scholarly journals Contemporary procedure characteristics and outcomes of accessory atrioventricular pathway ablations in an integrated community-based health care system using a tiered approach

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charlie Young ◽  
Annie Kwan ◽  
Lisa Yepez ◽  
Meghan McCarty ◽  
Amanda Chan ◽  
...  
Keyword(s):  
Success Rate ◽  
Accessory Pathway ◽  
Cost Effective ◽  
Procedure Time ◽  
Community Based ◽  
Tiered Approach ◽  
Accessory Pathways ◽  
Ablation Success ◽  
Accessory Atrioventricular Pathway ◽  
Time Parameters

Abstract Background Since the early descriptions of large series of accessory atrioventricular pathway ablations in adults and adolescents over 20 years ago, there have been limited published reports based on more recent experiences of large referral centers. We aimed to characterize accessory pathway distribution and features in a large community-based population that influence ablation outcomes using a tiered approach to ablation. Methods Retrospective analysis of 289 patients (age 14–81) who underwent accessory ablation from 2015–2019 was performed. Pathways were categorized into anteroseptal, left freewall, posteroseptal, and right freewall locations. We analyzed patient and pathway features to identify factors associated with prolonged procedure time parameters. Results Initial ablation success rate was 94.7% with long-term success rate of 93.4% and median follow-up of 931 days. Accessory pathways were in left freewall (61.6%), posteroseptal (24.6%), right freewall (9.6%), and anteroseptal (4.3%) locations. Procedure outcome was dependent on pathway location. Acute success was highest for left freewall pathways (97.1%) with lowest case times (144 ± 68 min) and fluoroscopy times (15 ± 19 min). Longest procedure time parameters were seen with anteroseptal, left anterolateral, epicardial-coronary sinus, and right anterolateral pathway ablations. Conclusions In this community-based adult and adolescent population, majority of the accessory pathways are in the left freewall and posteroseptal region and tend to be more easily ablated. A tiered approach with initial use of standard ablation equipment before the deployment of more advance tools, such as irrigated tips and 3D mapping, is cost effective without sacrificing overall efficacy.

scholarly journals Contemporary procedure characteristics and outcomes of accessory atrioventricular pathway ablations in an integrated community-based health care system

2021 ◽  
Author(s):  
Charlie Young ◽  
Annie Kwan ◽  
Lisa Yepez ◽  
Meghan McCarty ◽  
Amanda Chan ◽  
...  
Keyword(s):  
Success Rate ◽  
Procedure Time ◽  
Community Based ◽  
Ablation Success ◽  
Accessory Atrioventricular Pathway ◽  
Acute Success ◽  
Time Parameters ◽  
Traditional Approaches ◽  
Short Time

Abstract Purpose Descriptions of large series of accessory atrioventricular pathway (AP) ablations in adults and adolescents have been limited to referral centers and published over 20 years ago. We aimed to characterize contemporary accessory AP distribution and features in a large community-based population that influence ablation outcomes. Methods Retrospective analysis of 289 patients (age 14–81) who underwent AP ablation from 2015–2019 was performed. Pathways were categorized into anteroseptal (AS), left freewall (LFW), posteroseptal (PS), and right freewall (RFW) locations. We analyzed patient and pathway features to identify factors associated with prolonged procedure time parameters. Results Initial ablation success rate was 94.7% with long-term success rate of 93.4% and median follow-up of 931 days. APs were in LFW (61.6%), PS (24.6%), RFW (9.6%), and AS (4.3%) locations. Procedure outcome was dependent on pathway location. Acute success was highest for LFW pathways (97.1%) with lowest case times (144 ± 68 minutes) and fluoroscopy times (15 ± 19 minutes). Longest procedure time parameters were seen with AS, left anterolateral, epicardial-coronary sinus, and right anterolateral pathway ablations. A novel ECG algorithm was developed to predicts AP locations and further guide procedure planning. Conclusion In this community-based population, majority of APs are located in the left freewall and posteroseptal region, with only retrograde conduction, and can be ablated using traditional approaches with short time parameters and high success. Using a novel ECG algorithm for pathway localization, we can predict cases with longer procedure times, higher fluoroscopy exposure, and lower acute and long-term success for manifest pathways.

scholarly journals Radio Frequency Ablation of right sided accessory pathway - 8 years experience at SGNHC

2013 ◽  
Vol 8 (1) ◽  
pp. 19-22
Author(s):  
R Raut ◽  
MB KC ◽  
S Rajbhandari ◽  
M Dhungana ◽  
R Shah ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Radio Frequency ◽  
Success Rate ◽  
Recurrence Rate ◽  
Supraventricular Tachycardia ◽  
Accessory Pathway ◽  
Demographic Characteristics ◽  
Radio Frequency Ablation ◽  
Accessory Pathways

