Sample records for ablative maze procedure

  1. Intraoperative ablation of atrial fibrillation - replication of the Cox's maze III procedure with re-usable radiofrequency and cryoablation devices.

    PubMed

    Patwardhan, Anil

    2010-01-01

    The cut and sew Cox's maze III procedure is time-consuming. Therefore, various energy sources have been used for ablation, to replace the cut and sew technique. We have used the bipolar radiofrequency output of a standard electrosurgical generator with re-usable forceps for replicating the Cox's maze III procedure from August 1996. In addition, re-usable nitrous oxide based cryoprobe has been used at the atrioventricular valve annuli and on the coronary sinus. The 85.7% cure rate at one year compares with that for surgical ablation of atrial fibrillation using alternative energy sources.

  2. Maze Procedures for Atrial Fibrillation, From History to Practice.

    PubMed

    Kik, Charles; Bogers, Ad J J C

    2011-10-01

    Atrial fibrillation may result in significant symptoms, (systemic) thrombo-embolism, as well as tachycardia-induced cardiomyopathy with cardiac failure, and consequently be associated with significant morbidity and mortality. Nowadays symptomatic atrial fibrillation can be treated with catheter-based ablation, surgical ablation or hybrid approaches. In this setting a fairly large number of surgical approaches and procedures are described and being practised. It should be clear that the Cox-maze procedure resulted from building up evidence and experience in different steps, while some of the present surgical approaches and techniques are being based only on technical feasibility with limited experience, rather than on a process of consequent methodology. Some of the issues still under debate are whether or not the maze procedure can be limited to the left atrium or even to isolation of the pulmonary veins or that bi-atrial procedures are indicated, whether or not cardiopulmonary bypass is to be applied and which route of exposure facilitates an optimal result. In addition, maze procedures are not procedures guide by electrophysiological mapping. At least in theory not in all patients all lesions of the maze procedures are necessary. A history and aspects of current practise in surgical treatment of atrial fibrillation is presented.

  3. Maze Procedures for Atrial Fibrillation, From History to Practice

    PubMed Central

    Kik, Charles; Bogers, Ad J.J.C.

    2011-01-01

    Atrial fibrillation may result in significant symptoms, (systemic) thrombo-embolism, as well as tachycardia-induced cardiomyopathy with cardiac failure, and consequently be associated with significant morbidity and mortality. Nowadays symptomatic atrial fibrillation can be treated with catheter-based ablation, surgical ablation or hybrid approaches. In this setting a fairly large number of surgical approaches and procedures are described and being practised. It should be clear that the Cox-maze procedure resulted from building up evidence and experience in different steps, while some of the present surgical approaches and techniques are being based only on technical feasibility with limited experience, rather than on a process of consequent methodology. Some of the issues still under debate are whether or not the maze procedure can be limited to the left atrium or even to isolation of the pulmonary veins or that bi-atrial procedures are indicated, whether or not cardiopulmonary bypass is to be applied and which route of exposure facilitates an optimal result. In addition, maze procedures are not procedures guide by electrophysiological mapping. At least in theory not in all patients all lesions of the maze procedures are necessary. A history and aspects of current practise in surgical treatment of atrial fibrillation is presented. PMID:28357007

  4. The effects of the Cox maze procedure on atrial function

    PubMed Central

    Voeller, Rochus K.; Zierer, Andreas; Lall, Shelly C.; Sakamoto, Shun–ichiro; Chang, Nai–Lun; Schuessler, Richard B.; Moon, Marc R.; Damiano, Ralph J.

