scholarly journals Choice of Steerable Sheath Impacts Contact Force Stability During Pulmonary Vein Isolation

2020 ◽  
Author(s):  
Evan Hiner ◽  
Dipak Shah
Keyword(s):  
Pulmonary Vein ◽  
Contact Force ◽  
Delivery Time ◽  
Jet Ventilation ◽  
The Right ◽  
Procedural Outcomes ◽  
First Time ◽  
Steerable Sheath ◽  
Catheter Stability

Purpose: A stable contact force (CF) is correlated with more effective radiofrequency ablation (RFA) lesions and long-term procedural outcomes. Efforts to improve catheter stability include jet ventilation, pacing, steerable sheaths, and CF sensing ablation catheters. This study compares CF stability and effective RF lesions between two commercially available steerable sheaths. Methods: Thirty patients underwent first time RFA at a single center using the Agilis NxT or SureFlex Steerable Sheath. High power short duration RFA was utilized targeting a 10Ω drop. Sheath performance was assessed for the entire procedure and around each pulmonary vein (PV) in terms of mean CF, CF variability, RF time per lesion, and inefficient contact lesions (defined as lesions with CF < 5g for at least 10% of the RF delivery time). Results: Operator-targeted mean CF was achieved using both sheaths; however, overall CF variability was 12.8% lower using the SureFlex sheath (p = 0.08). CF variability was generally 16% greater in the right PVs than the left PVs (p = 0.001), but trended lower with the SureFlex sheath. There were 8% more inefficient contact lesions using Agilis as compared to SureFlex (p = 0.035), especially in the right inferior PV (p = 0.009). RF time per lesion was on average 12% (1.4s) shorter using SureFlex than Agilis (p < 0.05). Conclusion: Choice of steerable sheath may affect catheter stability and potential lesion quality, especially in the right PVs.

Isolated left ventricular apical hypoplasia in a young child

2021 ◽  
Vol 14 (1) ◽  
pp. e239297
Author(s):  
H Ravi Ramamurthy ◽  
Onkar Auti ◽  
Vimal Raj ◽  
Kiran Viralam
Keyword(s):  
Left Ventricle ◽  
Left Ventricular ◽  
Long Term Outcomes ◽  
Wave Inversion ◽  
St Segment ◽  
Cardiac Apex ◽  
The Right ◽  
First Time ◽  
Left Lead

A 16-month-old, healthy, asymptomatic male child presented with a diagnosis of dilated cardiomyopathy. Cardiovascular examination and chest radiograph were normal. ECG revealed sinus rhythm, and the augmented vector left lead showed raised ST segment, T wave inversion and q waves. Echocardiography showed a globular left ventricle with notched cardiac apex, abnormal echogenicity in the left ventricular apical myocardium, single papillary muscle and normal biventricular function. Cardiac MRI scan revealed a globular left ventricle with fibrofatty changes and retraction of the apex, the papillary muscles closely approximated, and the right ventricle wrapping around the apex of the left ventricle. This is described as isolated left ventricular apical hypoplasia. Diagnosis of this rare entity can be made by MRI, and it has been diagnosed largely in adults. The pathophysiology and long-term outcomes are unknown. We characterise the echocardiography findings of this rare anomaly in a child for the first time in the literature.

P2848Electrical reconnections after pulmonary vein isolation with or without contact force-guided catheters: a comparison of the proficiency of atrial fibrillation ablation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Fujimoto ◽  
K Yodogawa ◽  
Y Iwasaki ◽  
M Hachisuka ◽  
R Mimuro ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Contact Force ◽  
High Volume ◽  
Procedure Time ◽  
Surgical Ablation ◽  
Af Ablation ◽  
Significant Difference ◽  
The Right ◽  
Posterosuperior Segment

Abstract Background Atrial fibrillation (AF) ablation is the most commonly performed catheter ablation (CA) procedure today. The 2015 ACC/AHA/HRS Advanced Training Statement reported that the success rate of AF ablation is higher in high-volume centers than in low-volume centers. We tested whether the procedure proficiency of each operator was associated with the outcome of AF ablation, and whether the ablation outcome depended on whether contact force (CF)-guided catheters were used or not, in a high-volume center. Methods We conducted a retrospective observational study including all AF patients who underwent radiofrequency CA with or without CF support since 2016 at our hospital. The patients who underwent CA at other hospitals or underwent a balloon or surgical ablation in the first session were excluded. Each ipsilateral pulmonary vein (PV) pair was divided into 8 segments. The reconnection numbers and sites of the PV segment were evaluated in the second session. Operators were divided into the experienced group (≥100 AF cases/year, at least every 3 years) and developing group (other than the experienced group), respectively. Results Among 728 patients who underwent an initial AF ablation and were followed for 510±306 days, 131 (90 males, 65±10 years) received a second ablation procedure and were analyzed. A total of 260 and 264 PV isolations (PVI) were performed by the experienced and developing group operators in the initial ablation, respectively. Compared to the experienced group, the developing group had a longer procedure time for the PVI (35±15 vs. 28±10 min, p<0.001), higher frequency of reconnections of the PVs (73% vs. 59%, p=0.01) and higher number of reconnection gaps (2.1±2.0 vs. 1.5±2.0, p=0.02), respectively. There were no significantly differences in the number of gaps between the catheters with and without CF (1.6±2.0 vs. 1.4±2.0, p=0.65) in the experienced group, however, in the developing group a smaller total number of gaps (1.5±1.6 vs. 2.4±2.1, p=0.006) and less frequency reconnection gaps of the posterosuperior segment of the right PV (10% vs. 45%, p=0.005) were seen with catheters with CF than without. There was no significant difference in the procedure time for the PVI between catheters with and without CF. Conclusions The operator proficiency may predict the outcome after AF ablation even in high-volume centers. It is preferable to perform PVI with a CF-sensing catheter for operators without adequate proficiency. Acknowledgement/Funding JSPS KAKENHI Grant Number JP18K15865

