Kalarus, Zbigniew*
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Hybridní ablace (hybrid ablation, HABL) fibrilace síní jako kombinace endoskopické, minimálně invazivní, epikardiální ablace při zavřeném hrudníku spolu s přesností endokardiální metody vedené systémem CARTO byla zavedena ve snaze překonat limitace současných možností léčby pacientů s perzistující fibrilací síní (persistent atrial firbrillation, PSAF) a dlouhodobě perzistující fibrilací síní (long-standing persistent atrial fibrillation, LSPAF). Smyslem toho monocentrického, prospektivního klinického registru bylo zhodnotit bezpečnost a proveditelnost i účinnost HABL u pacientů s PSAF a LSPAF jeden rok po výkonu. V období od července 2009 do prosince 2014 byla HABL provedena celkem u devadesáti (n = 90) pacientů (PSAF, n = 39 a LSPAF, n = 51). Průměrná délka incidence fibrilace síní byla 4,5 ± 3,7 roku. Šest měsíců po ablaci bylo 78 % pacientů v sinusovém rytmu. Dvanáct měsíců po výkonu bylo v sinusovém rytmu 86 % pacientů a 62,3 % v sinusovém rytmu bez podávání antiarytmik skupin I/III. Na základě těchto výsledků lze usuzovat, že u pacientů s perzistující a dlouhodobě perzistující fibrilací síní je třeba uvažovat o kombinaci epikardiální a endokardiální radiofrekvenční ablace, protože se jedná a bezpečnou a účinnou metodu obnovy sinusového rytmu.
The hybrid ablation (HABL) of atrial fibrillation which combines endoscopic, minimally invasive, closed chest epicardial ablation with endocardial CARTO-guided accuracy was introduced to overcome limitations of current therapeutic options for patients with persistent (PSAF) and long-standing persistent atrial fibrillation (LSPAF). The purpose of this single-centre, prospective clinical registry was to evaluate procedural safety and feasibility as well as effectiveness of the HABL in patients with PSAF and LSPAF 1-year post-procedure. From July 2009 to December 2014, ninety (n = 90) patients with PSAF (n = 39) and LSPAF (n = 51) underwent HABL. Mean AF duration was 4.5 ± 3.7 years. At 6 months post-procedure 78% patients were in SR. At 12 months post-procedure 86% patients were in SR and 62.3% in SR and of class I/III AADs. These results suggest that combination of epicardial and endocardial RF ablation should be considered as a treatment option for patients with persistent and long-standing persistent atrial fibrillation as it is safe and effective in restoring sinus rhythm.
- MeSH
- ablace metody MeSH
- fibrilace síní * chirurgie MeSH
- kardiovaskulární chirurgické výkony metody MeSH
- katetrizační ablace metody přístrojové vybavení MeSH
- kombinovaná terapie metody MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony metody MeSH
- prospektivní studie MeSH
- stupeň závažnosti nemoci MeSH
- venae pulmonales chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
OBJECTIVES: The ASD2 (Acute Extravascular Defibrillation, Pacing, and Electrogram) study evaluated the ability to adequately sense, pace, and defibrillate patients with a novel implantable cardioverter-defibrillator (ICD) lead implanted in the substernal space. BACKGROUND: Subcutaneous ICDs are an alternative to a transvenous defibrillator system when transvenous implantation is not possible or desired. An alternative extravascular system placing a lead under the sternum has the potential to reduce defibrillation energy and the ability to deliver pacing therapies. METHODS: An investigational lead was inserted into the substernal space via a minimally invasive subxiphoid access, and a cutaneous defibrillation patch or subcutaneous active can emulator was placed on the left mid-axillary line. Pacing thresholds and extracardiac stimulation were evaluated. Up to 2 episodes of ventricular fibrillation were induced to test defibrillation efficacy. RESULTS: The substernal lead was implanted in 79 patients, with a median implantation time of 12.0 ± 9.0 min. Ventricular pacing was successful in at least 1 vector in 76 of 78 patients (97.4%), and 72 of 78 (92.3%) patients had capture in ≥1 vector with no extracardiac stimulation. A 30-J shock successfully terminated 104 of 128 episodes (81.3%) of ventricular fibrillation in 69 patients. There were 7 adverse events in 6 patients causally (n = 5) or possibly (n = 2) related to the ASD2 procedure. CONCLUSIONS: The ASD2 study demonstrated the ability to pace, sense, and defibrillate using a lead designed specifically for the substernal space.
- MeSH
- defibrilátory implantabilní * škodlivé účinky statistika a číselné údaje MeSH
- elektrokardiografie MeSH
- implantace protézy škodlivé účinky metody mortalita statistika a číselné údaje MeSH
- kardiostimulace umělá * škodlivé účinky statistika a číselné údaje MeSH
- lidé středního věku MeSH
- lidé MeSH
- mediastinum chirurgie MeSH
- prospektivní studie MeSH
- senioři MeSH
- srdeční arytmie terapie MeSH
- sternum chirurgie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinická studie MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
AIMS: The Atrial Fibrillation Ablation Pilot Study is a prospective registry designed to describe the clinical epidemiology of patients undergoing an atrial fibrillation (AFib) ablation, and the diagnostic/therapeutic processes applied across Europe. The aims of the 1-year follow-up were to analyse how centres assess in routine clinical practice the success of the procedure and to evaluate the success rate and long-term safety/complications. METHODS AND RESULTS: Seventy-two centres in 10 European countries were asked to enrol 20 consecutive patients undergoing a first AFib ablation procedure. A web-based case report form captured information on pre-procedural, procedural, and 1-year follow-up data. Between October 2010 and May 2011, 1410 patients were included and 1391 underwent an AFib ablation (98.7%). A total of 1300 patients (93.5%) completed a follow-up control 367 ± 42 days after the procedure. Arrhythmia documentation was done by an electrocardiogram in 76%, Holter-monitoring in 52%, transtelephonic monitoring in 8%, and/or implanted systems in 4.5%. Over 50% became asymptomatic. Twenty-one per cent were re-admitted due to post-ablation arrhythmias. Success without antiarrhythmic drugs was achieved in 40.7% of patients (43.7% in paroxysmal AF; 30.2% in persistent AF; 36.7% in long-lasting persistent AF). A second ablation was required in 18% of the cases and 43.4% were under antiarrhythmic treatment. Thirty-three patients (2.5%) suffered an adverse event, 272 (21%) experienced a left atrial tachycardia, and 4 patients died (1 haemorrhagic stroke, 1 ventricular fibrillation in a patient with ischaemic heart disease, 1 cancer, and 1 of unknown cause). CONCLUSION: The AFib Ablation Pilot Study provided crucial information on the epidemiology, management, and outcomes of catheter ablation of AFib in a real-world setting. The methods used to assess the success of the procedure appeared at least suboptimal. Even in this context, the 12-month success rate appears to be somewhat lower to the one reported clinical trials.
- MeSH
- antiarytmika terapeutické užití MeSH
- elektrokardiografie MeSH
- fibrilace síní diagnóza mortalita chirurgie MeSH
- Kaplanův-Meierův odhad MeSH
- katetrizační ablace metody mortalita MeSH
- lidé MeSH
- pilotní projekty MeSH
- pooperační péče metody mortalita MeSH
- prospektivní studie MeSH
- recidiva MeSH
- výsledek terapie MeSH
- znovupřijetí pacienta statistika a číselné údaje MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
- MeSH
- cévní mozková příhoda * MeSH
- fibrilace síní * diagnóza terapie MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH