RESUMEN
AIMS: Atrial fibrosis and autonomic remodelling are proposed pathophysiological mechanisms in atrial fibrillation (AF). Their impact on conduction velocity (CV) dynamics and wavefront propagation was evaluated. METHODS AND RESULTS: Local activation times (LATs), voltage, and geometry data were obtained from patients undergoing ablation for persistent AF. LATs were obtained at three pacing intervals (PIs) in sinus rhythm (SR). LATs were used to determine CV dynamics and their relationship to local voltage amplitude. The impact of autonomic modulation- pharmacologically and with ganglionated plexi (GP) stimulation, on CV dynamics, wavefront propagation, and pivot points (change in wavefront propagation of ≥90°) was determined in SR. Fifty-four patients were included. Voltage impacted CV dynamics whereby at non-low voltage zones (LVZs) (≥0.5â mV) the CV restitution curves are steeper [0.03 ± 0.03â m/s ΔCV PI 600-400â ms (PI1), 0.54 ± 0.09â m/s ΔCV PI 400-250â ms (PI2)], broader at LVZ (0.2-0.49â mV) (0.17 ± 0.09â m/s ΔCV PI1, 0.25 ± 0.11â m/s ΔCV PI2), and flat at very LVZ (<0.2â mV) (0.03 ± 0.01â m/s ΔCV PI1, 0.04 ± 0.02â m/s ΔCV PI2). Atropine did not change CV dynamics, while isoprenaline and GP stimulation resulted in greater CV slowing with rate. Isoprenaline (2.7 ± 1.1 increase/patient) and GP stimulation (2.8 ± 1.3 increase/patient) promoted CV heterogeneity, i.e. rate-dependent CV (RDCV) slowing sites. Most pivot points co-located to RDCV slowing sites (80.2%). Isoprenaline (1.3 ± 1.1 pivot increase/patient) and GP stimulation (1.5 ± 1.1 increase/patient) also enhanced the number of pivot points identified. CONCLUSION: Atrial CV dynamics is affected by fibrosis burden and influenced by autonomic modulation which enhances CV heterogeneity and distribution of pivot points. This study provides further insight into the impact of autonomic remodelling in AF.
Asunto(s)
Fibrilación Atrial , Fibrosis , Atrios Cardíacos , Humanos , Femenino , Masculino , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/cirugía , Persona de Mediana Edad , Atrios Cardíacos/fisiopatología , Atrios Cardíacos/inervación , Anciano , Potenciales de Acción , Ablación por Catéter , Remodelación Atrial , Frecuencia Cardíaca , Técnicas Electrofisiológicas Cardíacas , Sistema Nervioso Autónomo/fisiopatología , Función del Atrio Izquierdo , Isoproterenol/farmacología , Atropina/farmacología , Factores de Tiempo , Sistema de Conducción Cardíaco/fisiopatología , Resultado del TratamientoRESUMEN
Local ablation for hepatocellular carcinoma, a non-surgical option that directly targets and destroys tumor cells, has advanced significantly since the 1990s. Therapies with different energy sources, such as radiofrequency ablation, microwave ablation, and cryoablation, employ different mechanisms to induce tumor necrosis. The precision, safety, and effectiveness of these therapies have increased with advances in guiding technologies and device improvements. Consequently, local ablation has become the first-line treatment for early-stage hepatocellular carcinoma. The lack of organized evidence and expert opinions regarding patient selection, preprocedure preparation, procedural methods, swift post-treatment evaluation, and follow-up has resulted in clinicians following varied practices. Therefore, an expert consensus-based practical recommendation for local ablation was developed by a group of experts in radiology and hepatology from the Research Committee of the Korean Liver Cancer Association in collaboration with the Korean Society of Image-Guided Tumor Ablation to provide useful information and guidance for performing local ablation and for the pre- and post-treatment management of patients.
