scholarly journals Experimental use of stereotactic radiosurgery for non-invasive interventions in arrhythmology

2021 ◽  
Vol 28 ◽  
pp. 44-50
Author(s):  
V. A. Vaskovskiy ◽  
I. A. Taymasova ◽  
D. V. Kalinin ◽  
N. A. Antipina ◽  
A. A. Nikolaeva ◽  
...  
Keyword(s):  
Pulmonary Veins ◽  
Fibrous Tissue ◽  
Average Weight ◽  
Intravenous Sedation ◽  
Target Zones ◽  
Morphological Examination ◽  
Av Node ◽  
Loop Recorder ◽  
Non Invasive

 Purpose. The experimental study aimed to study the effects of stereotaxic radioablation of various doses on the myocardium of the atria, ventricles and atrioventricular (AV) node in the long term (up to 6 months); as well as assessment of collateral damage during radioablation.Methods. The study comprised 4 domestic pigs. The animals were 10-12 weeks old, the average weight was 30±2.7 kg. A linear accelerator was used for the experiment. Each animal underwent radiation exposure in different areas: 1st animal - AV node (dose 35 Gy), 2nd animal - AV node and the apex of the left ventricle (LV) (dose 40/35 Gy, respectively), 3rd animal - pulmonary veins (PV) and left atrium (dose 30 Gy), 4th - AV node and LV free wall (dose 45/40 Gy). Under intravenous sedation with hemodynamic monitoring, contrast-based CT of the heart was performed to assess the degree of displacement of the heart chambers in one respiratory and cardiac cycle and to assess the anatomy of the chambers of the heart and adjacent organs. The allocation and the contouring of the target zones were carried out in three projections: axial, frontal and sagittal. For electrocardiographic control, a loop recorder was implanted in each animal. The average exposure time was 11±7 minutes. After a follow-up period, morphological examination of the autopsy material was performed.Results. The average follow-up period after ablation was 134.75±77.34 days. The electrophysiological effect of the ablation was achieved in cases of complete AV-block development. This effect was developed in 2 out of 3 animals, where AV-node was exposed: 2nd animal - 40 Gy on 108th day of observation and 4th animal - 45 Gy on 21st day of observation. No cardiac tachyarrhythmia was recorded in the animals. The results of myocardium macro- and microscopic examination showed significant changes in the target zones. These areas had precise but uneven damage boundaries, which were within the planned ones (conformal exposure with a high degree of precision). The transmural nature of the changes was noted as well. Massive fields of fibrous tissue of various degrees of maturity (with a predominance of subepicardial localization) with focal hemorrhages of various ages and granulations were detected, which were surrounded by cardiomyocytes with coagulated and vacuolated cytoplasm.Conclusion. The use of non-invasive stereotactic treatment of tachyarrhythmias has high prospects in modern electrophysiology as an alternative ablation method. 

scholarly journals Experimental use of stereotactic radiosurgery for non-invasive interventions in arrhythmology

2021 ◽  
Vol 28 (1) ◽  
pp. 5-13
Author(s):  
V. A. Vaskovskiy ◽  
I. A. Taymasova ◽  
D. V. Kalinin ◽  
N. A. Antipina ◽  
A. A. Nikolaeva ◽  
...  
Keyword(s):  
Pulmonary Veins ◽  
Fibrous Tissue ◽  
Average Weight ◽  
Intravenous Sedation ◽  
Target Zones ◽  
Morphological Examination ◽  
Av Node ◽  
Non Invasive

