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Acute and Mid-Term Results after Pulmonary Veins Isolation Using a Novel Circular Irrigated Multielectrode Mapping and Ablation Catheter (nMARQTM)  [PDF]
Ibrahim Marai, Mahmoud Suleiman, Jonathan Lessick, Miry Blich, Sobhi Abadi, Monther Boulos
World Journal of Cardiovascular Diseases (WJCD) , 2016, DOI: 10.4236/wjcd.2016.612051
Abstract:
Background: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation in both paroxysmal and persistent AF. However, this procedure is still challenging and time consuming. Objective: The aim of this study was to present our approach for PVI using a novel circular irrigated multielectrode mapping and ablation catheter (nMARQTM) and to present acute and mid-term results. Methods: The study included 31 consecutive patients with symptomatic AF (4 had persistent and 27 had paroxysmal AF) who underwent PVI using the nMARQTM catheter. Circular ablation was guided by CT image integrated into fast anatomical map and by intra cardiac echo. Isolation of pulmonary veins was identified using the nMARQTM catheter if it was possible to advance it into the veins, otherwise Lasso catheter was used. Patients were followed up to 20 months. Results: PVI was achieved in 119 (98%) out of 121 pulmonary veins identified, and final PVI was obtained in 30 (97%) out of 31 patients. Lasso catheter was needed for PVI confirmation in 16 (52%) patients. Touch up ablation using standard catheter guided by Lasso catheter was needed in 4 (13%) patients. Pericardial tamponade occurred in 1 patient who was treated with pericardiocentesis. No other major complications were detected. During follow-up (mean 15.9 ± 3.6 months, range 9 - 20 months), 4 (13%) patients had recurrence of atrial tachyarrhythmia. Conclusion: PVI using the novel nMARQTM catheter is safe with good acute and mid-term efficacy. Long term follow up trials are needed.
Pulmonary Vein Isolation using a High Density Mesh Ablator Catheter: incorporation of three-dimensional navigation and mapping
Jiun Tuan,Mohamed Jeilan,Faizel Osman,Suman Kundu
Journal of Atrial Fibrillation , 2009, DOI: 10.4022/jafib.v1i9.549
Abstract: Background We evaluated the use of a novel High Density Mesh Ablator (HDMA) catheter in combination with three-dimensional navigation for the treatment of paroxysmal atrial fibrillation. Methods The HDMA catheter was used to carry out pulmonary vein isolation in a consecutive series of patients. Three-dimensional geometry of the left atrial-pulmonary vein (LA-PV) junctions were first created with the HDMA catheter. Ostial, proximal and distal sites within the pulmonary veins were tagged with catheter shadows on the created geometry to allow for re-interrogation of these exact sites after ablation. Results The HDMA catheter was successfully used to create three dimensional geometry of the LA-PV junction in a total of 20 pulmonary veins which involved 5 patients. In all cases, ostial ablation alone was sufficient to achieve electrical isolation. No significant pulmonary vein stenosis was seen acutely after ablation. Conclusion We describe the successful use of the novel HDMA catheter to create three-dimensional geometry of the LA-PV junction to assist with pulmonary vein isolation. Keywords : Atrial Fibrillation, pulmonary vein isolation, ablation
Evaluation Of Atrial Fibrillation Burden Before Catheter Ablation Predicts Outcome After Pulmonary Vein Isolation  [cached]
Alexander Berkowitsch,Thomas Neumann,Malte Kuniss,Roland Brandt
Indian Pacing and Electrophysiology Journal , 2009,
Abstract: Background: Paroxysmal atrial fibrillation (PAF) is defined as recurrent AF terminating spontaneously within 7 days. This definition allows the consideration of any AF occurrence lasting < 7 days as paroxysmal, irrespective of the frequency and duration of episodes. The aim of this study was to investigate symptomatic AF burden (AFB) defined as total duration of symptomatic AF episodes within 3 months prior to abalation, for prediction of outcome after pulmonary vein isolation (PVI).Methods: A total of 320 consecutive patients with symptomatic AF (PAF=244, men=214, age=58 y) were enrolled. AFB in patients with PAF was defined as time spent in AF within 3 months prior to PVI. After the AFB cut-off point was optimized at 500 h, patients with PAF were categorized into 2 groups: Group 1 - patients with AFB<500 h (n=192), Group 2 - patients with AFB≥500 h (n=52). Patients with persistent AF (PersAF, n = 76) comprised control group (Group 3). PVI was performed either with irrigated tip catheter (n=215) or using cryoballoon (n=105). The endpoint of study was first documented recurrence of AF >30 sec.Results: Symptomatic AFB was found to be appropriate for prediction of outcome after PVI. The freedom from AF within 2 years was observed in 69%, 31%, and 43% patients in Group 1, 2 and 3, respectively (Group 1 vs. Group 2, p <.001; Group 1 vs. Group 3, p< .001; Group 2 vs. Group 3, p = 0.46).Conclusions: Low AFB < 500 h /3 months was associated with better outcome after PVI. Patients with PAF and high AFB should be treated as patients with PersAF.
