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Journal of Cardiovascular... Mar 2015
Topics: Animals; Catecholamines; Cell Membrane Permeability; Male; Pulmonary Veins; Sodium; Tetrodotoxin
PubMed: 25495799
DOI: 10.1111/jce.12595 -
Journal of Cardiovascular... Jan 2002No prior studies have quantitatively analyzed the characteristics of bipolar or unipolar electrograms that may be helpful in identifying successful ostial ablation sites... (Clinical Trial)
Clinical Trial Comparative Study
INTRODUCTION
No prior studies have quantitatively analyzed the characteristics of bipolar or unipolar electrograms that may be helpful in identifying successful ostial ablation sites in patients with atrial fibrillation undergoing segmental pulmonary vein isolation.
METHODS AND RESULTS
The characteristics of bipolar and unipolar electrograms recorded at 185 successful and 120 unsuccessful ostial pulmonary venous ablation sites were analyzed in 21 patients with atrial fibrillation. A decapolar Lasso catheter was positioned near the ostia of the pulmonary veins, and a conventional ablation catheter was used to deliver radiofrequency energy at individual ostial sites where pulmonary vein potentials were recorded. With both bipolar and unipolar recordings, the only timing parameter that distinguished successful from unsuccessful ostial ablation sites was the timing of the electrogram recorded by the ablation catheter relative to the earliest pulmonary vein potential recorded by the Lasso catheter. With both bipolar and unipolar recordings, electrograms demonstrated a larger amplitude at successful than at unsuccessful ablation sites. Unipolar electrograms had a steeper intrinsic deflection at successful than at unsuccessful ostial ablation sites. The morphologies of the unipolar electrograms recorded by the ablation catheter and by the contiguous electrode of the Lasso catheter usually were identical.
CONCLUSION
In patients undergoing segmental isolation of the pulmonary veins, unipolar recordings provide more information than bipolar recordings helpful in distinguishing successful from unsuccessful ostial ablation sites. Furthermore, unipolar recordings, but not bipolar recordings, allow accurate localization of the position of the ablation catheter relative to the electrodes of the Lasso catheter.
Topics: Adult; Atrial Fibrillation; Catheter Ablation; Electrocardiography; Electrodiagnosis; Electrophysiology; Female; Humans; Male; Middle Aged; Pulmonary Veins; Treatment Failure
PubMed: 11843477
DOI: 10.1046/j.1540-8167.2002.00013.x -
World Journal of Surgical Oncology May 2022A right top pulmonary vein (RTPV) that crosses behind the right main or intermediate bronchus is a variation of the superior posterior pulmonary vein in the right upper... (Review)
Review
Right top pulmonary vein is a venous anomaly of which surgeons should be aware in subcarinal dissection for thoracoscopic esophagectomy: a case report and literature review.
BACKGROUND
A right top pulmonary vein (RTPV) that crosses behind the right main or intermediate bronchus is a variation of the superior posterior pulmonary vein in the right upper lobe. Damage or ligation of this abnormal vessel can lead to massive intraoperative bleeding and serious complications, such as congestion of the posterior segment of the right upper lobe and cardiac tamponade. Subcarinal lymph node dissection is mandatory in radical thoracoscopic esophagectomy for esophageal cancer, and the RTPV is an anomalous vessel of which thoracic surgeons should be aware.
CASE PRESENTATION
A 70-year-old man underwent thoracoscopic esophagectomy for esophageal cancer (T3N1M0). An anomaly of the superior posterior pulmonary vein in the right lobe was recognized on preoperative computed tomography imaging. With simulation and intraoperative navigation using three-dimensional imaging of the same view as that observed during the operation, radical subcarinal dissection could be performed with preservation of the RTPV.
CONCLUSION
In our review of the relevant literature, the incidence of RTPV ranged from 0.28 to 9.3%, and its mean vascular diameter was 7.0 mm at the maximum and 2.2 ± 0.72 mm at the minimum, with the right superior pulmonary vein being a relatively common inflow site. Our case in which the RTPV ran dorsal to the right main bronchus is very rare. In radical subcarinal dissection of thoracoscopic esophagectomy, it is important to recognize the posterior pericardial plane and release the ventral fixation of these lymph nodes to free space for the back side. This is also true in the case of RTPV, which should be noted to avoid injury. In cases involving an RTPV larger than 4.5 mm, ligation should be avoided, and preoperative recognition of the exact run of this abnormal vessel using three-dimensional imaging can be very useful.
