A novel local impedance algorithm to guide effective pulmonary vein isolation in AF patients: 1-year outcome from the CHARISMA Study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Segreti ◽  
A De Simone ◽  
V Schillaci ◽  
G Zucchelli ◽  
C Pandozi ◽  
...  
Keyword(s):  
Time Course ◽  
De Novo ◽  
Holter Monitoring ◽  
Rf Ablation ◽  
Tissue Impedance ◽  
Local Tissue ◽  
Spot Center ◽  
Rf Applications ◽  
Tissue Characteristics

Abstract Background Recently, a novel technology able to measure local tissue impedance (LI) providing a measure of tissue characteristics aimed at validating confidently ablation endpoints has become available for clinical use. Purpose We report the outcomes of our acute and long-term clinical evaluation of this algorithm in consecutive atrial fibrillation ablation cases. Methods Consecutive patients (pts) undergoing AF ablation at 6 Italian centers were included in the CHARISMA registry. A novel RF ablation catheter and a dedicated algorithm were used to measure LI through the distal catheter's electrode. The ablation was guided by looking at the magnitude and time course of impedance drop during RF delivery. The maximum distance between each ablation spot (center-to-center) was suggested to be ≤4 mm. RF applications were targeted to a LI drop of 10 Ω and RF applications were stopped when a maximum cutoff LI drop of <40 Ω was observed. Successful single RF ablation was defined according with a reduction of signal voltage (RedV) by at least 50% and inability to capture local tissue on pacing. Ablation endpoint was PVI as assessed by entrance and exit block. Post-ablation, all pts were monitored with ambulatory event monitoring, as well as Holter monitoring at 3, 6, and 12 months post-ablation. Additional ECG monitoring was performed as indicated by patient symptoms. Results A total of 1914 point by point first pass RF applications >10 s performed around PVs were analyzed from 98 pts (mean age = 61±11 years, 69% male, 55% paroxysmal AF, 45% persistent AF, 60% de novo procedures, 40% redo procedures). The mean LI was 105±15Ω prior to ablation and 92±13Ω after ablation (p<0.0001, mean absolute LI drop of 12.7±8Ω) during a median RF delivery time of 22 [17–31] sec. Effective ablation spots (88%) showed a higher absolute impedance drop (13.6±8Ω at effective RedV vs 6±3Ω at ineffective RedV, p<0.0001) compared with ineffective sites (12%). No steam pops or complications, including atrio-esophageal fistula or tamponade were reported during or after the procedures. At the end of the procedures all PVs were successfully isolated in all study pts. During a median follow-up of 369 [287–446] days, 13 pts (13.2%) developed an AF/AT recurrence after the 90-days blanking period (9.2% with paroxysmal vs 18% with persistent AF, p=0.239; 8.5% for de novo vs 20.5% for redo procedures, p=0.127). The time to recurrence was comparable among AF type (HR=1.97; 0.66 to 5.86; log-rank p=0.2265 for persistent vs paroxysmal AF) and procedural type (HR=2.56; 0.84 to 7.82; log-rank p=0.087 for redo vs de novo procedure) Conclusions In our experience, the magnitude of the LI drop during RF delivery was associated with effective lesion formation. An ablation strategy for PVI guided by LI technology was safe and effective, and resulted in a very low recurrence rate of AF at 1-year follow-up irrespective of paroxysmal/persistent AF type or de novo/redo procedure. Funding Acknowledgement Type of funding source: None

scholarly journals The magnitude and the course of local impedance drop to guide successful AF ablation: insight from an Italian registry

