scholarly journals Radiofrequency catheter denervation of sinus node: a randomized comparison of right and left atrial approach for the cardioneuroablation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
D Wichterle ◽  
H Jansova ◽  
P Stiavnicky ◽  
P Peichl ◽  
P Stojadinovic ◽  
...  
Keyword(s):  
Left Atrial ◽  
Superior Vena ◽  
Sinus Node ◽  
Vena Cava ◽  
Right Atrial ◽  
High Frequency Stimulation ◽  
Sinus Rate ◽  
Neurally Mediated Syncope ◽  
Significant Difference ◽  
Final Effect

Abstract Funding Acknowledgements Type of funding sources: None. Background Radiofrequency catheter ablation of superior paraseptal ganglionic plexus is an important step to eliminate the vagal modulation of sinus node for the treatment of neurally-mediated syncope. The reasonable effect can be achieved by targeting this plexus from the endocardial aspect of both right (RA) and left (LA) atria. Purpose We investigated the efficacy of RA and LA ablation in terms of sinus nodal denervation. Methods The study included 24 patients (age: 42 ± 13 years, 50% males) who underwent cardioneuroablation for recurrent cardioinhibitory syncope in general anesthesia. Right atrial semicircular lesion at the posteroseptal quadrant of superior vena cava ostium was composed of 5-6 equidistantly distributed ablation sites (30 W, 30 s, 20 ml/min).  Left atrial lesion of comparable size was placed strictly contralaterally across the interatrial septum in the anterior vestibulum of a right superior pulmonary vein. Patients were randomly (1:1) assigned to RA-to-LA or LA-to-RA ablation. Sinus rate and the response to extracardiac right vagal nerve high-frequency stimulation (50 Hz, 0.05 ms, 1 V/kg [<70V], 5 s) were recorded at baseline and after each ablation cluster. Results Study protocol ablations overall resulted in sinus acceleration (81 ± 13 vs. 59 ± 12 bpm, P <0.0001) and attenuation of inducible sinus arrests (maximum pause: 1.2 ± 1.4 vs. 5.5 ± 3.0 s, P <0.0001). Temporal development of outcome measures with the progression of ablation is shown in the Figure. There was no significant difference between study groups. Irrespective of ablation order, the first ablation cluster on average generated 77% of the final effect on sinus rate and 68% of the final effect on suppression of vagally-induced sinus pauses.   Conclusions  Neither RA nor LA approach is preferable for targeting the superior paraseptal ganglionic plexus. Both ablation clusters convey complementary and, in part, mutually independent effects. Biatrial cardioneuroablation seems essential for efficacious sinus nodal denervation. Abstract Figure.

Single-Patch Fold-Back Technique for Augmentation of the Superior Vena Cava in Sinus Venosus Atrial Septal Defect Associated with Partial Anomalous Pulmonary Venous Return

2015 ◽  
Vol 17 (6) ◽  
pp. 282
Author(s):  
Suguru Ohira ◽  
Kiyoshi Doi ◽  
Takeshi Nakamura ◽  
Hitoshi Yaku
Keyword(s):  
Atrial Septal Defect ◽  
Superior Vena Cava ◽  
Septal Defect ◽  
Venous Return ◽  
Superior Vena ◽  
Pulmonary Veins ◽  
Vena Cava ◽  
Sinus Venosus ◽  
Right Atrial ◽  
Anomalous Pulmonary Venous Return

Sinus venosus atrial septal defect (ASD) is usually associated with partial anomalous pulmonary venous return (PAPVR) of the right pulmonary veins to the superior vena cava (SVC), or to the SVC-right atrial junction. Standard procedure for repair of this defect is a patch roofing of the sinus venosus ASD and rerouting of pulmonary veins. However, the presence of SVC stenosis is a complication of this technique, and SVC augmentation is necessary in some cases. We present a simple technique for concomitant closure of sinus venosus ASD associated with PAPVR and augmentation of the SVC with a single autologous pericardial patch.

