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Texas Heart Institute Journal Feb 2020
Review
Topics: Action Potentials; Atrial Appendage; Atrial Fibrillation; Atrial Function, Left; Catheter Ablation; Heart Rate; Humans; Pulmonary Veins; Recurrence; Risk Factors; Treatment Outcome
PubMed: 32148460
DOI: 10.14503/THIJ-19-7061 -
The Journal of Thoracic and... Jul 2014Surgical and catheter-based interventions on pulmonary veins are associated with pulmonary vein stenosis (PVS), which can progress diffusely through the "upstream"...
BACKGROUND
Surgical and catheter-based interventions on pulmonary veins are associated with pulmonary vein stenosis (PVS), which can progress diffusely through the "upstream" pulmonary veins. The mechanism has been rarely studied. We used a porcine model of PVS to assess disease progression with emphasis on the potential role of endothelial-mesenchymal transition (EndMT).
METHODS
Neonatal piglets underwent bilateral pulmonary vein banding (banded, n = 6) or sham operations (sham, n = 6). Additional piglets underwent identical banding and stent implantation in a single-banded pulmonary vein 3 weeks postbanding (stented, n = 6). At 7 weeks postbanding, hemodynamics and upstream PV pathology were assessed.
RESULTS
Banded piglets developed pulmonary hypertension. The upstream pulmonary veins exhibited intimal thickening associated with features of EndMT, including increased transforming growth factor (TGF)-β1 and Smad expression, loss of endothelial and gain of mesenchymal marker expression, and coexpression of endothelial and mesenchymal markers in banded pulmonary vein intimal cells. These immunopathologic changes and a prominent myofibroblast phenotype in the remodeled pulmonary veins were consistently identified in specimens from patients with PVS, in vitro TGF-β1-stimulated cells isolated from piglet and human pulmonary veins, and human umbilical vein endothelial cells. After stent implantation, decompression of a pulmonary vein was associated with reappearance of endothelial marker expression, suggesting the potential for plasticity in the observed pathologic changes, followed by rapid in-stent restenosis.
CONCLUSIONS
Neonatal pulmonary vein banding in piglets recapitulates critical aspects of clinical PVS and highlights a pathologic profile consistent with EndMT, supporting the rationale for evaluating therapeutic strategies designed to exploit reversibility of upstream pulmonary vein pathology.
Topics: Animals; Animals, Newborn; Biomarkers; Cells, Cultured; Constriction, Pathologic; Disease Models, Animal; Disease Progression; Epithelial-Mesenchymal Transition; Hemodynamics; Human Umbilical Vein Endothelial Cells; Hyperplasia; Hypertension, Pulmonary; Myofibroblasts; Neointima; Phenotype; Pulmonary Veins; Pulmonary Veno-Occlusive Disease; Recurrence; Smad Proteins; Swine; Time Factors; Transforming Growth Factor beta1
PubMed: 24084286
DOI: 10.1016/j.jtcvs.2013.08.046 -
The Journal of Thoracic and... Mar 2016
Topics: Female; Humans; Male; Pulmonary Veins; Pulmonary Veno-Occlusive Disease; Vascular Surgical Procedures
PubMed: 26896354
DOI: 10.1016/j.jtcvs.2015.11.040 -
Europace : European Pacing,... Dec 2023Pulsed field ablation (PFA) is emerging as a non-thermal, tissue-specific technique for pulmonary vein isolation (PVI) in atrial fibrillation therapy. This pre-clinical...
AIMS
Pulsed field ablation (PFA) is emerging as a non-thermal, tissue-specific technique for pulmonary vein isolation (PVI) in atrial fibrillation therapy. This pre-clinical study aims to investigate the feasibility and safety of PVI using a novel PFA system including a nanosecond-scale PFA generator, a novel lotos PFA catheter, and a customized 12 Fr steerable sheath.
