Clinico-pathological correlation of linear dermatoses along the lines of Blaschko: An observational study

Several epidemiological studies have described linear dermatoses; however, only few studies have correlated linear dermatoses along Blaschko’s lines with the histopathological findings. The aims of this study were to investigate the clinical patterns of various linear dermatological lesions along Blaschko’s lines and investigate the correlations between these dermatological lesions and their histopathological features. Patients who attended our dermatology out-patient department with linear dermatoses along the Blaschko’s lines were included in the study. Detailed history was obtained, clinical examination was performed, and a final provisional clinical diagnosis was noted. Subsequently, biopsy of the lesions was performed for histopathological examination. Of 62 patients who presented with linear lesions along the Blaschko’s lines, 45 patients underwent biopsy and histopathological examination. Of 45 patients who underwent biopsy, clinico-pathological correlation was observed in 100% of those diagnosed with lichen striatus and linear morphea, 89% of those diagnosed with hypomelanosis of Ito, 80% of those diagnosed with linear epidermal nevus, 75% of those diagnosed with lichen planus, and 67% of those diagnosed with nevus depigmentosus. The importance of correlation of linear lesions with their histopathological features in dermatology cannot be over emphasized. However, 100% correlation may be wishful thinking, and a correlation can help choose the appropriate line of management. Our results highlight this discrepancy and add to the knowledge on linear dermatosis.

76 Right mini-thoracotomy surgical Cox-maze (left atrial lesion) vs. catheter ablation using contact force-sensing technology in patients with persistent atrial fibrillation

Aims Pulmonary vein isolation (PVI) often is not sufficient in patients (pts) with persistent atrial fibrillation (AF). Substrate modification (SM) by catheter ablation (CA) of low-voltage zones (LVZ) has yielded favourable results, but those studies were performed before the introduction of contact force (CF) sensing technology. Surgical ablation (SA) studies support the hypothesis that empiric bi-atrial linear ablation (Cox Maze IV procedure) is able to improve success, but there is less data on outcome of patients undergoing left atrial (LA) linear lesions alone. In current guidelines, both CA and SA have Class IIa indication in pts with persistent AF. In this single-centre retrospective study, we analysed the long-term outcomes of CA and SA in pts with persistent AF. Methods and results In the CA group (Figure 1), pts underwent PVI and additional SM in the presence of LVZ (roof line and supero-septal line) using TactiCath™ or SmartTouch™ ablation catheters aiming at contact values ≥10 g < 20 g and FTI >400 g/s. Ablation was performed in a temperature-controlled fashion with energy of 30 W except at the posterior wall (20–25 W). In the SA group (Figure 2), pts underwent ablation procedure (creation of a pure LA endocardial lesion set consistent with the Cox Maze IV) performed by a right mini-thoracotomy approach using the Atricure™ cryoablation probe, a left atrial appendage (LAA) epicardial exclusion using the Atriclip™ system, and mitral valve repair in the presence of severe mitral valve regurgitation. No right atrial lesions were created. 196 pts were included. 120 pts underwent CA [median age: 65 (58–72) years, median LA volume index (LAVI): 66 (56–75) ml/m2], in pts with LVZs PVI + SM was performed [bidirectional block of lines in 100%]. 76 pts underwent SA [median age: 64 (58–74) years, median LAVI 90 (78–103) ml/m2], in 42 pts a mitral valve repair was performed. At 24 months (figure), 89% and 68% of pts were free of AF in the SA and CA group, respectively, mainly without antiarrhythmic drugs (92% SA group and 89% CA group). Conclusions In patients with persistent AF, SA performed by a right mini-thoracotomy approach with linear lesions limited to LA leads to excellent 2-year freedom from AF despite significantly larger LAVI compared with the CA group. LAA epicardial exclusion likely contributed to surgical efficacy by eliminating the LAA as trigger/driver.

Anti-glaucoma agents-induced pseudodendritic keratitis presumed to be herpetic simplex keratitis: a clinical case series

Anti-glaucoma agents-induced corneal toxicity may be misdiagnosed as herpetic simplex keratitis (HSK). In our study, nineteen glaucoma patients were presumed to have HSK before referral. Corneal lesions were classified into (I) linear pseudodendritic lesions formed by elevated opacified cells, (II) linear pseudodendritic lesions formed by grouped superficial punctate keratitis (SPK), (III) satellite full-thickness epithelial defects, (IV) satellite lesions formed by elevated opacified cells, and (V) geographic lesions formed by grouped SPK. We observed thirty-one events, with 15 in the lower and 16 in the central corneas. There were 21 (67.7%) type II, five (16.1%) type V, two (6.5%) of each for types III and IV, and one (3.2%) type I events. Among linear lesions (types I and II), 17 (77.3%) had horizontal and 5 (22.7%) had curvilinear orientations. Exposure duration to the last-added anti-glaucoma agent was three days to 14.5 years. About half of the events (16/31, 51.6%) used prostaglandin analogues, and 30/31 (96.8%) applied benzalkonium chloride (BAK)-containing agents. All lesions resolved within two months after decreasing offending medications or enhancing protection of ocular surface. In conclusion, anti-glaucoma agents-induced pseudodendritic keratitis presents majorly in central-lower cornea as horizontally linear lesions, and BAK-containing agents are observed in the most events.