Partial Anomalous Pulmonary Venous Connection: Forty-Six Years of Follow-Up

2021 ◽  
Vol 12 (1) ◽  
pp. 70-75
Author(s):  
Anne Kathrine M. Nielsen ◽  
Vibeke E. Hjortdal
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Sinus Node ◽  
Vena Cava ◽  
Node Disease ◽  
Sinus Node Disease ◽  
Patch Technique ◽  
Anomalous Pulmonary Venous Connection

Background: Surgical repair of partial anomalous pulmonary venous connection (PAPVC) may disturb the electrical conduction in the atria. This study documents long-term outcomes, including the late occurrence of atrial tachyarrhythmia and bradyarrhythmia. Methods: This retrospective study covers all PAPVC operations at Aarhus University Hospital between 1970 and 2010. Outcome measures were arrhythmias, sinus node disease, pacemaker implantation, pathway stenosis (pulmonary vein(s), intra-atrial pathway, and/or superior vena cava), and mortality. Data were collected from databases, surgical protocols, and hospital records until May 2018. Results: A total of 83 patients were included with a postoperative follow-up period up to 46 years. Average age at follow-up was 43 ± 21 years. During follow-up, new-onset atrial fibrillation or atrial flutter appeared in four patients (5%). Sinus node disease was present in nine patients (11%). A permanent pacemaker was implanted in seven patients (8%) at an average of 12.7 years after surgery. Pulmonary venous and/or superior vena cava obstruction was seen in five patients (6%). Stenosis was most prevalent in the two-patch technique, and arrhythmia was most prevalent in the single-patch technique. Sixty-seven (81%) of 83 patients had neither bradyarrhythmias nor tachyarrhythmias or pacemaker need. Conclusions: This study contributes important long-term data concerning the course of patients who have undergone repair of PAPVC. It confirms that PAPVC can be operated with low postoperative morbidity. However, late-onset stenosis, bradyarrhythmias and tachyarrhythmias, and need for pacemaker call for continued follow-up.

scholarly journals Multicenter study of novel mapping technique to detect non-pulmonary vein triggers excluding the origin from left atrial posterior wall and superior vena cava

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Matsunaga ◽  
Y Egami ◽  
M Yano ◽  
M Yamato ◽  
R Shutta ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Superior Vena Cava ◽  
Left Atrial ◽  
Medical Center ◽  
Superior Vena ◽  
Vena Cava ◽  
Posterior Wall ◽  
Mapping Technique ◽  
Left Atrial Posterior ◽  
Self Reference

Abstract Background It has been reported that elimination of non-pulmonary vein (PV) triggers after PV isolation is a good predictor of atrial tachyarrhythmia free survival. However, precise mapping of triggers outside from superior vena cava (SVC) or left atrial posterior wall (LAPW) are difficult. The aim of this study is to assess the efficacy of self-reference mapping technique to eliminate non-PV triggers originated from outside of primordial pulmonary vein area. Methods Total of 431 patients (446 procedures) underwent atrial fibrillation (AF) ablation in a hospital and in a medical center from January 2017 to March 2019. After isolation of PV, non-PV triggers were induced with isoproterenol and/or adenosine triphosphate. Reproducible non-PV triggers were targeted to ablate using following self-reference mapping technique: A trigger conducts centrifugally and the earliest site should be distinguished from other later activated sites. Using a PentaRay multipolar catheter, the operators annotated the earliest site of local activation and a reference tag was placed. The multipolar catheter was then moved to the reference tag and the process repeated. Ultimately, we identified clusters of early circumferential activation and ablated. Results A total of 32 non-PV triggers excluding the origin from LAPW and SVC were induced in 23 patients. Nineteen triggers (59%) were located in the right atrium and 13 triggers (41%) in the left atrium (Figure 1). All triggers were eliminated with ablation and AF was non-inducible in all patients at the end of the procedure. During the follow-up (529±270 days), 18 patients (77%) were free from atrial tachyarrhythmias after a 3-month blanking period. Three patients received additional ablation procedures for recurrent atrial arrhythmias. No non-PV triggers ablated during the previous procedure were observed. Conclusion A novel self-reference mapping technique is useful for eliminating non-PV triggers in terms of the short- and long-term success. Figure 1. Distribution of non-PV triggers Funding Acknowledgement Type of funding source: None

