Abstract 4088: Isolated Potentials and Pace-Mapping to Guide Ablation for Ventricular Tachycardia in Patients with Non-Ischemic Cardiomyopathy

Background : Isolated potentials (IPs) during sinus rhythm are indicators of fixed scar in patients with prior infarcts. IPs in conjunction with pace-mapping (PM) have been helpful to guide ablation of post-infarction ventricular tachycardia (VT). The purpose of this study was to determine the value of IPs in conjunction with PM to guide VT ablation in patients with non-ischemic cardiomyopathy. Methods : 32 consecutive patients (23 male, age 56±13 years, ejection fraction 0.30±0.14) with VT and non-ischemic cardiomyopathy were analyzed. Thirty/32 patients had an implanted cardioverter defibrillator (ICD). Electroanatomic maps of the left (n=21) and right ventricle (n=13), the coronary sinus (n=3), and the epicardium (n=4) were obtained during baseline rhythm. PM was performed at sites with low voltage (<1.5mV). Radiofrequency energy was delivered at sites with concealed entrainment or matching pace-maps. Mean follow-up time was 10±9 months. Results : 173 VTs (cycle length 359±86 ms) were induced. Appropriate ablation sites with IPs during sinus rhythm were recorded in 19/32 patients (59%) (group A). In these patients, a total of 195 appropriate target sites were identified for 56/100 induced VTs (56%); 136/195 sites (70%) displayed IPs. In the remaining 13 patients, no target sites with IPs were identified (group B) despite combined endocardial and transcutaneous epicardial mapping in 3/13 patients. In these 13 patients, a total of 96 appropriate target sites were identified for 25/73 induced VTs (34%). Fifteen/19 patients (79%) in group A were non-inducible at the end of the procedure compared to 2/13 patients (15%) in group B. During a mean follow-up of 10±9 months, 15/19 patients (79%) in group A compared to 1/13 patients (8%) in group B remained arrhythmia free (p=0.0002). Conclusion : IPs in conjunction with PM are helpful in identifying critical isthmus areas for ablation of VT in patients with non-ischemic cardiomyopathy. Differences in the extent of fixed scar tissue may be the reason for differences in the prevalence of IPs, and this might explain better ablation results in some patients with non-ischemic cardiomyopathy.

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Low-voltage-area ablation in paroxysmal atrial fibrillation: Extended follow-up results of the VOLCANO trial

10.22541/au.161661216.67499040/v1 ◽

2021 ◽

Author(s):

Masaharu Masuda ◽

Mitsutoshi Asai ◽

Osamu Iida ◽

Shin Okamoto ◽

Takayuki Ishihara ◽

...

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Low Voltage ◽

Recurrence Rates ◽

Group A ◽

C 32 ◽

Group B ◽

Group D

Introduction: The randomized controlled VOLCANO trial demonstrated comparable 1-year rhythm outcomes between patients with and without ablation targeting low-voltage areas (LVAs) in addition to pulmonary vein isolation among paroxysmal atrial fibrillation (AF) patients with LVAs. To compare long-term AF/atrial tachycardia (AT) recurrence rates and types of recurrent-atrial-tachyarrhythmia between treatment cohorts during a > 2-year follow-up period. Methods: An extended-follow-up study of 402 patients enrolled in the VOLCANO trial with paroxysmal AF, divided into 4 groups based on the results of voltage mapping: Group A, no LVA (n=336); group B, LVA ablation (n=30); group C, LVA presence without ablation (n=32); and group D, incomplete voltage map (n=4). Results: At 25 (23, 31) months after the initial ablation, AF/AT recurrence rates were 19% in group A, 57% in group B, 59% in group C, and 100% in group D. Recurrence rates were higher in patients with LVAs than those without (group A vs. B+C, p<0.0001), and were comparable between those with and without LVA ablation (group B vs. C, p=0.83). Among patients who underwent repeat ablation, ATs were more frequently observed in patients with LVAs (Group B+C, 50% vs. A, 14%, p<0.0001). In addition, LVA ablation increased the incidence of AT development (group B, 71% vs. C, 32%, p<0.0001), especially biatrial tachycardia (20% vs. 0%, p=0.01). Conclusion: Patients with LVAs demonstrated poor long-term rhythm outcomes irrespective of LVA ablation. ATs were frequently observed in patients with LVAs, and LVA ablation might exacerbate iatrogenic ATs.

