scholarly journals Ablation Outcomes for Atypical Atrial Flutter versus Recurrent Atrial Fibrillation Following Index Pulmonary Vein Isolation

2020 ◽  
Author(s):  
Tauseef Akhtar ◽  
Usama Daimee ◽  
Bhradeev Sivasambu ◽  
Thomas Boyle ◽  
Armin Arbab-Zadeh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Survival Rates ◽  
Free Survival ◽  
Af Ablation ◽  
Recurrent Atrial Fibrillation ◽  
Background Data ◽  
Ablation Success ◽  
The Mean ◽  
One Year

Background: Data related to electrophysiologic characteristics of atypical atrial flutter (AFL) following atrial fibrillation (AF) ablation and its prognostic value on repeat ablation success are limited. Methods: We studied consecutive patients undergoing a repeat LA ablation for either recurrent AF or atypical AFL, following 3 months after index AF ablation, between January 2012 and July 2019. The demographics, procedural data, complications, and 1-year arrhythmia-free survival rates were recorded for each subject after the first repeat ablation. Results: Of the total 336 included patients, 102 underwent a repeat ablation for atypical AFL and 234 for recurrent AF. The mean age was 63.7  10.7 years, and 72.6 % of patients were male. The atypical AFL cohort had significantly higher LA diameters (4.6 vs. 4.4 cm, p=0.04) and LA volume indices (LAVi; 85.1 vs. 75.4 ml/m2, p=0.03) compared to AF patients at repeat ablation. Atypical AFLs were roof-dependent in 35.6% and peri-mitral in 23.8% of cases. Major complications at repeat ablation occurred in 0.9 % of the total cohort. Arrhythmia-free survival at one year was significantly higher in the recurrent atypical AFL than the recurrent AF cohort (75.5 vs. 65.0 %, p=0.04). Conclusion: In our series, roof-dependent flutter is the most common form of atypical atrial flutter post AF ablation. Patients developing atypical AFL after index AF ablation have greater LA dimensions than patients with recurrent AF. The success rate of first repeat ablation is significantly higher among patients with recurrent atypical AFL compared to recurrent AF after index AF ablation.

Abstract 15934: Comparison of Atrial Fibrillation Burden Reduction in Patients With Paroxysmal and Persistent Atrial Fibrillation Undergoing Cryoballoon Pulmonary Vein Isolation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Dan L Musat ◽  
Nicolle S Milstein ◽  
Jacqueline Pimienta ◽  
Advay Bhatt ◽  
Tina C Sichrovsky ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Persistent Atrial Fibrillation ◽  
Loop Recorder ◽  
Similar Reduction ◽  
Af Ablation ◽  
Ablation Success ◽  
One Year ◽  
Af Recurrence

Background: Pulmonary vein isolation (PVI) is a cornerstone of atrial fibrillation (AF) ablation procedures to treat symptomatic AF. Ablation success is defined by absence of AF recurrence >30 seconds. However, reduction in AF burden (AFB) is also an important endpoint. Whether patients with paroxysmal (PAF) and persistent AF (PeAF) have similar reduction in AFB post-ablation is unknown. Objective: To compare the decrease in AFB following cryoballoon (CB) PVI in patients with PAF and PeAF. Methods: We enrolled consecutive pts with an implantable loop recorder (ILR) who subsequently underwent CB PVI. All patients were followed prospectively for at least one year, or until repeat ablation; we compared AFB pre and post-ablation. Results: The cohort included had 47 patients (66 ± 10 years; 32 [68%] male; PAF [n=23, 49%]; CHA 2 DS 2 -VASc 2.7 ± 1.7, 34 [72%] on AAD at the time of ablation). A median of 136 days [IQR 280, 73; minimum of 30 days] of ILR data pre-ablation were available. The median AFB for PAF was 4.7% [IQR 0.9, 14.8] and PeAF was 6.8% [IQR 1.1, 40.4]. After excluding a 3-month post-ablation blanking period, recurrent AF occurred in 12 (52%) PAF and 11 (46%) PeAF patients. The median AFB post-ablation for PAF and PeAF cohorts was 0.03%, [IQR 0, 0.3] and 0.04%, [IQR 0, 1.1], respectively. This represents a >99% reduction in AFB. Conclusion: Although 50% of patients undergoing CB PVI for PAF or PeAF had a recurrence of AF, there was >99% reduction in AFB in both groups. These data highlight the importance of using AFB burden as a marker of therapeutic efficacy post-AF ablation.

