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JACC. Clinical Electrophysiology Aug 2020
Topics: Atrial Fibrillation; Catheter Ablation; Catheters; Humans; Prospective Studies; Pulmonary Veins
PubMed: 32819532
DOI: 10.1016/j.jacep.2020.05.004 -
Europace : European Pacing,... Aug 2023
Topics: Humans; Pulmonary Veins
PubMed: 37656987
DOI: 10.1093/europace/euad259 -
The Journal of Thoracic and... Sep 2010Pulmonary vein isolation is indicated in patients with symptomatic isolated atrial fibrillation not controlled with antiarrhythmic therapy. We describe our surgical...
OBJECTIVE
Pulmonary vein isolation is indicated in patients with symptomatic isolated atrial fibrillation not controlled with antiarrhythmic therapy. We describe our surgical experience with thoracoscopic pulmonary vein isolation in patients in whom percutaneous ablation has failed.
METHODS
Thirty-four adult patients with unsuccessful catheter ablations (range 1-4, mean 2 +/- 1) underwent thoracoscopic bipolar-radiofrequency pulmonary vein isolation. Seventeen patients had paroxysmal atrial fibrillation, 12 with persistent and 5 with long-standing persistent fibrillation, for a mean of 6 years (range 3-10 years), 13 years (5-25 years), and 9 years (3-15 years), respectively.
RESULTS
There was no mortality during the procedure or follow-up (mean 16 +/- 11 months). Two patients needed conversion to thoracotomy owing to hemorrhage, and ablation could not be completed. Antiarrhythmic therapy was withdrawn 3 months postoperatively. Postoperative sinus rhythm was maintained in 82% of those with paroxysmal atrial fibrillation (13/15 at 6 months, 9/11 at 12 months), 60% had persistent atrial fibrillation (8/12 at 6 months and 6/10 at 12 months), and 20% had long-standing persistent atrial fibrillation (1/5 at 6 and 12 months). Preoperative left atrial diameter significantly differed between patients with paroxysmal fibrillation (mean 42 +/- 6 mm) and those with persistent and long-standing persistent fibrillation (means 50 +/- 4 and 47 +/- 2 mm). Left atrial size greater than 45 mm and atrial fibrillation type were preoperative factors that significantly influenced outcome in the univariate logistic regression analysis.
CONCLUSIONS
Thoracoscopic pulmonary vein isolation in patients with previously unsuccessful catheter ablations demonstrates satisfactory sinus rhythm maintenance rates in paroxysmal and persistent atrial fibrillation, but not in long-standing persistent atrial fibrillation. As with other minimally invasive surgical techniques, there is an important learning curve.
Topics: Adult; Aged; Atrial Fibrillation; Catheter Ablation; Female; Humans; Logistic Models; Male; Middle Aged; Pulmonary Veins; Risk Assessment; Risk Factors; Spain; Thoracic Surgery, Video-Assisted; Thoracotomy; Time Factors; Treatment Failure
PubMed: 20117799
DOI: 10.1016/j.jtcvs.2009.11.009 -
Europace : European Pacing,... Apr 2023Single-shot pulmonary vein isolation can improve procedural efficiency. To assess the capability of a novel, expandable lattice-shaped catheter to rapidly isolate...
AIMS
Single-shot pulmonary vein isolation can improve procedural efficiency. To assess the capability of a novel, expandable lattice-shaped catheter to rapidly isolate thoracic veins using pulsed field ablation (PFA) in healthy swine.
