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Journal of Medical Imaging and... Nov 2021Echocardiography has long been the mainstay in the evaluation of cardiac and pericardial disease. As computed tomography (CT) has advanced, it has become a valuable... (Review)
Review
Echocardiography has long been the mainstay in the evaluation of cardiac and pericardial disease. As computed tomography (CT) has advanced, it has become a valuable partner in the imaging of the pericardium. The advantages of CT include a larger field of view, multiplanar reconstruction and increased discrimination between various soft tissues and fluids. CT is less operator dependent and can more easily, and reproducibly, image areas of the pericardium for which echocardiography has poor windows such as the right pericardium. The introduction of EKG gating has decreased cardiac motion artifact and can allow functional evaluation although echocardiography remains the primary source of real-time imaging of cardiac and valve motion. It is essential for the skilled cardiac imager to understand the strengths and weaknesses of CT and its role in the definition and assessment of pericardial disease.
Topics: Echocardiography; Heart Diseases; Humans; Magnetic Resonance Imaging; Pericardium; Tomography, X-Ray Computed
PubMed: 34588141
DOI: 10.1016/j.jmir.2021.09.005 -
Radiographics : a Review Publication of... 2019
Review
Topics: Coxsackievirus Infections; Enterovirus B, Human; Female; Heart; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pericarditis; Pericardium
PubMed: 31697617
DOI: 10.1148/rg.2019190081 -
Europace : European Pacing,... Mar 2021We investigated the efficacy of linear multi-electrode irreversible electroporation (IRE) ablation in a porcine model.
AIMS
We investigated the efficacy of linear multi-electrode irreversible electroporation (IRE) ablation in a porcine model.
METHODS AND RESULTS
The study was performed in six pigs (weight 60-75 kg). After median sternotomy and opening of the pericardium, a pericardial cradle was formed and filled with blood. A linear seven polar 7-Fr electrode catheter with 2.5 mm electrodes and 2.5 mm inter-electrode spacing was placed in good contact with epicardial tissue. A single IRE application was delivered using 50 J at one site and 100 J at two other sites, in random sequence, using a standard monophasic defibrillator connected to all seven electrodes connected in parallel. The pericardium and thorax were closed and after 3 weeks survival animals were euthanized. A total of 82 histological sections from all 18 electroporation lesions were analysed. A total of seven 50 J and fourteen 100 J epicardial IRE applications were performed. Mean peak voltages at 50 and 100 J were 1079.2 V ± 81.1 and 1609.5 V ± 56.8, with a mean peak current of 15.4 A ± 2.3 and 20.2 A ± 1.7, respectively. Median depth of the 50 and 100 J lesions were 3.2 mm [interquartile range (IQR) 3.1-3.6] and 5.5 mm (IQR 4.6-6.6) (P < 0.001), respectively. Median lesion width of the 50 and 100 J lesions was 3.9 mm (IQR 3.7-4.8) and 5.4 mm (IQR 5.0-6.3), respectively (P < 0.001). Longitudinal sections showed continuous lesions for 100 J applications.
CONCLUSION
Epicardial multi-electrode linear application of IRE pulses is effective in creating continuous deep lesions.
Topics: Animals; Catheter Ablation; Catheters; Electrodes; Electroporation; Pericardium; Swine
PubMed: 33200191
DOI: 10.1093/europace/euaa280 -
JACC. Cardiovascular Imaging Jun 2020Frequently, multimodality imaging is indispensable in the care of patients with pericardial disease. With cardiac magnetic resonance imaging, pericardial inflammation... (Review)
Review
Frequently, multimodality imaging is indispensable in the care of patients with pericardial disease. With cardiac magnetic resonance imaging, pericardial inflammation can be characterized as acute, subacute, or chronic. This spectrum of inflammation is variably associated with reduced compliance of the pericardium, which may result in constrictive pathophysiology, typically well-defined with echocardiography. This interplay between inflammation and hemodynamics is often optimally characterized with multimodality imaging and has redefined the approach of pericardiologists to diagnose, prognosticate, and tailor individual therapies.
