Pulmonary vein isolation (PVI) is widely accepted as the mainstay of interventional treatment of atrial fibrillation. Ablation with radiofrequency (RF) point-by-point catheters is highly operator dependent and may fail because of ineffective lesions or gaps. Several balloon-based catheter ablation technologies have emerged as an alternative to effect PVI. Cryoballoon ablation is widely used, and current iterations of the technology show comparable acute and long-term efficacy to RF ablation. Techniques such as time to isolation have emerged to improve efficacy and safety. Laser balloon is a highly compliant variably sized balloon that has been validated as an effective strategy for PVI.
- Klíčová slova
- kryobiopsie,
- MeSH
- biopsie metody MeSH
- bronchoskopie * metody MeSH
- diagnostické techniky dýchacího ústrojí MeSH
- kryochirurgie * metody přístrojové vybavení MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- MeSH
- endometrium * chirurgie MeSH
- fotokoagulace metody MeSH
- katetrizační ablace metody přístrojové vybavení MeSH
- kryochirurgie metody přístrojové vybavení MeSH
- laserová terapie metody přístrojové vybavení MeSH
- lidé MeSH
- mikrovlny terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE: We evaluated the correlation between pulmonary venous (PV) anatomy and acute and long-term success of PV isolation (PVI) with two balloon-based ablation catheter techniques. METHODS: One hundred consecutive patients were analyzed in two equal groups treated with either the second-generation cryoballoon (CRYO) catheter or the visually guided laser ablation (VGLA) catheter. All patients underwent multi-detector computed tomography (CT) imaging. The primary and secondary efficacy endpoints were the procedural achievement of proven electrical isolation of all veins and freedom from atrial fibrillation (AF) within a 1-year follow-up period, respectively. RESULTS: Variant PV anatomy was observed in 32% of patients in the CRYO group and in 40% of patients in the VGLA group. All PVs were targeted with either the CRYO catheter (n = 199) or the VGLA catheter (n = 206). One hundred ninety-three of 199 PVs (97%) were successfully isolated in the CRYO group and 194 of 206 PVs (94%) in the VGLA group (p = 0.83). Over a 12-month follow-up, AF recurrence was documented in 11/45 (24%) and 7/43 (16%) patients in the CRYO and the VGLA groups, respectively (p = 0.21). In the CRYO group, a larger left inferior PV size was associated with worse long-term outcome (p = 0.001). In the VGLA group, a larger left superior PV size (p = 0.003) and more oval right inferior PV were associated with worse acute success (p = 0.038). There was no absolute cutoff between PV anatomy and clinical success. CONCLUSIONS: The variability of PV anatomy did not significantly compromise acute success of PVI or patient outcomes.
- MeSH
- analýza selhání vybavení MeSH
- design vybavení MeSH
- fibrilace síní radiografie chirurgie ultrasonografie MeSH
- kryochirurgie přístrojové vybavení MeSH
- laserová terapie přístrojové vybavení MeSH
- lidé středního věku MeSH
- lidé MeSH
- převodní systém srdeční účinky záření chirurgie ultrasonografie MeSH
- srdeční katétry * MeSH
- venae pulmonales radiografie chirurgie ultrasonografie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky kontrolované MeSH
- srovnávací studie MeSH
INTRODUCTION: Pulmonary vein (PV) reconnection remains the most important cause of AF recurrence after AF ablation. The second-generation cryoballoon catheter's ability to achieve durable PV isolation was assessed in a prospective nonrandomized clinical trial. METHODS AND RESULTS: PV isolation was performed by 4-minute ablations. Following verification of electrical isolation by a multielectrode mapping catheter, 1 additional lesion per PV was applied. Esophageal temperatures were monitored and all patients underwent postprocedure esophageal endoscopy. All patients underwent a second PV remapping procedure at ∼3 months to assess for PVI durability. Eighty-four (100%) veins were acutely isolated using only the 28 mm cryoballoon in 21 consecutive PAF patients with 2.2 ± 0.6 cryoapplications per vein, with the majority (83%) occurring after a single freeze. One patient presented with hematemesis and an esophageal ulceration that was treated conservatively; there were no episodes of esophageal fistula or phrenic nerve palsy. At 3.4 (2.9-4.1) months postablation, 68/75 veins (91%) remained electrically isolated; all PVs remained durably isolated in 79% of patients. Two patients accounted for 5 of 7 reconducting veins. The most common site for reconnection was the inferior aspect of the RIPV (3/7 reconnections). Reconnected veins had poorer occlusion at the index ablation procedure than veins that maintained chronic isolation (occlusion grade 2.9 ± 0.7 vs. 3.4 ± 0.7, P = 0.001). Clinical AF recurrence was detected in 2 patients (11%) at follow-up. CONCLUSIONS: The improved thermodynamic characteristics of the second-generation cryoballoon led to a high rate of both single-shot PVI and chronic lesion durability. This high rate of durable PV isolation is anticipated to translate to improved clinical outcome.