Background Radiofrequency ablation has been established as the curative treatment for most of supraventricular tachycardia since 1987. In SGNHC, ablation has been done routinely since 2003. In our experience, right sided accessory pathway (AP) has been technically difficult and challenging with low success rate as mentioned in literature outside. So, the objective of this article was to analyze the demographic characteristics, success and recurrence rate and complication of right sided AP ablation in our centre. Methods and Materials From 13th Oct 2003 to 9th Sept. 2011, altogether 768 patients who underwent ablation were analyzed. Result Among 768 patients, 416(54.2%) were accessory pathways out of which 72(17.3%) were right sided AP. Majority of right sided accessory pathway were manifest (WPW) comprising 77.1%, significantly higher compare to left sided pathway where manifest AP was only 44.1 % (p< 0.001). Among all attempted ablation of right sided AP, 11 ablations failed so that the success rate was 84.7% lower than that of left sided pathway where success rate was 98.4% (p<0.001). Among 61 successful ablations, 2 relapsed during follow up period, recurrence rate being 3.3%. Although there were few complications in the ablation of other tachyarrhythmia, there was no complication noted during the ablation of 72 right sided AP. Conclusion Right sided pathway are mostly manifest. The success rate of right sided pathway is lower in comparison to left sided pathway. Our success rate is comparable to the result in the literature which indicates that ablation of right sided accessory pathway in our centre is reasonably good. DOI: http://dx.doi.org/10.3126/njh.v8i1.8332 Nepalese Heart Journal Vol.8(1) 2011 pp.19-22

E-Voting Kepala Desa dan Modal Sosial

2019 ◽  
Vol 2 (6) ◽  
pp. 759
Author(s):  
Khaulah Afifah ◽  
Lala M Kolopaking ◽  
Zessy Ardinal Barlan
Keyword(s):  
Social Capital ◽  
Random Sampling ◽  
Qualitative Data ◽  
Sampling Technique ◽  
Cost Effective ◽  
Simple Random Sampling ◽  
Community Based ◽  
Time Saving ◽  
The Social ◽  
Voting System

Head of a village election with e-voting system is a new thing for community The success level of e-voting system can be reached by fulfil several principles in order to the implementation going effective and the result of the election can be accepted by all. The objectives of this research is to analyze the relation between the success level of e-voting system with social capital of the community. This research is carried out with the quantitative approach and supported by qualitative data. This research takes 60 respondents using simple random sampling technique. The results showed that the success level of e-voting has a correlation with the level of social capital of the community. Based on the field study, the social capital of the community is classified as high. The high social capital makes the implementation of e-voting successful and the success level is also high, because in the election ten years ago occurred a conflict. The community considers e-voting easier and more practical, cost effective and time-saving, and the results of e-voting are also reliable. A practical and fast of e-voting system can be a solution especially for “rural-urban” community who are busy or work outside the village.Keywords: E-voting, the success level of the system, social capital Pemilihan kepala desa dengan sistem e-voting merupakan hal yang baru bagi masyarakat. Keberhasilan penerapan sistem e-voting dilihat dari terpenuhinya beberapa prinsip agar penerapannya berlangsung efektif dan hasilnya dapat diterima oleh seluruh masyarakat. Penelitian ini bertujuan untuk menganalisis hubungan tingkat keberhasilan sistem e-voting dalam pemilihan kepala desa dengan tingkat modal sosial masyarakat. Bentuk penelitian ini adalah penelitian kuantitatif yang didukung oleh analisis data kualitatif. Penelitian ini mengambil enam puluh responden dengan teknik simple random sampling. Hasil penelitian menunjukkan bahwa tingkat keberhasilan e-voting memiliki hubungan dengan tingkat modal sosial masyarakat. Berdasarkan kajian di lapang, modal sosial masyarakat tergolong tinggi. Tingginya modal sosial tersebut membuat pelaksanaan e-voting berhasil dan tingkat keberhasilannya juga tergolong tinggi karena pada pemilihan sepuluh tahun silam sempat terjadi konflik. Masyarakat menganggap sistem evoting lebih mudah dan praktis, hemat dalam segi biaya dan waktu, serta hasil dari pemilihan juga dapat dipertanggungjawabkan. Sistem e-voting yang praktis dan cepat dapat menjadi solusi khususnya bagi masyarakat daerah “desa-kota” yang memiliki kesibukan atau pekerjaan di luar desa.Kata Kunci: E-voting, keberhasilan sistem, modal sosial. 

