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Midterm Follow-up (midterm + follow-up)

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Selected Abstracts

Transcatheter Intracardiac Echocardiography-Assisted Closure of Interatrial Shunts: Complications and Midterm Follow-Up

ECHOCARDIOGRAPHY, Issue 2 2009
Gianluca Rigatelli M.D.
Objective: It has been suggested that intracardiac echocardiography (ICE) improves the safety and effectiveness of transcatheter device-based closure of interatrial shunts, but the impact of this technique on midterm follow-up is unknown. We sought to prospectively evaluate midterm follow-up results of ICE-aided transcatheter closure of interatrial shunts in adults. Methods: Over a 48-month period, we prospectively enrolled 140 consecutive patients (mean age 43 ± 15. 5 years, 98 females) who had been referred to our center for catheter-based closure of interatrial shunts. All patients were screened with transesophageal echocardiography (TEE) before the operation. Patients who met the inclusion criteria underwent ICE study and attempted closure. Immediate success rates, predischarge occlusion rates, complication rates, as well as fluoroscopy and procedural times, patients' radiological exposure, midterm complication rates, and midterm occlusion rates were evaluated. Results: One hundred patients out of 140 (71.4%) underwent an attempt at transcatheter closure. After ICE study and measurements, the TEE-planned device type and size was changed in 31 patients with patent foramen ovale whereas the TEE-planned device size was changed in 41 patients with atrial septal defect (globally 72%). Procedural success rate, predischarge occlusion rate, and complication rate were 99, 90.7, and 12%, respectively. On mean follow-up of 36.6 ± 14.8 months the follow-up occlusion rate was 96.5%. No aortic erosion or device thrombosis was observed. Conclusions: ICE-guided interatrial shunt transcatheter closure is safe and effective and appears to have excellent midterm results thus avoiding the complications caused by device oversizing, such as aortic erosion and device thrombosis. [source]

Effects of Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy on Doppler Tei Index: A Midterm Follow-Up

ECHOCARDIOGRAPHY, Issue 2 2005
F.E.S.C., Josef Veselka M.D., Ph.D.
Alcohol septal ablation (PTSMA) improves outflow gradient, left ventricular (LV) diastolic function, and symptoms in patients with hypertrophic obstructive cardiomyopathy (HOCM). Tei index (TI) is a Doppler parameter reflecting both systolic and diastolic LV function. Midterm changes of TI after PTSMA have not been determined up to now. Twenty-seven consecutive patients (mean age 53 ± 13 years) with symptomatic HOCM underwent PTSMA procedure. Clinical and echocardiographic data were collected at baseline, 6 and 12 months after PTSMA. TI decreased from 0.67 ± 0.11 to 0.55 ± 0.06, isovolumic contractile time (ICT) decreased from 74 ± 20 to 48 ± 11 ms, isovolumic relaxation time decreased from 146 ± 25 to 117 ± 9 ms, and LV ejection time decreased from 330 ± 42 to 298 ± 13 ms. LV remodeling was determined by LV dimension increase from 46 ± 6 to 48 ± 6 mm and basal septum thickness reduction from 22 ± 4 to 15 ± 3 mm. LV ejection fraction decreased from 78 ± 7 to 73 ± 6% and maximal outflow gradient decreased from 69 ± 44 to 15 ± 11 mmHg. All changes were statistically significant (P < 0.01). Symptomatic improvement was characterized by relief of dyspnea (2.5 ± 0.7 versus 1.4 ± 0.6 NYHA class; P < 0.01) and angina pectoris (2.6 ± 0.9 versus 0.7 ± 0.7 CCS class; P < 0.01). PTSMA is an effective method of therapy for HOCM. Shortening of TI suggests the improvement of LV myocardial performance in the midterm follow-up. [source]

Transcatheter Intracardiac Echocardiography-Assisted Closure of Interatrial Shunts: Complications and Midterm Follow-Up

ECHOCARDIOGRAPHY, Issue 2 2009
Gianluca Rigatelli M.D.
Objective: It has been suggested that intracardiac echocardiography (ICE) improves the safety and effectiveness of transcatheter device-based closure of interatrial shunts, but the impact of this technique on midterm follow-up is unknown. We sought to prospectively evaluate midterm follow-up results of ICE-aided transcatheter closure of interatrial shunts in adults. Methods: Over a 48-month period, we prospectively enrolled 140 consecutive patients (mean age 43 ± 15. 5 years, 98 females) who had been referred to our center for catheter-based closure of interatrial shunts. All patients were screened with transesophageal echocardiography (TEE) before the operation. Patients who met the inclusion criteria underwent ICE study and attempted closure. Immediate success rates, predischarge occlusion rates, complication rates, as well as fluoroscopy and procedural times, patients' radiological exposure, midterm complication rates, and midterm occlusion rates were evaluated. Results: One hundred patients out of 140 (71.4%) underwent an attempt at transcatheter closure. After ICE study and measurements, the TEE-planned device type and size was changed in 31 patients with patent foramen ovale whereas the TEE-planned device size was changed in 41 patients with atrial septal defect (globally 72%). Procedural success rate, predischarge occlusion rate, and complication rate were 99, 90.7, and 12%, respectively. On mean follow-up of 36.6 ± 14.8 months the follow-up occlusion rate was 96.5%. No aortic erosion or device thrombosis was observed. Conclusions: ICE-guided interatrial shunt transcatheter closure is safe and effective and appears to have excellent midterm results thus avoiding the complications caused by device oversizing, such as aortic erosion and device thrombosis. [source]

Effects of Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy on Doppler Tei Index: A Midterm Follow-Up