METHODS AND RESULTS
A total of 11 Yorkshire swine were included in this study, with 4 in the acute cohort and 7 in the chronic cohort. Under general anaesthesia, transseptal puncture and pulmonary vein (PV) angiography was initially performed. The PFA catheter was navigated to position at the right and left PV antrum after the electroanatomic reconstruction of the left atrium. Biphasic PFA applications were performed on PVs in both the spindle-shaped and the lotos-shaped poses. Pulmonary vein isolation and PFA-associated safety were assessed 30 min after ablation in both cohorts and 30 days later in the chronic cohort. Detailed necropsy and histopathology were performed. Additional intracardiac echocardiography and coronary angiogram were evaluated for safety. All target PVs (n = 20) were successfully isolated on the first attempt. No spasm of coronary artery or microbubble was seen during the procedure. Eleven of 12 PVs (91.6%) remained in isolation at the 30-day invasive study. No evidence of PV stenosis was observed in any targets. However, transient diaphragm capture occurred in 17.6%. Histopathological examinations showed no evidence of collateral injury.
CONCLUSION
This study provides scientific evidence demonstrating the safety and efficacy of the novel PFA catheter and system for single-shot PVI, which shows great potential.
Topics: Humans; Swine; Animals; Pulmonary Veins; Feasibility Studies; Atrial Fibrillation; Catheter Ablation; Catheters; Treatment Outcome
PubMed: 38109928
DOI: 10.1093/europace/euad362 -
Heart Rhythm Aug 2021Although cryoballoon ablation of atrial fibrillation (AF) traditionally has been guided by pulmonary vein (PV) occlusion, there is evidence and growing interest in... (Review)
Review
Although cryoballoon ablation of atrial fibrillation (AF) traditionally has been guided by pulmonary vein (PV) occlusion, there is evidence and growing interest in performing segmental, nonocclusive cryoballoon ablation to target not only large/common PVs but extra-PV structures such as the left atrial (LA) roof and posterior wall in conjunction with PV isolation. A number of studies have demonstrated improved clinical efficacy associated with nonocclusive cryoballoon ablation of the LA roof and posterior wall in addition to PV isolation, particularly in patients with persistent AF. Not only can the cryoballoon be used for targeting extra-PV structures through segmental, nonocclusive ablation, but the large size and durability of cryolesions coupled with the enhanced stability afforded through cryoadhesion render the cryoballoon an effective tool for such an approach. This article reviews the rationale and practical approach to segmental, nonocclusive cryoballoon ablation of large/common PV antra and the LA roof and posterior wall.
Topics: Atrial Fibrillation; Cryosurgery; Humans; Pulmonary Veins; Recurrence; Treatment Outcome
PubMed: 33905811
DOI: 10.1016/j.hrthm.2021.04.020 -
The Journal of Thoracic and... Mar 2016Pulmonary vein characteristics that influence survival after repair of stenosis have not been defined. We sought to develop a predictive model relating postrepair...
OBJECTIVES
Pulmonary vein characteristics that influence survival after repair of stenosis have not been defined. We sought to develop a predictive model relating postrepair survival to preoperative pulmonary vein characteristics on computed tomography and magnetic resonance imaging.
METHODS
Patients who underwent pulmonary vein stenosis repair (1990-2012) with preoperative computed tomography and magnetic resonance imaging were reviewed. We measured pulmonary vein short and long cross-sectional diameters at the left atrial junction (downstream), vein bifurcation (upstream), and narrowest point, and calculated the total cross-sectional area indexed for body surface area. The relationship between pulmonary vein dimensions and survival was related via risk-adjusted parametric hazard analyses.
RESULTS
Of 145 patients who underwent surgical repair, 31 had preoperative computed tomography and magnetic resonance imaging and were analyzed. Surgical repairs were sutureless (n = 30) or pericardial patch reconstruction (n = 1). Mean follow-up was 4.28 ± 4.2 years. In-hospital mortality was 9.7%; unadjusted survival was 75% ± 7%, 69% ± 8%, and 64% ± 7% at 1, 3, and 5 years, respectively. Median downstream total cross-sectional area indexed for body surface area was 163 mm(2)/m(2), upstream total cross-sectional area indexed for body surface area was 263 mm(2)/m(2), and total cross-sectional area indexed for body surface area at maximal stenosis, localized at the left atrial junction in approximately two thirds of patients, was 163 mm(2)/m(2). Smaller upstream total cross-sectional area indexed for body surface area (P = .030) and greater number of stenotic pulmonary veins (P = .0069) were associated with increased early (<1 year) risk of death. Smaller downstream total cross-sectional area indexed for body surface area tended to be associated with a late risk of death (P = .059).