A Novel Approach for the Treatment of Sialolithiasis that Preserves Salivary Duct Anatomy

2021 ◽  
pp. 000348942110189
Author(s):  
Gani Atilla Şengör ◽  
Ahmet Mert Bilgili
Keyword(s):  
Salivary Gland ◽  
Success Rate ◽  
Cost Effective ◽  
Complete Removal ◽  
Level Of Evidence ◽  
Invasive Approach ◽  
Pneumatic Lithotripsy ◽  
Novel Approach ◽  
Surgical Methods ◽  
Salivary Gland Stones

Objective: The sialendoscopy era in the treatment of salivary gland stones has reduced the use of classical surgical methods. However, the miniature ducts and tools may cause difficulties in removing large sialoliths. Therefore, invasive combined oral surgeries or gland resection may be considered. We searched for the most suitable method in order to stay in line with the minimally invasive approach that preserves the ductus anatomy, and that can reduce the surgical fears of patients. Materials and Methods: The study included 84 cases (23 parotid and 61 submandibular) in whom stones were fragmented by pneumatic lithotripsy and removed between January 2015 and January 2020. The parotid cases comprised 7 females and 16 males, and the submandibular cases comprised 25 females and 36 males. Intraductal lithotripsy was performed using pneumatic lithotripter. This study has fourth level of evidence. Results: Based on total number of cases (n = 84), success rate was 67/84 (79.7%) immediately after sialendoscopy, and overall success rate was 77/84 (91.6%). Based on number of stones treated (n = 111), our immediate success rate was 94/111 (84.6%), and overall success rate was 104/111 (93.7%). The success criteria were complete removal of the stone and fragments in a single sialendoscopy procedure and resolution of symptoms. Conclusions: We successfully treated salivary gland stones, including L3b stones, in our patient cohort with sialendoscopy combined with pneumatic lithotripsy. The lithotripsy method that we have adapted seems to be more useful and cost-effective compared to its alternatives. We were also able to preserve the ductus anatomy and relieve patients’ concerns. Level of Evidence: Level IV

scholarly journals “Nodoventricular” accessory pathway: Evidence for a distinct accessory atrioventricular pathway with atrioventricular node-like properties

1988 ◽  
Vol 11 (5) ◽  
pp. 1035-1040 ◽  
Author(s):  
George J Klein ◽  
Gerard M Guiraudon ◽  
Charles R Kerr ◽  
Arjun D Sharma ◽  
Raymond Yee ◽  
...  
Keyword(s):  
Accessory Pathway ◽  
Atrioventricular Node ◽  
Accessory Atrioventricular Pathway

Comparison of alteplase and urokinase for pharmacomechanical thrombolysis of clotted hemodialysis access

2018 ◽  
Vol 20 (5) ◽  
pp. 501-506 ◽  
Author(s):  
Ru Yu Tan ◽  
Suh Chien Pang ◽  
Swee Ping Teh ◽  
Kian Guan Lee ◽  
Tze Tec Chong ◽  
...  
Keyword(s):  
Success Rate ◽  
Vascular Access ◽  
Clinical Success ◽  
Univariate Analysis ◽  
Clinical Success Rate ◽  
Skin Dose ◽  
Hemodialysis Access ◽  
Procedure Time ◽  
Technical Success Rate ◽  
Tertiary Teaching

Background: Percutaneous pharmacomechanical thrombolysis is increasingly used to salvage thrombosed hemodialysis access. We aim to evaluate the effectiveness of alteplase compared to urokinase in percutaneous pharmacomechanical thrombolysis clotted access. Methods: Records of patients who underwent pharmacomechanical thrombolysis at Interventional Nephrology Suite in a tertiary teaching hospital from 1 January 2016 to 31 December 2016 were reviewed. Technical and clinical success rates, thrombosis-free and cumulative survivals, procedure time, and radiation dose imparted to patients were compared for pharmacomechanical thrombolysis with urokinase versus alteplase. Results: A total of 122 incident patients underwent pharmacothrombolysis (n = 53 for urokinase, n = 69 for alteplase) during the study period. The mean dose of urokinase and alteplase used was 176,897 ± 73,418 units and 3.7 ± 0.8 mg, respectively. Pharmacomechnical thrombolysis using urokinase versus alteplase has similar technical success rate (98.1% vs 97.1%, p = 0.599), clinical success rate (88.7% vs 97.1%, p = 0.068), complication rate (9.4% vs 13.0%, p = 0.373), and primary patency rates at 3 months (57.1% vs 70.1%, p = 0.106). Thrombosis-free survivals of the vascular access were 113.2 (35.3, 196) days versus 122 (84, 239) days (p = 0.168). Cumulative survivals were 239 (116, 320) vs 213 (110.5, 316.5) days (p = 0.801). Procedure time, fluoroscopy time, skin dose, and dose were significantly lower for pharmacomechanical thrombolysis using alteplase compared to urokinase (p = 0.045, p < 0.0001, p = 0.006, p = 0.001, respectively). Stenting was found to be associated with successful dialysis following thrombolysis on univariate analysis (odds ratio: 9.167, 95% confidence interval: 1.391–19.846, p = 0.021), although this was no longer significant in multivariate analysis (p = 0.078). Conclusion: Alteplase is an effective and safe alternative to urokinase for pharmacomechanical thrombolysis of clotted vascular access.