- MeSH
- akční potenciály MeSH
- časové faktory MeSH
- design vybavení MeSH
- elektrofyziologické techniky kardiologické MeSH
- ezofágoskopie MeSH
- fibrilace síní diagnóza patofyziologie chirurgie MeSH
- kryochirurgie škodlivé účinky přístrojové vybavení MeSH
- lidé středního věku MeSH
- lidé MeSH
- nerandomizované kontrolované studie jako téma MeSH
- prospektivní studie MeSH
- recidiva MeSH
- senioři MeSH
- srdeční katétry * MeSH
- venae pulmonales patofyziologie chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
Introduction The authors carried out a retrospective assessment of the efficacy of CryoMaze procedure employed between early 2004 and June 2011 jointly with performing other cardiac surgeries in patients suffering permanent/persistent or paroxysmal Atrial Fibrillation (AF) and other supraventricular arrhythmias. Included in the set to be assessed were 383 patients. This paper aims to assess the effectiveness of the procedure in maintaining the Sinus Rhythm (SR). Methods Within one year following the discharge from the Center, the patients, then outpatients, underwent four follow-up checks – data obtained in the checks have been used to compile this assessment. Conclusion One year after the CryoMaze therapy was given, 74% of the patients exhibited sinus rhythm. No complications attributable to the use of cryoenergy were observed. The best results in restoring and maintaining the sinus rhythm were achieved in the group of patients indicated for CryoMaze because of their paroxysmal atrial fibrillation.
- MeSH
- elektrická defibrilace metody využití MeSH
- farmakoterapie metody MeSH
- fibrilace síní prevence a kontrola terapie MeSH
- kardiochirurgické výkony metody využití MeSH
- katetrizační ablace metody využití MeSH
- klinický obraz nemoci MeSH
- kryochirurgie dějiny metody přístrojové vybavení MeSH
- lidé MeSH
- peroperační komplikace prevence a kontrola MeSH
- pooperační komplikace prevence a kontrola MeSH
- retrospektivní studie MeSH
- srdeční arytmie epidemiologie prevence a kontrola terapie MeSH
- statistika jako téma MeSH
- supraventrikulární tachykardie prevence a kontrola terapie MeSH
- úspěšnost MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- Check Tag
- lidé MeSH
BACKGROUND: Because of its technical feasibility and presumed safety benefits, balloon cryoablation is being increasingly employed for pulmonary vein (PV) isolation. While acute isolation has been demonstrated in most patients, little data are available on the chronic durability of cryoballoon lesions. METHODS AND RESULTS: Twelve atrial fibrillation patients underwent PV isolation using either a 23-mm or 28-mm cryoballoon. For each vein, after electrical isolation was verified with the use of a circular mapping cathether, 2 bonus balloon ablation lesions were placed. Gaps in balloon occlusion were overcome using either a spot cryocatheter or a "pull-down" technique. A prespecified second procedure was performed at 8-12 weeks to assess for long-term PV isolation. Acute PV isolation was achieved in all PVs in the patient cohort (n = 48 PVs), using the cryoballoon alone in 47/48 PVs (98%); a "pull-down" technique was employed for 5 PVs (1 right superior pulmonary vein, 2 right inferior pulmonary veins, and 2 left inferior pulmonary veins). The gap in the remaining vein was ablated with a spot cryocatheter. During the second mapping procedure, 42 of 48 PVs (88%) remained isolated. One vein had reconnected in 2 patients, while 2 veins had reconnected in another 2 patients. All PVs initially isolated with the "pull-down" technique remained isolated at the second procedure. CONCLUSIONS: Cryoballoon ablation allows for durable PV isolation with the use of a single balloon. With maintained chronic isolation in most PVs, it may represent a significant step toward consistent and lasting ablation procedures.
- MeSH
- barevná dopplerovská echokardiografie MeSH
- časové faktory MeSH
- dospělí MeSH
- elektrokardiografie MeSH
- fibrilace síní diagnóza patofyziologie chirurgie MeSH
- flebografie MeSH
- katetrizace přístrojové vybavení MeSH
- kryochirurgie * přístrojové vybavení MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- recidiva MeSH
- venae pulmonales diagnostické zobrazování patofyziologie chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
Prezentujeme kazuistiku mladého muže s incesantní idiopatickou komorovu extrasystolií vycházející z levého aortálního Valsalvova sinu. Lokalizace ektopického ložiska a jeho anatomický vztah ke kmeni levé věnčité tepny byly stanoveny pomocí elektroanatomického mapování a angiografických vyšetření. Nebolestivá a bezpečná destrukce ložiska ablací byla provedena pomocí kryoenergie.
A case of a young man with incessant idiopathic ventricular premature beats originating from the left aortic sinus of Valsalva is presented. Localization of the ectopic focus and its anatomic relation to the left main coronary artery was identified using electroanatomic mapping and angiography. Painless and safe destruction of the ectopic focus was completed with cryoablation.
- MeSH
- angiografie metody využití MeSH
- dospělí MeSH
- katetrizační ablace metody přístrojové vybavení využití MeSH
- komorové extrasystoly diagnóza etiologie terapie MeSH
- kryochirurgie metody přístrojové vybavení využití MeSH
- lidé MeSH
- mapování potenciálů tělesného povrchu metody využití MeSH
- Valsalvův sinus patofyziologie patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
XV, 172 s. : obr., tab., fot. ; 24 cm
- Konspekt
- Lékařské vědy. Lékařství
- NLK Obory
- nefrologie
- chirurgie
- urologie