Modified Maze lines plus pulmonary vein isolation created by radiofrequency catheter ablation on the atrial wall to treat atrial fibrillation in elderly
Caiyi LU,Shiwen WANG,Xinping DU,Yinglong HOU,Qiao XUE,Xinli WU,Rui CHEN,Peng LIU,
Caiyi LU
,Shiwen WANG,Xinping DU,Yinglong HOU,Qiao XUE,Xinli WU,Rui CHEN,Peng LIU

老年心脏病学杂志(英文版) , 2005,
Abstract: Objective To evaluate the effect of modified Maze lines plus pulmonary vein (PV) isolation created by radiofrequency catheter ablation (RFCA) on atrial wall guided by a novel geometry mapping system in the treatment of elderly patients with paroxysmal atrial fibrillation (PAF). Methods After regular electrophysiological study, transseptal punctures were achieved twice with Swartz L1 and R1 sheaths. PV angiographies were conducted to evaluate their orifices and branches. A balloon electrode array catheter with 64 electrodes was put in the middle of the left atrium. Atrium geometry was constructed using Ensite 3000 Navx system. Two RFCA lesion loops and three lines (modified Maze) were created on left and right atrial walls. Each lesion point was ablated for 30 seconds with preset temperature 50 (ae) and energy 30W. The disappearance or 80% decrease of the amplitude of target atrial potential and 10 to 20(|), decrease of ablation impedance were used as an index of effective ablation. Results A total of 11 patients (7 male and 4 female, mean age, 68.7±5.1 years) were enrolled. PAF history was 7.9±4.5 years. PAF could not be prevented by mean 3.1±1.6 antiarrhythmic agents in 6.3±3.4 years. None of the patients had complications with structural heart disease or stroke. Left atrial diameter was 41.3±3.6 mm and LVEF was 59.2±3.7% on echocardiography. Two loops and three lines were completed with 67.8±13.1 (73-167) lesion points. Altogether 76-168 (89.4±15.3) lesion points were created in each patient. PAF could not be provoked by rapid burst pacing up to 600 beat per minute delivered from paroxysmal coronary sinus electrode pair.Complete PV electrical isolation was confirmed by three-dimensional activation mapping. Mean procedure time was 2.7±0.6 hours and fluoroscopy time was 17.8±9.4 minutes. Patients were discharged with oral aspirin and without antiarrhythmic agents. During follow up of 6.5±1.8 months, seven patients were PAF symptom free (63.6%). PAF attacks were decreased more than 70% in two patients (18.2%). PAF frequency did not change in another two patients (18.2%). Conclusions Ensite 3000 Navx guided modified Maze lines plus PV isolation on the atrial wall is safe and feasible in the elderly patients. It has the advantages of exact procedural endpoint, shorter X-ray exposure, fewer complications and satisfied long-term effect PAF control.
The necessity of vein catheter use during normal labour
Z. Qareshi,M. Lori Pour,A.R. Sayadi
Journal of Mazandaran University of Medical Sciences , 2006,
Abstract: Background and purpose: Although the necessity of NPO condition during normal labour is a controversial subject among obstetricians and anesthesiologists, the most valid midwifery references emphasize on necessity of vein catheter use in all cases during normal labour. Now a days, most hospitals routinely use vein catheter even in cases with no indication and this may lead to decrease of motility and comfort of parturient, increase in cost and probability of blood transmitted pathogens. According to the policy of the ministry of health on decreasing venous injection, this study carried out to assess the real necessity of vein catheter and describing various drugs during labour.Materials and Methods: This is a descriptive-analytical study carried out in Niknafs hospital of Rafsanjan. 380 pregnant women hospitalized for normal delivery and actually delivered normally were selected. Proper questinaires were filled in labour unit and the data analyzed using SPSS software.Results: The mean age, gravidity and parity were 25.9 , 2.3 and 1.1 respectively. In average, the patients had 5.1cm cervix dilatation when they were admitted and after that they stayed in labour unit until delivery which took an average time of 3 hours and 34.3 minuites. The mean time between admission and start of vein catheter use was just 33.3 minuits. The mean volume of infused fluid during labour via vein catheter was 365 ml. According to valid midwifery texts, there was no indication for vein catheter use in 87.3% of subjects. Only 21.7% of the subjects did not get syntocinon via vein catheter whereas 36% with physician order and 42.3% without physician order received syntocinon. Except for that, only 6.7% of the patients got other drugs. The type of fluid in 76.3% of the cases was ringer lactate solution. In average they received 115.72 ml fluid per hour.Conclusion: Regarding the small average amount of received fluid (mostely ringer lactate solution), it can be concluded that vein catheter does not have that much effect on preventing hypoglycemia and dehydration, it is not useful very much for prescribing other drugs and it provides a ready way for useless and wide syntocinon use that can lead to various side effects like neonatal hyper bilirobinemia. Therefor, it is essential to restrict the use of vein catheter to cases with real indication and appropriate time.
