surgical ablation
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2021 ◽  
Vol 11 (1) ◽  
pp. 210
Author(s):  
Patrick M. McCarthy ◽  
James L. Cox ◽  
Olga N. Kislitsina ◽  
Jane Kruse ◽  
Andrei Churyla ◽  
...  

Atrial fibrillation (AF) is the most common of all cardiac arrhythmias, affecting roughly 1% of the general population in the Western world. The incidence of AF is predicted to double by 2050. Most patients with AF are treated with oral medications and only approximately 4% of AF patients are treated with interventional techniques, including catheter ablation and surgical ablation. The increasing prevalence and the morbidity/mortality associated with AF warrants a more aggressive approach to its treatment. It is the purpose of this invited editorial to describe the past, present, and anticipated future directions of the interventional therapy of AF, and to crystallize the problems that remain.


Surface ◽  
2021 ◽  
Vol 13(28) ◽  
pp. 206-245
Author(s):  
S. P. Turanska ◽  
◽  
A. P. Kusyak ◽  
A. L. Petranovska ◽  
V. V. Turov ◽  
...  

Bone tumor diseases are one of the main problems in modern clinical practice. After surgery, some of the tumor cells capable of proliferation may remain, leading to tumor recurrence. In addition, surgical ablation of bone tumors creates bone tissue defects. Therefore, the problem of manufacturing specific biomaterials with a dual function of treating bone tumors and regeneration of bone defects has become a priority. The use of methods of targeted delivery and local controlled release of drugs contributes to the creation of the desired therapeutic concentration of drugs in the disease focus and increases their bioavailability. In recent years, promising samples capable of effective controlled release have been developed in which cisplatin, doxorubicin and gemcitabine have been used as model chemotherapeutic drugs. These approaches have been promising and have shown the potential to destroy residual tumor cells, however, they may become resistant to such drugs, which leads to treatment failure. The main purpose of the review is to summarize the latest world experience in the synthesis, research and use of composites based on bioactive ceramic materials and modern antitumor drugs as promising implants, embodying a new generation of complex remedies for targeted delivery with osteoconductive and antitumor properties, prolonged action, for local application. Examples are given of bioglass application with cytotoxic / cytostatic components, as well as results of development of the newest directions of antitumor therapy of bones, in which acquisition of resistance of tumor cells is not observed. The antitumor functions of such multifunctional samples are performed, for example, by chemotherapy, photothermal therapy, magnetic hyperthermia, and photodynamic therapy. These data are of scientific, practical and methodical interest.


Author(s):  
G P Bijvoet ◽  
S M Chaldoupi ◽  
E Bidar ◽  
R J Holtackers ◽  
J G L M Luermans ◽  
...  

Abstract Background Surgical epicardial AF ablation can be performed as a stand-alone (thoracoscopic) procedure or concomitant to other cardiac surgery. In hybrid AF ablation thoracoscopic surgical epicardial ablation is combined with a percutaneous endocardial ablation. The Medtronic Gemini-S clamp is a surgical tool that uses irrigated bipolar biparietal RF energy applied with two clamp lesions that overlap to create one epicardial box lesion including the posterior LA wall and the pulmonary veins. Case summary We describe three patients with therapy-refractory persistent AF and different stages of atrial remodelling in whom the Medtronic Cardioblate Gemini-S Irrigated RF Surgical Ablation System was used for hybrid AF ablation. Acute endocardial validation at the end of the hybrid ablation revealed a complete box lesion in all three cases. At 2-year follow-up, two out of three patients had recurrence of atrial arrhythmias. Invasive electro-anatomical mapping confirmed persistence of the box lesion, and the mechanism of arrhythmia recurrence in both patients was unrelated to posterior left atrium or the pulmonary veins. The third patient has been without arrhythmia symptoms since the ablation procedure. A 3D late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) illustrates the ablation scar non-invasively in two cases. Discussion Thoracoscopic biparietal RF AF ablation with the Medtronic Cardioblate Gemini-S Irrigated RF Surgical Ablation System results in permanent transmural scar formation, irrespective of the stage of atrial remodelling, as shown in this small population by means of multimodality scar evaluation.


2021 ◽  
Vol 12 (4) ◽  
pp. 66-74
Author(s):  
Aleksandr S. Zotov ◽  
Emil R. Sakharov ◽  
Sergey V. Korolev ◽  
Olga V. Drakina ◽  
Robert I. Khabazov ◽  
...  

Atrial fibrillation is one of the most common types of cardiac arrhythmia observed in clinical practice. Despite advances in the diagnosis and treatment, atrial fibrillation remains one of the leading causes of cardiovascular mortality and morbidity. In addition, atrial fibrillation is quite often combined with other pathologies of the cardiovascular system and is a marker of an unfavorable outcome. Several previous studies have demonstrated reduced survival in patients with coronary artery disease and atrial fibrillation who have not undergone surgery for arrhythmia. According to other data, the presence of preoperative atrial fibrillation among patients undergoing isolated coronary artery bypass grafting was associated with significantly higher rates of major postoperative complications. Nowadays, no one doubts the fact that atrial fibrillation during a coronary artery bypass surgery is a risk factor for increased hospital mortality, postoperative morbidity and leads to a decrease in the long-term survival. The studies confirm the necessity of surgical ablation for atrial fibrillation during coronary revascularization to reduce both short-term and long-term postoperative mortality and late complications.