Asunto(s)
Carcinoma Hepatocelular , Consenso , Neoplasias Hepáticas , Neoplasias Hepáticas/cirugía , Humanos , Carcinoma Hepatocelular/cirugía , República de Corea , Técnicas de Ablación/métodos , Selección de Paciente , Ablación por Catéter/métodos , Ablación por Radiofrecuencia/métodosAsunto(s)
Fibrilación Atrial , Ablación por Catéter , Embolia Aérea , Fístula Esofágica , Oxigenoterapia Hiperbárica , Embolia Intracraneal , Humanos , Fibrilación Atrial/cirugía , Fibrilación Atrial/terapia , Embolia Aérea/etiología , Embolia Aérea/terapia , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Fístula Esofágica/etiología , Oxigenoterapia Hiperbárica/métodos , Embolia Intracraneal/etiología , Masculino , Atrios Cardíacos/diagnóstico por imagen , Fístula/etiología , Persona de Mediana EdadRESUMEN
Objective: To investigate the safety and efficacy of a varicose vein sealant kit in the treatment of great saphenous vein dysfunction. Methods: It was a randomized controlled trial. A total of 180 patients with great saphenous vein dysfunction were enrolled prospectively, and scheduled for surgical treatment in 9 hospitals, including the Second Affiliated Hospital of Naval Medical University, Shanghai Oriental Hospital Affiliated to Tongji University, Xuanwu Hospital Capital Medical University, the First Hospital of Hebei Medical University, Ganzhou People's Hospital, Shanxi Bethune Hospital, the Second Affiliated Hospital of Zhejiang University School of Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, and Zhongshan Hospital Affiliated to Xiamen University, from June to October 2022. Using a random number table method, the subjects were divided into an experimental group and a control group, with 90 cases in each group. The patients of experimental group received treatment with varicose vein sealant kit, while the patients of control group received radiofrequency ablation. The main outcome measure was the complete closure rate of the great saphenous vein in both groups of patients 3 months after surgery. The secondary outcome measures were the complete closure rate of the great saphenous vein in both groups of patients immediately after surgery and 6 months after surgery, the operation time for closing the main trunk of the great saphenous vein, pain score, venous clinical severity score (VCSS), Aberdeen varicose veins questionnaire (AVVQ) at different times before and after surgery, and the incidence of complications in both groups of patients. The non inferiority threshold for the two treatment methods is set at "-10.00%". Results: A total of 177 patients were ultimately enrolled. There were 89 cases in the experimental group, including 38 males and 51 females, with a median age [M (Q1, Q3)] of 59.7(49.6, 66.7) years, and 88 cases in the control group, including 30 males and 58 females, with a median age of 57.2(46.9, 65.9) years. A total of 174 patients completed a 3-month follow-up, and 167 patients completed a 6-month follow-up. The closure time of the main saphenous vein in the experimental group was (22.1±11.1) min, which was longer than the control group, which was (18.7±9.8) min (P=0.031). The complete closure rate of the great saphenous vein immediately after surgery in both the experimental group and the control group was 100%. The complete closure rates of the great saphenous vein at 3 months after surgery were 98.8% (85/86) and 98.9% (87/88), respectively. The lower limit of the 95%CI for the difference between the two groups was -3.19%, which was greater than the non-inferiority threshold of -10.00% (non-inferiority P<0.001). The complete closure rates of the great saphenous vein at 6 months after surgery were 97.6% (81/83) and 100% (84/84), the lower limit of the 95%CI for the difference between the two groups was -5.71%, which was greater than the non-inferiority threshold of -10.00% (non-inferiority P<0.001). The immediate pain scores after complete anesthesia awakening of the experimental group and the control group were both 1.0 (0, 2.0), with no statistically significant difference (P=0.365). The incidence of bruising in the experimental group and the control group one week after surgery was 61.2% (52/85) and 67.1% (57/85), respectively, with no statistically significant difference (P=0.181). There was no statistically significant difference in VCSS and AVVQ scores between groups before surgery and at 1, 3, and 6 months after surgery (all P>0.05). There was no statistically significant difference in the incidence of complications such as deep vein thrombosis, phlebitis, pain, and subcutaneous hematoma in the lower limbs 3 months after surgery (all P>0.05). Conclusion: The varicose vein sealant kit is safe and effective in treating great saphenous vein dysfunction, and can achieve a complete closure rate of great saphenous vein that is not inferior to traditional radiofrequency ablation.