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Obstructive sleep apnea, cardiac arrhythmias and continuous positive airway pressure therapy: one-year follow-up

Pneumologia ◽

10.2478/pneum-2020-0005 ◽

2020 ◽

Vol 69 (1) ◽

pp. 47-52

Author(s):

Liliana Alexandrina Grigoriu ◽

Stefan Dumitrache-Rujinski ◽

Radu Gabriel Vatasescu ◽

Ionela Erhan ◽

Miron Alexandru Bogdan

Keyword(s):

Sinus Rhythm ◽

Cardiac Arrhythmias ◽

Positive Airway Pressure ◽

Cpap Therapy ◽

Pressure Therapy ◽

Cpap Titration ◽

Obstructive Sleep ◽

Group A ◽

Group B

AbstractBackgroundCardiac arrhythmias represent one of the consequences of obstructive sleep apnea (OSA). The gold standard of moderate–severe symptomatic OSA treatment is positive pressure therapy [continuous positive airway pressure (CPAP)]. The use of CPAP in patients with cardiac arrhythmias and OSA may contribute to the maintenance of sinus rhythm.AimTo assess the effects of the CPAP therapy in addition to pharmacological and/or ablative interventions in maintaining the sinus rhythm in patients with cardiac arrhythmias and moderate–severe OSA.Materials and methodsPatients diagnosed with cardiac arrhythmias [atrial fibrillation (AF)/flutter] and high pretest OSA suspicion (at least two items out of the following: snoring, witnessed apneas, obesity and excessive daytime sleepiness), performed a cardiorespiratory polygraphy (nasal flowmetry, pulse oximetry, thoracoabdominal movements, snoring and body position) for positive diagnosis and OSA severity assessment. Patients with moderate–severe OSA underwent CPAP titration with consecutive therapy indication (CPAP therapy plus pharmacological and/or ablative intervention). At 1 year, patients who used CPAP (group A) and those without CPAP (group B) were re-evaluated for the presence or absence of cardiac arrhythmias.ResultsSixty-three patients with AF/flutter and high pretest suspicion of OSA performed cardiorespiratory polygraphy. Sixty patients (39 men) were diagnosed with OSA, out of which 40 (26 men) had moderate–severe OSA (apnea–hypopnea index, AHI ≥ 15/h) and underwent CPAP titration. At 1 year of follow-up, 17 patients (42.5%) were found adherent to the CPAP therapy (group A) and 23 (57.5%) did not use CPAP (group B). The two groups were similar in terms of age, body mass index, daytime sleepiness (assessed by Epworth Sleepiness Scale) and oxygen desaturation index, and statistically significant differences were recorded for the values of AHI and the time spent below SaO2 <90% (t90%), statistically significant higher (p < 0.01, respectively p < 0.04) in group A compared to group B. At 1 year, in group A, more patients had sinus rhythm compared to those with AF/flutter (13, respectively 4). In group B, 8 patients were in sinus rhythm and 15 with AF/flutter.ConclusionsThe CPAP therapy added to standard therapy (pharmacological therapy and/or ablative procedures) in patients with moderate–severe OSA and installed cardiovascular disease (arrhythmias) has a favourable effect on maintaining the sinus rhythm at 1 year of follow-up.

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TO DETERMINE THE ROLE OF RANOLAZINE FOR RHYTHM CONTROL STRATEGY IN PATIENTS WITH NON- VALVULAR ATRIAL FIBRILLATION- AN OBSERVATIONAL STUDY FROM A TERTIARY CARE CENTER. (RANOVA STUDY)

10.36106/gjra/9601756 ◽

2020 ◽

pp. 48-53

Author(s):

Praveen Shukla ◽

Awadhesh Kumar Sharma ◽

Biswajit Majumder ◽

Pritam Kumar Chatterjee ◽

Vinay Krishna ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Control Strategy ◽