ECHOCARDIOGRAPHY, Issue 2 2005
F.E.S.C., Josef Veselka M.D., Ph.D.
Alcohol septal ablation (PTSMA) improves outflow gradient, left ventricular (LV) diastolic function, and symptoms in patients with hypertrophic obstructive cardiomyopathy (HOCM). Tei index (TI) is a Doppler parameter reflecting both systolic and diastolic LV function. Midterm changes of TI after PTSMA have not been determined up to now. Twenty-seven consecutive patients (mean age 53 ± 13 years) with symptomatic HOCM underwent PTSMA procedure. Clinical and echocardiographic data were collected at baseline, 6 and 12 months after PTSMA. TI decreased from 0.67 ± 0.11 to 0.55 ± 0.06, isovolumic contractile time (ICT) decreased from 74 ± 20 to 48 ± 11 ms, isovolumic relaxation time decreased from 146 ± 25 to 117 ± 9 ms, and LV ejection time decreased from 330 ± 42 to 298 ± 13 ms. LV remodeling was determined by LV dimension increase from 46 ± 6 to 48 ± 6 mm and basal septum thickness reduction from 22 ± 4 to 15 ± 3 mm. LV ejection fraction decreased from 78 ± 7 to 73 ± 6% and maximal outflow gradient decreased from 69 ± 44 to 15 ± 11 mmHg. All changes were statistically significant (P < 0.01). Symptomatic improvement was characterized by relief of dyspnea (2.5 ± 0.7 versus 1.4 ± 0.6 NYHA class; P < 0.01) and angina pectoris (2.6 ± 0.9 versus 0.7 ± 0.7 CCS class; P < 0.01). PTSMA is an effective method of therapy for HOCM. Shortening of TI suggests the improvement of LV myocardial performance in the midterm follow-up. [source]

Reduced Fluoroscopy During Atrial Fibrillation Ablation: Benefits of Robotic Guided Navigation

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2010
DANIEL STEVEN M.D.
Reduced Fluoroscopy in PVI Using RN.,Background: Recently, a nonmagnetic robotic navigation system (RN, Hansen-SenseiÔ) has been introduced for remote catheter manipulation. Objective: To investigate the influence of RN combined with intuitive 3-dimensional mapping on the fluoroscopy exposure to operator and patient during pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) in a prospective randomized trial. Methods: Sixty patients were randomly assigned to undergo PVI either using a RN guided (group 1; n = 30, 20 male, 62 ± 7.7 years) or conventional ablation approach (group 2; n = 30, 14 male, 61 ± 7.6 years). A 3-dimensional mapping system (NavXÔ) was used in both groups. Results: Electrical disconnection of the ipsilateral pulmonary veins (PVs) was achieved in all patients. Use of RN significantly lowered the overall fluoroscopy time (9 ± 3.4 vs 22 ± 6.5 minutes; P < 0.001) and reduced the operator's fluoroscopy exposure (7 ± 2.1 vs 22 ± 6.5 minutes; P < 0.001). The difference in fluoroscopy duration between both groups was most pronounced during the ablation part of the procedure (3 ± 2.4 vs 17 ± 6.3 minutes; P < 0.001). The overall procedure duration tended to be prolonged using RN without reaching statistical significance (156 ± 44.4 vs 134 ± 12 minutes, P = 0.099). No difference regarding outcome was found during a midterm follow-up of 6 months (AF freedom group 1 = 73% vs 77% in group 2 [P = 0.345]). Conclusion: The use of RN for PVI seems to be effective and significantly reduces overall fluoroscopy time and operator's fluoroscopy exposure without affecting mid-term outcome after 6-month follow-up. (J Cardiovasc Electrophysiol, Vol. 21, pp. 6,12, January 2010) [source]

The Importance of Ventricular Septal Morphology in the Effectiveness of Dual Chamber Pacing in Hypertrophic Obstructive Cardiomyopathy

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2000
PETKOW DIMITROW
It has been reported that older patients with hypertrophic obstructive Cardiomyopathy (HOCM) benefited the most from dual chamber (DDD) pacing. Since in older patients the distribution of septal hypertrophy and left ventricular (LV) cavity shape differs from that in younger patients, we decided to study the efficacy of DDD pacing on the reduction of LV outflow tract (LVOT) gradient in different patterns of septal hypertrophy. We compared HOCM patients with nonreversed septal curvature, thus preserving the elliptical LV cavity contour (common in the elderly), (group I) versus patients with reversed septal curvature, deforming the LV cavity to a crescent shape (common in the young), (group II). Eighteen HOCM patients were studied (11 patients in group I and 7 patients in group II). After implantation of a DDD pacemaker, the LVOT gradient was measured using Doppler echocardiography at various programmed AV delay intervals to determine the maximal percentage decrease of LVOT gradient from baseline. The measurement was repeated after at least a 6-month follow-up (chronic DDD pacing). The baseline LVOT gradient was comparable between groups (79 ± 28 vs 81 ± 25 mmHg, P = 0.92). The LVOT gradient reduction at acute DDD pacing was significantly greater in group I than group II (61 ± 18% vs 23 ± 10%, P = 0.0001). This difference in favor of the patients from group I was maintained at midterm follow-up (69 ± 17% vs 40 ± 17% P = 0.0076). In conclusion, patients with normal septal curvature and preserved elliptical LV cavity shape had a greater reduction of LVOT gradient after DDD pacing than patients with reversed septal curvature deforming LV cavity. The proposed criterion assessing the septal curvature may be useful to predict the efficacy of DDD pacing in the reduction of LVOT gradient. [source]