CONCLUSIONS
Smaller upstream or downstream total cross-sectional area indexed for body surface area negatively influenced survival. Early survival seemed especially poor for patients with a greater number of stenotic veins and upstream pulmonary vein involvement. The total cross-sectional area indexed for body surface area measurements can help to inform prognosis and stratify patients for enrollment in clinical trials of agents directed at pulmonary vein pathology.
Topics: Body Surface Area; Child, Preschool; Constriction, Pathologic; Female; Hospital Mortality; Humans; Infant; Magnetic Resonance Imaging; Male; Phlebography; Predictive Value of Tests; Pulmonary Circulation; Pulmonary Veins; Pulmonary Veno-Occlusive Disease; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Survival Analysis; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures
PubMed: 26481279
DOI: 10.1016/j.jtcvs.2015.08.121 -
Current Cardiology Reviews 2022Atrial Fibrillation (AF) is the most common form of electrical disturbance of the heart and contributes to significant patient morbidity and mortality. With a better...
Atrial Fibrillation (AF) is the most common form of electrical disturbance of the heart and contributes to significant patient morbidity and mortality. With a better understanding of the mechanisms of atrial fibrillation and improvements in mapping and ablation technologies, ablation has become a preferred therapy for patients with symptomatic AF. Pulmonary Vein Isolation (PVI) is the cornerstone for AF ablation therapy, but particularly in patients with AF occurring for longer than 7 days (persistent AF), identifying clinically significant nonpulmonary vein targets and achieving durability of ablation lesions remains an important challenge.
Topics: Atrial Fibrillation; Catheter Ablation; Cryosurgery; Humans; Pulmonary Veins; Recurrence; Treatment Outcome
PubMed: 34325644
DOI: 10.2174/1573403X17666210729101752 -
The Journal of Histochemistry and... Sep 2022Myocardial sleeves around pulmonary veins (PVs) are highly innervated structures with heterogeneous morphological and electrophysiological characteristics. Autonomic...
Myocardial sleeves around pulmonary veins (PVs) are highly innervated structures with heterogeneous morphological and electrophysiological characteristics. Autonomic nerve dysfunction in the myocardium may be associated with an increased risk of cardiovascular morbidity and mortality. This article studied autonomic neural remodeling in myocardial sleeves around PVs and atrial-PV ostia with immunohistochemical and morphometric methods with clinicopathological correlations. PVs were collected from 37 and atrial-PV ostia from 17 human autopsy hearts. Immunohistochemical analysis was performed using antibodies against tyrosine hydroxylase (TH), choline acetyltransferase (CHAT), and growth-associated protein 43 (GAP43). In the PV cohort, subjects with immediate cardiovascular cause of death had significantly decreased sympathetic nerve density in fibro-fatty tissue vs those with non-cardiovascular cause of death (1624.53 vs 2522.05 µm/mm, =0.038). In the atrial-PV ostia cohort, parasympathetic nerve density in myocardial sleeves was significantly increased in subjects with underlying cardiovascular cause of death (19.48 µm/mm) than subjects with underlying non-cardiovascular cause of death with no parasympathetic nerves detected (=0.034). Neural growth regionally varied in sympathetic nerves and was present in most of the parasympathetic nerves. Heterogeneous autonomic nerve distribution and growth around PVs and atrial-PV ostia might play a role in cardiovascular morbidity and mortality. No association in nerve density was found with atrial fibrillation.
Topics: Atrial Fibrillation; Choline O-Acetyltransferase; GAP-43 Protein; Heart Atria; Humans; Myocardium; Pulmonary Veins; Tyrosine 3-Monooxygenase
PubMed: 36154512
DOI: 10.1369/00221554221129899 -
Journal of General Internal Medicine Feb 2016
Topics: Adult; Dextrocardia; Female; Humans; Pulmonary Veins; Scimitar Syndrome; Tomography, X-Ray Computed
PubMed: 25941106
DOI: 10.1007/s11606-015-3358-7 -
JACC. Clinical Electrophysiology Apr 2023
Topics: Humans; Pulmonary Veins; Seat Belts; Atrial Fibrillation; Respiration, Artificial; Catheter Ablation
PubMed: 37100532
DOI: 10.1016/j.jacep.2022.11.031