    2010-01-01

    Objective The effects of the Cox maze procedure on atrial function remain poorly defined. The purpose of this study was to investigate the effects of a modified Cox maze procedure on left and right atrial function in a porcine model. Methods After cardiac magnetic resonance imaging, 6 pigs underwent pericardiotomy (sham group), and 6 pigs underwent a modified Cox maze procedure (maze group) with bipolar radiofrequency ablation. The maze group had preablation and immediate postablation left and right atrial pressure–volume relations measured with conductance catheters. All pigs survived for 30 days. Magnetic resonance imaging was then repeated for both groups, and conductance catheter measurements were repeated for the right atrium in the maze group. Results Both groups had significantly higher left atrial volumes postoperatively. Magnetic resonance imaging–derived reservoir and booster pump functional parameters were reduced postoperatively for both groups, but there was no difference in these parameters between the groups. The maze group had significantly higher reduction in the medial and lateral left atrial wall contraction postoperatively. There was no change in immediate left atrial elastance or in the early and 30-day right atrial elastance after the Cox maze procedure. Although the initial left atrial stiffness increased after ablation, right atrial diastolic stiffness did not change initially or at 30 days. Conclusions Performing a pericardiotomy alone had a significant effect on atrial function that can be quantified by means of magnetic resonance imaging. The effects of the Cox maze procedure on left atrial function could only be detected by analyzing segmental wall motion. Understanding the precise physiologic effects of the Cox maze procedure on atrial function will help in developing less-damaging lesion sets for the surgical treatment of atrial fibrillation. PMID:19026812

  5. Surgical ablation for atrial fibrillation for two decades: are the results of new techniques equivalent to the Cox maze III procedure?

    PubMed

    Stulak, John M; Suri, Rakesh M; Burkhart, Harold M; Daly, Richard C; Dearani, Joseph A; Greason, Kevin L; Joyce, Lyle D; Park, Soon J; Schaff, Hartzell V

    2014-05-01

    A significant evolution has occurred in surgical ablation for atrial fibrillation (AF) toward alternate energy sources, lesion sets, and approaches, with the intent of simplifying the Cox maze III operation and maintaining similar outcomes. Because no large comparative studies with long-term follow-up exist, we have reviewed our experience. From January 1993 to January 2011, 1540 patients underwent surgical ablation for AF. The operations were performed in conjunction with repair of congenital heart disease in 351 (30%) and adult-acquired disease in 1189 patients (70%). In the 1189 patients, preoperative AF was paroxysmal in 598 (50%) and persistent in 591 (50%). The energy sources included cut and sew in 521 (44%), cryothermy in 267 (22%), radiofrequency in 262 (22%), and a combination in 139 patients (12%). The lesion sets included biatrial in 810 (68%), isolated pulmonary vein isolation in 269 (23%), and isolated left atrial in 110 (9%). AF ablation was performed during isolated mitral valve surgery in 516 patients (43%). The median follow-up was 33 months (maximum, 20.3 years), and late rhythm follow-up was available for 80%. The cut and sew Cox maze III procedure was superior at each follow-up interval (P = .01, P = .03, and P < .001). On multivariate analysis, the cut and sew maze procedure was independently associated with less risk of recurrent AF at a follow-up period of 1 to 5 years (hazard ratio, 0.4; 95% confidence interval, 0.24-0.69; P < .001) and >5 years (hazard ratio, 0.23; 95% confidence interval, 0.12-0.42; P < .001) for all patients. When performed during isolated mitral valve surgery, the cut and sew Cox maze III was also independently associated with less risk of recurrent AF at >5 years (hazard ratio, 0.23; 95% confidence interval, 0.08-0.66; P = .007). The cut and sew Cox maze III procedure appears to offer significantly greater freedom from AF without antiarrhythmic medications compared with alternate energy sources and lesion

  6. A novel atrial volume reduction technique to enhance the Cox maze procedure: initial results.

    PubMed

    Marui, Akira; Nishina, Takeshi; Tambara, Keiichi; Saji, Yoshiaki; Shimamoto, Takeshi; Nishioka, Masahiko; Ikeda, Tadashi; Komeda, Masashi

    2006-11-01

    further study with a larger number of patients and a longer follow-up period is needed, this safe and thus far potent technique that catheter-based ablation cannot copy might extend indication of the Cox maze procedure for patients with tough atrial fibrillation.