scholarly journals Comparing single approaches success in index atrial fibrillation ablation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
R Caldeira Da Rocha ◽  
R Carvalho ◽  
A Ferreira ◽  
T Rodrigues ◽  
G Silva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Success Rate ◽  
High Rate ◽  
Single Shot ◽  
Single Center ◽  
Event Free Survival ◽  
Free Survival ◽  
Af Ablation ◽  
Significant Difference ◽  
One Year

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atrial Fibrillation (AF) ablation can be performed by inducing pulmonary vein electrical isolation. There are two widely used approaches: point-by-point and single-shot.  Catheter AF ablation is effective in restoring and maintaining sinus rhythm. However, efficacy is limited by high rate of AF recurrence, after an initially successful procedure. Purpose To evaluate AF index ablation successfulness using single-shot techniques and compare them to conventional one (point-by-point using irrigated- tip ablation catheter). Methods We analyzed, from a single center, all patients submitted to an index AF ablation procedure and its successfulness. The last was defined as AF, atrial tachycardia or flutter recurrence (with a duration superior to 30seconds) event- free survival, determined by holter and/or event recorder. These exams were performed after 6 and 12months and then annually, until 5years post procedure were accomplished. Results From November 2004 to November 2020, 821patients were submitted to first AF ablation (male patients 67,2%(N = 552), mean age of 59 ± 12years old). Paroxysmal AF(PAF) was present in 62,9%(N = 516), with short-duration persistent AF in 21,8%(N = 179) and long-standing persistent in 15,3%(N = 126). Ablation techniques were irrigated tip catheter point-by-point (PbP)ablation in 266 patients (32,4%) and single-shot (SS)techniques on the remaining 555(67,6%), including PVAC in 294(35,8%),225(27,4%) submitted to cryoablation and 36(4,4%) to nMARQ. Globally, AF ablation had one-year success rate of 72,5%, and 56,2% at 3 years. A significant difference between AF duration type was found: Arrhythmic recurrence risk was 58% higher in persistent AF(PeAF) (HR 1.58;95%IC 1,22-2,04; p < 0.001). In patients presenting with PAF prior to the procedure, success was significantly higher in those submitted to SS technique(HR:0.69;95%CI 0,47-0,90;p = 0.046), while those with PeAF had similar results. Conclusion In this single center analysis almost three-quarters had achieved one-year event-free survival, and more than a half reached long-term freedom from atrial arrhythmia. Patients with paroxysmal atrial fibrillation submitted to single-shot procedure presented with a higher success-rate. Moreover, our study confirmed previous data on the importance of atrial fibrillation classification to postprocedural outcomes. Abstract Figure. Survival Curves

Clinical outcome of non-use of touch-up focal ablation catheters strategy during cryoballoon atrial fibrillation ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Matsunaga ◽  
Y Egami ◽  
M Yano ◽  
M Yamato ◽  
R Shutta ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcome ◽  
Pulmonary Veins ◽  
Conventional Group ◽  
Atrial Tachyarrhythmia ◽  
Free Survival ◽  
Af Ablation ◽  
Frequent Use ◽  
Class 1 ◽  
Focal Ablation

