Persistent atrial fibrillation originating from prominent Eustachian ridge: Precise identification of non-pulmonary vein foci using a high-density grid mapping catheter.
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ABSTRACT:
SUBMITTER: Yamauchi Y
PROVIDER: S-EPMC8226311 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Pulmonary veins (PVs) are a major source of ectopic beats that initiate AF. PV isolation from the left atrium is an effective therapy for the majority of paroxysmal AF. However, investigators have reported that ectopy originating from non-PV areas can also initiate AF. Patients with recurrent AF after persistent PV isolation highlight the need to identify non-PV ectopy. Furthermore, adding non-PV ablation after multiple AF ablation procedures leads to lower AF recurrence and a higher AF cure rate. These findings suggest that non-PV ectopy is important in both the initiation and recurrence of AF. This article summarises current knowledge about the electrophysiological characteristics of non-PV AF, suitable mapping and ablation strategies, and the safety and efficacy of catheter ablation of AF initiated by ectopic foci originating from non-PV areas.
| S-EPMC6304799 | biostudies-other
Project description:The Eustachian valve (EV) is an embryological remnant of the inferior vena cava that during fetal life helps divert oxygenated blood from the IVC toward the foramen ovale to escape the pulmonary circulation. This remnant usually regresses after birth and is considered a benign finding in the majority of cases. However, EV can lead to complications in the neonatal period or later in life. In this short case series, we present four newborn infants with prominent EV who were symptomatic after birth and required admission to the neonatal intensive care unit.
| S-EPMC4737625 | biostudies-other
Project description:We present a case of redo atrial fibrillation (AF) ablation for pulmonary vein reconnection. In mapping of posterior wall of left upper pulmonary vein (LUPV) with HD grid, a new and unique multipolar mapping catheter, it demonstrated presence of local electrocardiogram signals (EGM). But during mapping with the Tacticath ablation catheter, these signals were not visible. Nevertheless, ablation at this point resulted in isolation of LUPV. The unique mapping technology offered by HD grid mapping catheter may enable us to discover local EGM not otherwise visible in conventional bipole parallel recordings, to have more accurate maps and deliver for effective therapies.
| S-EPMC6373640 | biostudies-literature
Project description:ImportanceCatheter ablation of persistent atrial fibrillation (AF) has limited success. Procedural strategies beyond pulmonary vein isolation have failed to consistently improve results. The vein of Marshall contains innervation and AF triggers that can be ablated by retrograde ethanol infusion.ObjectiveTo determine whether vein of Marshall ethanol infusion could improve ablation results in persistent AF when added to catheter ablation.Design, setting, and participantsThe Vein of Marshall Ethanol for Untreated Persistent AF (VENUS) trial was an investigator-initiated, National Institutes of Health-funded, randomized, single-blinded trial conducted in 12 centers in the United States. Patients (N = 350) with persistent AF referred for first ablation were enrolled from October 2013 through June 2018. Follow-up concluded in June 2019.InterventionsPatients were randomly assigned to catheter ablation alone (n = 158) or catheter ablation combined with vein of Marshall ethanol infusion (n = 185) in a 1:1.15 ratio to accommodate for 15% technical vein of Marshall ethanol infusion failures.Main outcomes and measuresThe primary outcome was freedom from AF or atrial tachycardia for longer than 30 seconds after a single procedure, without antiarrhythmic drugs, at both 6 and 12 months. Outcome assessment was blinded to randomization treatment. There were 12 secondary outcomes, including AF burden, freedom from AF after multiple procedures, perimitral block, and others.ResultsOf the 343 randomized patients (mean [SD] age, 66.5 [9.7] years; 261 men), 316 (92.1%) completed the trial. Vein of Marshall ethanol was successfully delivered in 155 of 185 patients. At 6 and 12 months, the proportion of patients with freedom from AF/atrial tachycardia after a single procedure was 49.2% (91/185) in the catheter ablation combined with vein of Marshall ethanol infusion group compared with 38% (60/158) in the catheter ablation alone group (difference, 11.2% [95% CI, 0.8%-21.7%]; P = .04). Of the 12 secondary outcomes, 9 were not significantly different, but AF burden (zero burden in 78.3% vs 67.9%; difference, 10.4% [95% CI, 2.9%-17.9%]; P = .01), freedom from AF after multiple procedures (65.2% vs 53.8%; difference, 11.4% [95% CI, 0.6%-22.2%]; P = .04), and success achieving perimitral block (80.6% vs 51.3%; difference, 29.3% [95% CI, 19.3%-39.3%]; P < .001) were significantly improved in vein of Marshall-treated patients. Adverse events were similar between groups.Conclusions and relevanceAmong patients with persistent AF, addition of vein of Marshall ethanol infusion to catheter ablation, compared with catheter ablation alone, increased the likelihood of remaining free of AF or atrial tachycardia at 6 and 12 months. Further research is needed to assess longer-term efficacy.Trial registrationClinicalTrials.gov Identifier: NCT01898221.