  7. Late outcomes after the Cox maze IV procedure for atrial fibrillation.

    PubMed

    Henn, Matthew C; Lancaster, Timothy S; Miller, Jacob R; Sinn, Laurie A; Schuessler, Richard B; Moon, Marc R; Melby, Spencer J; Maniar, Hersh S; Damiano, Ralph J

    2015-11-01

    The Cox maze IV procedure (CMPIV) has been established as the gold standard for surgical ablation; however, late outcomes using current consensus definitions of treatment failure have not been well described. To compare to reported outcomes of catheter-based ablation, we report our institutional outcomes of patients who underwent a left-sided or biatrial CMPIV at 5 years of follow-up. Between January 2002 and September 2014, data were collected prospectively on 576 patients with AF who underwent a CMPIV (n = 532) or left-sided CMPIV (n = 44). Perioperative variables and long-term freedom from AF, with and without AADs, were compared in multiple subgroups. Follow-up at any time point was 89%. At 5 years, overall freedom from AF was 93 of 119 (78%), and freedom from AF off AADs was 77 of 177 (66%). No differences were found in freedom from AF, with or without AADs, at 1, 2, 3, 4, and 5 years for patients with paroxysmal AF (n = 204) versus with persistent/longstanding persistent AF (n = 305), or for those who underwent standalone versus a concomitant CMP. Duration of preoperative AF and hospital length of stay were the best predictors of failure at 5 years. The outcomes of the CMPIV remain good at late follow-up. The type of preoperative AF or the addition of a concomitant procedure did not affect late success. The results of the CMPIV remain superior to those reported for catheter ablation and other forms of surgical AF ablation, especially for patients with persistent or longstanding AF. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  8. The Effects of Using Different Procedures to Score Maze Measures

    ERIC Educational Resources Information Center

    Pierce, Rebecca L.; McMaster, Kristen L.; Deno, Stanley L.

    2010-01-01

    The purpose of this study was to examine how different scoring procedures affect interpretation of maze curriculum-based measurements. Fall and spring data were collected from 199 students receiving supplemental reading instruction. Maze probes were scored first by counting all correct maze choices, followed by four scoring variations designed to…

  9. Results of clinical application of the modified maze procedure as concomitant surgery

    PubMed Central

    Bakker, Robbert C.; Akin, Sakir; Rizopoulos, Dimitris; Kik, Charles; Takkenberg, Johanna J.M.; Bogers, Ad J.J.C.

    2013-01-01

    OBJECTIVES Atrial fibrillation is the most common cardiac arrhythmia and is associated with significant morbidity and mortality. The classic cut-and-sew maze procedure is successful in 85–95% of patients. However, the technical complexity has prompted modifications of the maze procedure. The objective of this study was to retrospectively evaluate the clinical safety and efficacy of the maze treatment performed at our institution. METHODS From March 2001 until February 2009, 169 patients underwent a modified maze procedure for atrial fibrillation at the Erasmus MC, Rotterdam. Patient characteristics, surgical procedure and follow-up data were obtained by reviewing the medical charts and consulting with the referring physicians. The efficacy of the procedure as measured by AF recurrence was analysed with a repeated measurements model. The quality of life of the patients was assessed with the SF-36 (a short-form health survey with 36 questions) questionnaire and compared with that of the general Dutch population. RESULTS Of the 169 patients who underwent a modified maze procedure, 163 had their maze procedure as a concomitant procedure. The 30-day mortality rate was 4.7% (n = 8). The rate of post-procedural AF recurrence varied significantly over time (P < 0.0001). Decreased left ventricular function, increased age and higher preoperative creatinine levels were predictors of AF recurrence. Quality of life, as measured with the SF-36 questionnaire, was comparable with that of the Dutch population for all health domains. CONCLUSIONS Concomitant maze is a relatively safe treatment that eliminates atrial fibrillation in the majority of patients, although the probability of recurrent AF increases with the passage of time. Decreased left ventricular function, increased age and higher preoperative creatinine levels are associated with an increased risk of AF recurrence. PMID:23103720

