Home About us Contact
|
Home About us Contact | ||
|
|
||
Atrial Ablation (atrial + ablation)
Selected AbstractsPrevalence of Fever in Patients Undergoing Left Atrial Ablation of Atrial Fibrillation Guided by Barium EsophagraphyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2009RUBINDER S. RUBY M.D. Background: Real-time esophageal imaging is critical in avoiding esophageal injury. However, the safety of esophageal imaging with barium has not been specifically explored. Methods: Three hundred seventy consecutive patients underwent left atrial (LA) ablation of atrial fibrillation (AF) under conscious sedation. One hundred eighty-five patients (50%) underwent the ablation procedure with, and 185 patients (50%) underwent the procedure without administration of barium. Fever, as a surrogate for aspiration, was defined as a maximal temperature ,100°F within the first 24 hours following the ablation procedure. Results: Thirty of the 370 patients (8%) developed fever within 24 hours after LA ablation. The prevalence of fever was 9% (17/185) among patients who received barium and 7% (13/185) among those who did not receive barium (P = 0.6). Evaluation revealed the following causes of fever in 14 of the 30 patients (47%) with no difference in prevalence between the 2 groups: pericarditis, venous thromboembolism, hematoma, and infiltrate on chest radiography. Multivariate analysis failed to reveal any factors associated with development of fever. None of the patients experienced serious complications such as respiratory failure or atrioesophageal fistula. Conclusions: Fever may occur in approximately 10% of patients undergoing LA ablation of AF. Administration of barium is not associated with fever or other complications such as aspiration pneumonia. Real-time imaging of the esophagus with barium administration in conjunction with conscious sedation appears to be safe. [source] Novel Imaging Techniques of the Esophagus Enhancing Safety of Left Atrial AblationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2005SCOTT J. POLLAK M.D. This report describes different imaging techniques of the esophagus in four patients during radiofrequency catheter ablation of atrial fibrillation in the left atrium. A novel use of a mixture of barium cream and gadolinium diglutamate allowed esophageal imaging during magnetic resonance angiography of the left atrium and pulmonary veins. Barium cream used during computer tomography angiographic imaging of the left atrium and pulmonary veins allowed esophageal imaging. The esophagus was also imaged with an electroanatomic mapping system. Esophageal and left atrial imaging helped to avoid catheter ablation in left atrial tissue overlapping the esophagus. [source] Left Atrial Ablation at the Anatomic Areas of Ganglionated Plexi for Paroxysmal Atrial FibrillationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2010EVGENY POKUSHALOV M.D., Ph.D. Background:,Modification of left atrial ganglionated plexi (GP) is a promising technique for the treatment of paroxysmal atrial fibrillation (AF) but its therapeutic efficacy is not established. This study aimed at evaluating the effectiveness of anatomic GP modification by means of an implantable arrhythmia monitoring device. Methods:,In 56 patients with paroxysmal AF, radiofrequency ablation at anatomic sites, where the main clusters of GP have been identified in the left atrium, was performed. In all patients, an electrocardiogram monitor (Reveal XT, Medtronic Inc., Minneapolis, MN, USA) was implanted before (n = 7) or immediately after (n = 49) AF ablation. Results:,Average duration of the procedure was 142 ± 18 min and average fluoroscopy time 20 ± 7 min. In total, 53,81 applications of RF energy were delivered (mean of 18.2 ± 3.8 at each of the four areas of GP ablation). Heart rate variability was assessed in 31 patients. Standard deviation of RR intervals over the entire analyzed period, the root mean square of differences between successive RR intervals, and high frequencies decreased, while HRmin, HRmean, and LF to HF ratio increased immediately postablation; these values returned to baseline 6 months after the procedure. At end of 12-month follow-up, 40 (71%) patients were free of arrhythmia recurrence. Ten patients had AF recurrence, two patients had left atrial flutter, and four patients had episodes of flutter as well as AF recurrence. Duration of episodes of AF after ablation gradually decreased over the follow-up period. Conclusions:,Regional ablation at the anatomic sites of the left atrial GP can be safely performed and enables maintenance of sinus rhythm in 71% of patients with paroxysmal AF for a 12-month period. (PACE 2010; 33:1231,1238) [source] The Proarrhythmic Effect of Incomplete Pulmotricuspid Isthmus Ablation in a Patient with Sarcoid-Related Ventricular Tachycardia?JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2008ARASH