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Vena Safena , Várices , Insuficiencia Venosa , Humanos , Vena Safena/cirugía , Várices/cirugía , Insuficiencia Venosa/cirugía , Resultado del Tratamiento , Estudios Prospectivos , Masculino , Femenino , Persona de Mediana Edad , Ablación por Catéter/métodosRESUMEN
OBJECTIVES: The purpose of this study was to demonstrate the discriminating predictive indicators in peripheral blood and left atrium blood for predicting the risk of left atrial spontaneous echo contrast (LASEC) in atrial fibrillation patients underwent catheter ablation. METHODS: A total of 108 consecutive AF patients treated with radiofrequency ablation between July 2022 and July 2023 were enrolled and divided into two groups based on preprocedural transesophageal echocardiography: the non LASEC group (n = 71) and the LASEC group (n = 37). Circulating platelet and endothelial- derived MPs (PMPs and EMPs) in peripheral blood and left atrial blood were detected. Plasma soluble P-selectin (sP-selectin) and von Willebrand factor (vWF) were observed. Diagnostic efficiency was measured using receiver operating characteristic (ROC) curve. RESULTS: Peripheral sP-selectin, vWF and EMPs expressions elevated in all subjects when compared to those in left atrium blood. Levels of sP-selectin and vWF were significantly higher in peripheral blood of LASEC group than those of non LASEC group (p = 0.0018,p = 0.0271). Significant accumulations of peripheral PMPs and EMPs were documented in LASEC group by comparison with non LASEC group (p = 0.0395,p = 0.018). The area under curve(AUC) of combined PMPs and sP-selectin in predicting LASEC was 0.769 (95%CI: 0.678-0.845, sensitivity: 86.49%, specificity: 59.15%), significantly larger than PMPs or sP-selectin alone. CONCLUSIONS: Expressions of PMPs, sP-selectin, EMPs and vWF Increased in NVAF patients with LASEC and that might be potential biomarkers for LASEC prediction.
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Fibrilación Atrial , Biomarcadores , Ablación por Catéter , Ecocardiografía Transesofágica , Atrios Cardíacos , Selectina-P , Valor Predictivo de las Pruebas , Factor de von Willebrand , Humanos , Fibrilación Atrial/sangre , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/cirugía , Masculino , Femenino , Persona de Mediana Edad , Atrios Cardíacos/diagnóstico por imagen , Selectina-P/sangre , Factor de von Willebrand/metabolismo , Factor de von Willebrand/análisis , Biomarcadores/sangre , Anciano , Resultado del Tratamiento , Función del Atrio Izquierdo , Factores de Riesgo , Medición de RiesgoAsunto(s)
Ablación por Catéter , Taquicardia Ventricular , Complejos Prematuros Ventriculares , Humanos , Complejos Prematuros Ventriculares/cirugía , Complejos Prematuros Ventriculares/fisiopatología , Complejos Prematuros Ventriculares/diagnóstico , Ablación por Catéter/métodos , Taquicardia Ventricular/cirugía , Taquicardia Ventricular/fisiopatología , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiología , Electrocardiografía , Resultado del Tratamiento , Sistema de Conducción Cardíaco/fisiopatología , Sistema de Conducción Cardíaco/cirugíaRESUMEN
BACKGROUND: There has been no consensus on what power of radiofrequency energy can be used to produce the best surgical results in patients with atrial fibrillation. In addition, patients undergoing local anesthesia and fentanyl analgesia may experience pain when radiofrequency ablation is performed. This study investigated the effect of different power radiofrequency ablations in treatment and postoperative pain in patients with atrial fibrillation. METHODS: A retrospective study was performed with 60 patients who underwent radiofrequency ablation for atrial fibrillation between January and June 2023. Patients were divided into 2 groups according to the power of the radiofrequency ablation catheter used, with 30 patients in the conventional power group (35 W) and 30 patients in the high-power group (50 W). The cardiac electrophysiological indexes and postoperative pain of the 2 groups were compared. RESULTS: Most of the procedural key parameters between the 2 groups had no significant differences. However, the total application time during radiofrequency ablation and pulmonary vein isolation time in the high-power group were significantly shorter than those in the conventional power group (p < 0.001). Patients in the high-power group reported significantly less pain than those in the conventional power group in the immediate postoperative period and the late postoperative period (p < 0.001). CONCLUSIONS: High-power radiofrequency ablation showed a shorter treatment time, and could reduce postoperative pain compared to conventional power ablation.