  10. Variations in Anticoagulation Practices Following the Maze Procedure.

    PubMed

    Chung, Jennifer; Sami, Magdi; Albert, Carole; Varennes, Benoit De

    2015-01-01

    The current real-world anticoagulation practices following left atrial appendectomy in the context of the Maze procedure are unknown. This is a cohort study of all patients who underwent the Maze procedure with amputation of the left atrial appendage from June 2005 to November 2012. Data was prospectively collected at regular intervals with an interview and Holter monitoring. All patients received anticoagulation for 3 months. Those then kept on anticoagulation and those for whom anticoagulation was stopped were compared in terms of death, bleeding and incidence of stroke. In total, there were 113 patients, of whom 66 were treated with anticoagulation (Group A) and 47 were not (Group B). There were no significant baseline differences between the two groups, including the presence of atrial fibrillation (A:19.7%, B:10.6%, p=0.30), CHADS2 score (A:1.41±1.05, B:1.15±1.08, p=0.19), and left atrial size (A:48.3±7.1mm, B:47.6±7.8 mm, p=0.57). There were 275 patient-years of follow-up, with an average of 2.43 years per patient. Only two patients experienced strokes, both in Group A (p=0.27). Of the 5 bleeding events, 4 occurred in the first 3 months while on anticoagulation and the remaining event occurred in Group A at 3 years post-operatively (p=0.10). No standardized approach to anticoagulation after the Maze procedure is apparent in real-world practice in an urban Canadian setting. Patients who undergo the Maze procedure with amputation of the left atrial appendage are at a low risk of stroke, but the optimal anticoagulation strategy requires further investigation.

  11. Barnes Maze Procedure for Spatial Learning and Memory in Mice.

    PubMed

    Pitts, Matthew W

    2018-03-05

    The Barnes maze is a dry-land based rodent behavioral paradigm for assessing spatial learning and memory that was originally developed by its namesake, Carol Barnes. It represents a well-established alternative to the more popular Morris Water maze and offers the advantage of being free from the potentially confounding influence of swimming behavior. Herein, the Barnes maze experimental setup and corresponding procedures for testing and analysis in mice are described in detail.

  12. Surgical ablation of atrial fibrillation during mitral-valve surgery.

    PubMed

    Gillinov, A Marc; Gelijns, Annetine C; Parides, Michael K; DeRose, Joseph J; Moskowitz, Alan J; Voisine, Pierre; Ailawadi, Gorav; Bouchard, Denis; Smith, Peter K; Mack, Michael J; Acker, Michael A; Mullen, John C; Rose, Eric A; Chang, Helena L; Puskas, John D; Couderc, Jean-Philippe; Gardner, Timothy J; Varghese, Robin; Horvath, Keith A; Bolling, Steven F; Michler, Robert E; Geller, Nancy L; Ascheim, Deborah D; Miller, Marissa A; Bagiella, Emilia; Moquete, Ellen G; Williams, Paula; Taddei-Peters, Wendy C; O'Gara, Patrick T; Blackstone, Eugene H; Argenziano, Michael

    2015-04-09

    Among patients undergoing mitral-valve surgery, 30 to 50% present with atrial fibrillation, which is associated with reduced survival and increased risk of stroke. Surgical ablation of atrial fibrillation has been widely adopted, but evidence regarding its safety and effectiveness is limited. We randomly assigned 260 patients with persistent or long-standing persistent atrial fibrillation who required mitral-valve surgery to undergo either surgical ablation (ablation group) or no ablation (control group) during the mitral-valve operation. Patients in the ablation group underwent further randomization to pulmonary-vein isolation or a biatrial maze procedure. All patients underwent closure of the left atrial appendage. The primary end point was freedom from atrial fibrillation at both 6 months and 12 months (as assessed by means of 3-day Holter monitoring). More patients in the ablation group than in the control group were free from atrial fibrillation at both 6 and 12 months (63.2% vs. 29.4%, P<0.001). There was no significant difference in the rate of freedom from atrial fibrillation between patients who underwent pulmonary-vein isolation and those who underwent the biatrial maze procedure (61.0% and 66.0%, respectively; P=0.60). One-year mortality was 6.8% in the ablation group and 8.7% in the control group (hazard ratio with ablation, 0.76; 95% confidence interval, 0.32 to 1.84; P=0.55). Ablation was associated with more implantations of a permanent pacemaker than was no ablation (21.5 vs. 8.1 per 100 patient-years, P=0.01). There were no significant between-group differences in major cardiac or cerebrovascular adverse events, overall serious adverse events, or hospital readmissions. The addition of atrial fibrillation ablation to mitral-valve surgery significantly increased the rate of freedom from atrial fibrillation at 1 year among patients with persistent or long-standing persistent atrial fibrillation, but the risk of implantation of a permanent pacemaker