Abstract Background It has been reported that frequent use of touch-up focal ablation catheters was related to worse outcomes after cryoballoon (CB) atrial fibrillation (AF) ablation. It is unknown whether non-use of touch-up focal ablation catheters strategy affects the outcome of AF ablation. Therefore, this study aimed to assess whether non-use of touch-up focal ablation catheters strategy improve clinical outcome after AF ablation using CB. Methods A total of 151 consecutive patients who received CB ablation from February 2017 to August 2019 were enrolled. Non-use of a touch-up focal ablation catheters strategy was started from February 2018. Patients were divided into 2 groups according to the type of strategy. In the non-touch-up group, pulmonary veins were isolated without touch-up focal ablation catheters as much as possible and in conventional group, touch-up focal ablation catheters were used as required. The 1-year atrial tachyarrhythmia free survival without class 1 or 3 antiarrhythmic drugs after a 90-day blanking period was assessed between the 2 groups. Results The conventional group consisted of 76 patients and the non-touch-up group consisted of 75 patients. Baseline characteristics were comparable between 2 groups. Touch-up focal ablation catheters were used more in the conventional group (11 patients, 14%) than non-touch-up group (0 patients, 0%) (p<0.001). Pulmonary isolation was achieved in all patients of both groups. Atrial tachyarrhythmia recurrence occurred more frequently in the non-touch-up group (15/75 patients, 20%) than conventional group (7/76 patients, 9%) (p=0.045). Conclusion Non-use of a touch-up focal ablation catheters strategy may be related to worse outcome after CB AF ablation. Funding Acknowledgement Type of funding source: None

Bifurcated bypass in severe chronic limb threatening ischaemia

Vascular ◽  
2021 ◽  
pp. 170853812199985
Author(s):  
Daniele Adami ◽  
Michele Marconi ◽  
Alberto Piaggesi ◽  
Davide M Mocellin ◽  
Raffaella N Berchiolli ◽  
...  
Keyword(s):  
Survival Rates ◽  
Primary Patency ◽  
Free Survival ◽  
Mortality And Morbidity ◽  
Bypass Patency ◽  
Stage 4 ◽  
Endovascular Approach ◽  
The Mean ◽  
Clinical Records

Objectives Revascularization according to the angiosome concept is of proven importance for limb salvage in chronic limb threatening ischaemia but it is not always practicable. Bifurcated bypasses could be considered as an option when an endovascular approach is not feasible or has already failed and a single bypass would not allow direct revascularization of the ischaemic area. Bifurcated bypasses are characterized by landing on two different arteries, the main artery (in direct continuity with the foot vessels) and the secondary one (perfusing the angiosome district). The aim of this study is to evaluate the safety and effectiveness of bifurcated bypass in chronic limb threatening ischaemia. Methods Thirty-five patients were consecutively treated with a bifurcated bypass for chronic limb threatening ischaemia from January 2014 to December 2019 in a single vascular surgery centre. Data from clinical records and operative registers were collected prospectively in an electronic database and retrospectively analysed. Primary and primary assisted bypass patency, amputation-free survival, morbidity and mortality rates at 12 and 24 months were analysed. Results Mean follow-up period was 25.1 months (range 2–72 months). Thirty-six bifurcated bypasses were performed on 35 patients (age 75.3 ± 7.2 years; 69.4% were male). According to Wound, Ischemia, foot Infection classification 22.2% belonged to stage 3 and 77.8% to stage 4 and the mean Rutherford’s class was 5.1 ± 0.7. Immediate technical success was 100%. Early mortality and morbidity rates were respectively 5.5%, and 33.3%; foot surgery was performed in 50% of cases with wound healing in all patients. Primary patency and primary assisted bypass patency were 96.7% and 100% at 6 months; 85.2% and 92% at 12 months, 59.9% and 73.4% at 24 months, respectively. Amputation-free survival at 12 and 24 months was, respectively, 95.6% and 78.8%. Overall survival rates at 12 and 24 months were respectively 94.4% and 91.6%. Conclusions Bifurcates bypass can provide good results in patients with chronic limb threatening ischaemia without endovascular option, especially in diabetic ones. Bifurcated bypass is a complex surgical solution, both to be planned and performed, and it is quite invasive for frail patients that should be accurately selected.