Normal Sinus Rhythm ◽

Rhythm Control ◽

Normal Sinus ◽

History Of ◽

Group A ◽

Group B

Objectives – Non- valvular atrial fibrillation (NVAF) is the most commonly occurring arrhythmia worldwide .Ranolazine is an emerging drug with a ray of hope in the management of NVAF. This is the first large observational study with longer follow up of one year. Methods - It is a hospital based observational prospective study. A total of 100 patients was recruited for the study .The primary objective was to determine the efficacy of ranolazine in converting NVAF to sinus rhythm & the secondary objective was to study epidemiological aspects of NVAF. Results –After 1 month of follow up conversion to normal sinus rhythm was 12% in group A & 6% in group B (6%), it was not significant statistically (Z=1.48p=0.13). After 6 months, conversion to normal sinus rhythm was increased from 12% to 18% in group A which was preserved at 12 months of follow up and statistically significant and higher than that of group B (6.0%) (Z=2.61p=0.009). In predisposing risk factors & other co-morbidities HTN was present in 61%, obesity together with overweight in 37%, smoking in 44%, history of moderate amount of alcohol intake in 35%, history of CVA/TIA in 13%, DM in 11%, CKD in 4%, CAD in 30%, COPD in 20% and congestive heart failure in 15% of the patients. Conclusion- Ranolazine is an effective option when used for rhythm control strategy in NVAF. HTN is the predominant predisposing risk factor.

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Abstract 4089: Unique Epicardial Substrate in Non-Ischemic CM: Echo Signature, Electrogram Correlates and Outcome with Substrate Based Ablation

Circulation ◽

10.1161/circ.118.suppl_18.s_826-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Rupa Bala ◽

Oscar Cano ◽

Mathew D Hutchinson ◽

Fermin C Garcia ◽

Michael P Riley ◽

...

Keyword(s):

Ischemic Cardiomyopathy ◽

Low Voltage ◽

Left Ventricular ◽

Rf Ablation ◽

Distinct Area ◽

Normal Left Ventricular ◽

Voltage Mapping ◽

Low Amplitude ◽

Pace Mapping

We present a unique series of patients (pts) with non-ischemic cardiomyopathy (NICM) and unmappable ventricular tachycardia (VT) who demonstrated predominantly normal left ventricular (LV) endocardial (ENDO) voltage and abnormal epicardial (EPI) substrate defined by intracardiac echo (ICE) and fractionated electrograms (EGMS). This substrate served as an appropriate ablation target for VT. All patients underwent ICE imaging and detailed ENDO and EPI voltage mapping to further characterize the substrate and define the EGM correlates. 5 pts with NICM had increased echogenicity in the lateral epicardium by ICE imaging. Detailed LV ENDO mapping (199 ± 94.5 points) identified no voltage abnormalities in 4 pts. In one pt, a 16.2cm2 low voltage area in the LV ENDO was present and adjacent to the EPI abnormality. In all pts, detailed EPI mapping (477 ± 158 points) revealed a distinct area (20.6 ± 3.6 cm2) of low voltage (<1.0mV) that correlated with the echogenic area. These areas displayed low amplitude EGMS that were wide (>80msec), split, and late (beyond QRS). (Figure 1 ). After excluding coronary branch vessels and the course of the phrenic nerve, all pts underwent substrate based ablation based on pace-mapping and targeting of abnormal EGMS to eliminate the targeted VT. No VT has recurred during mean follow-up of 20mo (range 1–30 mo). Unique EPI substrate in NICM, defined by echo imaging and confirmed by EGM correlates, can be successfully targeted for RF ablation to provide effective VT control.

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Learning curve in performing radiofrequency ablation of accessory pathways in patients with Wolf-Parkinson-White syndrome

Medicinski pregled ◽

10.2298/mpns0610468v ◽

2006 ◽

Vol 59 (9-10) ◽

pp. 468-471

Author(s):

Dejan Vukajlovic ◽

Aleksandar Neskovic

Keyword(s):

Radiofrequency Ablation ◽

Learning Curve ◽

Success Rate ◽

Radiofrequency Energy ◽

Operator Experience ◽

Wpw Syndrome ◽

Accessory Pathways ◽

Group A ◽

Group B

Introduction. This study examines the effect of operator experience on radiofrequency ablation (RFA) of accessory pathways success rate in patients with Wolff-Parkinson-White (WPW) syndrome. Material and methods. The first 100 consecutive patients with WPW syndrome treated by radiofrequency ablation at our Clinic, were divided into group A (first 50 patients) and group B (the following 50 patients). Various parameters were compared between these 2 groups. Results. The success rate in group A was 69% and in group B 92%, p<0,01. There were 6 patients with recurrent WPW syndrome, after 3 months of follow-up, 5 were from group A and 1 from group B, p<0,05. Significantly more applications of radiofrequency energy were delivered in group A (10,0?4,8 in group A and 6,2 ?3,1 in group B, p<0,05). Two patients from group A presented with complications: one had intermittent complete AV-block, and the other pericardial effusion. Conclusion. This study shows a clear learning curve in performing RFA of accessory pathways in patients with WPW syndrome. .