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Fibrilación Atrial , Ablación por Catéter , Dolor Postoperatorio , Humanos , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/cirugía , Fibrilación Atrial/fisiopatología , Estudios Retrospectivos , Masculino , Dolor Postoperatorio/etiología , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/prevención & control , Femenino , Persona de Mediana Edad , Resultado del Tratamiento , Anciano , Ablación por Catéter/efectos adversos , Factores de Tiempo , Dimensión del Dolor , Frecuencia CardíacaRESUMEN
INTRODUÇÃO: O fechamento percutâneo transcateter do apêndice atrial esquerdo surgiu recentemente como uma alternativa segura e eficaz à terapia anticoagulante de longo prazo na prevenção de AVC e na redução dos riscos de sangramento em pacientes com FA não valvular. No entanto, o papel da combinação do fechamento percutâneo transcateter do apêndice atrial esquerdo e ablação por cateter em um único procedimento ainda não está claro. OBJETIVOS: Neste estudo, os autores buscaram comparar a segurança do fechamento percutâneo transcateter do apêndice atrial esquerdo, ablação por cateter e o procedimento combinando-os em pacientes com fibrilação atrial. MÉTODOS: As bases de dados MEDLINE, EMBASE e a Cochrane Central foram revisadas sistematicamente em busca de estudos que relatassem o desfecho de complicações periprocedimentos na ablação por cateter e oclusão do apêndice atrial esquerdo em uma abordagem "one-stop". O procedimento combinado dessas abordagens, o fechamento percutâneo transcateter do apêndice atrial esquerdo e a ablação por cateter isoladamente foram analisados. Foi realizada uma metaanálise em rede bayesiana para estimar os efeitos relativos entre tratamentos utilizando razão de risco (RR) e para classificar cada um de acordo com a "Surface Under the Cumulative Ranking Curve" (SUCRA). RESULTADOS: Identificamos 11 ensaios relevantes representando 3343 participantes. A avaliação dos valores SUCRA indicou que apenas o LAAC (0,84) emergiu como o tratamento mais eficaz para a redução das complicações periprocedimento, seguido por apenas ablação (0,60) e abordagem combinada (0,05). O risco de complicações periprocedimento foi maior para o grupo apenas ablação (RR 0,73; intervalo credível [CrI] 0,45, 1,1) e menor para o grupo LAAC (RR 0,62; CrI 0,35, 1,0) quando comparados ao grupo combinado. Na comparação indireta entre os grupos LAAC apenas e ablação apenas, não houve significância estatística (Odds Ratio [OR] 1,1; CrI 0,27, 4,4; p=0,60). CONCLUSÃO: Nesta metanálise de rede, a abordagem combinada do fechamento percutâneo transcateter do apêndice atrial esquerdo e da ablação por cateter foi associada a um aumento de complicações periprocedimentos quando comparado aos procedimentos isoladamente. Portanto, deve-se avaliar cuidadosamente os benefícios e riscos de realizar esses procedimentos em conjunto, levando em consideração a segurança do paciente.
Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Apéndice Atrial , Metaanálisis en Red , Cierre del Apéndice Auricular Izquierdo , Accidente Cerebrovascular , HemorragiaRESUMEN
RATIONALE: Tachycardia is a common arrhythmia in clinical practice, and its pathogenesis is mostly related to reentry. However, there are also a few tachycardia that are not related to reentry. Actively clarifying the pathogenesis of these non-reentry related tachycardia is of great significance for its treatment. PATIENT CONCERNS: A 55-year-old female patient presented with recurrent palpitations with a fastest heart rate of 180 beats/minute 10 years ago. DIAGNOSIS: Dual atrioventricular nodal non-reentrant tachycardia (DAVNNT). INTERVENTIONS: DAVNNT can be cured by radiofrequency ablation of atrioventricular nodal slow path modification. OUTCOMES: The tachycardia has stopped. CONCLUSION: DAVNNT is a rare disease in clinical practice. Its characteristic is not reentration-related arrhythmias, but the phenomenon of increased heart rate caused by electrical conduction down the double pathway of atrioventricular nodal tract and subsequent pathway. Electrophysiological examination helps to clarify the diagnosis and pathogenesis, and catheter ablation can cure the disease.