Purpose. The aim of the experimental study was to study the effects of stereotaxic radioablation of various doses on the myocardium of the atria, ventricles and atrioventricular (AV) node in the long term (up to 6 months); as well as assessment of collateral damage during radioablation.Material and methods. The research was carried out on 4 domestic pigs. The animals were 10-12 weeks old, the average weight was 30±2.7 kg. Linear accelerator «TrueBeam», Varian was used for the experiment. Animals were divided into groups according to the zones of planned radiation exposure: 1st animal AV node (dose 35 Gy), 2nd animal AV node and the apex of the left ventricle (LV) (dose 40/35 Gy, respectively), 3rd animal pulmonary veins (PV) and left atrium (dose 30 Gy), 4th AV node and free wall of the LV (dose 45/40 Gy). Under intravenous sedation with hemodynamic monitoring, contrast-based CT of the heart was performed to assess the degree of displacement of the heart chambers in one respiratory and cardiac cycle and to assess the anatomy of the chambers of the heart and adjacent organs. The allocation and the contouring of the target zones were carried out in 3 projections: axial, frontal and sagittal. For electrophysiological control, loop recorders were implanted in each animal. The average exposure time was 11±7 minutes. The long-term follow-up period was 6 months, followed by morphological examination of autopsy material.Results. The average follow-up period after the experiment was 134.75±77.34 days. The electrophysiological effect of the ablation was achieved in cases of complete AV-block development. This effect was developed in 2 out of 3 animals, whose AV-node was exposed: 2nd animal 40 Gy on 108th day of observation and 4th animal 45 Gy on 21st day of observation. No cardiac arrhythmias were recorded in all cases. The results of macroand microscopic examination showed significant changes in the target zones. These areas had precise but uneven damage boundaries, which were within the planned ones (conformal exposure with a high degree of precision). The transmural nature of the changes was noted as well. Massive fields of fibrous tissue of various degrees of maturity (with a predominance of subepicardial localization) with focal hemorrhages of various ages and granulations were detected, which were surrounded by cardiomyocytes with coagulated and vacuolated cytoplasm.Conclusion. The use of non-invasive stereotactic treatment of tachyarrhythmias has high prospects in modern arrhythmology as an alternative ablation method.

Experimental use of stereotactic radiosurgery in non-invasive interventions in arrhythmology

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
I Taimasova ◽  
VA Vaskovskiy ◽  
NA Antipina ◽  
AV Golanov ◽  
ASH Revishvili
Keyword(s):  
Pulmonary Veins ◽  
Average Weight ◽  
Intravenous Sedation ◽  
Target Zones ◽  
Av Node ◽  
Promising Alternative ◽  
Non Invasive ◽  
Stereotactic Treatment

Abstract Funding Acknowledgements Type of funding sources: None. Background Non-invasive stereotactic treatment with particle beam may be considered as a promising alternative to catheter ablation in patients with different types of tachyarrhythmias. Purpose the purpose of the experimental study was to develop a technique for stereotactic radioablation in order to create a stable functional and morphological damage in heart tissue with subsequent analysis of precision, efficiency and safety of the exposure in the long-term observation period. Materials and methods The research was carried out on four domestic pigs. The animals were 10-12 weeks old, the average weight was 30 ± 2.7 kg. Beam delivering linear accelerator was used during the experiment. Animals were divided into groups according to the zones of planned radiation exposure: 1st animal – atrioventricular (AV) node (dose 35 Gy), 2nd animal - AV node and the apex of the left ventricle (LV) (dose 40/35 Gy, respectively), 3rd animal - pulmonary veins muscle sleeves and left atrium (dose 30 Gy), 4th - AV node and free wall of the LV (dose 45/40 Gy, respectively). Under intravenous sedation with hemodynamic monitoring, contrast-based CT scan of the heart was performed to assess the degree of displacement of the heart chambers in one respiratory and cardiac cycle- and to assess the anatomy of the chambers of the heart and adjacent organs. The allocation and the contouring of the target zones were carried out in three projections: axial, frontal and sagittal. For electrophysiological control, loop recorders were implanted in each animal. The average exposure time was 11 ± 7 minutes. The long-term follow-up period was six months, followed by morphological examination of autopsy material. The study followed the "Principles of laboratory animal care". Results The average follow-up period after the experiment was 134.75 ± 77.34 days. The electrophysiological effect of the ablation was considered to be achieved in cases of complete AV-block development. This effect was developed in two out of three animals, whose AV-node was exposed: 2nd animal - 40 Gy on 108th day of observation and 4th animal - 45 Gy on 21st day of observation. No cardiac arrhythmias were recorded in all cases. The results of macro- and microscopic examination showed significant changes in the target zones. These areas had precise but uneven damage boundaries, which were within the planned ones (conformal exposure with a high degree of precision). The transmural nature of the changes was noted as well (pic. 1 A, B, C). Massive fields of fibrous tissue of various degrees of maturity (with a predominance of subepicardial localization) with focal hemorrhages of various ages and granulations were detected, which were surrounded by cardiomyocytes with coagulated and vacuolated cytoplasm (pic. 1 D, E, F). Conclusion The use of non-invasive stereotactic treatment of tachyarrhythmias has high potential in modern arrhythmology as an alternative ablation method. Abstract Figure. Macro- and microscopic results

scholarly journals Comparison of transthoracic echocardiography with computed tomography in evaluation of pulmonary veins