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
V Schillaci ◽  
G Zucchelli ◽  
F Solimene ◽  
A De Simone ◽  
C Pandozi ◽  
...  
Keyword(s):  
Time Course ◽  
Rf Ablation ◽  
Af Ablation ◽  
Funding Sources ◽  
A Value ◽  
Successful Ablation ◽  
The Mean ◽  
Rf Applications ◽  
Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: None. Background It has been demonstrated that an ablation strategy based on local impedance (LI) algorithm is helpful in guiding successful ablation of atrial fibrillation (AF) cases. How the magnitude and the course of LI drop could impact the effectiveness of ablation has to be proved. Purpose We aimed to evaluate LI drop characteristics in predicting effective radiofrequency (RF) ablation of consecutive AF cases. Methods Consecutive patients undergoing AF ablation at 8 Italian centers were included in the CHARISMA registry. A RF ablation catheter equipped with mini-electrodes technology and a dedicated algorithm was used to measure LI and to guide ablation. For our purpose, we defined the time to drop (τ) as the time for the first deflection of LI drop to the plateau. RF applications were targeted to a LI drop of 10 Ω and were stopped when a maximum cut-off LI drop of <40 Ω was observed. Successful single RF ablation was defined according with a reduction of signal voltage by at least 50% and inability to capture local tissue on pacing. The ablation endpoint was PVI as assessed by entrance and exit block. Follow-up were scheduled at 3, 6 and 12 months post-ablation. Results 153 consecutive patients (61% paroxysmal AF, 39% persistent AF) were enrolled in the study. 3556 point-by-point first-pass RF applications of >10 s duration were performed around PVs. The mean LI drop was 13 ± 8Ω, the mean τ was 18.7 ± 13s and the median LI drop/τ was 0.67 [QI-QIII, 0.37 – 1.17] Ω/s. Both absolute drops in LI and LI drop/τ were greater at successful ablation sites (n = 3122, 88%) than at ineffective ablation sites (n = 434, 12%) (14 ± 8Ω vs 6 ± 4Ω, p < 0.0001 for LI; 0.73[0.41–1.25]Ω/s vs 0.35[0.22–0.59]Ω/s for LI drop/τ, p < 0.0001). Every 5-point increment in LI drop was associated with successful ablation, with an OR of 3.13 (95%CI: 2.7 to 3.6, p < 0.0001), reaching the highest point when a value larger than 15 Ω was observed (99.9% of acute success). A significant trend was observed from lower to higher LI drop/τ values and a value greater than 0.65 Ω/s (best cut-off value on the basis of the ROC analysis) was significantly associated with successful RF delivery with an OR of 5.54 (95%CI: 4.31 to 7.11, p < 0.0001). No complications occurred during and after procedures. At 1-year follow-up, the AF recurrence rate was 12% after the 90-day blanking period. Conclusions The magnitude and time-course of the LI drop during RF delivery were associated with effective lesion formation. This ablation strategy for PVI guided by LI technology proved safe and effective, and resulted in a very low rate of AF recurrence over 1-year follow-up.

BioMime – A Sirolimus-eluting Coronary Stent System for the Treatment of Patients with De Novo Coronary Lesions – meriT-1 Report

2011 ◽  
Vol 6 (1) ◽  
pp. 39
Author(s):  
Keyword(s):  
Stent Thrombosis ◽  
Time Course ◽  
De Novo ◽  
Drug Eluting Stent ◽  
Cobalt Chromium ◽  
Cardiac Events ◽  
End Points ◽  
Safety And Efficacy ◽  
Binary Restenosis

Background:Since the first reported use of percutaneous transluminal coronary angioplasty, advances in the interventional cardiology arena have been fast paced. Developers and clinicians are adapting from the learning curve awarded by the time-course of drug-eluting stent (DES) evolution. BioMime™ sirolimus-eluting stent (SES) is a step towards biomimicry. The stent is built on a strut of ultra-low thickness (65μm), a cobalt–chromium platform using an intelligent hybrid of closed and open cells allowing for morphology-mediated expansion. It employs a well-known antiproliferative – sirolimus – that elutes from a known biodegradable copolymer formulation within 30 days. The resultant stent demonstrates almost 100% endothelialisation at 30 days in preclinical models.Methods:The meriT-1 was a prospective, single-arm, single-centre trial to evaluate the safety and efficacy of BioMime SES in 30 patients with a single de novo lesion in native coronary arteries. The primary safety and efficacy end-points were major adverse cardiac events (MACE) at 30 days and in-stent late lumen loss at eight months, as measured using quantitative coronary angiographic (QCA) method. Secondary safety and efficacy end-points included MACE at one and two years and angiographic binary restenosis at eight-month angiographic follow-up. Other end-points included the occurrence of stent thrombosis at acute, subacute, late and very late periods and the percentage of diameter stenosis by QCA.Results:No MACE were observed and the median in-stent late luminal loss in 20 (67%) subjects studied by QCA was 0.15mm, with 0% binary restenosis at eight-month follow-up. No stent thrombosis was observed up to one-year follow-up.Conclusions:In comparison to currently available DES, BioMime SES appears to have a considerable scientific basis for prevention of neointimal proliferation, restenosis and associated clinical events.