Increased cardiac output following occlusion of the descending thoracic aorta in dogs

1982 ◽  
Vol 243 (1) ◽  
pp. R152-R158 ◽  
Author(s):  
J. K. Stene ◽  
B. Burns ◽  
S. Permutt ◽  
P. Caldini ◽  
M. Shanoff
Keyword(s):  
Cardiac Output ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Thoracic Aorta ◽  
Vascular System ◽  
Superior Vena ◽  
Vena Cava ◽  
Right Atrial ◽  
Mean Systemic Pressure ◽  
Extracorporeal Bypass

Occlusion of the thoracic aorta (AO) in dogs with a constant volume right ventricular extracorporeal bypass increased cardiac output (Q) by 43% and mean arterial pressure by 46%, while mean systemic pressure (MSP) was unchanged. We compared AO with occlusion of the brachiocephalic and left subclavian arteries (BSO) which decreased cardiac output by 5%, increased mean arterial pressure by 32%, and increased MSP by 11%. We feel these results confirm that AO elevates preload by transferring blood volume from the splanchnic veins to the vascular system drained by the superior vena cava. If the heart is competent to keep right arterial pressure at or near zero, this increase in preload will elevate Q above control levels. Comparing our data with results of other authors who have not controlled right atrial pressure, emphasizes the importance of a competent right ventricle in allowing venous return to determine Q.

Influence of right atrial stretch on plasma renin activity in the conscious rat

1987 ◽  
Vol 65 (2) ◽  
pp. 257-259 ◽  
Author(s):  
Susan Kaufman
Keyword(s):  
Plasma Renin Activity ◽  
Superior Vena ◽  
Vena Cava ◽  
Extracellular Fluid ◽  
Plasma Renin ◽  
Renin Activity ◽  
Right Atrial ◽  
Balloon Inflation ◽  
Conscious Rat ◽  
Basal Plasma

Rats were prepared with inflatable balloons at the superior vena cava – right atrium junction. After recovery 1 week later, when blood was taken from conscious, normovolaemic animals plasma renin activity was found not to be influenced by right atrial stretch. Plasma renin activity was then measured in rats in which an extracellular fluid deficit had been produced by peritoneal dialysis against a hyperoncotic, isotonic solution. Although basal plasma renin activity was elevated (6.8 ± 0.9 from 1.5 ± 0.2 ng∙mL∙h, n = 19), no depression was observed in the experimental group after 15 or 90 min of balloon inflation. In rats pretreated with isoprenaline (10 μg/kg body wt.) plasma renin activity was also increased over basal levels, but again balloon inflation caused no reduction in plasma renin activity. It would appear that right atrial stretch has little, if any, influence on renin release in the conscious rat.

Sinus Node Injury as a Result of Superior Vena Cava Isolation during Catheter Ablation for Atrial Fibrillation and Atrial Flutter

2010 ◽  
Vol 34 (2) ◽  
pp. 163-170 ◽  
Author(s):  
GANG CHEN ◽  
JIAN ZENG DONG ◽  
XING PENG LIU ◽  
XIN YONG ZHANG ◽  
DE YONG LONG ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Flutter ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Sinus Node ◽  
Vena Cava