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Qing-Qing Dong ◽  
Wen-Yi Yang ◽  
Ya-Ping Sun ◽  
Qian Zhang ◽  
Guang Chu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Transthoracic Echocardiography ◽  
Anatomic Variation ◽  
Cardiac Computed Tomography ◽  
Pulmonary Veins ◽  
Non Invasive ◽  
Clear Identification ◽  
The Right

Abstract Background Transesophageal echocardiography may be used to assess pulmonary veins for atrial fibrillation ablation. No study focused on the role of transthoracic echocardiography (TTE) in evaluating the diameter and anatomy of pulmonary veins. Methods Among 142 atrial fibrillation patients (57.7% men; mean age, 60.5) hospitalised for catheter ablation, we assessed pulmonary veins and compared the measurements by TTE with cardiac computed tomography (CT) before ablation. Among 17 patients who had follow-up examinations, the second measurements were also studied. Results TTE identified and determined the diameters of 140 (98.6%) right and 140 (98.6%) left superior PVs, and 136 (95.7%) right and 135 (95.1%) left inferior PVs. A separate middle PV ostia was identified in 14 out of the 22 patients (63.6%) for the right side and in 2 out of 4 (50.0%) for the left side. The PV diameters before ablation assessed by CT vs. TTE were 17.96 vs. 18.07 mm for right superior, 15.92 vs. 15.51 mm for right inferior, 18.54 vs. 18.42 mm for left superior, and 15.56 vs. 15.45 mm for left inferior vein. The paired differences between the assessments of CT and TTE were not significant (P ≥ 0.31) except for the right inferior vein with a CT-minus-TTE difference of 0.41 mm (P = 0.018). The follow-up PV diameters by both CT (P ≥ 0.069) and TTE (P ≥ 0.093) were not different from baseline measurements in the 17 patients who had follow-up measurements. Conclusions With a better understanding of PV anatomy in TTE imaging, assessing PV diameters by non-invasive TTE is feasible. However, the clear identification of anatomic variation might still be challenging.

scholarly journals Enhancement of Maternal ECG Using Short-Term Fourier Transform for Foetal Electrocardiogram Extraction

2021 ◽  
pp. 84-91
Author(s):  
Prof. M. Senthil Vadivu ◽  
Saranya H ◽  
Vijay Kumar K S
Keyword(s):  
Fourier Transform ◽  
Wave Structure ◽  
Well Being ◽  
Short Term ◽  
Morphological Examination ◽  
Time Frequency ◽  
Non Invasive ◽  
Frequency Representation ◽  
Short Time

The objective of the project is to improve maternal abdomen recording for better prediction of foetal Electrocardiogram (FECG). One of the most difficult tasks in observing foetal well-being is obtaining a clean foetal Electrocardiogram (FECG) using non-invasive abdominal recordings. The foetal graph's low signal quality, on the other hand, makes morphological examination of its wave structure in clinical follow-up difficult. The signal contains precise information that can help doctors to monitor fetal health during pregnancy and labor. The abdominal signal is normalized and separated in the pre-processing stage for wave shape analysis in clinical follow-up. The Kaiser window is used for spectral analysis and segmenting the signal. The two-dimensional (2D) time-frequency representation is obtained by short-time Fourier transform (STFT). The STFT enhances the abdominal recordings of maternal Electrocardiogram (MECG) for efficient separation of foetal electrocardiogram (FECG) to monitor the foetus well-being.

scholarly journals Six-months success of radiofrequency ablation in cardiac arrhythmias treatment: Experience of our centre

2019 ◽  
Vol 76 (4) ◽  
pp. 398-403
Author(s):  
Ruzica Jurcevic-Mudric ◽  
Lazar Angelkov ◽  
Milosav Tomovic ◽  
Dejan Kojic ◽  
Predrag Milojevic
Keyword(s):  
Atrial Fibrillation ◽  
Ventricular Tachycardia ◽  
Radiofrequency Ablation ◽  
Atrial Flutter ◽  
Cardiac Arrhythmias ◽  
Paroxysmal Atrial Fibrillation ◽  
Atrial Tachycardia ◽  
Pulmonary Veins ◽  
Av Node