Topics: Aged; Esophageal Neoplasms; Esophagectomy; Humans; Lymph Node Excision; Male; Pulmonary Veins; Surgeons; Vascular Malformations
PubMed: 35590376
DOI: 10.1186/s12957-022-02635-w -
Biomolecules Dec 2021Ectopic activity in the pulmonary vein cardiac muscle sleeves can both induce and maintain human atrial fibrillation. A central issue in any study of the pulmonary veins... (Review)
Review
Ectopic activity in the pulmonary vein cardiac muscle sleeves can both induce and maintain human atrial fibrillation. A central issue in any study of the pulmonary veins is their difference from the left atrial cardiac muscle. Here, we attempt to summarize the physiological phenomena underlying the occurrence of ectopic electrical activity in animal pulmonary veins. We emphasize that the activation of multiple signaling pathways influencing not only myocyte electrophysiology but also the means of excitation-contraction coupling may be required for the initiation of triggered or automatic activity. We also gather information regarding not only the large-scale structure of cardiac muscle sleeves but also recent studies suggesting that cellular heterogeneity may contribute to the generation of arrythmogenic phenomena and to the distinction between pulmonary vein and left atrial heart muscle.
Topics: Animals; Atrial Fibrillation; Heart Atria; Myocardium; Pulmonary Veins
PubMed: 35053171
DOI: 10.3390/biom12010023 -
Journal of the American College of... Sep 2020
Topics: Atrial Fibrillation; Catheter Ablation; Humans; Pulmonary Veins
PubMed: 32854843
DOI: 10.1016/j.jacc.2020.07.032 -
The Journal of Thoracic and... Feb 2022Previous studies have demonstrated increased early mortality and pulmonary vein reintervention for patients with total anomalous pulmonary venous connection (TAPVC) and...
BACKGROUND
Previous studies have demonstrated increased early mortality and pulmonary vein reintervention for patients with total anomalous pulmonary venous connection (TAPVC) and heterotaxy syndrome (HTX+) compared with patients with TAPVC without heterotaxy syndrome (HTX-). We aimed to evaluate the longitudinal risk of pulmonary vein reintervention and mortality in HTX + patients.
METHODS
A retrospective review was performed to identify longitudinal interventions in patients with TAPVC seen at a single center from 1995 to 2019. The mean cumulative interventions were described for all patients using the Nelson-Aalen estimator. Survival with TAPVC was described using Kaplan-Meier estimates.
RESULTS
A total of 336 patients were identified with TAPVC, of whom 118 (35%) had heterotaxy syndrome. Functional single ventricles were identified in 106 of these 118 HTX + patients (90%) and in 14 of 218 HTX- patients (6%) (P < .001). Obstructed TAPVC (OBS+) was present in 49 of 118 HTX + patients (42%) and in 87 of 218 HTX- patients (40%) (P = .89). The median duration of follow-up was 6.5 years. Five-year survival was 69% for HTX+/OBS + patients, 72% for HTX+/OBS- patients, 86% for HTX-/OBS + patients, and 95% for HTX-/OBS- patients (P < .0001, log-rank test). The mean number of pulmonary vein interventions at the median follow-up time was greater in the HTX+/OBS + patients compared with HTX+/OBS- patients (mean, 2.0 vs 1.1; P = .030), HTX-/OBS + patients (mean, 1.3; P = .033), and HTX-/OBS- patients (mean, 1.3; P = .029).
CONCLUSIONS
Among the 4 cohorts, HTX+ was associated with a higher rate of mortality, and HTX+/OBS+ was associated with a greater number of pulmonary vein interventions. This may be due in part to the high prevalence of single ventricle physiology in the HTX + cohort.
Topics: Female; Heterotaxy Syndrome; Humans; Male; Postoperative Complications; Pulmonary Veins; Pulmonary Veno-Occlusive Disease; Recurrence; Reoperation; Retrospective Studies; Scimitar Syndrome; Time Factors; Treatment Outcome; Vascular Surgical Procedures
PubMed: 33966882
DOI: 10.1016/j.jtcvs.2021.03.058 -
Journal of Cardiovascular... Apr 2020
Topics: Catheter Ablation; Heart Atria; Humans; Pulmonary Veins
PubMed: 32090385
DOI: 10.1111/jce.14389 -
Archives of Cardiovascular Diseases Nov 2021The strategy for atrial fibrillation ablation in persistent atrial fibrillation remains controversial. A single-catheter approach was recently validated for pulmonary...