scholarly journals Radiofrequency Catheter Ablation of Left Free Wall Accessory Pathways: Comparison Between Retrograde and Transeptal Approach

2012 ◽  
Vol 4 (2) ◽  
pp. 139-147
Author(s):  
S Hashem ◽  
M Hossain ◽  
MA Ali ◽  
AK Choudhury ◽  
AA Masum
Keyword(s):  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Similar Efficacy ◽  
Vascular Complication ◽  
Free Wall ◽  
Efficacy And Safety ◽  
Accessory Pathways ◽  
Intention To Treat ◽  
Primary Success ◽  
Ablation Success

Background : This study was conducted to compare the conventional retrograde arterial approach (RAA) with the transeptal approach (TSA) for radiofrequency catheter ablation (RFA) of left accessory pathways (AP). Materials and Methods: Sixty consecutive patients (44 male; mean age of 35.60 ± 11.63 years) with 60 left APs (39 overt and 21 concealed) underwent catheter ablation using the TS method (30 patients) and the RA method (30 patients) in an alternate fashion. The analysis was performed according to the intention-to-treat principle. Results : The transeptal puncture was successfully performed in 29 patients (96%). This access allowed primary success in the ablation in all the patients without any complication. When we compared this approach with the RAA there was no difference as regards the primary success (p = 0.103), fluoroscopy time (p = 0.565) and total time (p = 0.1917). Three patient in the RAA group presented a vascular complication. The TSA allowed shorter ablation times (p=0.006) and smaller number of radiofrequency applications (p = 0.042) as compared to the conventional RAA. The patients who had unsuccessful ablation in the first session in each approach underwent with the opposite technique (cross-over), with a final ablation success rate of 100%. Conclusion : The TS and RA approaches showed similar efficacy and safety for the ablation of left accessory pathways. The TSA allowed shorter ablation times and smaller number of radiofrequency applications. When the techniques were used in a complementary fashion, they increased the final efficacy of the ablation DOI: http://dx.doi.org/10.3329/cardio.v4i2.10458 Cardiovasc. j. 2012; 4(2): 139-147

A community-based approach to evaluation of health outcomes and costs for telepsychiatry in a rural population: Preliminary results

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 155-157 ◽  
Author(s):  
Craig Kennedy ◽  
Peter Yellowlees
Keyword(s):  
Mental Health ◽  
Health Outcomes ◽  
Rural Areas ◽  
Pilot Trial ◽  
Public Mental Health ◽  
Cost Effective ◽  
Community Based ◽  
Public And Private ◽  
Preliminary Results ◽  
The People

A pilot trial was established to support visiting psychiatric services and local public and private practitioners through the use of videoconferencing. The purpose of the trial was to determine whether people in the community received better health-care with telemedicine. A community-based approach was used to evaluate health outcomes, costs, utilization, accessibility, quality and needs for such services in a rural community in Queensland. Over a two-year period data were collected from 124 subjects who met the criteria of having a mental health problem or mental disorder. Nine further subjects refused to participate in the study. Only 32 subjects used videoconferencing to receive mental health services. Preliminary results did not show any significant improvements in wellbeing or quality of life, although the time span was relatively short. However, the results confirmed that the people were no worse off from a consumer or a practitioner perspective from using videoconferencing. Most consumers found that videoconferencing with a psychiatrist moderately or greatly helped them in managing their treatment, with 98% of them preferring to be offered videoconferencing in combination with local services. Overall, videoconferencing is a crucial part of enhancing psychiatry services in rural areas. However, it is not necessarily cost-effective for all consumers, general practitioners, psychiatrists, or the public mental health service.

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