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Ablación por Catéter , Humanos , Femenino , Persona de Mediana Edad , Ablación por Catéter/métodos , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatología , Electrocardiografía , Nodo Atrioventricular/fisiopatología , Nodo Atrioventricular/cirugíaRESUMEN
BACKGROUND: Increased left atrial pressure (LAP) contributes to dyspnea and heart failure with preserved ejection fraction in patients with atrial fibrillation (AF). The purpose of this study was to investigate the differences in baseline LAP and LAP response to rapid pacing between paroxysmal and persistent AF. METHODS AND RESULTS: This observational study prospectively enrolled 1369 participants who underwent AF catheter ablation, excluding those with reduced left ventricular ejection fraction. H2FPEF score was calculated by echocardiography and baseline characteristics. Patients underwent LAP measurements during AF, sinus rhythm, and heart rates of 90, 100, 110, and 120 beats per minute (bpm), induced by right atrial pacing and isoproterenol. The baseline LAP-peak in the persistent AF group consistently exceeded that in the paroxysmal AF (PAF) group across each H2FPEF score subgroup (all P<0.05). LAP-peak increased with pacing (19.5 to 22.5 mm Hg) but decreased with isoproterenol (20.4 to 18.4 mm Hg). Under pacing, patients with PAF exhibited a significantly lower LAP-peak (90 bpm) than those with persistent AF (17.7±8.2 versus 21.1±9.3 mm Hg, P<0.001). However, there was no difference in LAP-peak (120 bpm) between the 2 groups (22.1±8.1 versus 22.9±8.4 mm Hg, P=0.056) because the LAP-peak significantly increased with heart rate in the group with PAF. CONCLUSIONS: Patients with PAF exhibited lower baseline LAP with greater increases during rapid pacing compared with individuals with persistent AF, indicating a need to revise the H2FPEF score for distinguishing PAF from persistent AF and emphasizing the importance of rate and rhythm control in PAF for symptom control. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT02138695.
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Fibrilación Atrial , Presión Atrial , Insuficiencia Cardíaca , Volumen Sistólico , Humanos , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/terapia , Fibrilación Atrial/cirugía , Femenino , Masculino , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/terapia , Volumen Sistólico/fisiología , Presión Atrial/fisiología , Persona de Mediana Edad , Anciano , Estudios Prospectivos , Frecuencia Cardíaca/fisiología , Ablación por Catéter , Ecocardiografía , Estimulación Cardíaca Artificial , Función del Atrio Izquierdo/fisiología , Función Ventricular Izquierda/fisiología , Isoproterenol/administración & dosificaciónRESUMEN
Local ablation for hepatocellular carcinoma (HCC), a non-surgical option that directly targets and destroys tumor cells, has advanced significantly since the 1990s. Therapies with different energy sources, such as radiofrequency ablation, microwave ablation, and cryoablation, employ different mechanisms to induce tumor necrosis. The precision, safety, and effectiveness of these therapies have increased with advances in guiding technologies and device improvements. Consequently, local ablation has become the first-line treatment for early-stage HCC. The lack of organized evidence and expert opinions regarding patient selection, pre-procedure preparation, procedural methods, swift post-treatment evaluation, and follow-up has resulted in clinicians following varied practices. Therefore, an expert consensus-based practical recommendation for local ablation was developed by a group of experts in radiology and hepatology from the Research Committee of the Korean Liver Cancer Association in collaboration with the Korean Society of Image-guided Tumor Ablation to provide useful information and guidance for performing local ablation and for the pre- and post-treatment management of patients.