Topics: Acute Disease; Asymptomatic Diseases; Cardiac Imaging Techniques; Chronic Disease; Clinical Decision-Making; Hemodynamics; Humans; Multimodal Imaging; Pericarditis; Pericardium; Predictive Value of Tests
PubMed: 31734199
DOI: 10.1016/j.jcmg.2019.08.027 -
Circulation Journal : Official Journal... Apr 2020
Topics: Adipose Tissue; Cadaver; Humans; Inflammation; Pericardium; Plaque, Atherosclerotic; Vasa Vasorum
PubMed: 32281580
DOI: 10.1253/circj.CJ-20-0249 -
Cardiac Electrophysiology Clinics Sep 2020The intracoronary artery and venous routes provide unique roadmaps for mapping and interventions for ventricular arrhythmias and certain atrial arrhythmias. The unique... (Review)
Review
The intracoronary artery and venous routes provide unique roadmaps for mapping and interventions for ventricular arrhythmias and certain atrial arrhythmias. The unique anatomic location of these vessels on the epicardial surface enables mapping/interventions without the need to access the pericardial space. These anatomic routes also track deep into certain intramural regions, with interventions that are not accessible from either epicardial or endocardial routes. To map smaller vessels, multipolar catheters and wires are used to record local electrograms. Endocardial/epicardial ablation at adjacent sites is sometimes required to enhance successful outcomes. This article describes tools, techniques, and site-specific mapping and interventions.
Topics: Arrhythmias, Cardiac; Catheter Ablation; Coronary Vessels; Epicardial Mapping; Humans; Pericardium
PubMed: 32771192
DOI: 10.1016/j.ccep.2020.06.006 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Sep 2021
Topics: Adipose Tissue; Humans; Pericardium
PubMed: 34523589
DOI: 10.5543/tkda.2021.21189 -
Cardiac Electrophysiology Clinics Sep 2020Supraventricular arrhythmias are the most common cardiac arrhythmias encountered; however, it is uncommon that supraventricular tachycardias require percutaneous... (Review)
Review
Supraventricular arrhythmias are the most common cardiac arrhythmias encountered; however, it is uncommon that supraventricular tachycardias require percutaneous epicardial access for successful mapping and ablation. There are particular scenarios where epicardial access and ablation should be considered. Certain accessory pathways particularly in the posteroseptal region may require epicardial access for successful ablation. These pathways may also be approached from within the coronary sinus system. In addition, tachycardias near the phrenic nerve in the right atrium or left atrium may require epicardial access for successful ablation or to allow displacement of the phrenic nerve facilitating safe catheter ablation.
Topics: Catheter Ablation; Epicardial Mapping; Humans; Pericardium; Tachycardia, Supraventricular
PubMed: 32771189
DOI: 10.1016/j.ccep.2020.05.001 -
Cardiac Electrophysiology Clinics Sep 2020Hybrid surgical ventricular tachycardia (VT) ablation combines surgical epicardial access/exposure with contemporary mapping and ablation techniques adapted from... (Review)
Review
Hybrid surgical ventricular tachycardia (VT) ablation combines surgical epicardial access/exposure with contemporary mapping and ablation techniques adapted from percutaneous catheter ablation procedures. Patients considered for a hybrid surgical approach for VT are those who have had prior cardiac surgery or failed percutaneous epicardial access due to pericardial adhesions. They often represent the most challenging end of the spectrum of patients and usually have undergone multiple unsuccessful ablations. In this review, the indications, preprocedure work-up, ablation techniques, and outcomes from hybrid surgical access VT ablations are discussed as well as key technical details that present unique challenges to its success.
Topics: Arrhythmias, Cardiac; Catheter Ablation; Epicardial Mapping; Humans; Pericardium
PubMed: 32771191
DOI: 10.1016/j.ccep.2020.05.002 -
Current Pharmaceutical Design 2018Epicardial adipose tissue is not only a specific adipose tissue depot but also an active endocrine organ producing numerous substances with an important role in the... (Review)
Review
Epicardial adipose tissue is not only a specific adipose tissue depot but also an active endocrine organ producing numerous substances with an important role in the development of obesity-related heart diseases. It is located between myocardium and visceral pericardium and consists predominantly of adipocytes, immunocompetent cells, ganglia and interconnecting nerve branches. Several studies documented a positive correlation between pericardial and epicardial fat and left ventricular hypertrophy and septal thickening, leading to diastolic dysfunction, electrocardiographic abnormalities and facilitating cardiac failure. The cellular cross-talks between epicardial fat and myocardium may include both the vasocrine and the paracrine mechanisms. Adipokines secreted from epicardial adipose tissue, vascular and stromal cells diffuse into interstitial fluid crossing the adventitia, media and intima and modulate cardiac function and cardiomyocyte phenotype and survival. In this article, we review the significance of epicardial adipose tissue and its association with cardiovascular diseases, cellular interactions between epicardial fat and myocardium, secretions of adipokines and inflammatory mediators and a potential of epicardial fat as a therapeutic target for the prevention of obesity-related heart diseases.
Topics: Adipose Tissue; Animals; Heart Diseases; Humans; Inflammation; Pericardium
PubMed: 29318960
DOI: 10.2174/1381612824666180110102125