Background/Aim. Numerous trials have shown a high success of radiofrequency ablation (RFA) in the treatment of the patients with cardiac arrhythmias. We aimed to examine the RFA initial success in treatment of different cardiac arrhythmias and the RFA success after 6 months of followup. Second aim was to evaluate influence of all clinical and echocardiography parameters on initial and 6-month success and failure of RFA. Methods. The present study included 320 consecutive patients with atrial and ventricular arrhythmias in which RFA was performed during 2014 in the Institute for Cardiovascular Diseases ?Dedinje?, Belgrade, Serbia. We evaluated the initial RFA success and success of this procedure after 6-month follow-up. We also investigated the prognostic role of clinical and echocardiography parameters on initial and 6-month success and failure of RFA. Results. The RFA initial success for RFA of atrioventriculas (AV) node and AV nodal reentrant tachycardia (AVNRT) was 100%, RFA of pulmonary veins 99%, RFA of atrial flutter 92%, RFA of premature ventricular complexes (PVC) and the Wolf-Parkinson-White (WPW) syndrome 87%, RFA of ventricular tachycardia 85% and RFA of atrial tachycardia 78%. The success of RFA after 6 months of follow-up for RFA of the AV node was 100%, RFA of AVNRT 94%, RFA of atrial flutter 90%, RFA of WPW syndrome 86%, RFA of pulmonary veins 79% (paroxysmal atrial fibrillation 88% and persistent atrial fibrillation 63% with a significant difference p < 0.05), RFA of PVC 78%, RFA of ventricular tachycardia 77% and RFA of atrial tachycardia 67%. Conclusion. This study proved a very high RFA initial success in treatment of cardiac arrhythmias and a satisfactory RFA success after 6 months of follow-up. Only the prognostic value had the type of atrial fibrillation in the group with catheter ablated pulmonary veins: after 6-month follow-up, the patients with paroxysmal atrial fibrillation had a significantly better outcome than those with persistent form.

scholarly journals Implantable "loop recorder": A new diagnostic tool for syncope of unknown cause

2005 ◽  
Vol 133 (7-8) ◽  
pp. 338-342
Author(s):  
Goran Milasinovic ◽  
Mirjana Zivkovic ◽  
Velibor Jovanovic ◽  
Vera Jelic ◽  
Dragutin Savic ◽  
...  
Keyword(s):  
Diagnostic Tool ◽  
Heart Rhythm ◽  
Implantable Loop Recorder ◽  
Loop Recorder ◽  
Non Invasive ◽  
Maximum Period ◽  
Conventional Tests ◽  
Unexplained Syncope ◽  
Implementation Method

Introduction. The implantable loop recorder (ILR) is a new diagnostic tool in cardiology for establishing The causes of unexplained syncope in patients where standard conventional tests, invasive tests included, have failed. The device is a diagnostic "pacemaker," surgically implanted underneath the skin of the chest, with leads attached to the case of the device, not requiring endovenous lead implantation. Heart rhythm is monitored continuously on the basis of an endless loop, up to a maximum period of 14 months. Recording is carried out either by applying an outside activator whenever symptoms occur, or automatically, according to a preset algorithm for bradycardia, tachycardia, and/or asystolic detection. Objective. The aim of this study was to present this new diagnostic method as well as our first experiences with its implementation. METHOD We followed 5 patients (3 male, 2 female, mean age: 46.4?19) who had ILRs ("Reveal Plus," Medtronic Inc., USA) implanted at our centre, over a period of 14 months (7.6 ?5.5], concentrating on their clinical course, symptom occurrence, and electronically monitored heart rhythm at the time of ILR auto activation and/or recordings triggered by outside activation whenever a patient's symptoms were discernible. Results. In three patients, the ILR revealed syncope aetiology by documenting heart rhythm at the time of its occurrence. In one patient, involving a lethal outcome, the ILR was not explanted, so that the rhythm at the time of the fatal syncope, although assumed, remained undocumented, in one, most recently implanted patient, follow-up is still in progress. Conclusion. The implantable loop recorder represents an important innovation and a step forward in establishing the causes of recurrent syncope, which cannot be determined by standard invasive and non-invasive testing.

scholarly journals Taxonomic signatures of cause-specific mortality risk in human gut microbiome

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Aaro Salosensaari ◽  
Ville Laitinen ◽  
Aki S. Havulinna ◽  
Guillaume Meric ◽  
Susan Cheng ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Gut Microbiome ◽  
Human Gut ◽  
Cross Sectional ◽  
Microbiome Composition ◽  
Human Gut Microbiome ◽  
Non Invasive ◽  
Sequencing Technologies

