Úvod: Torakoskopická ablace fibrilace síní (TARAFS) s použitím bipolární radiofrekvenční energie (Medtronic Cardioblate Gemini-S) by měla vést k antrální izolaci plicních žil (PŽ) a izolaci zadní stěny levé síně (LS). Elektrofyziologické nálezy po ablaci touto technikou ale nejsou známy. Metody a výsledky: U 22 pacientů s recidivou fibrilace síní (FS) po oboustranné TARAFS provedené pro perzistující FS byla zvolena radiofrekvenční katetrizační ablace s odstupem alespoň tří měsíců po TARAFS. Výsledky: Z 22 pacientů nebyla izolace zadní stěny LS nalezena u 15 (68,2 %) pacientů. U 12 pacientů nebyly endokardiálně zjištěny známky žádné předchozí ablace, u dvou pacientů byly izolovány pravé PŽ a u jednoho pacienta byly izolovány levé PŽ. Na konci ablace byla izolace zadní stěny LS dokončena u všech 15 pacientů. U 18 z celkových 22 pacientů bylo katetrizační ablací dosaženo nevyvolatelnosti FS. Závěr: U značného počtu pacientů s recidivou FS po TARAFS není izolace plicních žil ani zadní stěny LS dokončena a na elektroanatomické voltážové mapě nejsou nalezeny žádné známky předchozí ablace, které by usnadnily následnou katetrizační ablaci. U většiny pacientů je k dosažení nevyvolatelnosti FS kromě izolace zadní stěny LS nutná další ablace.
Background: Thoracoscopic atrial fibrillation ablation (TARAFS) using irrigated bipolar radiofrequency energy (Medtronic Cardioblate Gemini-S) should result in wide isolation of the pulmonary veins (PVs) and posterior left atrial (LA) wall (the box-lesion technique). Electrophysiological findings after this technique using this instrumentation are not known. Methods and results: 22 patients with AF recurrence after bilateral TARAFS for persistent AF had a radiofrequency catheter ablation (CA) at least three months after TARAFS. Results: Out of 22 patients, the box lesion was not completed in 15 (68.2%) patients. 12 had no endocardial signs of any prior ablation, 2 had right pulmonary PVs isolated and 1 had left PVs isolated. At the end of CA, box lesion was finished in all 15 patients and AF non-inducibility was achieved in 18 patients. Conclusion: In a considerable number of patients with AF recurrence after TARAFS box lesion is not finished and no signs of prior ablation to guide a touch-up catheter ablation are found on electroanatomical voltage map. In majority of patients, additional ablation beside box lesion is needed to achieve AF non-inducibility.
- Klíčová slova
- voltážová mapa,
- MeSH
- ablace metody MeSH
- fibrilace síní * chirurgie MeSH
- lidé MeSH
- prospektivní studie MeSH
- recidiva MeSH
- torakoskopie metody MeSH
- Check Tag
- lidé MeSH
Cannabis preparations are gaining popularity among patients with various skin diseases. Due to the lack of scientific evidence, dermatologists remain cautious about their prescriptions. So far, only a few studies have been published about the effects of high-potency cannabis extracts on microorganisms (especially dermatophytes) causing skin problems that affect more than 25% of the worldwide population. Even though, the high-potency cannabis extracts prepared by cold extraction are mostly composed of non-psychoactive tetrahydrocannabinolic acid (THCA) and only low amount of THC, their use in topical treatment can be stigmatized. The in vitro antimicrobial and antifungal activity of two high potent cannabis strains extracted by three solvents traditionally or currently used by cannabis users (ethanol; EtOH, butane; BUT, dimethyl ether; DME) was investigated by broth dilution method. The chemical profile of cannabis was determined by high-performance liquid chromatography with ultraviolet detection and gas chromatography with mass spectrometer and flame ionization detector. The extraction methods significantly influenced chemical profile of extracts. The yield of EtOH extracts contained less cannabinoids and terpenes compared to BUT and DME ones. Most of the extracts was predominantly (>60%) composed of various cannabinoids, especially THCA. All of them demonstrated activity against 18 of the 19 microorganisms tested. The minimal inhibitory concentrations (MICs) of the extracts ranged from 4 to 256 μg/mL. In general, the bacteria were more susceptible to the extracts than dermatophytes. Due to the lower content of biologically active substances, the EtOH extracts were less effective against microorganisms. Cannabis extracts may be of value to treat dermatophytosis and other skin diseases caused by various microorganisms. Therefore, they could serve as an alternative or supportive treatment to commonly used antibiotics.