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Carcinoma Hepatocelular , Consenso , Neoplasias Hepáticas , Humanos , Técnicas de Ablación/métodos , Carcinoma Hepatocelular/cirugía , Carcinoma Hepatocelular/diagnóstico por imagen , Ablación por Catéter/métodos , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Selección de Paciente , República de CoreaRESUMEN
Catheter ablation (CA) is an essential method for the interventional treatment of atrial fibrillation (AF), and it is very important to reduce long-term recurrence after CA. The mechanism of recurrence after CA is still unclear. We established a long-term model of beagle canines after circumferential pulmonary vein ablation (CPVA). The transcriptome and proteome were obtained using high-throughput sequencing and TMT-tagged LC-MS/LC analysis, respectively. Differentially expressed genes and proteins were screened and enriched, and the effect of fibrosis was found and verified in tissues. A downregulated protein, neuropeptide Y (NPY), was selected for validation and the results suggest that NPY may play a role in the long-term reinduction of AF after CPVA. Then, the molecular mechanism of NPY was further investigated. The results showed that the atrial effective refractory period (AERP) was shortened and fibrosis was increased after CPVA. Atrial myocyte apoptosis was alleviated by NPY intervention, and Akt activation was inhibited in cardiac fibroblasts. These results suggest that long-term suppression of NPY after CPVA may lead to induction of AF through promoting cardiomyocyte apoptosis and activating the Akt pathway in cardiac fibroblasts, which may make AF more likely to reinduce.
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Apoptosis , Fibrilación Atrial , Ablación por Catéter , Miocardio , Neuropéptido Y , Venas Pulmonares , Animales , Perros , Apoptosis/efectos de los fármacos , Fibrilación Atrial/metabolismo , Fibrilación Atrial/cirugía , Fibrilación Atrial/patología , Ablación por Catéter/métodos , Modelos Animales de Enfermedad , Fibrosis , Atrios Cardíacos/metabolismo , Atrios Cardíacos/patología , Multiómica , Miocardio/metabolismo , Miocardio/patología , Miocitos Cardíacos/metabolismo , Miocitos Cardíacos/efectos de los fármacos , Miocitos Cardíacos/patología , Neuropéptido Y/metabolismo , Proteoma/metabolismo , Proteómica/métodos , Proteínas Proto-Oncogénicas c-akt/metabolismo , Venas Pulmonares/metabolismo , Venas Pulmonares/cirugía , TranscriptomaRESUMEN
Introduction: Thyroid nodules are extremely common being detected by ultrasonography in up to 67% of the population, with current surgical tenet maintaining that lobectomy is required for large symptomatic benign nodules or autonomously functionally nodules resulting in a risk of hypothyroidism or recurrent laryngeal nerve injury even in high volume centres. The introduction of radiofrequency ablation (RFA) has allowed thermal ablation of both benign and autonomously functioning thyroid nodules with minimal morbidity. The moving shot technique is the most well-established technique in performing RFA of thyroid nodules, and has proven to be safe, efficacious, accurate and successful amongst experienced clinicians. The purpose of this article to propose the use of a novel guide when performing RFA of thyroid nodules in clinical practice utilizing the moving shot technique. Methods: The technique proposed of RFA involves the use of a 10MHz linear ultrasound probe attached to an 18G guide which provides robust in line visualisation of a 7cm or 10cm radiofrequency probe tip (STARmed, Seoul, Korea) utilizing the trans isthmic moving shot technique. A geometric analysis of the guide has been illustrated diagrammatically. Results: The use of an 18G radiofrequency probe guide (CIVCO Infiniti Plus™ Needle Guide) maintains in line visualisation of the radiofrequency probe over a cross-sectional area up to 28cm2, facilitating efficient and complete ablation of conceptual subunits during RFA of thyroid nodules. Discussion: Radiofrequency ablation of thyroid nodules can be performed safely and effectively using the novel radiofrequency probe guide proposed which we believe potentially improves both accuracy and overall efficiency, along with operator confidence in maintaining visualisation of the probe tip, and hence we believe provides a valuable addition to the armamentarium of clinicians wishing to embark on performing RFA of thyroid nodules.