Comparative efficacy and safety of different catheter ablation strategies for persistent atrial fibrillation: a network meta-analysis of randomized clinical trials

Aims Whereas pulmonary vein isolation (PVI) is the universally agreed target in catheter ablation of paroxysmal atrial fibrillation (AF), an ideal ablation set in persistent AF remains questioned. Aim of this study is to conduct a network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing different ablation strategies in persistent AF patients. Methods and results Network meta-analysis was performed in a frequentist framework with the different ablation strategies constituting the competitive arms of interest. Primary efficacy endpoint was recurrences of atrial tachyarrhythmia (AF, atrial flutter, and/or organized atrial tachycardia). Secondary endpoints included major peri-procedural complications, procedure, and fluoroscopy duration. PubMED/MEDLINE and EMBASE databases were searched through June 2020. 2548 records were screened and 57 full-text articles assessed. Eventually 24 RCTs were included, encompassing 3245 patients (median follow-up 15 months, IQR 12–18). Compared to PVI alone, PVI plus linear lesions in the left atrium and elimination of extra-PV sources was the only strategy associated with a reduced risk of arrhythmia recurrence (RR 0.49, 95%CI 0.27–0.88). Most treatment arms were associated with longer procedural time compared with PVI; however, major peri-procedural complications and fluoroscopy time did not differ. Conclusion A comprehensive strategy including PVI, linear lesions in the left atrium, and elimination of extra-PV sources (constrained by a heterogeneous definition across studies) was associated with reduced risk of recurrent atrial tachyarrhythmias compared to PVI alone. All investigated treatment arms yielded similar safety profiles. Further research should rely on enhanced substrate-based approach definitions to solve one of the most evident knowledge gaps in interventional electrophysiology.

Catheter, surgical, or hybrid procedure: what future for atrial fibrillation ablation?

Background The debate on the best treatment strategy for atrial fibrillation (AF) has expanded following the introduction of the so-called “hybrid procedure” that combines minimally invasive epicardial ablation with endocardial catheter ablation. However, the advantage of the hybrid approach over conventional epicardial ablation remains to be established. Methods From June 2008 to December 2020, 609 surgical AF ablation procedures through a right minithoracotomy were performed at our institution. From 2008 to 2011, a unipolar radiofrequency (RF) device was used, whereas from 2011 to 2020 a bipolar RF device was used. In addition, between September 2016 and April 2017, 60 patients underwent endocardial completion of epicardial linear ablation. In 30 of these latter patients, surgical isolation of the Bachmann’s bundle (BB) was also performed. Starting from 2021, surviving patients at follow-up were asked to undergo electrocardiographic evaluation and left ventricular function assessment and to complete a questionnaire addressing quality of life and predisposing factors for recurrent AF. Results The ablation procedure was completed in all patients. Upon discharge, 30 (4.9%) patients showed recurrence of AF, whereas the remaining patients (95.1%) were in sinus rhythm. All patients in whom a hybrid approach was used either with or without BB ablation were discharged in sinus rhythm. After a mean follow-up of 74 months, 122 (20%) patients developed recurrent AF, including 19.9% in whom a unipolar RF device was used, 21% in whom a bipolar RF device was used, 23% who had undergone a hybrid procedure without BB ablation and 3.3% who had undergone a hybrid procedure with BB ablation. On multivariate analysis, reduced left ventricular ejection fraction, worsening of European Heart Rhythm Association symptom class, and cognitive impairment or depression during follow-up were found to be significantly associated with AF recurrence. Conclusions Surgical AF ablation through a right minithoracotomy is safe and may allow the creation of additional linear lesions, particularly in the BB. The placement of adjunctive linear lesions in the setting of a hybrid procedure can be more effective in reducing the risk for AF recurrence than isolated surgical ablation or hybrid ablation without the addition of further linear lesions, with no incremental risk to the patient.

Catheter, Surgical, or Hybrid Procedure: What Future for Atrial Fibrillation Ablation?