scholarly journals Prevalence and Predisposing Factors of Atrial Fibrillation in a Multi-Ethnic Society: The Impact of Racial Differences in Bahrain

2011 ◽  
Vol 4 ◽  
pp. OJCS.S8032 ◽  
Author(s):  
Taysir Garadah ◽  
Saleh Gabani ◽  
Mohamed Al Alawi ◽  
Ahmed Abu-Taleb
Keyword(s):  
Atrial Fibrillation ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Middle Eastern ◽  
Predisposing Factors ◽  
Cell Disease ◽  
Clinical Events ◽  
History Of ◽  
The Mean ◽  
One Year

Background The prevalence and epidemiological data of atrial fibrillation (AF) among multi-ethnic populations is less well studied worldwide. Aim Evaluation of the prevalence and predisposing factors of AF in patients who were admitted to acute medical emergencies (ER) in Bahrain over the period of one year. Methods Two hundred and fifty three patients with onset of AF were studied. The mean difference of biochemical data and clinical characteristics between Middle Eastern (ME) and sub continental (SC) patients was evaluated. The odds ratio of different predisposing factors for the development of clinical events in AF patients was assessed using multiple logistic regression analysis. Results Out of 7,450 patients that were admitted to ER over one year, 253 had AF based on twelve leads Electrocardiogram (ECG), with prevalence of 3.4%. In the whole study, the mean age was 59.45 ± 18.27 years, with 164 (65%) male. There were 150 ME patients (59%), and 107 (41%) SC, 55 (22%) were Indian (IND) and 48 (19%) were South Asian (SA). In the whole study clinical presentation was of 48% for palpitation, pulmonary edema was of 14%, angina pectoris on rest of 12%, 10% had embolic phenomena, 6% had dizziness, and 7% were asymptomatic. The odds ratio of different variables for occurrence of clinical events in the study was positive of 2.2 for history of hypertension, 1.8 for sickle cell disease, 1.2 for high body mass index (BMI) >30, 1.1 for mitral valve disease. The ME patients, compared with SC, were older, had significantly higher body mass index, higher history of rheumatic valve disease, sickle cell disease with high level of uric acid and lower hemoglobin. The history of hypertension, DM and smoking was higher among the SC patients. The rate of thyroid disease was equal in both groups. Conclusion The prevalence of atrial fibrillation was 3.4% with male predominance of 65%. Patients of sub continental origin were younger with a significantly high history of hypertension and ischemic heart disease. The patients of Middle Eastern origin had significantly high rate of rheumatic heart disease, and sickle cell disease. The history of hypertension was the most important independent clinical predictor of adverse events in patients presented with AF.

scholarly journals Catheter ablation or surgical therapy in moderate-severe tricuspid regurgitation caused by long-standing persistent atrial fibrillation. Propensity score analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jiangang Wang ◽  
Songnan Li ◽  
Qing Ye ◽  
Xiaolong Ma ◽  
Yichen Zhao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Tricuspid Regurgitation ◽  
Propensity Score Analysis ◽  
Survival Rates ◽  
Group Analysis ◽  
Tricuspid Valve Repair ◽  
Surgical Ablation ◽  
Severe Tricuspid Regurgitation ◽  
Recurrent Atrial Fibrillation