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Ablación por Radiofrecuencia , Nódulo Tiroideo , Nódulo Tiroideo/cirugía , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/patología , Humanos , Ablación por Radiofrecuencia/métodos , Ultrasonografía Intervencional/métodos , Femenino , Ablación por Catéter/métodosRESUMEN
BACKGROUND: Despite improvement in treatment strategies for atrial fibrillation (AF), a significant proportion of patients still experience recurrence after ablation. This study aims to propose a novel algorithm based on Transformer using surface electrocardiogram (ECG) signals and clinical features can predict AF recurrence. METHODS: Between October 2018 to December 2021, patients who underwent index radiofrequency ablation for AF with at least one standard 10-second surface ECG during sinus rhythm were enrolled. An end-to-end deep learning framework based on Transformer and a fusion module was used to predict AF recurrence using ECG and clinical features. Model performance was evaluated using areas under the receiver operating characteristic curve (AUROC), sensitivity, specificity, accuracy and F1-score. RESULTS: A total of 920 patients (median age 61 [IQR 14] years, 66.3% male) were included. After a median follow-up of 24 months, 253 patients (27.5%) experienced AF recurrence. A single deep learning enabled ECG signals identified AF recurrence with an AUROC of 0.769, sensitivity of 75.5%, specificity of 61.1%, F1 score of 55.6% and overall accuracy of 65.2%. Combining ECG signals and clinical features increased the AUROC to 0.899, sensitivity to 81.1%, specificity to 81.7%, F1 score to 71.7%, and overall accuracy to 81.5%. CONCLUSIONS: The Transformer algorithm demonstrated excellent performance in predicting AF recurrence. Integrating ECG and clinical features enhanced the models' performance and may help identify patients at low risk for AF recurrence after index ablation.
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Fibrilación Atrial , Ablación por Catéter , Aprendizaje Profundo , Electrocardiografía , Recurrencia , Humanos , Fibrilación Atrial/cirugía , Masculino , Femenino , Persona de Mediana Edad , AncianoRESUMEN
CASE PRESENTATION: A 41-year-old man who currently smokes with previous sporadic use of cocaine and cannabinoids was admitted at the hospital suffering from hemoptysis which had developed 4 days before. The patient was on anticoagulant therapy with rivaroxaban due to paroxysmal atrial fibrillation diagnosed in 2018, for which he had undergone pulmonary vein electrical isolation by radiofrequency and ablation of cavotricuspid isthmus in January 2019. The procedure was completed in July 2019. Treatment with flecainide was introduced due to recurrences of atrial fibrillation. In February 2021, a new attempt at ablation was performed by electrical isolation of the left atrial posterior wall. The latest cardiologic checkup documented an echocardiographic framework of mild left atrial dilatation and normal-sized right ventricle with longitudinal shortening index at the lower limits, and a recurrence of asymptomatic atrial fibrillation at Holter ECG (March 2022).
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Fibrilación Atrial , Hemoptisis , Humanos , Masculino , Adulto , Hemoptisis/etiología , Hemoptisis/diagnóstico , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/cirugía , Ablación por Catéter/métodos , Ecocardiografía , Venas Pulmonares/cirugía , Venas Pulmonares/diagnóstico por imagenRESUMEN
AIMS: Patients undergoing catheter ablation (CA) of ventricular arrhythmias (VAs) are generally observed overnight in the hospital given the concern for complications. To evaluate the efficacy and safety of same-day discharge (SDD) of patients undergoing elective CA of premature ventricular complexes (PVCs). METHODS AND RESULTS: A retrospective evaluation of all patients undergoing elective VA ablation at Ascension St Vincent Hospital from 1 January 2018 to 31 December 2019 was undertaken. Of those, the patients undergoing PVC ablation were divided into SDD and non-SDD. Patients underwent SDD at the discretion of the operator. The primary safety outcome was the 30-day incidence of complications and death. The primary efficacy outcome was procedural success. Among 188 patients who underwent VA ablation, 98 (52.1%) were PVC ablations, and of those, 55 (56.1%) were SDD. There was no difference in age, gender, comorbidities, or ejection fraction between the two groups. Patients that were non-SDD were more likely to be on chronic anticoagulation (P = 0.03), have ablation in the LV (P = 0.04), have retrograde access (P = 0.03), and receive heparin during the procedure (P = 0.01). There were no complications in the SDD group compared with one (2.3%) in the non-SDD group. There was no difference in primary efficacy between the two groups with a 90.9% acute success in the SDD and 88.4% in the non-SDD (P = 0.68). CONCLUSION: Same-day discharge for CA of PVCs is feasible and could lower healthcare resource utilization without compromising outcomes in this unique population.