ARYANA M.D. Proarrhythmia is relatively common after extensive atrial ablation for atrial fibrillation, but has not been frequently documented after catheter ablation of ventricular tachycardia (VT). In theory, this phenomenon could occur if an incomplete ablation line is created between two nonconducting structures, such as dense scar or valvular annuli. This report illustrates the possible proarrhythmic effect of ablation in a patient with sarcoid-related VT and extensive right ventricular (RV) myopathy who presented with slow incessant VT one month after an ablation procedure including ablation at the pulmotricuspid isthmus (PTI). The extensive preexisting RV myopathy appeared to be an important substrate in the pathogenesis of this patient's incessant VT. This case suggests that the PTI region may serve as a critical tachycardia isthmus if sufficiently modified with an incomplete ablation line in the setting of significant myocardial scarring. [source] Esophageal Luminal Temperature Measurement Underestimates Esophageal Tissue Temperature During Radiofrequency Ablation Within the Canine Left Atrium: Comparison Between 8 mm Tip and Open Irrigation CathetersJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2008JENNIFER E. CUMMINGS M.D. Introduction: Evaluation of luminal temperature during left atrial ablation is used clinically; however, luminal temperature does not necessarily reflect temperature within the esophageal wall and poses a risk of atrioesophageal fistula. This animal study evaluates luminal esophageal temperature and its relation to the temperature of the external esophageal tissue during left atrial lesions using the 8 mm solid tip and the open irrigated tip catheters (OIC). Methods and Results: A thermocouple was secured to the external surface of the esophagus at the level of the left atrium of the dogs. Luminal esophageal temperature was measured using a standard temperature probe. In four randomized dogs, lesions were placed using an 8 mm solid tip ablation catheter. In six randomized dogs, lesions were placed using the 3.5 mm OIC. The average peak esophageal tissue temperature when using the OIC was significantly higher than that of the 8 mm tip catheter (88.6°C ± 15.0°C vs. 62.3°C ± 12.5°C, P < 0.05). Both OIC and 8 mm tip catheter had significantly higher peak tissue temperatures than luminal temperatures (OIC: 88.6°C ± 15.0°C vs 39.7°C ± 0.82°C, P < 0.05) (8 mm: 62.3°C ± 12.5°C vs 39.0 ± 0.5°C, P < 0.05). Both catheters achieved peak temperatures faster in the tissue as compared to the lumen of the esophagus, although the tissue temperature peaked significantly faster for the OIC (OIC: 25 seconds vs 90 seconds, P < 0.05) (8 mm: 63 seconds vs 105 seconds, P < 0.05). Conclusion: Despite the significant difference in actual tissue temperatures, no significant difference was observed in luminal temperatures between the OIC and 8 mm tip catheter. [source] Catheter Ablation of Chronic Atrial Fibrillation with Noncontact Mapping:PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2p1 2003Are Continuous Linear Lesions Associated with Ablation Success? SEIDL, K., et al.: Catheter Ablation of Chronic Atrial Fibrillation with Noncontact Mapping: Are Continuous Linear Lesions Associated with Ablation Success?Catheter-based, right and left atrial compartmentalization procedure was evaluated using a noncontact mapping (NCM) system. Its usefulness to identify and close discontinuities in linear lesions in both atria was evaluated. The impact of linear lesion continuity on ablation success of chronic AF was also investigated. Nineteen patients with symptomatic, drug refractory chronic AF were studied. Right atrial ablation with three predefined lines was attempted in all patients. In 18 patients, left atrial ablation was performed with four linear lesions. During a follow-up of 12 ± 3 months, 6 of 19 patients remained in sinus rhythm (SR) without antiarrhythmic agents (AAs). In addition, four patients were maintained in SR with AA. Thirteen of 14 patients with gaps identified during off-line analysis had recurrence of AF. Only one patient with a gap was free of recurrence without AAs. In the remaining five patients without recurrence of AF, no gap was observed during off-line analysis. In all four patients who were free of AF with additional treatment of AAs, two gaps had been identified. In the remaining nine patients with chronic AF recurrence, a mean of 4.9 gaps were identified. Excluding the initial learning period (first five patients) the success rate increased to 43% (6/14 patients) without and to 71% (10/14 patients) with AA. NCM identifies discontinuities in lines of ablation. Successful ablation of chronic AF is associated with continuity of linear lesions and good clinical technique demands a vigilant search for and closure of every gap. (PACE 2003; 26[Pt. I]:534,543) [source] | ||||||||||