METHODS AND RESULTS
The study catheter (SpherePVI; Affera Inc) was used to isolate thoracic veins in two cohorts of swine survived for 1 and 5 weeks. In Experiment 1, an initial dose (PULSE2) was used to isolate the superior vena cava (SVC) and the right superior pulmonary vein (RSPV) in six swine and the SVC only in two swine. In Experiment 2, a final dose (PULSE3) was used for SVC, RSPV, and left superior pulmonary vein (LSPV) in five swine. Baseline and follow-up maps, ostial diameters, and phrenic nerve were assessed. Pulsed field ablation was delivered atop the oesophagus in three swine. All tissues were submitted for pathology. In Experiment 1, all 14/14 veins were isolated acutely with durable isolation demonstrated in 6/6 RSPVs and 6/8 SVC. Both reconnections occurred when only one application/vein was used. Fifty-two and 32 sections from the RSPVs and SVC revealed transmural lesions in 100% with a mean depth of 4.0 ± 2.0 mm. In Experiment 2, 15/15 veins were isolated acutely with 14/15 veins (5/5 SVC, 5/5 RSPV, and 4/5 LSPV) durably isolated. Right superior pulmonary vein (31) and SVC (34) sections had 100% transmural, circumferential ablation with minimal inflammation. Viable vessels and nerves were noted without evidence of venous stenosis, phrenic palsy, or oesophageal injury.
CONCLUSION
This novel expandable lattice PFA catheter can achieve durable isolation with transmurality and safety.
Topics: Swine; Animals; Atrial Fibrillation; Pulmonary Veins; Vena Cava, Superior; Feasibility Studies; Catheter Ablation; Catheters; Treatment Outcome
PubMed: 36794699
DOI: 10.1093/europace/euad030 -
Circulation Journal : Official Journal... Jan 2022The use of iodine contrast agents is one possible limitation in cryoballoon ablation (CBA) for atrial fibrillation (AF). This study investigated intracardiac echography...
Peri-Balloon Leak Flow Velocity Assessed by Intra-Cardiac Echography Predicts Pulmonary Vein Electrical Gap - Intra-Cardiac Echography-Guided Contrast-Free Cryoballoon Ablation.
BACKGROUND
The use of iodine contrast agents is one possible limitation in cryoballoon ablation (CBA) for atrial fibrillation (AF). This study investigated intracardiac echography (ICE)-guided contrast-free CBA.Methods and Results:The study was divided into 2 phases. First, 25 paroxysmal AF patients (Group 1) underwent CBA, and peri-balloon leak flow velocity (PLFV) was assessed using ICE and electrical pulmonary vein (PV) lesion gaps were assessed by high-density electroanatomical mapping. Then, 24 patients (Group 2) underwent ICE-guided CBA and were compared with 25 patients who underwent conventional CBA (historical controls). In Group 1, there was a significant correlation between PLFV and electrical PV gap diameter (r=-0.715, P<0.001). PLFV was higher without than with an electrical gap (mean [±SD] 127.0±28.6 vs. 66.6±21.0 cm/s; P<0.001) and the cut-off value of PLFV to predict electrical isolation was 105.7 cm/s (sensitivity 0.700, specificity 0.929). In Group 2, ICE-guided CBA was successfully performed with acute electrical isolation of all PVs and without the need for "rescue" contrast injection. Atrial tachyarrhythmia recurrence at 6 months did not differ between ICE-guided and conventional CBA (3/24 [12.5%] vs. 5/25 [20.0%], respectively; P=0.973, log-rank test).
CONCLUSIONS
PLFV predicted the presence of an electrical PV gap after CBA. ICE-guided CBA was feasible and safe, and could potentially be performed completely contrast-free without a decrease in ablation efficacy.
Topics: Atrial Fibrillation; Catheter Ablation; Cryosurgery; Echocardiography; Humans; Pulmonary Veins; Recurrence; Treatment Outcome
PubMed: 34334554
DOI: 10.1253/circj.CJ-21-0423 -
Computational and Mathematical Methods... 2022The accuracy of left atrial pulmonary vein CT enhanced single-phase and dual-phase scanning in the detection of left atrial appendage (LAA) thrombosis and spontaneous...
The Comparison of the Diagnostic Value of Left Atrial Pulmonary Vein Single-Phase and Dual-Phase Enhanced CT Scanning for Left Atrial Appendage Thrombosis and SEC in Patients with Atrial Fibrillation.
OBJECTIVE
The accuracy of left atrial pulmonary vein CT enhanced single-phase and dual-phase scanning in the detection of left atrial appendage (LAA) thrombosis and spontaneous echo contrast (SEC) before radio frequency ablation was compared in atrial fibrillation patients, so as to optimize the scanning scheme.