P4763High power radiofrequency ablation with fixed short duration is rapid, efficient and safe for circumferential pulmonary vein isolation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Schreieck ◽  
M Duckheim ◽  
U Yurtbil ◽  
J Flassak ◽  
C Scheckenbach ◽  
...  
Keyword(s):  
Left Atrium ◽  
Short Duration ◽  
Temperature Rise ◽  
Posterior Wall ◽  
Rf Ablation ◽  
Esophageal Temperature ◽  
Single Spot ◽  
Rf Applications ◽  
Circumferential Pulmonary Vein Isolation

Abstract Background Short duration 50 Watt radiofrequency (RF) ablation has been shown to be feasible for atrial fibrillation (AF) ablation with short procedure times. Purpose We evaluated 50 Watt RF power with a different fixed short application duration at the anterior and posterior left atrial wall using contact force (CF) sensing catheters for circumferential pulmonary vein isolation (PVI). Methods Consecutive patients (pts) with indication for de novo AF ablation (n=40, age 64±12 years) with paroxysmal (n=23) or persistent (n=17) AF underwent high density 3D mapping of the left atrium. Low voltage areas of more than 5% of the left atrium were only found in 20% of pts. Thereafter, circumferential PVI using CF sensing catheters was performed. For each RF application (50 Watt, RF duration 11–13s at the anterior wall, 9–11s at the posterior wall) a stable catheter tip position with minimal mean CF of 3g was required and application was stopped in case of CF more than 30g. Esophageal temperature measurement was performed with temperature cut off 39.0°C. In case of temperature rise, ablation protocol was switched to conventional 20 Watt RF applications for ablation adjacent to the esophagus. Results Complete PVI was achieved in all pts with 81±29 short RF applications resulting in cumulative RF applications duration of 13.1±4.2min and an ablation duration of 59±17min for complete PVI. Even RF application with low CF (3–5g) were effective. Due to esophageal temperature rise, switch to conventional RF application with 20 Watt was performed in 43% of pts at least at one posterior PV entrance. After a waiting period of 20 min only in 33% of pts any PV conduction recurs, in 28% of pts only at a single spot and reconnected fibers were not associated with low CF application at that spot, but clearly associated with low energy application at the posterior wall. All PV were successfully re-isolated in most of pts with a single spot high energy RF application. No serious complications occurred in association with PVI. Follow up will be available at presentation time. Conclusion RF ablation with 50 Watt fixed short duration is efficient and safe for circumferential PVI. Ablation procedure durations are shorter and early recurrence rates are lower compared to reported conventional ablation procedures. The importance of CF titration seems to be diminished by 50 Watt RF applications in the left atrium. Further follow up have to be waited.

P1447Use of novel local impedance-based catheter in typical right atrial flutter ablation: preliminary data from a multicenter Italian study

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
V Ducceschi ◽  
C Pandozi ◽  
A Arestia ◽  
L Rossi ◽  
G Bencardino ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Conduction Block ◽  
Right Atrial ◽  
Rf Ablation ◽  
Lesion Formation ◽  
Tissue Impedance ◽  
Novel Technology ◽  
Before And After ◽  
Acute Success ◽  
Tissue Characteristics

