Ultrasound-guided extra-cardiac vagal stimulation during cardioneuroablationa-a pilot feasibility study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
R Piotrowski ◽  
A Zuk ◽  
J Baran ◽  
A Sikorska ◽  
T Krynski ◽  
...  
Keyword(s):  
Jugular Vein ◽  
Vagal Stimulation ◽  
Vasovagal Syncope ◽  
Cranial Nerves ◽  
Vagal Nerve ◽  
Electrode Position ◽  
Wisdom Tooth ◽  
Ultrasound Guided ◽  
Vein Wall ◽  
Jugular Veins

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf N/A Background. Cardioneuroablation (CNA) is a promising method for treatment of vagally-induced vasovagal syncope or functional atrio-ventricular block. Extra-cardiac vagal stimulation (ECVS) from the internal jugular vein is used during CNA to document asystolic response prior to CNA and lack of effects of vagal stimulation on heart rate after CNA.  The recommended technique is placing the pacing catheter under fluoroscopy in the internal right and left jugular vein up to the level of the upper wisdom tooth. However, this technique has several limitations such as increased radiation exposure, unselective cranial nerves stimulation and lack of visualization of vagal nerve. Ultrasound-guided (USG) approach may be an interesting option because it allows visualization of the vagal nerve and enables selective  stimulation under visual control. Purpose. To assess the utility of USG-guided ECVS during CNA procedures. Methods. The study group consisted of 6 patients (4 males, mean age 35 ± 12-year-old) underwent CNA.  Firstly, electrode for ECVS was introduced under fluoroscopy into the right and left jugular veins up to the level of the upper wisdom tooth and ECVS was performed. Next, the USG-guided examinations were performed in supine position with head extension. The probe was placed in the transverse plane above the medial edge of the sternocleidomastoid muscle. The course of vagal nerve was identified and place for imaging in the close neighborhood of the jugular vein was chosen. ECVS was performed when the electrode was in good contact with the vein wall and was in the vicinity of the vagal nerve. In both approaches vagal response (asystole and atrio-ventricular block) during ECVS was assessed before and after CNA. Results. In all patients ECVS was performed from both right and left jugular vein. Localization of vagal nerve using USG was possible in all patients and took less than one minute (see Figure). The effects of ECVS were identical using standard fluoroscopic and USG-guided approach. Conclusions. USG-guided ECVS during CNA is easy, results are comparable with standard fluoroscopic approach and is probably associated with less fluoroscopy. Since this non-invasive method is the only one which enables vagal nerve visualization, it should become a preferred approach when using ECVS during CNA procedures. Abstract Figure. A electrode position for USG-guided ECVS

Light Microscopy, Immunohistochemistry and Electron Microscopy of the Valves of the Lower Limb Veins and Jugular Veins

1992 ◽  
Vol 7 (1) ◽  
pp. 27-30 ◽  
Author(s):  
D. M. Butterworth ◽  
S. S. Rose ◽  
P. Clark ◽  
P. Rowland ◽  
S. Knight ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Lower Limb ◽  
Jugular Vein ◽  
Fibrous Tissue ◽  
Venous Disease ◽  
Muscle Fibres ◽  
Electron Microscopic ◽  
Vein Wall ◽  
Jugular Veins ◽  
Saphenous Veins

Objectives: To demonstrate the light, electron microscopy and immunohistochemistry appearances of the valves of lower limb veins and jugular veins of subject with evidence of venous disease. Design: A prospective study of saphenous veins obtained at post mortem examination and jugular vein obtained at time of surgery. Setting: Health Service district general hospital. Patients: Patients with no evidence of venous disease being treated in the hospital for unrelated conditions, or examined at autopsy in the Department of Pathology. Interventions: Sections of saphenous vein from the lower limb and jugular vein were examined using conventional histology, immunohistochemical staining and electron microscopy. Main outcome measures: Microscopic and electron microscopic appearances of histological sections of venous valves. Results: The valve agger contains an increased amount of fibrous tissue compared with the vein wall and saphenous and jugular veins. However, in saphenous veins the muscle layer of the wall could be traced across the base of the agger, but this was deficient in jugular valves. Electron microscopic examination showed that most of the valve cusp was composed of collagen fibrils, aggregated in irregularly arranged bundles. Elastic fibre material was present in the subendothelial zones. Nerve and muscle fibres were not present in the cusp. Conclusions: Valve cusps in both high and low pressure systems are similar, and the authors suggest that cusp/agger/vein wall complex is important for valve function.

Value of Ultrasound Guidance in Placement of Hemodialysis Access Catheters in Patients with End-Stage Renal Disease

2008 ◽  
Vol 74 (11) ◽  
pp. 1111-1113
Author(s):  
Chandra Hassan ◽  
H.T. Girishkumar ◽  
Bala Thatigotla ◽  
Muhammad Asad ◽  
Mahalingam Sivakumar ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Jugular Vein ◽  
Venous Occlusion ◽  
Central Vein ◽  
Ultrasound Guided ◽  
Hemodialysis Catheter ◽  
Ultrasound Assessment ◽  
Stage Renal Disease ◽  
End Stage

The increasingly frequent use of ultrasound for the placement of central venous catheters has shown improved results. This study examined the role of ultrasound in the placement of hemodialysis access catheters in patients with end-stage renal disease. The subjects were all end-stage renal disease patients admitted to our hospital between January 2004 and April 2005 and who underwent ultrasound-guided placement of a hemodialysis catheter in a central vein. All patients underwent perioperative ultrasound assessment of the venous access site, followed by fluoroscopic confirmation of the catheter placement. Data from medical charts and the hospital computer system were subjected to statistical analysis. A total of 126 patients underwent ultrasound-guided placement of a hemodialysis catheter in a central vein; 58 had undergone prior placement of a central vein catheter, but 69 had not. Patients in the later group had a 100 per cent success rate in catheter placement after ultrasound assessment of one central vein. Among patients who had previously undergone central vein catheterization, 29 had jugular venous occlusion, 12 had bilateral jugular venous occlusion and thus required placement of femoral venous catheters and, 15 patients had jugular vein stenosis and 2 patients had the jugular vein thrombosed. The use of ultrasound to assess the central veins facilitated the identification of vein suitable for catheterization and the avoidance of occluded central veins. This protocol is effective and improves patient safety.