- Publikační typ
- časopisecké články MeSH
Úvod: Hrudní pás umožňuje pořídit 1svodový EKG záznam. Získaná data byla validována pro měření srdeční frekvence a rovněž i pro detekci fibrilace síní díky srovnání s krátkými EKG záznamy z holterovského EKG měření u selektovaných pacientů. Zatím ale nebyla ověřena možnost vyhodnocení dlouhých EKG záznamů u neselektovaných kardiologických pacientů se širokým spektrem srdečních chorob. Metodologie a výsledky: Do studie bylo zařazeno 54 hospitalizovaných a 53 ambulantních pacientů a 54 zdravých kontrol (n = 161 celkově). U všech účastníků studie byl pomocí hrudního pásu Polar H10 pořízen 1-2hodinový EKG záznam (celkově 1 153 229 úderů srdce; průměrná srdeční frekvence 76,6/min; sinusový rytmus u 86,3 %, fibrilace síní zjištěna u 13,7 %; dokumentováno 0,46 % síňových extrasystol a 0,49 % komorových extrasystol). Z výše uvedeného počtu 1 153 229 srdečních tepů jich 1 128 319 bylo hodnoceno lékařem jako snadno interpretovatelných. Celkově tak bylo 2,16 % záznamu vyhodnoceno jako obtížně interpretovatelný nebo neinterpretovatelný šum (A: 2,31 %; B: 1,95 %; C: 2,20 %). Z EKG záznamu z hrudního pásu lékař při srovnání s 12svodovým EKG záznamem spolehlivě určil základní srdeční rytmus u většiny účastníků (u 51/54 [94,4 %] hospitalizovaných pacientů a u 100 % ambulantních pacientů a zdravých kontrol). U tří jedinců byl základní rytmus na EKG vyhodnocen jako nejasný. U všech tří byly všechny komplexy QRS stimulované. U hospitalizovaných pacientů byl EKG záznam z hrudního pásu zobrazený v reálném čase na mobilním telefonu srovnatelný s EKG záznamem z telemetrického monitorování (shoda v 53 z 54 případů; 98,1 %). Závěr: EKG záznam z hrudního pásu, pořízený u hospitalizovaných i ambulantních pacientů s různými typy poruch srdečního rytmu, stejně tak jako u zdravých kontrol, lze v každodenní praxi použít pro zhodnocení základního srdečního rytmu, záchyt fibrilace síní i extrasystol, a to při minimálním procentu obtížně hodnotitelných záznamů. Opatrnosti je třeba při interpretaci EKG záznamu u pacientů se stimulovaným rytmem a u pacientů s flutterem síní. Hrudní pás je tak možno použít pro kontinuální EKG monitorování, hodnocení srdečního rytmu i screening fibrilace síní.
Background: The chest-belt can be used to obtain a 1-lead ECG. Data from it have been validated for the determination of heart rate and for the possibility to detect atrial fibrillation (AF) compared to ECG-Holter on a short ECG recording in selected patients. However, validation of the possibility to evaluate long ECG recordings in patients with a wide range of heart diseases has not yet been performed. Methodology and results: 54 hospitalized patients, 53 outpatients and 54 healthy controls were enrolled in the study (n = 161 in total). Using a Polar H10 chest-belt, 1-2 hours of ECG were recorded in all patients (1 153 229 heartbeats, average heart rate 76.6/min, 86.3% in sinus rhythm, 13.7% with atrial fibrillation, 0.46% atrial premature beats, 0.49% ventricular premature beats). The presence of noise was 2.16% (A: 2.31%; B: 1.95%; C: 2.20%). 1 128 319 /1 153 229 were evaluated as easy to interpret. Using ECG from the belt, the basic rhythm was reliably determined by the physician in majority of patients (51/54, 94.4% in hospitalized patients; in 100% of outpatients and healthy controls) when compared to 12-lead ECG. 3 cases were evaluated as unclear; in all of these cases, all QRS complexes were stimulated by a pacemaker. In hospitalized patients, real-time ECG from the belt was comparable to telemetric ECG monitoring (match in 53/54, 98.1%). Conclusion: The ECG obtained from the chest-belt in hospitalized patients and outpatients with a wide range of cardiovascular diseases, as well as in healthy individuals, is usable in real practice for evaluation of baseline rhythm, atrial fibrillation and premature contractions with a minimal proportion of difficulties to interpret recordings due to artefacts. Caution should be exercised in interpretation of the ECG in patients with stimulated rhythm and in patients with atrial flutter. The chest belt can be used as a means for continuous monitoring of ECG, evaluation of rhythm and screening of atrial fibrillation.