Background - The debate on the best treatment strategy for AF has expanded following the introduction of the so-called “hybrid procedure” that combines minimally invasive epicardial ablation with endocardial catheter ablation. However, the advantage of the hybrid approach over conventional epicardial ablation remains to be established.Methods -From June 2008 to December 2020, 609 surgical AF ablation procedures through a right minithoracotomy were performed at our institution. From 2008 to 2011, a unipolar radiofrequency (RF) device was used, whereas from 2011 to 2020 a bipolar RF device was used. In addition, between September 2016 and April 2017, 60 patients underwent endocardial completion of epicardial linear ablation. In 30 of these latter patients, surgical isolation of the Bachmann’s bundle (BB) was also performed. Starting from 2021, surviving patients at follow-up were asked to undergo ECG evaluation and left ventricular function assessment and to complete a questionnaire addressing quality of life and predisposing factors for recurrent AF. Results - The ablation procedure was completed in all patients. Upon discharge, 30 (4.9%) patients showed recurrence of AF, whereas the remaining patients (95.1%) were in sinus rhythm. All patients in whom a hybrid approach was used either with or without BB ablation were discharged in sinus rhythm. After a mean follow-up of 74 months, 122 (20%) patients developed recurrent AF, including 19.9% in whom a unipolar RF device was used, 21% in whom a bipolar RF device was used, 23% who had undergone a hybrid procedure without BB ablation and 3.3% who had undergone a hybrid procedure. On multivariate analysis, reduced left ventricular ejection fraction, worsening of EHRA symptom class, and cognitive impairment or depression during follow-up were found to be significantly associated with AF recurrence. Conclusions - Surgical AF ablation through a right minithoracotomy is safe and may allow the creation of additional linear lesions, particularly in the BB. The placement of adjunctive linear lesions in the setting of a hybrid procedure is more effective in reducing the risk for AF recurrence than isolated surgical ablation or hybrid ablation without the addition of further linear lesions, with no incremental risk to the patient.

A CLINICOEPIDEMIOLOGICAL STUDY ON PAEDERUS DERMATITIS IN A TERTIARY CARE CENTRE, CHENNAI

Paederus dermatitis is a form of irritant contact dermatitis due to contact with certain insects of the genus Paederus presenting with mostly erythematous linear lesions of sudden onset on exposed parts of the body. To study the clinico epi Aim: demiological features in patients with Paederus dermatitis. A retrospective analysis of clinicoepidemiological Materials & Methods: features of patients affected with Paederus dermatitis who had attended the Dermatology OPD, in a tertiary care hospital between January 2018 to December 2019 was done. All the required data had been collected from the OPD records and details were tabulated and analysed. A total of 56 patients had been affected with Result: Paederus dermatitis during the study period, of which 32 were males and 24 were females. 41out of 56 (73.21%) of patients presented between the months of August and December. Most common age group affected were between 11 to 30 yrs, with front and back of neck being the most common affected sites. In 42 out of the 56 patients the lesions resolved with post inammatory hyperpigmentation. Conclusion: Paederus dermatitis is a common condition that is often misdiagnosed and hence awareness is required for the clinicians and the general public to prevent it.

Clinical Safety and Efficacy of Ablation for Atrial Fibrillation Patients With a History of Stroke

Objectives: To evaluate the clinical safety and efficacy of radiofrequency catheter ablation for atrial fibrillation patients with a history of stroke.Methods and Results: A total of 116 symptomatic, drug-refractory AF patients with a history of stroke, and 1:2 matched patients without a history of stroke were enrolled. Of these, 28 cases occurred stroke within 3 months (Group 1), 88 cases with stroke history longer than 3 months (Group 2), and 232 cases without stroke (Group 3). PVI was performed in all patients, extended to ablation of linear lesions ablation. The periprocedural stroke rates and other procedure-related in-hospital complications did not differ significantly among the three groups. The maintenance rate of SR after the procedure showed no significant difference (p = 0.333), 52.7, 66.4, and 70.7% in Group 1, 2, and 3, respectively. Furthermore, the comparison between a history of stroke and those without it were also shown no significant difference (p = 0.351).Conclusions: Radiofrequency ablation for AF patients occurred stroke, even within 3 months is safe and effective, without higher periprocedural complication rate and recurrence rate.

A clinical study on linear dermatoses at a teriary care teaching hospital in Davangere

<p class="abstract"><strong>Background:</strong> Skin lesions present with innumerable patterns like discoid, petaloid, arcuate, annular, polycyclic, livedo, reticulate, target, stellate, digitate, linear, serpiginous and whorled. Most of the linear lesions follow the Blaschko’s lines. Aim was to study the incidence of linear dermatoses, the age and sex incidence, various types of clinical presentation, various sites of distribution and their clinical correlation. </p><p class="abstract"><strong>Methods:</strong> Detailed history including family history, History of disease documented with clinical examination. After counselling and after recording their consent for the test, skin biopsy along with routine investigations was done wherever needed and the results were evaluated. <strong></strong></p><p class="abstract"><strong>Results:</strong> Lichen striatus was seen in 29.91% followed by linear herpes zoster in 24.7%, linear lichen planus in 18.22%, linear verrucous epidermal nevus in 14.01%, segmental vitiligo in 3.73%, nevus depigmentation in 2.33% and others. Maximal cases were asymptomatic and reported for cosmetic reason. Intense itching was the main reason to bring the lichen planus patients and few cases of the lichen striatus patients for treatment. </p><p class="abstract"><strong>Conclusions:</strong> Lichen striatus was found to be more common, female preponderance. Majority of patients showed unilateral distribution more on the extremities. Histopathological correlation shows the importance of histopathology which ultimately changes the management in any given condition.</p><p> </p>