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Absorbable suture material in carotid surgery

VASA ◽

10.1024/0301-1526/a000468 ◽

2015 ◽

Vol 44 (6) ◽

pp. 451-457 ◽

Cited By ~ 4

Author(s):

Vincenzo Gasbarro ◽

Luca Traina ◽

Francesco Mascoli ◽

Vincenzo Coscia ◽

Gianluca Buffone ◽

...

Keyword(s):

Suture Material ◽

Absorbable Suture ◽

Paediatric Surgery ◽

Carotid Surgery ◽

Suture Materials ◽

Absorbable Suture Material ◽

Absorbable Sutures ◽

Group A ◽

Group B

Abstract. Background: Absorbable sutures are not generally accepted by most vascular surgeons for the fear of breakage of the suture line and the risk of aneurysmal formation, except in cases of paediatric surgery or in case of infections. Aim of this study is to provide evidence of safety and efficacy of the use of absorbable suture materials in carotid surgery. Patients and methods: In an 11 year period, 1126 patients (659 male [58.5 %], 467 female [41.5 %], median age 72) underwent carotid endarterectomy for carotid stenosis by either conventional with primary closure (cCEA) or eversion (eCEA) techniques. Patients were randomised into two groups according to the type of suture material used. In Group A, absorbable suture material (polyglycolic acid) was used and in Group B non-absorbable suture material (polypropylene) was used. Primary end-point was to compare severe restenosis and aneurysmal formation rates between the two groups of patients. For statistical analysis only cases with a minimum period of follow-up of 12 months were considered. Results: A total of 868 surgical procedures were considered for data analysis. Median follow-up was 6 years (range 1-10 years). The rate of postoperative complications was better for group A for both cCEA and eCEA procedures: 3.5 % and 2.0 % for group A, respectively, and 11.8 % and 12.9 % for group B, respectively. Conclusions: In carotid surgery, the use of absorbable suture material seems to be safe and effective and with a general lower complications rate compared to the use of non-absorbable materials.

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Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

Reviews on Recent Clinical Trials ◽

10.2174/1574887114666190201111332 ◽

2019 ◽

Vol 14 (2) ◽

pp. 141-146

Author(s):

Simone Zanella ◽

Enrico Lauro ◽

Francesco Franceschi ◽

Francesco Buccelletti ◽

Annalisa Potenza ◽

...

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

The Elderly ◽

Long Term Follow Up ◽

Group A ◽

Group B ◽

Absorbable Tacks

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

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A Study on Frozen Shoulder and its clinical management through Nasaapana and Nasya

Journal of Ayurveda and Integrated Medical Sciences (JAIMS) ◽

10.21760/jaims.v1i1.3631 ◽

2016 ◽

Vol 1 (1) ◽

Author(s):

Praveenkumar H. Bagali ◽

A. S. Prashanth

Keyword(s):

Medical Science ◽

Frozen Shoulder ◽

Signs And Symptoms ◽

Treatment Modalities ◽

Animal Kingdom ◽

Shoulder Joints ◽

Group A ◽

Group B

The unique position of man as a master mechanic of the animal kingdom is because of skilled movements of his hands and when this shoulder joints get obstructed, we call it as Apabahuka (Frozen shoulder), we do not find satisfactory management in modern medical science. Various effective treatment modalities have been mentioned which reverse the pathogenesis, Shodhana is advised initially followed by Shamana therapies. In the present study 30 patients were selected incidentally and placed randomly into two groups A and B, with 15 subjects in each group. Group A received Amapachana with Panchakola Churna, Jambeera Pinda Sweda and Nasya Karma. Group B received Amapachana with Panchakola Churna, Jambeera pinda Sweda and Nasaapana. In both the groups two months follow up was done. Both groups showed significant improvement in the signs and symptoms of Apabahuka as well as the activities of daily livings, thereby improving the quality of life of the patients. Nasya Karma and Nasaapana provided highly significant results in all the symptoms of Apabahuka. In the present study as per the clinical data, Nasaapana is found to be more effective than Nasya Karma.