scholarly journals Acute blue finger syndrome: a rare benign cause of acute digit discolouration

2019 ◽  
Vol 12 (1) ◽  
pp. e223365
Author(s):  
Kiran Dhaliwal ◽  
Colin Thomas Brewster ◽  
Sivarajasingham Pakeerathan
Keyword(s):  
Rapid Assessment ◽  
Middle Finger ◽  
X Rays ◽  
Benign Condition ◽  
Volar Aspect ◽  
History Of ◽  
The Right ◽  
Digital Ischaemia ◽  
First Time

Acute blue finger syndrome is a rare benign condition that mimics digital ischaemia. We discuss the case of a 32-year-old woman who presented with a 6hour history of blue discolouration of the middle finger of the right hand, associated with pain and swelling. There was no history of trauma and this was the first time that the patient had experienced these symptoms. Examination found blue discolouration of the digit primarily on the volar aspect with associated swelling. All investigations, including blood tests, X-rays and Doppler scanning, were normal. The symptoms resolved spontaneously within 48 hours. There were no recurrent episodes or long-term sequelae. Patients presenting with an acutely blue finger need rapid assessment to exclude digit ischaemia. Knowledge of this rare benign condition may prevent unnecessary distress, invasive investigations and potentially harmful treatment of a healthy patient.

scholarly journals P648 Right heart volume overload after surgical correction of atrial septal defect sinus venosus type with partial anomalous pulmonary veins drainage

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
I Ruiz-Zamora ◽  
L Alvarez-Roy ◽  
G Pinillos-Francia ◽  
A Gutierrez-Fernandez ◽  
M Gomez-Llorente ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulmonary Vein ◽  
Congenital Heart ◽  
Pulmonary Veins ◽  
Venous Drainage ◽  
Sinus Venosus ◽  
The Right

Abstract 40 year-old male with history of congenital heart disease. Atrial septal defect (ASD) sinus venosus type associated with partial anomalous pulmonary venous drainage (PAPVD) was diagnosed during childhood and surgically repaired at the age of three. Since then the patient was asymptomatic and he was lost to follow up when reached adulthood. A transthorathic echocardiogram was performed during a hospitalization because of a complicated pneumonia. A severe dilatation of right chambers and main pulmonary artery was observed. The estimated Qp:Qs by this technique was 2.0 but the atrial septum seemed to be intact. Agitated saline was administered in this procedure and no passage of microbubbles was observed. A cardiac MRI was performed because of suspicion of anomalous pulmonary venous drainage. The findings observed in the echocardiogram were confirmed and an uncommon PAPVD was demonstrated by this technique: the superior left pulmonary vein drainaged into a dilated innominated vein. Also, a small pulmonary vein from the right upper lobe emptied into a "venous conduct" (yellow circle) located posterior to the superior cava vein (SCV) that later drainaged into the right atrium under the mouth of the SVC, posterior to the interatrial septum. Surgically correctioin of the PAPVD was performed. Discussion PAPVD is a congenital heart disease characterized by the drainage of one or several pulmonary veins –but not all of them- into the right atrium or systemic veins, which leads to left-to-right shunting. The estimated incidence of this disease ranges between 0.1 and 0.2% of the general population. The right superior pulmonary vein is the most frequently involved and is commonly associated to ASD sinus venosus type. Bilateral anomalous drainage, as occurred in this case, is exceptional. Furhermore, this case highlights the importance of long-term follow-up in patients with congenital heart disease due to the fact that, even when the disease is considered to be cured, long term complications could appear compromising the prognosis of the patient. Abstract P648 Figure. Unusual PAPVD

Long-Term Inhibition of Return of Attention

2003 ◽  
Vol 14 (1) ◽  
pp. 19-25 ◽  
Author(s):  
Steven P. Tipper ◽  
Sarah Grison ◽  
Klaus Kessler
Keyword(s):  
Inhibition Of Return ◽  
Right Hemisphere ◽  
New Information ◽  
Memory Representations ◽  
Efficient Processing ◽  
Exogenous Cue ◽  
Face Stimuli ◽  
The Right ◽  
First Time

During search of the environment, the inhibition of the return (IOR) of attention to already-examined information ensures that the target will ultimately be detected. Until now, inhibition was assumed to support search of information during one processing episode. However, in some situations search may have to be completed long after it was begun. We therefore propose that inhibition can be associated with an episode encoded into memory such that later retrieval reinstates inhibitory processing and encourages examination of new information. In two experiments in which attention was drawn to face stimuli with an exogenous cue, we demonstrated for the first time the existence of long-term IOR. Interestingly, this was the case only for faces in the left visual field, perhaps because more efficient processing of faces in the right hemisphere than the left hemisphere results in richer, more retrievable memory representations.