Abstract Funding Acknowledgements NO FUNDING Background Many studies demonstrated the importance of an optimal tissue contact to obtain safe and effective lesions and to improve the clinical outcome in ablation of cavotricuspid isthmus (CTI) for typical right atrial flutter (AFL). Data about a novel technology able to measure local tissue impedance (LI) providing a measure of tissue characteristics and lesion formation is still lacking in right atrium or CTI working. Purpose This analysis explores the relationship between LI measures and ablation spot lesion locations during ablation of CTI in common AFL patients (pts). Methods Consecutive pts undergoing AFL ablation from the CHARISMA registry were included. A novel RF ablation catheter with dedicated algorithm (DirectSense - DS -) was used to measure LI at the distal electrode of this catheter. Each targeted spot was characterized in terms of LI parameters during RF delivery at the lateral, intermediate and posterior portions of the CTI. Successful single RF ablation was defined according with a reduction of voltage (RedV) by at least 50% or split in two separate potentials (SPL). Ablation endpoint was the creation of bidirectional conduction block across the isthmus. Results A total of 135 ablation spot lesions were delivered in 20 pts (median 5 [3-11] lesions per pt): 7 (5%) at lateral, 88 (65%) at intermediate and 40 (30%) at posterior portions of the CTI. Acute success was obtained in all cases and no complications were observed. The median ablation time was 26 [17 – 36] seconds per lesion. 100 (74%) and 51 (38%) ablation spots were effective according with RedV or SPL, respectively. The mean LI was 106 ± 15Ω prior to ablation and 93 ± 13Ω after ablation (p < 0.0001, mean absolute LI drop 14 ± 7Ω, mean percentage LI drop 13%±6). Effective ablation spots showed a higher absolute impedance drop (15 ± 7Ω at effective RedV vs 9.6 ± 8Ω at ineffective RedV, p = 0.0001; 15.6 ± 7Ω at effective SPL vs 12.5 ± 7Ω at ineffective SPL, p = 0.0173) or % impedance drop (14%±6 at effective RedV vs 9%±7 at ineffective RedV, p < 0.0001; 14.5%±6 at effective SPL vs 11.6%±6 at ineffective SPL, p = 0.0103) compared with ineffective sites. No significant differences were found in terms of starting LI, ending LI or LI drop among CTI areas. The percentage of LI drop was associated both with RedV (odd ratio 1.17 (95%CI: 1.08 to 1.26, p = 0.0001)) and with SPL (odd ratio 1.08 (1.02 to 1.14, p = 0.0132)). Conclusion In our preliminary experience, measured LI before and after RF delivery and LI drop appear to be consistent and homogeneous across different CTI ablation locations. The magnitude of the LI drop was associated with effective lesion formation and conduction block.

scholarly journals Risk of de novo aneurysm formation in patients with a prior diagnosis of ruptured or unruptured aneurysm: systematic review and meta-analysis

2019 ◽  
Vol 131 (1) ◽  
pp. 14-24 ◽  
Author(s):  
Enrico Giordan ◽  
Giuseppe Lanzino ◽  
Leonardo Rangel-Castilla ◽  
Mohammad Hassan Murad ◽  
Waleed Brinjikji
Keyword(s):  
Systematic Review ◽  
Time Course ◽  
De Novo ◽  
Meta Analysis ◽  
Incidence Density ◽  
Ruptured Aneurysms ◽  
Aneurysm Formation ◽  
Significant Difference ◽  
De Novo Aneurysm

OBJECTIVEDe novo aneurysms are rare entities periodically discovered during follow-up imaging. Little is known regarding the frequency with which these lesions form or the time course. This systematic review and meta-analysis was undertaken to estimate the incidence of de novo aneurysms and to determine risk factors for aneurysm formation.METHODSThe authors searched multiple databases for studies of patients with unruptured and ruptured aneurysms describing the rate of de novo aneurysm formation. The primary outcome was incidence of de novo aneurysm formation. A meta-analysis was performed using a random-effects model. The authors examined the associations of multiple aneurysms, prior subarachnoid hemorrhage, smoking, sex, age at presentation, and hypertension with de novo aneurysm formation.RESULTSThe meta-analysis included 14,968 aneurysm patients who received imaging follow-up from 35 studies. The overall incidence of de novo aneurysm formation was 2% (95% CI 2%–3%) over a mean follow-up time of 8.3 years. The estimated incidence density was 0.3%/patient-year. There was no statistically significant difference in rates of de novo aneurysm formation between patients who had ruptured aneurysms and those with unruptured aneurysms. In 8 studies, 11.2% of de novo aneurysms were found in patients with ≤ 5 years of follow-up and 88.8% were found at > 5 years. The mean time to rupture for de novo aneurysms was 10 years.CONCLUSIONSThis systematic review demonstrates that formation of de novo aneurysms is rare. Overall, routine screening for de novo aneurysms is likely to be of low yield and could be performed at time intervals of at least 5 to 10 years.