  13. Epicardial Radiofrequency Ablation Failure During Ablation Procedures for Ventricular Arrhythmias: Reasons and Implications for Outcomes.

    PubMed

    Baldinger, Samuel H; Kumar, Saurabh; Barbhaiya, Chirag R; Mahida, Saagar; Epstein, Laurence M; Michaud, Gregory F; John, Roy; Tedrow, Usha B; Stevenson, William G

    2015-12-01

    Radiofrequency ablation (RFA) from the epicardial space for ventricular arrhythmias is limited or impossible in some cases. Reasons for epicardial ablation failure and the effect on outcome have not been systematically analyzed. We assessed reasons for epicardial RFA failure relative to the anatomic target area and the type of heart disease and assessed the effect of failed epicardial RFA on outcome after ablation procedures for ventricular arrhythmias in a large single-center cohort. Epicardial access was attempted during 309 ablation procedures in 277 patients and was achieved in 291 procedures (94%). Unlimited ablation in an identified target region could be performed in 181 cases (59%), limited ablation was possible in 22 cases (7%), and epicardial ablation was deemed not feasible in 88 cases (28%). Reasons for failed or limited ablation were unsuccessful epicardial access (6%), failure to identify an epicardial target (15%), proximity to a coronary artery (13%), proximity to the phrenic nerve (6%), and complications (<1%). Epicardial RFA was impeded in the majority of cases targeting the left ventricular summit region. Acute complications occurred in 9%. The risk for acute ablation failure was 8.3× higher (4.5-15.0; P<0.001) after no or limited epicardial RFA compared with unlimited RFA, and patients with unlimited epicardial RFA had better recurrence-free survival rates (P<0.001). Epicardial RFA for ventricular arrhythmias is often limited even when pericardial access is successful. Variability of success is dependent on the target area, and the presence of factors limiting ablation is associated with worse outcomes. © 2015 American Heart Association, Inc.

  14. Localization of gaps during redo ablations of paroxysmal atrial fibrillation: Preferential patterns depending on the choice of cryoballoon ablation or radiofrequency ablation for the initial procedure.

    PubMed

    Galand, Vincent; Pavin, Dominique; Behar, Nathalie; Auffret, Vincent; Fénéon, Damien; Behaghel, Albin; Daubert, Jean-Claude; Mabo, Philippe; Martins, Raphaël P

    2016-11-01

    Pulmonary vein (PV) isolation, using cryoballoon or radiofrequency ablation, is the cornerstone therapy for symptomatic paroxysmal atrial fibrillation (AF) refractory to antiarrhythmic drugs. One-third of the patients have recurrences, mainly due to PV reconnections. To describe the different locations of reconnection sites in patients who had previously undergone radiofrequency or cryoballoon ablation, and to compare the characteristics of the redo procedures in both instances. Demographic data and characteristics of the initial ablation (cryoballoon or radiofrequency) were collected. Number and localization of reconduction gaps, and redo characteristics were reviewed. Seventy-four patients scheduled for a redo ablation of paroxysmal AF were included; 38 had been treated by radiofrequency ablation and 36 by cryoballoon ablation during the first procedure. For the initial ablation, procedural and fluoroscopy times were significantly shorter for cryoballoon ablation (147.8±52.6min vs. 226.6±64.3min [P<0.001] and 37.0±17.7min vs. 50.8±22.7min [P=0.005], respectively). Overall, an identical number of gaps was found during redo procedures of cryoballoon and radiofrequency ablations. However, a significantly higher number of gaps were located in the right superior PV for patients first ablated with radiofrequency (0.9±1.0 vs. 0.5±0.9; P=0.009). Gap localization displayed different patterns. Although not significant, redo procedures of cryoballoon ablation were slightly shorter and needed shorter durations of radiofrequency to achieve PV isolation. During redo procedures, gap localization pattern is different for patients first ablated with cryoballoon or radiofrequency ablation, and right superior PV reconnections occur more frequently after radiofrequency ablation. Redo ablation of a previous cryoballoon ablation appears to be easier. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  15. Surgical ablation of atrial fibrillation in patients with a giant left atrium undergoing mitral valve surgery.