Abstract Background This study aimed to describe the mid-term outcomes of different treatments in patients with atrial fibrillation caused tricuspid regurgitation. Methods A retrospective study of patients diagnosed as atrial fibrillation caused moderate-severe tricuspid regurgitation undergoing ablation (n = 411) were reviewed. The surgical cohort (n = 114) underwent surgical ablation and tricuspid valve repair; the catheter cohort (n = 279) was selected from those patients who had catheter ablation. Results The estimated actuarial 5-year survival rates were 96.8% (95% CI: 92.95–97.78) and 92.0% (95% CI: 85.26–95.78) in the catheter and surgical cohort, respectively. Tethering height was showed as independent risk factors for recurrent atrial fibrillation and tricuspid regurgitation in both cohorts. A matched group analysis using propensity-matched was conducted after categorizing total patients by tethering height < 6 mm and ≥ 6 mm. Kaplan–Meier analysis showed in patients with tethering height < 6 mm, there were no differences in survival from mortality, stroke, recurrent atrial fibrillation and tricuspid regurgitation between two groups. In patients with tethering height ≥ 6 mm, there were significantly higher cumulative incidence of stroke (95% CI, 0.047–0.849; P = 0.029), recurrent atrial fibrillation (95% CI, 0.357–09738; P = 0.039) and tricuspid regurgitation (95% CI, 0.359–0.981; P = 0.042) in catheter group. Conclusions Atrial fibrillation caused tricuspid regurgitation resulted in less leaflets coaptation, which risk the recurrence of atrial fibrillation and tricuspid regurgitation. Patients whose tethering height was less than 6 mm showed satisfying improvement in tricuspid regurgitation with the restoration of sinus rhythm after catheter ablation. However, in patients with severe leaflets tethering, the results favored surgical over catheter.

Clinical and histopathological prognostic factors in locoregional advanced laryngeal cancer

2016 ◽  
Vol 130 (10) ◽  
pp. 948-953 ◽  
Author(s):  
T S Santos ◽  
R Estêvão ◽  
L Antunes ◽  
V Certal ◽  
J C Silva ◽  
...  
Keyword(s):  
Laryngeal Cancer ◽  
Growth Pattern ◽  
Perineural Invasion ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Extracapsular Extension ◽  
Free Survival ◽  
Infiltrative Growth Pattern ◽  
One Year ◽  
Disease Free

AbstractObjective:To evaluate the clinical and histopathological factors affecting the prognosis of patients with squamous cell locoregional advanced laryngeal cancer.Methods:A retrospective chart review was conducted of 121 patients with locoregional advanced laryngeal cancer, primarily treated with surgery from 2007 to 2011. Disease-free survival and overall survival rates were analysed as oncological outcomes. Prognostic variables, namely gender, pharyngeal invasion, pathological assessment of tumour and nodal stage, adjuvant therapy, margin status, nodal extracapsular extension, tumour differentiation, lymphovascular and perineural invasion, and predominant growth pattern, were also analysed.Results:One-year and three-year disease-free survival rates were 81.3 per cent and 63.5 per cent, respectively. One-year and three-year overall survival rates were 88.3 per cent and 61.4 per cent, respectively. Multivariate analysis showed that nodal extracapsular extension (p < 0.05) and an infiltrative growth pattern (p < 0.05) were associated with disease progression. Nodal extracapsular extension (p < 0.05) was associated with higher mortality.Conclusion:Nodal extracapsular extension and an infiltrative growth pattern were the main prognostic factors in locoregional advanced laryngeal cancer. The presence of pharyngeal invasion, pathologically confirmed node-positive stage 2–3 disease, close or microscopic positive margins, and lymphovascular and perineural invasion have a negative impact on prognosis.

scholarly journals The Evolving Role of Radiation Therapy in the Treatment of Biliary Tract Cancer

2020 ◽  
Vol 10 ◽  
Author(s):  
Eleni Gkika ◽  
Maria A. Hawkins ◽  
Anca-Ligia Grosu ◽  
Thomas B. Brunner
Keyword(s):  
Biliary Tract ◽  
Survival Rates ◽  
Disease Free Survival ◽  
R0 Resection ◽  
Anatomical Location ◽  
Free Survival ◽  
Tract Cancer ◽  
Complete Surgical Resection ◽  
One Year

Biliary tract cancers (BTC) are a disease entity comprising diverse epithelial tumors, which are categorized according to their anatomical location as intrahepatic (iCCA), perihilar (pCCA), distal (dCCA) cholangiocarcinomas, and gallbladder carcinomas (GBC), with distinct epidemiology, biology, and prognosis. Complete surgical resection is the mainstay in operable BTC as it is the only potentially curative treatment option. Nevertheless, even after curative (R0) resection, the 5-year survival rate ranges between 20 and 40% and the disease free survival rates (DFS) is approximately 48–65% after one year and 23–35% after three years without adjuvant treatment. Improvements in adjuvant chemotherapy have improved the DFS, but the role of adjuvant radiotherapy is unclear. On the other hand, more than 50% of the patients present with unresectable disease at the time of diagnosis, which limits the prognosis to a few months without treatment. Herein, we review the role of radiotherapy in the treatment of cholangiocarcinoma in the curative and palliative setting.