Arabidopsis 4-COUMAROYL-COA LIGASE 8 contributes to the biosynthesis of the benzenoid ring of coenzyme Q in peroxisomes

2019 ◽  
Vol 476 (22) ◽  
pp. 3521-3532
Author(s):  
Eric Soubeyrand ◽  
Megan Kelly ◽  
Shea A. Keene ◽  
Ann C. Bernert ◽  
Scott Latimer ◽  
...  
Keyword(s):  
Oxidative Metabolism ◽  
Time Course ◽  
Reverse Genetics ◽  
De Novo ◽  
Coenzyme Q ◽  
Control Level ◽  
Wild Type ◽  
Fluorescent Reporters ◽  
Coa Ligase ◽  
Peroxisomal Targeting

Plants have evolved the ability to derive the benzenoid moiety of the respiratory cofactor and antioxidant, ubiquinone (coenzyme Q), either from the β-oxidative metabolism of p-coumarate or from the peroxidative cleavage of kaempferol. Here, isotopic feeding assays, gene co-expression analysis and reverse genetics identified Arabidopsis 4-COUMARATE-COA LIGASE 8 (4-CL8; At5g38120) as a contributor to the β-oxidation of p-coumarate for ubiquinone biosynthesis. The enzyme is part of the same clade (V) of acyl-activating enzymes than At4g19010, a p-coumarate CoA ligase known to play a central role in the conversion of p-coumarate into 4-hydroxybenzoate. A 4-cl8 T-DNA knockout displayed a 20% decrease in ubiquinone content compared with wild-type plants, while 4-CL8 overexpression boosted ubiquinone content up to 150% of the control level. Similarly, the isotopic enrichment of ubiquinone's ring was decreased by 28% in the 4-cl8 knockout as compared with wild-type controls when Phe-[Ring-13C6] was fed to the plants. This metabolic blockage could be bypassed via the exogenous supply of 4-hydroxybenzoate, the product of p-coumarate β-oxidation. Arabidopsis 4-CL8 displays a canonical peroxisomal targeting sequence type 1, and confocal microscopy experiments using fused fluorescent reporters demonstrated that this enzyme is imported into peroxisomes. Time course feeding assays using Phe-[Ring-13C6] in a series of Arabidopsis single and double knockouts blocked in the β-oxidative metabolism of p-coumarate (4-cl8; at4g19010; at4g19010 × 4-cl8), flavonol biosynthesis (flavanone-3-hydroxylase), or both (at4g19010 × flavanone-3-hydroxylase) indicated that continuous high light treatments (500 µE m−2 s−1; 24 h) markedly stimulated the de novo biosynthesis of ubiquinone independently of kaempferol catabolism.

Eine Therapie mit Everolimus und reduziertem Ciclosporin kann das Krebsrisiko von Nierentransplantierten verringern* (Sponsor: Novartis Pharma GmbH, Nürnberg)

2017 ◽  
Vol 05 (01) ◽  
pp. 22-22
Keyword(s):  
New Zealand ◽  
De Novo

ZusammenfassungDie Verknüpfung der A2309-Studie mit dem Australia and New Zealand Dialysis and Transplant (ANZDATA) Register erlaubte ein Follow up von 7 Jahren. Die Autoren bezeichnen diese Analyse als die bisher überzeugendste Evidenz, dass eine Immunsuppression mit de novo Everolimus und reduziertem Ciclosporin langfristig mit einer geringeren Krebsinzidenz nach Nierentransplantation assoziiert ist als die Standardtherapie.

Is 3 years adequate for tracking completely occluded coiled aneurysms?