2021 ◽  
Author(s):  
Scott C. Brancato ◽  
Mansen Wang ◽  
Kateri J. Spinelli ◽  
Maheer Gandhavadi ◽  
Neil K. Worrall ◽  
...  

2021 ◽  
Vol 24 (6) ◽  
pp. E968-E976
Author(s):  
Xiyu Zhu ◽  
Yali Wang ◽  
Ran Mo ◽  
Hoshun Chong ◽  
Cailong Cao ◽  
...  

Background: Atrial fibrillation (AF) recurrence after ablation will increase mortality and morbidity during follow up. We attempted to evaluate the relationship between circular RNAs (circRNA) and AF recurrence to establish a predictive model for early intervention. Methods: Patients who received surgical ablation retrospectively were analyzed. The expression of circRNAs were detected in the left atrial appendage. The independent risk factors of late recurrence were analyzed by multivariate analysis. The predictive model was visualized by Nomogram and tested by receiver operating characteristic curve and calibration plot. Kaplan-Meier plot was used to compare the rate of freedom from AF recurrence after surgery. The relationships between circRNAs and clinical characteristics were detected by Spearman’s correlation analysis. Results: A total of 136 patients were enrolled from September 2018 to June 2019, 55 patients experienced late recurrence during one-year follow up. Increased age, longer AF duration and increased circ 81906-RYR2, circ 44782-LAMA2, circ 418-KCNN2 and circ 35880-ANO5 were detected in recurrent patients. Multivariate analysis revealed that increased age (odds ratio (OR)=1.072, P = 0.006), longer AF duration (OR=1.007, P = 0.036) and increased circ 81906-RYR2 (OR=2.210, P < 0.001) were independent risk factors for late recurrence. Area under the curve was 0.77, and the cut-off value was 70 points of the predictive model. Kaplan-Meier plots showed that patients over 70 points tended to experience AF recurrence. Conclusion: Circ 81906-RYR2 could be a new predictor of late recurrence after surgical ablation. A predictive model consists of age, atrial fibrillation duration, and circ 81906-RYR2 was alternative for early intervention of AF recurrence.


2021 ◽  
Vol 154 (9) ◽  
Author(s):  
Nao Tokuda ◽  
Daiki Watanabe ◽  
Yuki Ashida ◽  
Iori Kimura ◽  
Azuma Naito ◽  
...  

Synergistic ablation (SA) is widely used to induce muscle hypertrophy in rodent studies. However, it has been demonstrated that SA-induced compensatory hypertrophy induces increases in maximum isometric force that are smaller in magnitude than the increase in muscle cross-sectional area, suggesting a reduction in the specific force production due to intrinsic contractile dysfunction in the hypertrophied fibers. Here, by using the mechanical skinned fibers, we investigated the mechanisms behind the reduction in specific force in the compensatory hypertrophied muscles. Rats had unilateral surgical ablation of the gastrocnemius and soleus muscles to induce the compensatory hypertrophy in the plantaris muscles. Two wk after surgery, the mean fiber diameter was increased by 19% in the SA group compared with the contralateral control (CNT) group. In contrast, compared with the CNT group, both the depolarization-induced force (−51%) and the Ca2+-activated maximum specific force (−32%) were markedly reduced in skinned fibers from the SA group. These deleterious functional alterations were accompanied by decreases in the amount of DHPRα1, RYR, junctophilin 1, and SH3 and cysteine-rich domain 3 (STAC3) in SA muscles. Thus, these data clearly show that SA induces not only an increase in skeletal muscle fiber hypertrophy but also leads to a reduction in the intrinsic contractile dysfunction due to the excitation–contraction uncoupling and impaired force-generating capacity.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Tatsuhiko Shimizu ◽  
Tomoyuki Kanazawa ◽  
Takanobu Sakura ◽  
Kazuyoshi Shimizu ◽  
Tatsuo Iwasaki

Abstract Background Atrial tachycardia (AT) is rare in children and can usually be reversed to sinus rhythm with pharmacotherapy and cardioversion. We report a rare case of severe left-sided heart failure due to refractory AT. Case presentation A 12-year-old boy had AT with a heart rate of 180 beats/minute, which was refractory to any medication and defibrillation despite the first attack. Due to rapid cardiorespiratory collapse shortly after arriving at our hospital, central extracorporeal membrane oxygenation (ECMO) with left arterial venting was started immediately. Although AT persisted after that, it stopped on the 3rd day after admission following surgical resection of the left atrial appendage thought to be the source of AT. He was weaned off ECMO on the 7th day and ventilator on the 14th day. Conclusions The appropriate timing of central ECMO and surgical ablation were effective in saving this child from a life-threatening situation caused by refractory AT.


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