Asunto(s)
Ablación por Catéter , Alta del Paciente , Complejos Prematuros Ventriculares , Humanos , Complejos Prematuros Ventriculares/cirugía , Complejos Prematuros Ventriculares/fisiopatología , Complejos Prematuros Ventriculares/diagnóstico , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Resultado del Tratamiento , Anciano , Complicaciones Posoperatorias/epidemiología , Factores de TiempoRESUMEN
BACKGROUND: Idiopathic ventricular arrhythmias (IVAs) arising from different portions of the communicating vein of the left ventricular summit (summit-CV) are not a rare phenomenon. Whereas its electrocardiographic (ECG) and electrophysiological characteristics are not fully investigated. OBJECTIVE: This study aimed to identify distinct ECG and electrophysiological features of IVAs originating from different portions of summit-CV. METHODS: Nineteen patients confirmed arising from summit-CV were included in this study. RESULTS: The 19 patients were divided into proximal and distal portion groups based on their target sites in summit-CV. In the proximal portion group, 100% (11/11) VAs showed dominant negative (rs or QS) waves in lead I, while in the distal portion group, 87.5% (7/8) showed dominant positive waves (R, Rs or r) (p < 0.000). In lead V1, 100% (11/11) of the proximal portion group showed dominant positive waves (R or Rs), while 62.50% (5/8) of the distal portion group showed positive and negative bidirectional or negative waves (RS or rS) (p < 0.005). RI>4mV, SI<3.5mV, RV1<13mV, SV1>3.5mV, RI/SI>0.83, and RV1/SV1< 2.6 indicated a distal portion of summit-CV with the predictive value of 0.909, 1.000, 0.653, 0.972, 0.903, 0.966, respectively. A more positive wave in lead I and a more negative wave in lead V1 indicated more distal origin in summit-CV. Target sites in proximal and distal summit-CV groups showed similar electrophysiological characteristics during mapping. CONCLUSIONS: There were significant differences in ECG characteristics of VAs at different portions of summit-CV, which could aid pre-procedure planning and facilitate radiofrequency catheter ablation (RFCA) procedures.
Asunto(s)
Potenciales de Acción , Ablación por Catéter , Electrocardiografía , Frecuencia Cardíaca , Ventrículos Cardíacos , Valor Predictivo de las Pruebas , Humanos , Ablación por Catéter/efectos adversos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Resultado del Tratamiento , Ventrículos Cardíacos/fisiopatología , Ventrículos Cardíacos/cirugía , Taquicardia Ventricular/fisiopatología , Taquicardia Ventricular/cirugía , Taquicardia Ventricular/diagnóstico , Técnicas Electrofisiológicas Cardíacas , Estudios Retrospectivos , AncianoRESUMEN
In this systematic review and meta-analysis, we aim to evaluate the efficacy and safety of catheter ablation as the first-line treatment of ventricular tachycardia (VT) in patients with structural heart disease (SHD) and preserved left ventricular ejection fraction (LVEF). Patients with SHD are particularly susceptible to VT, a condition that increases the risk of sudden cardiac death (SCD). Implantable cardioverter-defibrillators (ICDs) can terminate VT and prevent SCD but do not prevent VT recurrence. The efficacy and safety of CA as a first-line treatment in SHD patients with preserved LVEF remain unclear. We searched PubMed/Medline, EMBASE, Web of Science, and Cochrane CENTRAL for studies reporting the outcomes of CA therapy in patients with VT and preserved LVEF, published up to January 19, 2023. The primary outcome was the incidence of SCD following catheter ablation as the first-line treatment of VT in patients with SHD and preserved LVEF. Secondary outcomes included all-cause mortality, VT recurrence, procedural complications, CA success rate, and ICD implantation after catheter ablation. We included seven studies in the meta-analysis, encompassing a total of 920 patients. The pooled success rate of catheter ablation was 84.6% (95% CI 67.2-93.6). Complications occurred in 6.4% (95% CI 4.0-9.9) of patients, and 13.9% (95% CI 10.1-18.8) required ICD implantation after ablation. VT recurrence was observed in 23.2% (95% CI 14.8-34.6) of patients, while the rate of sudden cardiac death (SCD) was 3.1% (95% CI 1.7-5.6). The overall prevalence of all-cause mortality in this population was 5% (95% CI 1.8-13). CA appears promising as a first-line VT treatment in patients with SHD and preserved LVEF, especially for monomorphic hemodynamically tolerated VT. However, due to the lack of direct comparisons with ICDs and anti-arrhythmic drugs, further research is needed to confirm these findings.