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A Comparative Study of Amalaki Choorna along with Madhu and Vata Twak Kashaya Yoni Pichu Dharana in the Management of Shweta Pradara

Journal of Ayurveda and Integrated Medical Sciences (JAIMS) ◽

10.21760/jaims.v2i4.9322 ◽

2017 ◽

Vol 2 (4) ◽

Author(s):

Renuka M. Tenahalli

Keyword(s):

Vitamin C ◽

Early Stage ◽

Pathological Condition ◽

Before And After ◽

Group A ◽

Phosphorus Iron ◽

Group B ◽

Busy Schedule ◽

Iron And Calcium

Shweta Pradara (Leucorrhoea) is the disease which is characterized by vaginal white discharge. Vaginal white discharge this symptom is present in both physiological and pathological condition, when it becomes pathological it disturbs routine life style of the woman. Most of the women in the early stage will not express the symptoms because of hesitation and their busy schedule. If it is not treated it may leads to chronic diseases like PID (Garbhashaya Shotha etc.) Charaka mentioned Amalaki Choorna along with Madhu and Vata Twak Kashaya Yoni Pichu Dharana. This treatment is used in Shweta Pradara shown positive results, hence a study was under taken to assess its clinical efficacy. 30 diagnosed patients of Shweta Pradara were randomly selected, allocated in three groups. Group A and Group B received Amalaki Choorna with Madhu and Vata Twak Kashaya Yoni Pichu Dharana respectively and Group C received Amalaki Choorna with Madhu followed by Vata Twak Kashaya Yoni Pichu Dharana for 15 days. The patients were assessed for the severity of the symptoms subjectively and objectively before and after the treatment and at the end of the follow up. Data from each group were statistically analyzed and were compared. No side effects were noted and it may be considered as an effective alternative medicine in Shweta Pradara (leucorrhea). Amalaki is rich in natural source of vitamin C and contains phosphorus, iron and calcium. Honey contains carbohydrate, vitamin C, phosphorus iron and calcium. All together these help to increase Hb% and immunity. Vata Twak Kashaya contains tannin which helps to maintain normal pH of the vagina.

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Oral Tranexamic Acid for the Treatment of Melasma

Kathmandu University Medical Journal ◽

10.3126/kumj.v10i4.10993 ◽

2014 ◽

Vol 10 (4) ◽

pp. 40-43 ◽

Cited By ~ 26

Author(s):

D Karn ◽

S KC ◽

A Amatya ◽

EA Razouria ◽

M Timalsina

Keyword(s):

Tranexamic Acid ◽

Controlled Trial ◽

Severity Index ◽

Sustained Improvement ◽

Treatment Measures ◽

Group A ◽

Group B ◽

Novel Concept ◽

High Treatment

Background Melasma poses a great challenge as its treatment is unsatisfactory and recurrence is high. Treatment of melasma using tranexamic acid (oral, topical or intralesional) is a novel concept. Objective To compare the efficacy of oral tranexamic acid with routine topical therapies for the treatment of melasma. Methods It is a prospective, interventional, randomized controlled trial conducted among 260 melasma patients. Patients were divided into two groups consisting of 130 patients each. First group (Group A) was given routine treatment measures and oral Tranexamic Acid while second group (Group B) was treated only with routine topical measures. Capsule Tranexamic Acid was prescribed at a dose of 250 mg twice a day for three months and cases were followed for three months. Response was evaluated on the basis of Melasma Assessment Severity Index (MASI). Mean scores between the two groups were then compared. Results Statistically significant decrease in the mean Melasma Assessment Severity Index from baseline to 8 and 12 weeks was observed among group A patients (11.08±2.91 vs 8.95±2.08 at week 8 and vs. 7.84±2.44 at week 12; p<0.05 for both). While among group B patients the decrease in mean score was significant at 8 weeks and insignificant at 12 weeks follow up (11.60±3.40 vs 9.9±2.61 at 8 weeks and vs. 9.26±3 at 12 weeks; p<0.05 for former but p>0.05 for later). Conclusion Addition of oral tranexamic acid provides rapid and sustained improvement in the treatment of melasma. DOI: http://dx.doi.org/10.3126/kumj.v10i4.10993 Kathmandu Univ Med J 2012;10(4):40-43

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