2020 ◽  
Vol 133 (3) ◽  
pp. 758-764
Author(s):  
Eung Koo Yeon ◽  
Young Dae Cho ◽  
Dong Hyun Yoo ◽  
Su Hwan Lee ◽  
Hyun-Seung Kang ◽  
...  
Keyword(s):  
De Novo ◽  
Careful Monitoring ◽  
Surveillance Period ◽  
Radiological Data ◽  
De Novo Aneurysm ◽  
Low Probability ◽  
Almost All ◽  
Annual Risk

OBJECTIVEThe authors conducted a study to ascertain the long-term durability of coiled aneurysms completely occluded at 36 months’ follow-up given the potential for delayed recanalization.METHODSIn this retrospective review, the authors examined 299 patients with 339 aneurysms, all shown to be completely occluded at 36 months on follow-up images obtained between 2011 and 2013. Medical records and radiological data acquired during the extended monitoring period (mean 74.3 ± 22.5 months) were retrieved, and the authors analyzed the incidence of (including mean annual risk) and risk factors for delayed recanalization.RESULTSA total of 5 coiled aneurysms (1.5%) occluded completely at 36 months showed recanalization (0.46% per aneurysm-year) during the long-term surveillance period (1081.9 aneurysm-years), 2 surfacing within 60 months and 3 developing thereafter. Four showed minor recanalization, with only one instance of major recanalization. The latter involved the posterior communicating artery as an apparent de novo lesion, arising at the neck of a firmly coiled sac, and was unrelated to coil compaction or growth. Additional embolization was undertaken. In a multivariate analysis, a second embolization for a recurrent aneurysm (HR = 22.088, p = 0.003) independently correlated with delayed recanalization.CONCLUSIONSAlmost all coiled aneurysms (98.5%) showing complete occlusion at 36 months postembolization proved to be stable during extended observation. However, recurrent aneurysms were predisposed to delayed recanalization. Given the low probability yet seriousness of delayed recanalization and the possibility of de novo aneurysm formation, careful monitoring may be still considered in this setting but at less frequent intervals beyond 36 months.

Cerebellotrigeminal Dermal Dysplasia (Gómez-López-Hernández Syndrome)

2018 ◽  
Vol 16 (05) ◽  
pp. 362-368 ◽  
Author(s):  
Federica Sullo ◽  
Agata Polizzi ◽  
Stefano Catanzaro ◽  
Selene Mantegna ◽  
Francesco Lacarrubba ◽  
...  
Keyword(s):  
De Novo ◽  
Chromosomal Rearrangements ◽  
Number Of Patients ◽  
Wide Range ◽  
Visual Problems ◽  
Neurodevelopmental Abnormalities ◽  
Clinical Triad ◽  
High Degree ◽  
Motor Handicap

Cerebellotrigeminal dermal (CTD) dysplasia is a rare neurocutaneous disorder characterized by a triad of symptoms: bilateral parieto-occipital alopecia, facial anesthesia in the trigeminal area, and rhombencephalosynapsis (RES), confirmed by cranial magnetic resonance imaging. CTD dysplasia is also known as Gómez-López-Hernández syndrome. So far, only 35 cases have been described with varying symptomatology. The etiology remains unknown. Either spontaneous dominant mutations or de novo chromosomal rearrangements have been proposed as possible explanations. In addition to its clinical triad of RES, parietal alopecia, and trigeminal anesthesia, CTD dysplasia is associated with a wide range of phenotypic and neurodevelopmental abnormalities.Treatment is symptomatic and includes physical rehabilitation, special education, dental care, and ocular protection against self-induced corneal trauma that causes ulcers and, later, corneal opacification. The prognosis is correlated to the mental development, motor handicap, corneal–facial anesthesia, and visual problems. Follow-up on a large number of patients with CTD dysplasia has never been reported and experience is limited to few cases to date. High degree of suspicion in a child presenting with characteristic alopecia and RES has a great importance in diagnosis of this syndrome.

scholarly journals 64 Use of sirolimus-coated balloon in De novo lesions; mid-term follow-up from a single-centre registry

2021 ◽  
Author(s):  
Bhagya Harindi Loku Waduge ◽  
Harkaran Kalkat ◽  
Ameenathul Mazaya Fawzy ◽  
Abdullah Saif ◽  
Sampath Athukorala ◽  
...  
Keyword(s):  
De Novo ◽  
Single Centre
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