred H M Wittkampf, Eliseo Vano, Sabine Ernst, Richard Schilling, Eugenio Picano, Lluis Mont, Pierre Jais, Joseph de Bono, Christopher Piorkowski, Eduardo Saad, Francisco Femenia
Despite the advent of non-fluoroscopic technology, fluoroscopy remains the cornerstone of imaging in most interventional electrophysiological procedures, from diagnostic studies over ablation interventions to device implantation. Moreover, many patients receive additional X-ray imaging, such as cardiac computed tomography and others. More and more complex procedures have the risk to increase the radiation exposure, both for the patients and the operators. The professional lifetime attributable excess cancer risk may be around 1 in 100 for the operators, the same as for a patient undergoing repetitive complex procedures...
July 2014: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Stephan Willems, Boris A Hoffmann, Benjamin Schaeffer, Arian Sultan, Doreen Schreiber, Jakob Lüker, Daniel Steven
The involvement of the Purkinje system in a subset of patients with idiopathic ventricular fibrillation or polymorphic VT/VF related to structural heart disease was first demonstrated in the pioneering work of Michel Haissaguerre and co-workers (Circulation 106:962-967, 2002 and Lancet 359:677-678, 2002). It is very important to identify these patients with recurrent episodes of ventricular fibrillation and/or ICD shocks with regard to the presence of triggering premature ventricular contractions (PVC), which may be amenable to mapping and catheter ablation by screening Holter and ICD recordings...
September 2014: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Cyril Mory, Vincent Auvray, Bo Zhang, Michael Grass, Dirk Schäfer, S James Chen, John D Carroll, Simon Rit, Françoise Peyrin, Philippe Douek, Loïc Boussel
PURPOSE: Reconstruction of the beating heart in 3D + time in the catheter laboratory using only the available C-arm system would improve diagnosis, guidance, device sizing, and outcome control for intracardiac interventions, e.g., electrophysiology, valvular disease treatment, structural or congenital heart disease. To obtain such a reconstruction, the patient's electrocardiogram (ECG) must be recorded during the acquisition and used in the reconstruction. In this paper, the authors present a 4D reconstruction method aiming to reconstruct the heart from a single sweep 10 s acquisition...
February 2014: Medical Physics
Hugo Van Herendael, Erica S Zado, Haris Haqqani, Cory M Tschabrunn, David J Callans, David S Frankel, David Lin, Fermin Garcia, Mathew D Hutchinson, Michael Riley, Rupa Bala, Sanjay Dixit, Mrinal Yadava, Francis E Marchlinski
BACKGROUND: Monomorphic ventricular premature depolarizations (VPDs) have been found to initiate ventricular fibrillation (VF) or polymorphic ventricular tachycardia (PMVT) in patients with and without structural heart disease. OBJECTIVE: The purpose of this study was to describe and characterize sites of origin of VPDs triggering VF and PMVT. METHODS: The distribution of mapping-confirmed VPDs, electrophysiology laboratory findings, and results of radiofrequency catheter ablation were analyzed...
April 2014: Heart Rhythm: the Official Journal of the Heart Rhythm Society
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