AbstractThe collection of fecal material and developments in sequencing technologies have enabled standardised and non-invasive gut microbiome profiling. Microbiome composition from several large cohorts have been cross-sectionally linked to various lifestyle factors and diseases. In spite of these advances, prospective associations between microbiome composition and health have remained uncharacterised due to the lack of sufficiently large and representative population cohorts with comprehensive follow-up data. Here, we analyse the long-term association between gut microbiome variation and mortality in a well-phenotyped and representative population cohort from Finland (n = 7211). We report robust taxonomic and functional microbiome signatures related to the Enterobacteriaceae family that are associated with mortality risk during a 15-year follow-up. Our results extend previous cross-sectional studies, and help to establish the basis for examining long-term associations between human gut microbiome composition, incident outcomes, and general health status.

scholarly journals Non-Invasive Dengue Diagnostics—The Use of Saliva and Urine for Different Stages of the Illness

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1345
Author(s):  
Mahathir Humaidi ◽  
Wei Ping Tien ◽  
Grace Yap ◽  
Choon Rong Chua ◽  
Lee Ching Ng
Keyword(s):  
Clinical Symptoms ◽  
Detection Algorithm ◽  
Acute Stage ◽  
Serum Samples ◽  
Non Invasive ◽  
Fever Onset ◽  
Dengue Transmission ◽  
Dengue Diagnostics ◽  
Potential Tool

Dengue diagnosis is largely dependent on clinical symptoms and routinely confirmed with laboratory detection of dengue virus in patient serum samples collected via phlebotomy. This presents a challenge to patients not amenable to venipuncture. Non-invasive methods of dengue diagnosis have the potential to enhance the current dengue detection algorithm. In this study, samples from dengue infected patients were collected between January 2012 until September 2012 and September 2013 until December 2013 in two different setups. Panel A samples (blood, urine, and saliva) were collected daily when the 39 patients were hospitalised and during their follow-up visits while Panel B samples (saliva) were collected from 23 patients during the acute stage of dengue. Using DENV PCR on Panel A, from day 2 to day 4 post fever onset, serum showed the best overall positivity followed by saliva and urine (100%/82.1%/67.9%). From day 5 until day 10 post fever onset, serum and urine had similar positivity (67.4%/61.2%), followed by saliva (51.3%). Beyond day 10 post fever onset, DENV was undetectable in sera, but urine and saliva showed 56.8% and 28.6% positivity, respectively. DENV in urine was detectable up until 32 days post fever. Panel B results showed overall sensitivity of 32.4%/36% (RNA/NS1) for DENV detection in saliva. Our results suggest that the urine-based detection method is useful especially for late dengue detection, where DENV is undetected in sera but still detectable in urine. This provides a potential tool for the physician to pick up new cases in an area where there is ongoing dengue transmission and subsequently prompt for intensified vector control activities.

scholarly journals Risk assessment in precapillary pulmonary hypertension: a comparative analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Thomas Sonnweber ◽  
Eva-Maria Schneider ◽  
Manfred Nairz ◽  
Igor Theurl ◽  
Günter Weiss ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Pulmonary Hypertension ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Prediction ◽  
Mortality Risk ◽  
Assessment Tool ◽  
Risk Models ◽  
Non Invasive

Abstract Background Risk stratification is essential to assess mortality risk and guide treatment in patients with precapillary pulmonary hypertension (PH). We herein compared the accuracy of different currently used PH risk stratification tools and evaluated the significance of particular risk parameters. Methods We conducted a retrospective longitudinal observational cohort study evaluating seven different risk assessment approaches according to the current PH guidelines. A comprehensive assessment including multi-parametric risk stratification was performed at baseline and 4 yearly follow-up time-points. Multi-step Cox hazard analysis was used to analyse and refine risk prediction. Results Various available risk models effectively predicted mortality in patients with precapillary pulmonary hypertension. Right-heart catheter parameters were not essential for risk prediction. Contrary, non-invasive follow-up re-evaluations significantly improved the accuracy of risk estimations. A lack of accuracy of various risk models was found in the intermediate- and high-risk classes. For these patients, an additional evaluation step including assessment of age and right atrium area improved risk prediction significantly. Discussion Currently used abbreviated versions of the ESC/ERS risk assessment tool, as well as the REVEAL 2.0 and REVEAL Lite 2 based risk stratification, lack accuracy to predict mortality in intermediate- and high-risk precapillary pulmonary hypertension patients. An expanded non-invasive evaluation improves mortality risk prediction in these individuals.

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