Widespread distribution and rate differentiation of the atrial pacemaker complex

1980 ◽  
Vol 239 (3) ◽  
pp. H406-H415 ◽  
Author(s):  
J. P. Boineau ◽  
R. B. Schuessler ◽  
D. B. Hackel ◽  
C. B. Miller ◽  
C. W. Brockus ◽  
...  
Keyword(s):  
Superior Vena ◽  
Sinus Node ◽  
P Wave ◽  
Right Atrial ◽  
Superior Vena Caval ◽  
Heart Rates ◽  
Widespread Distribution ◽  
Depolarization Wave ◽  
Lower Limits ◽  
Origin Point

In a study to examine the basis of rate-related changes in the electrocardiographic P wave we found a multicentric rather than unifocal origin of the atrial depolarization wave in dogs. Three to five pacemakers, or origin points, were distributed over a 30- to 40-mm area compared to the 11-mm size of the sinus node. Two or three of the sites could excite simultaneously, or one specific site would dominate excitation. Each separate origin point dominated excitation within a specific range of heart rates, and on reaching either the upper or lower limits of this range, a new focus abruptly dominated and initiated the atrial wave front. We have obtained evidence to suggest that these findings may be explained by a widely distributed atrial pacemaker complex. The spatial distribution of this system exceeded the dimensions of the canine sinus node by a factor of three to four times. The pacemaker centers, although distributed, were consistently located at specific positions along the superior vena caval-right atrial junction. Also, each separate pacemaker site appeared functionally differentiated to generate a specific range of heart rates. We propose that in addition to the sinus node there are other specialized atrial pacemaker centers, and that this specialization, including the differentiated response and coordination, is conferred by focal receptor characteristics and their inputs.

scholarly journals Recurrent cardiac hydatid cyst located near the root of the superior vena cava and the interatrial septum: a case report

2022 ◽  
pp. 1-4
Author(s):  
Redha Lakehal ◽  
Farid Aymer ◽  
Soumaya Bendjaballah ◽  
Rabah Daoud ◽  
Khaled Khacha ◽  
...  
Keyword(s):  
Hydatid Cyst ◽  
Facial Paralysis ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Lower Lobe ◽  
Lateral Wall ◽  
Right Atrial ◽  
Risk Of Rupture ◽  
The Right

Introduction: Cardiac localization of hydatid disease is rare (<3%) even in endemic countries. Affection characterized by a long functional tolerance and a large clinical and paraclinical polymorphism. Serious cardiac hydatitosis because of the risk of rupture requiring urgent surgery. The diagnosis is based on serology and echocardiography. The aim of this work is to show a case of recurrent cardiac hydatid cyst discovered incidentally during a facial paralysis assessment. Methods: We report the observation of a 26-year-old woman operated on in 2012 for pericardial hydatid cyst presenting a cardiac hydatid cyst located near the abutment of the SCV discovered incidentally during an exploration for left facial paralysis: NYHA stage II dyspnea. Chest x-ray: CTI at 0.48. ECG: RSR. Echocardiography: Image of cystic appearance at the level of the abutment of the SVC. SAPP: 38 mmhg, EF: 65%. Thoracic scan: 30/27 mm cardiac hydatid cyst bulging the lateral wall of the right atrium and the trunk of the right pulmonary artery with fissured cardiac hydatid cyst of the apical segment of the right lung of the right lower lobe with multiple bilateral intra parenchymal and sub pleural nodules. The patient was operated on under CPB. Intraoperative exploration: Presence of a hard and whitish mass, about 03 / 03cm developed in the full right atrial wall opposite the entrance to the superior vena cava. Procedure: Resection of the mass removing the roof of the LA, the AIS and the wall of the RA with reconstruction of the roof of the RA by patch in Dacron and reconstruction of the IAS and the wall of the RA by a single patch in Dacron. Results: The postoperative suites were simple. Conclusion: The hydatid cyst is still a real endemic in Algeria, the cardiac location is rare but serious and can constitute a real surgical emergency, hence the importance of prevention. Keywords: Hydatid cyst of the heart; Recurrence; Surgery; Cardiopulmonary Bypass; Prevention

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