| S-EPMC7592031 | biostudies-literature
Project description:BACKGROUND:The post-thrombotic syndrome frequently develops in patients with proximal deep-vein thrombosis despite treatment with anticoagulant therapy. Pharmacomechanical catheter-directed thrombolysis (hereafter "pharmacomechanical thrombolysis") rapidly removes thrombus and is hypothesized to reduce the risk of the post-thrombotic syndrome. METHODS:We randomly assigned 692 patients with acute proximal deep-vein thrombosis to receive either anticoagulation alone (control group) or anticoagulation plus pharmacomechanical thrombolysis (catheter-mediated or device-mediated intrathrombus delivery of recombinant tissue plasminogen activator and thrombus aspiration or maceration, with or without stenting). The primary outcome was development of the post-thrombotic syndrome between 6 and 24 months of follow-up. RESULTS:Between 6 and 24 months, there was no significant between-group difference in the percentage of patients with the post-thrombotic syndrome (47% in the pharmacomechanical-thrombolysis group and 48% in the control group; risk ratio, 0.96; 95% confidence interval [CI], 0.82 to 1.11; P=0.56). Pharmacomechanical thrombolysis led to more major bleeding events within 10 days (1.7% vs. 0.3% of patients, P=0.049), but no significant difference in recurrent venous thromboembolism was seen over the 24-month follow-up period (12% in the pharmacomechanical-thrombolysis group and 8% in the control group, P=0.09). Moderate-to-severe post-thrombotic syndrome occurred in 18% of patients in the pharmacomechanical-thrombolysis group versus 24% of those in the control group (risk ratio, 0.73; 95% CI, 0.54 to 0.98; P=0.04). Severity scores for the post-thrombotic syndrome were lower in the pharmacomechanical-thrombolysis group than in the control group at 6, 12, 18, and 24 months of follow-up (P<0.01 for the comparison of the Villalta scores at each time point), but the improvement in quality of life from baseline to 24 months did not differ significantly between the treatment groups. CONCLUSIONS:Among patients with acute proximal deep-vein thrombosis, the addition of pharmacomechanical catheter-directed thrombolysis to anticoagulation did not result in a lower risk of the post-thrombotic syndrome but did result in a higher risk of major bleeding. (Funded by the National Heart, Lung, and Blood Institute and others; ATTRACT ClinicalTrials.gov number, NCT00790335 .).
| S-EPMC5763501 | biostudies-literature
Project description:BackgroundIn minimally invasive cardiac surgery (MICS) and extracorporeal membrane oxygenation (ECMO), a guidewire is inserted from the femoral vein (FV) into the right atrium. However, rarely, the guidewire or catheter strays into the hepatic vein (HV) because of the inferior vena cava (IVC)-HV angle. We report two cases in which a guidewire and venous cannula from the FV strayed into the HV, likely owing to a Eustachian valve.Case presentationBoth patients were women who underwent transesophageal echocardiography-guided FV cannulation. In case 1, a guidewire from the FV strayed into the HV owing to a Eustachian valve. In case 2, ECMO was established postoperatively. Transthoracic echocardiography confirmed the venous cannula had strayed into the HV. Computed tomography indicated IVC-HC angles of 129° (case 1) and 102° (case 2).ConclusionA Eustachian valve can impede devices inserted from the FV and even allow them to stray into the HV.
| S-EPMC9307693 | biostudies-literature
Project description:A 45-year-old man with stage IV melanoma presented with incessant nonsustained wide complex tachycardia. He was found to have a right ventricular intracardiac metastasis that created a nidus for ventricular tachycardia refractory to multiple therapeutic interventions. The patient underwent catheter ablation for this rare indication, with successful arrhythmia control by direct ablation over the tumor surface. (Level of Difficulty: Advanced.).
| S-EPMC8353569 | biostudies-literature
Project description:Atrial septal defect closure is now routinely performed using a percutaneous approach under echocardiographic guidance. Since some echocardiographic features play an important role in the assessment of the defect and safety of the procedure, the salient features of the anatomical variations seen in adults undergoing transcatheter device closure should be well known to prevent inadvertent adverse effect or complications. It has been reported that the valve of the inferior vena cava, Eustachian valve, could be mistaken as the atrial septum thus ending in a wrong diagnosis and causing inadvertent surgical or percutaneous closure of an Eustachian valve to interatrial septum. We present a concise article that brings out a practical issue encountered during device closure of atrial septal defects.
| S-EPMC5485441 | biostudies-literature
Project description:Understanding how active dendrites are exploited for behaviorally relevant computations is a fundamental challenge in neuroscience. Grid cells in medial entorhinal cortex are an attractive model system for addressing this question, as the computation they perform is clear: they convert synaptic inputs into spatially modulated, periodic firing. Whether active dendrites contribute to the generation of the dual temporal and rate codes characteristic of grid cell output is unknown. We show that dendrites of medial entorhinal cortex neurons are highly excitable and exhibit a supralinear input-output function in vitro, while in vivo recordings reveal membrane potential signatures consistent with recruitment of active dendritic conductances. By incorporating these nonlinear dynamics into grid cell models, we show that they can sharpen the precision of the temporal code and enhance the robustness of the rate code, thereby supporting a stable, accurate representation of space under varying environmental conditions. Our results suggest that active dendrites may therefore constitute a key cellular mechanism for ensuring reliable spatial navigation.
| S-EPMC6358004 | biostudies-literature
Project description:A patient with previous catheter ablation therapy for atrial fibrillation was examined for an abnormal shadow on a chest radiograph. ECG-gated multidetector CT clearly showed the left upper pulmonary vein connected with the left inferior pulmonary vein. We hypothesize an intrapulmonary venous connection as a collateral.
| S-EPMC8749409 | biostudies-literature