AIMS: Atrial fibrillation (AF) inducibility with rapid atrial pacing following AF ablation is associated with higher risk of AF recurrence. The predictive value of AF inducibility in paroxysmal AF patients after pulmonary vein isolation (PVI), done under general anaesthesia (GA), remains questionable since GA might alter AF inducibility and/or sustainability. METHODS: Consecutive patients (n = 120) with paroxysmal AF without prior catheter ablation (CA) were enlisted in the study. All patients were ablated under GA. We have used a point-by-point CA and elimination of dormant conduction after adenosine in all patients. A predefined stimulation protocol was used to induce arrhythmias after PVI. Regular supraventricular tachycardias were mapped and ablated. Patients were divided into 3 subgroups - noninducible, inducible AF with spontaneous termination in five minutes, inducible AF without spontaneous termination. During 12 months of follow-up, all patients were examined four-times with 7-day ECG recordings. RESULTS: There was no statistical difference between the three subgroups in a rate of arrhythmia recurrence (11.1 vs. 27.5 vs. 27.3%, P=0.387), despite a clear trend to a better success rate in the non-inducible group. The subgroups did not differ in left atrial (LA) diameter (41.0±6, 43.0±7, 42.0±5 mm, P=0.962) or in any other baseline parameter. CONCLUSION: AF inducibility as well as presence or absence of its early spontaneous termination after PVI done under general anaesthesia in paroxysmal AF patients were not useful as predictors of procedural failure.
- MeSH
- celková anestezie MeSH
- dospělí MeSH
- fibrilace síní etiologie patofyziologie MeSH
- katetrizační ablace škodlivé účinky metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- recidiva MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- venae pulmonales patofyziologie chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: The prognostic significance of adenosine-mediated pulmonary vein (PV) dormant conduction is unclear. We prospectively followed patients with adenosine-mediated PV reconduction with a subsequent repeated ablation until there was no reconduction inducible with patients without reconduction after PV isolation. METHOD AND RESULTS: Consecutive patients (n=179) with paroxysmal atrial fibrillation (AF) without prior catheter ablation (CA) were enlisted in the study. We used a point-by-point CA and general anesthesia in all patients. Twenty minutes after PV isolation we administered adenosine in a dose sufficient to produce an atrioventricular block. If a dormant conduction was present (n=54) we performed additional ablation until there was no adenosine mediated reconduction inducible. During 36 months of follow-up, all patients were examined for eight 7-day ECG recordings. There was no difference in arrhythmia recurrence rate between patients with and without dormant conduction (29.6 vs. 24.8% at 12 months, P=0.500; 31.5 vs. 30.4% at 36 months, P=1.000), for any echocardiographic parameter or any parameter of the ablation procedure. CONCLUSION: The patients with dormant conduction after adenosine during catheter ablation of paroxysmal atrial fibrillation with complete elimination of the dormant conduction by additional extensive ablation have the same outcome in the long term as patients without a dormant conduction.
- MeSH
- adenosin MeSH
- antiarytmika MeSH
- fibrilace síní patofyziologie chirurgie MeSH
- katetrizační ablace metody MeSH
- lidé MeSH
- prognóza MeSH
- recidiva MeSH
- venae pulmonales patofyziologie chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The impact of ECG gating during computed tomography (CT) acquisition of left atrium (LA) model on radiation dose, image quality and ablation event-free survival rate after catheter ablation (CA) of atrial fi brillation (AF) is not well defi ned. METHODS: Sixty-two patients with paroxysmal atrial fi brillation were randomized for two types of LA CT (with vs without ECG gating) before CA. Pulmonary veins isolation was performed in all patients. Patients were followed for 12 months after CA. RESULTS: There was no difference between the groups in CA length (131.61±32.57 vs 119.84±33.18 min; p=0.108), CA fl uoroscopy time (4.48±2.19 vs 3.89±1.83 min; p=0.251), CA fl uoroscopy dose (3.99±2.79 vs 3.91 vs2.91 Gy*cm2; p=0.735), visual data quality (1.77±0.88 vs 2.0±0.63; p=0.102) and registration error (2.42±0.72 vs 2.43±0.46 mm; p=0.612). We found a significant difference in CT Dose index (89.55±5.99 vs 19.19±4.33 mGy; p<0.0001) and Dose Length product (1438.87±147.75 vs 328.21±73.83 mGy*cm; p<0.0001). Twelve months after CA, 25 of 31 patients in the gated group and 24 of 31 patients in the non-gated group were free of AF (80.65 vs 77.42 %; p=0.838). CONCLUSION: ECG gating of computed tomography of LA before AF ablation burdens patients with a four times higher radiation dose while improving neither the quality of CT model or fusion of CT with the electroana-tomic map. As a result, it has no significant impact on arrhythmia recurrence rate after ablation (Tab. 3, Fig. 3, Ref. 25).
- MeSH
- dávka záření MeSH
- dospělí MeSH
- elektrokardiografie MeSH
- fibrilace síní chirurgie MeSH
- hodnocení rizik MeSH
- katetrizační ablace * metody MeSH
- lidé MeSH
- multidetektorová počítačová tomografie metody MeSH
- prospektivní studie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- randomizované kontrolované studie MeSH