BACKGROUND
The strategy for atrial fibrillation ablation in persistent atrial fibrillation remains controversial. A single-catheter approach was recently validated for pulmonary vein isolation.
AIM
To evaluate the feasibility of this approach to performing persistent atrial fibrillation ablation, including pulmonary vein isolation and atrial lines, if needed.
METHODS
We prospectively included 159 consecutive patients referred to our centre for a first persistent atrial fibrillation ablation between January 2018 and December 2018. All patients underwent pulmonary vein isolation. If the patient was still in atrial fibrillation (spontaneously or inducible), we subsequently performed a stepwise approach, including roof line, anterior mitral line, posterior box lesion and cavotricuspid isthmus line. Finally, if patient remained in atrial fibrillation at the end of the procedure, a synchronized direct-current cardioversion was applied to restore sinus rhythm.
RESULTS
At baseline, 54 patients were in sinus rhythm and underwent pulmonary vein isolation. For patients in atrial fibrillation, after pulmonary vein isolation and ablation of additional lines, if needed, 18 patients were converted to atrial tachycardia and one directly to sinus rhythm; 96 were still in atrial fibrillation and underwent direct-current cardioversion. After a mean follow-up of 17±6 months, 57 patients (36%) experienced atrial arrhythmia recurrence. No deaths, tamponades or phrenic nerve injuries were observed following the procedure. The main mode of arrhythmia recurrence was atrial fibrillation in 75% of cases and atrial tachycardia in 25% of cases.
CONCLUSION
A single-catheter approach, including pulmonary vein isolation and atrial lines, is feasible and safe in patients undergoing persistent atrial fibrillation ablation, with an acceptable success rate of 64% at mid-term follow-up.
Topics: Atrial Fibrillation; Catheter Ablation; Catheters; Feasibility Studies; Humans; Pulmonary Veins; Recurrence; Treatment Outcome
PubMed: 34620575
DOI: 10.1016/j.acvd.2021.06.012 -
Magnetic Resonance in Medicine Apr 2020To evaluate non-contrast-enhanced MRI of acute radio-frequency ablation (RFA) lesions in the left atrium (LA) and pulmonary vein (PV) ostia. The goal is to provide a...
PURPOSE
To evaluate non-contrast-enhanced MRI of acute radio-frequency ablation (RFA) lesions in the left atrium (LA) and pulmonary vein (PV) ostia. The goal is to provide a method for discrimination between necrotic (permanent) lesions and reversible injury, which is associated with recurrence after treatment of atrial fibrillation.
METHODS
Fifteen normal swine underwent RFA around the right-superior PV ostia. Electrical pulmonary vein isolation (PVI) was verified by electro-anatomic mapping (EAM) and pacing. MRI was carried out using a 3D respiratory-gated T -weighted long inversion time (TWILITE) sequence without contrast agent. Key settings were: inversion time 700 ms, triggering over 2 cardiac cycles, pixel size 1.1 mm . Contrast-enhanced imaging and T -weighted imaging were carried out for comparison. Six animals were sacrificed on ablation day for TTC-stained gross pathology, 9 animals were sacrificed after 2-3 mo after repeat EAM and MRI. Image intensity ratio (IIR) was used to measure lesion enhancement, and gross pathology was used to validate image enhancement patterns and compare lesion widths.
RESULTS
RFA lesions exhibited unambiguous enhancement in acute TWILITE imaging (IIR = 2.34 ± 0.49 at 1.5T), and the enhancement patterns corresponded well with gross pathology. Lesion widths in MRI correlated well with gross pathology (R = 0.84), with slight underestimation by 0.9 ± 0.5 mm. Lesion enhancement subsided chronically.
CONCLUSION
TWILITE imaging allowed acute detection of permanent RFA lesions in swine LA and PV ostia, without the need for contrast agent. Lesion enhancement pattern showed good correspondence to gross pathology and was well visualized by volume rendering. This method may provide valuable intra- or post-procedural assessment of RFA treatment.
Topics: Animals; Atrial Fibrillation; Catheter Ablation; Heart Atria; Magnetic Resonance Imaging; Pulmonary Veins; Radiofrequency Ablation; Swine
PubMed: 31565818
DOI: 10.1002/mrm.28001 -
The Journal of Thoracic and... Jul 2015
Topics: Female; Humans; Male; Pulmonary Veins
PubMed: 26126465
DOI: 10.1016/j.jtcvs.2015.05.020