    PubMed

    Kim, Ho Jin; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

    2016-08-01

    As the efficacy of surgical ablation for atrial fibrillation (AF) is reported to be suboptimal for patients with a giant left atrium (LA), its routine use on this population has remained controversial. We sought to evaluate the clinical outcomes of patients with a giant LA undergoing mitral valve (MV) surgery with/without the maze procedure. We identified 759 patients with a giant LA (>60 mm) and AF undergoing MV surgery from 1999 through 2012. Of these, 400 underwent MV surgery with the maze procedure (maze group), and the remainder (n=359) underwent MV surgery only (no-maze group). To reduce the impact of selection bias, propensity score analyses were performed based on 25 baseline covariates. Early death occurred in five (1.3%) and nine (2.5%) patients in the maze and the no-maze group, respectively (p=0.28). Freedom from AF at 5 years was 68.9% in the maze group and 9.6% in the no-maze group (p<0.001). After adjustment, the maze group showed a significantly lower risk of death (HR, 0.65; 95% CI 0.44 to 0.98; p=0.038), thromboembolic events (HR, 0.23; 95% CI 0.09 to 0.58; p=0.002) and composite adverse outcomes (death, congestive heart failure and valve-related complications; HR, 0.55; 95% CI 0.42 to 0.71; p<0.001) than the no-maze group. In subgroup analyses, MV surgery with the maze procedure resulted in higher survival and event-free survival in most risk subgroups than without the maze procedure. The concomitant maze procedure improved postoperative rhythm status, clinical outcomes and cardiac functions in patients with a giant LA undergoing MV surgery. This study indicates that the patients with a giant LA undergoing MV surgery may benefit from an addition of the maze procedure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  16. Modified radial v/s biatrial maze for atrial fibrillation in rheumatic valvular heart surgery.

    PubMed

    Sayed, Sajid A; Katewa, Ashish; Srivastava, Vivek; Jana, Sujit; Patwardhan, Anil M

    2014-01-01

    Atrial fibrillation (AF) is commonest sustained atrial arrhythmia producing high morbidity. Although Cox's Maze III procedure cures AF in majority, reduced atrial transport function (ATF) is a concern. Radial approach with ablation lines radial from sinus node towards atrioventricular annulii and parallel to atrial coronary arteries, has shown better ATF. Single blind open randomized prospective study of 80 patients was undertaken in two groups (40 each) of modified Cox's maze III and modified radial approach, to evaluate conversion to normal sinus rhythm (NSR) and ATF. Patients undergoing surgery for rheumatic valvular heart disease with continuous AF were prospectively randomized. Ablation lines were created with radiofrequency (RF) bipolar coagulation with cryoablation for the isthmal lesions and coronary sinus. Results were compared at 6 months and ATF was evaluated by atrial filling fraction (AFF) and A/E ratio on echocardiography. The rate of conversion to NSR in both groups was statistically insignificant by Fisher's exact test (p > 0.05). ATF was better in modified radial approach compared to modified Cox's Maze III (A/E compared by unpaired t test:0.52 ± 0.08 v/s 0.36 ± 0.10; p < 0.05. AFF compared using Mann Whitney U test: median AFF for radial group was 23 v/s 20 for biatrial group; p < 0.05). In patients with AF undergoing rheumatic valvular surgery, radiofrequency radial approach is as effective as modified Cox's maze III for conversion to NSR with better atrial transport function. Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  17. A novel approach to restore atrial function after the maze procedure in patients with an enlarged left atrium.