Catheter Displacement into Inferior Epigastric Vein Causing Local Phlebitis and Cellulitis
Noriko Hattori,Hidenori Hattori,Kazushi Takahashi,Norihiro Suzuki,Kazuo Kishi
Case Reports in Medicine , 2012, DOI: 10.1155/2012/492594
Abstract: Catheter insertion for intravenous hyperalimentation is a commonly and widely used clinical technique. When compared with the incidence of complications associated with insertions into the internal jugular vein or the subclavian vein, complications associated with insertions into the femoral vein are less frequent. In this paper, we describe a very rare complication of femoral vein catheter insertion—namely, catheter displacement into the inferior epigastric vein.
Pulmonary Vein Isolation by High Intensity Focused Ultrasound
Boris Schmidt,KR Julian Chun,Karl-Heinz Kuck,Matthias Antz
Indian Pacing and Electrophysiology Journal , 2007,
Abstract: Pulmonary vein isolation (PVI) using radiofrequency current (RFC) ablation is a potentially curative treatment option for patients with atrial fibrillation (AF). The shortcomings of the RFC technology (technically challenging, long procedure times, complications) steadily kindle the interest in new energy sources and catheter designs. High intensity focused ultrasound (HIFU) has the ability to precisely focus ultrasound waves in a defined area with a high energy density. HIFU balloon catheters (BC) positioned at the PV ostia appear to be an ideal tool to transmit the ablation energy in a circumferential manner to the PV ostia and may therefore bear substantial advantage over conventional ablation catheters in PVI procedures. In clinical trials the HIFU BC has shown promising success rates similar to RFC catheter ablation for PVI in patients with AF. However, procedure times are still long and serious complications have been observed. Therefore, it may be a valuable alternative to the conventional techniques in selected patients but further clinical trials have to be initiated.
Malpositioned Right Subclavian Vein Catheter into Contralateral Subclavian Vein-A Case Report  [PDF]
Deepak Sharma,Ritu Goyal
Indian Anaesthetists' Forum , 2009,
Abstract: Malposition of central venous catheter is well known technical complication. A case with unusual placement of right subclavian vein catheter into contralateral subclavian vein, when inserted through infraclavicular approach, is reported.
Pulmonary Vein Isolation Without Left Atrial Mapping  [cached]
Attila Kardos,Csaba Foldesi,Karoly Ladunga,Attila Toth
Indian Pacing and Electrophysiology Journal , 2007,
Abstract: Background: One of the crucial points during in most approaches developed for ablation of atrial fibrillation (AF) is the ability to identify the pulmonary vein (PVs) and to accurately locate their ostia. Objectives: The purpose of this case series was to investigate a simplified method for fusion of the multislice computer tomography (CT) derived 3D dataset with the electroanatomical map in order to facilitate the mapping procedure. Methods: In 5 consecutive patients (4 male) referred for catheter ablation of symptomatic drug-refractory paroxysmal atrial fibrillation contrast enhanced computer tomography was performed before the procedure and imported into an electroanatomical mapping system (Carto XP) using CartoMerge Image Integration Module. During the procedure a multipolar mapping catheter (Quick Star DS, Biosense Webster, Diamond Bar, CA, USA) was introduced to the coronary sinus (CS) to align the CSCT shell to the proper position. The CS potentials provided information to identify the ostium of the CS to achieve a more accurate fusion of the images. No mapping points were taken in the left atrium. The feasibility of the method was characterized by the distance of mapping points. Mapping, registration and outcome data were compared with a cohort of patients undergoing MRI image integration. Result: The mean distance between the mapping points taken in the CS by the Quick Star catheter and the CS CT surface was suitable (mean±SD, 1.4±0.3 mm). Full electrical isolation of the pulmonary veins could be achieved in all patients. The mean procedure and fluoroscopy time were 39 ± 22 and 134 ±38 min respectively, significantly decreased as compared to the MRI cohort. Conclusions: Highly accurate CT image and the electroanatomical map (EAM) fusion can be obtained by the Carto 3D electromanatomical mapping system using CS as the key anatomical structure for registration. Using this technique the mapping time of the left atrium can be reduced.
Septic Thrombophlebitis of the Cephalic Vein Caused by a Peripherally Inserted Venous Catheter  [cached]
M Mirmohammadsadeghi,O Aghadavoudi
Journal of Research in Medical Sciences , 2005,
Abstract: Septic thrombophlebitis of a vein is a rare but life-threatening complication of an intravascular (IV) catheter placed percutaneously in the veins. Most published clinical experiences with IV catheters, mainly in the outpatient settings, have reported very low rates of catheter-related bloodstream infection compared to rates with central venous catheters placed in a subclavian or internal jugular vein. Most of the complications reported with IV catheters have been non-infectious, particularly sterile phlebitis or thrombosis. We report a case of cephalic vein suppurative thrombophlebitis from an intravascular catheter and offer guidelines for diagnosis and management of this complication. Key words: Septic thrombophlebitis, Intravascular catheter, Suppurative thrombophlebitis
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