scholarly journals Outcomes of laparoscopic subtotal gastrectomy for gastric adenocarcinoma in Nghe An Friendship General Hospital

2019 ◽  
Vol 9 (3) ◽  
Author(s):  
Văn Chiến Đinh ◽  
Keyword(s):  
Lymph Nodes ◽  
General Hospital ◽  
Gastric Adenocarcinoma ◽  
Survival Rates ◽  
Subtotal Gastrectomy ◽  
Female Ratio ◽  
The Mean ◽  
Laparoscopic Subtotal Gastrectomy ◽  
One Year ◽  
Lymph Nodes Dissection

Tóm tắt Đặt vấn đề: Đánh giá tính an toàn và hiệu quả của phẫu thuật nội soi cắt đoạn dạ dày nạo vét hạch trong điều trị ung thư biểu mô dạ dày. Phương pháp nghiên cứu: Nghiên cứu hồi cứu mô tả, tất cả người bệnh ung thư biểu mô dạ dày được phẫu thuật nội soi cắt đoạn dạ dày từ 2012 đến 2019. Kết quả: 278 người bệnh ung thư dạ dày được phẫu thuật nội soi cắt đoạn dạ dày, tuổi trung bình 60,2 (33 -78), tỷ lệ nam/nữ 3,3. Ung thư ở giai đoạn IA, IB, IIA, IIB, IIIA và IIIB lần lượt là 2,2%, 9,7%, 22,3%, 30,9%, 27,3% và 7,5%. Số hạch vét được trung bình 12,2 hạch, số hạch di căn trung bình 3,1 hạch. Tỷ lệ tai biến, biến chứng chung là 2,5%. Không có tử vong trong và sau mổ. Thời gian mổ trung bình là 185 phút, nằm viện sau mổ 8,1 ngày. Thời gian sống sau mổ 1 năm, 2 năm, 3 năm và 5 năm là 95,7%, 80,2%, 71,1% và 53,4%. Kết luận: Phẫu thuật nội soi cắt đoạn dạ dày nạo vét hạch là khả thi, an toàn và hiệu quả trong điều trị ung thư biểu mô dạ dày, thời gian hồi phục và nằm viện ngắn. Abstract Introduction: To assess the initial outcomes including the effectiveness, safety of laparoscopic subtotal gastrectomy with lymph nodes dissection for gastric adenocarcinoma. Material and Methods: Prospective study conducted from 2012 to 2019 in Nghe An Friendship General Hospital. All the patients underwent the laparoscopic subtotal gastrectomy with lymph nodes dissection for gastric adenocarcinoma enrolled. Results: 278 patients underwent laparoscopic subtotal gastrectomy with lymph nodes dissection, mean age was 60.2 (33 - 78). Male and female ratio was 3.3. Stages of the tumor were 2.2% IA, 9.7% IB, 22.3% IIA, 30.9% IIB, 27.3% IIIA and 7.5% IIIB. The mean of lymph nodes removed were 12.2 and mean lymph nodes metastasis were 3.1. The overall complication and incident rates were 2.5%. No per-operative and post-operative mortality was observed. The mean operative time was 185 min. The mean postoperative length stays were 8.1 days. Overall survival rates for one year, two years, three year and five years were 95.7%, 80.2%, 71,1% and 53.4% respectively. Conclusion: Laparoscopic subtotal gastrectomy with lymph node resection for gastric adenocarcinoma is safe and effective, shorten recovery time and hospitalization. Keyword: Laparoscopic subtotal gastrectomy.

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