Orientation of the right superior pulmonary vein affects outcome after pulmonary vein isolation

2021 ◽  
Author(s):  
Nándor Szegedi ◽  
Milán Vecsey-Nagy ◽  
Judit Simon ◽  
Bálint Szilveszter ◽  
Szilvia Herczeg ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Anatomical Variations ◽  
Effective Diameter ◽  
Free Survival ◽  
Female Sex ◽  
The Right ◽  
The Impact ◽  
Af Recurrence

Abstract Aims Controversial results have been published regarding the influence of pulmonary vein (PV) anatomical variations on outcomes after pulmonary vein isolation (PVI). However, no data are available on the impact of PV orientation on the long-term success rates of point-by-point PVI. We sought to determine the impact of PV anatomy and orientation on atrial fibrillation (AF)-free survival in patients undergoing PVI using the radiofrequency point-by-point technique. Methods and results We retrospectively included 448 patients who underwent initial point-by-point radiofrequency ablation for AF at our department. Left atrial computed tomography angiography was performed before each procedure. PV anatomical variations, ostial parameters (area, effective diameter, and eccentricity), orientation, and their associations with 24-month AF-free survival were analysed. PV anatomical variations and ostial parameters were not predictive for AF-free survival (all P &gt; 0.05). Univariate analysis showed that female sex (P = 0.025) was associated with higher rates of AF recurrence, ventral-caudal (P = 0.002), dorsal-cranial (P = 0.034), and dorsal-caudal (P = 0.042) orientation of the right superior PV (RSPV), on the other hand, showed an association with lower rates of AF recurrence, when compared with the reference ventral-cranial orientation. On multivariate analysis, both female sex [odds ratio (OR) 1.83, 95% CI 1.15–2.93, P = 0.011] and ventral-caudal RSPV orientation, compared with ventral-cranial orientation, proved to be independent predictors of 24-month AF recurrence (OR 0.37, 95% CI 0.19–0.71, P = 0.003). Conclusion Female sex and ventral-caudal RSPV orientation have an impact on long-term arrhythmia-free survival. Assessment of PV orientation may be a useful tool in predicting AF-free survival and may contribute to a more personalized management of AF.

Abstract 18667: Impact of Direct Contact Force Measurement on Electrical Reconnections after Circumferential Pulmonary Vein Isolation for Atrial Fibrillation Using a Contact Force-Sensing Catheter

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kohki Nakamura ◽  
Shigeto Naito ◽  
Takehito Sasaki ◽  
Kentaro Minami ◽  
Masahiro Nakano ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Contact Force ◽  
Regression Models ◽  
Force Measurement ◽  
Operating Characteristics ◽  
Multiple Regression Models ◽  
Characteristics Analysis ◽  
The Mean ◽  
The Right ◽  
Circumferential Pulmonary Vein Isolation

Purpose: To prospectively evaluate the incidence of pulmonary vein (PV) reconnections (PVRs) and identify predictors of PVRs after circumferential PV isolation (CPVI) using a contact force (CF)-sensing ablation catheter. Methods: Sixty-five patients (51-males; 61±10 years) undergoing an initial CPVI were studied. Both the right and left CPVI lines were divided into 12 segments and multiple regression models were used to predict PVRs in the four regions (each including 6 segments), the anterior and posterior RPVs and LPVs (A-RPVs, P-RPVs, A-LPVs, and P-LPVs). Each radiofrequency application was delivered with 15-30W for <30s along the P-LPVs and 30-40W for 40-60s along the others. Results: In 63 reconnected gaps, the right-PVs had more gaps in the anterior and posterior carina, while the left-PVs had more in the posterior carina than elsewhere, respectively (P<0.05). The P-RPVs and P-LPVs had significantly more gaps than the A-LPVs (17 A-RPVs, 21 P-RPVs, 6 A-LPVs, and 19 P-LPVs; P<0.05). The mean CF in the A-RPVs and P-RPVs (odds ratios (ORs), 0.916 and 0.854; P=0.014 and <0.001, respectively) and Force-Power-Time Index (FPTI) in the A-LPVs (OR, 0.99; P=0.012) were significant negative predictors of PVRs. According to the receiver operating characteristics analysis, at optimal cutoffs of mean CFs of 18g (A-RPVs) and 12g (P-RPVs), and FPTI of 36,737g.W.s (A-LPVs), the sensitivity and specificity for predicting PVRs were 81.3% and 61.9%, 71.3% and 52.9%, and 58.6% and 100%, respectively. Conclusions: The carina regions can be common sites for PVRs despite a higher CF and FPTI. An optimal CF and FPTI may be needed to prevent PVRs during an initial CPVI, especially in the RPVs and A-LPVs.

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