Diagnostic block and radiofrequency ablation of the acromial branches of the lateral pectoral and suprascapular nerves for shoulder pain: a 3D cadaveric study

2021 ◽  
Vol 46 (4) ◽  
pp. 305-312
Author(s):  
John Tran ◽  
Philip Peng ◽  
Anne Agur ◽  
Nimish Mittal
Keyword(s):  
Radiofrequency Ablation ◽  
Shoulder Pain ◽  
Coracoid Process ◽  
Electrode Position ◽  
Anatomical Landmarks ◽  
Ultrasound Guided ◽  
Pectoral Nerve ◽  
Diagnostic Block ◽  
Superior Surface ◽  
Capture Rates

Background and objectivesAcromial branches of the lateral pectoral and suprascapular nerves have been proposed as targets for diagnostic block and radiofrequency ablation to treat superior shoulder pain; however, the nerve capture rates of these procedures have not been investigated. The objectives of this study were to use dissection and 3D modeling technology to determine the course of these acromial branches, relative to anatomical landmarks, and to evaluate nerve capture rates using ultrasound-guided dye injection and lesion simulation.MethodsUltrasound-guided dye injections, targeting the superior surface of coracoid process and floor of supraspinous fossa, were performed (n=5). Furthermore, needles targeting the superior and posterior surfaces of the coracoid process were placed under ultrasound guidance to simulate needle electrode position (n=5). Specimens were dissected, digitized, and modeled to determine capture rates of acromial branches of lateral pectoral and suprascapular nerves.ResultsThe course of acromial branches of lateral pectoral and suprascapular nerves were documented. Dye spread capture rates: acromial branches of lateral pectoral and suprascapular nerves were captured in all specimens. Lesion simulation capture rates: (1) when targeting superior surface of coracoid process, the entire acromial branch of lateral pectoral nerve was captured in all specimens and (2) when targeting posterior surface of coracoid process, the acromioclavicular and bursal branches of acromial branch of suprascapular nerve were captured in all specimens; coracoclavicular branch was captured in 3/5 specimens.ConclusionsThis study supports the anatomical feasibility of ultrasound-guided targeting of the acromial branches of lateral pectoral and suprascapular nerves. Further clinical investigation is required.

scholarly journals A Study of Malposition of Central Venous Catheter – A Comparative Study between Ultrasound Guided and Anatomical Landmark Technique

2018 ◽  
Vol 2 (3) ◽  
pp. 277-281
Author(s):  
Lalit Kumar Rajbanshi ◽  
Sambhu Bahadur Karki ◽  
Batsalya Arjyal
Keyword(s):  
Real Time ◽  
Internal Jugular Vein ◽  
Subclavian Vein ◽  
Jugular Vein ◽  
Venous Catheter ◽  
Anatomical Landmark ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Catheter Tip ◽  
Landmark Technique

Introduction: Central venous catheterization is a routine procedure for long-term infusion therapy and central venous pressure measurement. Sometimes, the catheter tip may be unintentionally placed at the position other than the junction of superior vena cava and right atrium. This is called malposition and can lead to erroneous pressure measurement, increase risk of thrombosis, venous obstruction or other life threatening complications like pneumothorax, cardiac temponade.Objectives: This study aimed to observe the incidence of the malposition and compare the same between ultrasound guided catheterization and blind anatomical landmark technique.Methodology: This study was a prospective comparative study conducted at the intensive care unit of Birat Medical College and Teaching Hospital for two-year duration. All the catheterizations were done either with the use of real time ultrasound or blind anatomical landmark technique. The total numbers of central venous catheterization, the total incidences of malposition were observed. Finally the incidences were compared between real time ultrasound guided technique and blind anatomical landmark technique.Results: In two-year duration of the study, a total of 422 central venous cannulations were successfully done. The real time ultrasound was used for 280 cannulations while blind anatomical landmark technique was used for 162 patients. The study observed various malposition in 36 cases (8.5%). The most common malposition was observed for subclavian vein to ipsilateral internal jugular vein (33.3%) followed by subclavian to subclavian vein (27.8%) and internal jugular to ipsilateral subclavian vein (16.7%). In four patients the catheter had a reverse course in the internal jugular vein while the tip was placed in pleural cavity in three cannulations. There was coiling of the catheter inside left subclavian vein in one patient. The malposition was significantly reduced with the use of the real time ultrasound (P< 0.001). However there is no significant difference in the incidence of the various malposition between ultrasound guidance technique and blind anatomical landmark technique when compared individually.Conclusion: The malposition of the central venous catheter tip was common complication with the overall incidence of 8.5%. The most common malposition was subclavian vein to internal jugular vein. The use of real time ultrasound during the catheterization procedure can significantly reduced the risk of malposition.Birat Journal of Health SciencesVol.2/No.3/Issue 4/Sep- Dec 2017, Page: 277-281

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