METHODS
78 patients with atrial fibrillation who were admitted to Cangzhou Central Hospital from October 2020 to September 2021 and underwent bilateral enhanced CT scan of left atrial pulmonary vein and transesophageal echocardiography (TEE) examination for planned frequency ablation were selected. TEE results were used as the "gold standard" to compare the diagnostic efficacy of the first phase, second phase, and double-phase comprehensive mode of enhanced left atrial pulmonary vein CT in detecting left atrial thrombosis and SEC.
RESULTS
The sensitivity, specificity, positive predictive value, and negative predictive value were 88.9%, 84.1%, 42.1%, and 98.3%, respectively, in the detection of left atrial thrombosis and SEC by the first phase of CT enhanced scan. The sensitivity, specificity, positive predictive value, and negative predictive value were 22.2%, 98.6%, 66.6%, and 90.7%, respectively, in the detection of left atrial thrombosis and SEC by the second phase of CT enhanced scan. The sensitivity, specificity, positive predictive value, and negative predictive value were 88.9%, 84.1%, 42.1%, and 98.3%, respectively, in the detection of left atrial thrombosis and SEC by the double-phase comprehensive mode of CT enhanced scan. There was no statistically significant difference in the accuracy of CT diagnosis of left atrial appendage thrombosis and SEC between the three modes of the first phase, the second phase, and the double-phase comprehensive CT ( > 0.05). The mean effective radiation dose of double-phase enhanced scan was 7.49 ± 1.02 mSv.
CONCLUSION
Single-phase enhanced CT scan of left atrial pulmonary vein can meet clinical requirements and significantly reduce the radiation dose compared with double-phase enhanced CT scan. Therefore, it is recommended as an initial screening examination for patients with atrial fibrillation before radiofrequency ablation.
Topics: Atrial Appendage; Atrial Fibrillation; Heart Diseases; Humans; Pulmonary Veins; Thrombosis; Tomography, X-Ray Computed
PubMed: 35607650
DOI: 10.1155/2022/8679511 -
Journal of the American College of... Dec 2014
Topics: Atrial Fibrillation; Catheter Ablation; Female; Humans; Male; Pulmonary Veins
PubMed: 25500230
DOI: 10.1016/j.jacc.2014.09.054 -
Journal of the American College of... Jul 1993We investigated whether mortality in totally anomalous pulmonary venous connection could be predicted from preoperative individual pulmonary vein size.
OBJECTIVES
We investigated whether mortality in totally anomalous pulmonary venous connection could be predicted from preoperative individual pulmonary vein size.
BACKGROUND
Some infants with this anomaly die with or without surgical repair because of stenosis of individual pulmonary veins.
METHODS
Individual pulmonary vein, vertical vein and pulmonary venous confluence diameters were retrospectively measured from preoperative echocardiograms in 32 infants with totally anomalous pulmonary venous connection presenting to Children's Hospital, Boston over a 4 1/2-year period. Data on body surface area, other cardiac anomalies, presence of initial pulmonary venous obstruction and early surgery and outcome were also recorded.
RESULTS
Of 32 patients, 6 (18.8%) died before hospital discharge, and 8 (25.0%) died subsequently. Six (75.0%) of the eight patients who died late had individual pulmonary vein stenosis at sites remote from the surgical anastomosis to the left atrium. The remaining 18 patients (56.3%) are alive at a mean follow-up period of 9.7 months. A Cox proportional hazards model revealed that small sum of individual pulmonary vein diameters (p = 0.0004), small confluence size (p = 0.02) and presence of heterotaxy syndrome (p = 0.008) were each significant univariate predictors of survival. Multivariate analysis showed that small pulmonary vein sum was a strong predictor of survival (p = 0.008), independent of the presence of heterotaxy syndrome. An analysis stratified by the presence of heterotaxy syndrome showed that the predictive effect of small pulmonary vein sum on survival was strongest in patients without heterotaxy syndrome.
CONCLUSIONS
These data show that individual pulmonary vein size at diagnosis is a strong, independent predictor of survival in patients with totally anomalous pulmonary venous connection. In patients with this anomaly and small individual pulmonary veins, the anomaly may not be correctable by surgical creation of an anastomosis between the pulmonary venous confluence and the left atrium.
Topics: Echocardiography; Follow-Up Studies; Heart Defects, Congenital; Hospital Mortality; Humans; Infant; Infant, Newborn; Multivariate Analysis; Prognosis; Proportional Hazards Models; Pulmonary Veins; Survival Rate
PubMed: 8509542
DOI: 10.1016/0735-1097(93)90835-o -
Journal of Cardiothoracic Surgery May 2021This study aimed to explore whether the mechanical stretching-induced expression of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in pulmonary veins...
Mechanical stretching of the pulmonary vein mediates pulmonary hypertension due to left heart disease by regulating SAC/MAPK pathway and the expression of IL-6 and TNF-α.
BACKGROUND
This study aimed to explore whether the mechanical stretching-induced expression of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in pulmonary veins occurred through the stretch-activated channel (SAC)/ mitogen-activated protein kinases (MAPKs) pathway.
METHODS
Sixty male Sprague-Dawley rats were divided into three sham groups and seven model groups. A metal clip was placed on the ascending aorta in the model group to establish PH-LHD rat model. The sham group received a similar operation without ascending aorta clamped. On day 25, pulmonary vein was given mechanical stretching with 0 g, 2.0 g tension in two model groups and two sham groups. Another four model groups were given 2.0 g tension after MAPKs pathway inhibitors soaked. The last sham group and model group rats' pulmonary veins, pulmonary artery and lung tissues were obtained on day 35. Pulmonary vein, pulmonary artery and lung tissue were evaluated by echocardiography, HE staining, immunohistochemistry and western blotting respectively.
RESULTS
On day 25, left heart weight, right ventricular pressure (35.339 cmHO) and left atrial pressure (13.657 cmHO) were increased in model group than those in sham group. Echocardiography showed left heart failure in the PH-LHD group (Interventrieular septum dimension 1.716 mm, left ventricular internal end diastolic dimension 4.888 mm, left ventricular posterior wall thickness in diastole 1.749 mm, ejection fraction 76.917%). But there was no difference in lung tissue between the sham group and PH-LHD group as showed by HE staining. Our results showed that the expression of IL-6 and TNF-α was highly expressed in PH-LHD rats' serum and pulmonary vein, which were further increased after 2.0 g tension was given and were decreased after SAC/MAPKs inhibitors treatment. Meanwhile, on day 25, immunohistochemistry analysis showed the expression of IL-6 and TNF-α was higher in the PH-LHD rats' pulmonary vein than that in pulmonary artery and lung tissue, and these expressions in pulmonary vein of PH-LHD group were also higher than that in sham group. However, on day 35, IL-6 and TNF-α were all increased in the pulmonary veins, arteries and lung tissues. Besides, our results uncovered that SAC/MAPKs pathway were upregulating in PH-LHD rats' pulmonary vein.
CONCLUSION
In conclusion, pulmonary vein mechanical stretching exacerbated PH-LHD possibly through the SAC/MAPKs pathway and upregulating expression of IL-6 and TNF-α.
Topics: Animals; Biomarkers; Biomechanical Phenomena; Blotting, Western; Echocardiography; Hypertension, Pulmonary; Immunohistochemistry; Interleukin-6; Male; Mitogen-Activated Protein Kinase Kinases; Pulmonary Veins; Random Allocation; Rats; Rats, Sprague-Dawley; Signal Transduction; Tumor Necrosis Factor-alpha; Up-Regulation; Vascular Remodeling; Ventricular Dysfunction, Left
PubMed: 33971931
DOI: 10.1186/s13019-021-01471-5 -
Circulation Journal : Official Journal... Feb 2021
Topics: Atrial Fibrillation; Catheter Ablation; Coronary Vessels; Humans; Pulmonary Veins; Spasm
PubMed: 33504713
DOI: 10.1253/circj.CJ-20-1238