    PubMed

    Marui, Akira; Tambara, Keiichi; Tadamura, Eiji; Saji, Yoshiaki; Sasahashi, Nozomu; Ikeda, Tadashi; Nishina, Takeshi; Komeda, Masashi

    2007-08-01

    Left atrial (LA) volume reduction surgery concomitant with the maze procedure has been reported to facilitate sinus rhythm recovery even in patients with refractory atrial fibrillation (AF) with an enlarged LA. However, it is unknown whether the procedures can also restore effective atrial function of the enlarged LA with over-stretched myocardium. The maze procedures in association with mitral valve surgery were performed to 57 AF patients with an enlarged LA (LA diameter >or=60mm). Among them, 32 patients had concomitant LA volume reduction surgery (VR group). Another 25 patients did not have the volume reduction (control group). Three months postoperatively LA end-diastolic volume (LAEDV, ml) assessed by magnetic resonance (MR) imaging was larger in the VR group than that in the control group (291+/-117 vs 223+/-81 ml, p<0.05). Postoperatively, sinus rhythm recovery rate was better (84 vs 68%, p<0.05) and LAEDV was drastically smaller (118+/-48 vs 203+/-76 ml, p<0.001) in the VR group than those in the control group. Among the patients with sinus rhythm recovery in both groups, LA contraction ejection fraction (%) improved in the VR group but not in the control group (22.3+/-7.8 vs 10.3+/-4.7%, p<0.001). The LA volume reduction surgery concomitant with the maze procedure restored contraction of the enlarged LA; however, the maze procedure alone did not restore LA contraction in spite of successful sinus rhythm recovery. LA volume reduction surgery may be desirable to the patients with refractory AF with over-stretched LA.

  18. [Cox/maze III procedure combined with mitral valve replacement in treatment of rheumatic mitral valve disease with atrial fibrilation].

    PubMed

    Chen, Rukun; Wang, Yongqing; Chen, Yongbing; Chen, Suocheng

    2002-06-25

    To compare the curative effect of Cox/maze III procedure combined with mitral replacement and that of mitral valve replacement (MVR). Fifty-six patients suffering from rheumatic heart disease with atrial fibrillation (AF) were treated by Cox/maze III procedure combined with MVR (maze group). Another 56 age, sex, and heart function-matched patients with the same diagnosis underwent MVR alone during the same period. Warfarin was administered after operation in both groups. Comparison of operative complication and curative effects was made. The aortic cross-clamp time and cardio pulmonary bypass time (CPB) were longer in maze group than in MVT group (75 +/- 22 min vs 41 +/- 11 min, P < 0.05 and 124 +/- 40 min VS 68 +/- 19 min, P < 0.05). Bleeding happened after the heart reatored beating in 2 patients in maze group and in one patient in MVT group, all these 3 patients responding satisfactorily to hemostasis. The early post-operative mortality was 1.79% (1/56) in both groups. In maze group, AF disappeared in all patients but one who had node rhythm. Normal sinus rhythm was restored in 98.18% of the patients (54/55). Atrial contractility was restored in all patients with sinus rhythm. One year after operation, 98.18% patients' cardiac function changed to grade and 1.82% changed to grade II. In MVR group AF disappeared after operation temporarily for 24 hours in 7 patients and re-appeared, and AF disappeared in one patients for 2 years so far. One year after operation, the cardiac function of 94.6% patients in MVR group changed to grade I, of 3.6% patients to grade II, and of 1.8% patients to grade III. No serious hemorrhage relate d to anticoagulant therapy happened. One patient in MVR group suffered from hemiplegia due to cerebral embolism. The late mortality was 1.8% on maze group amd 3.6% in MVR group. Cox/maze III procedure combined with NVR is safe and effective in treating rheumatic heart disease with AF.

  19. Designing Comparative Effectiveness Trials of Surgical Ablation for Atrial Fibrillation: Experience of the Cardiothoracic Surgical Trials Network

    PubMed Central

    Gillinov, A. Marc; Argenziano, Michael; Blackstone, Eugene H.; Iribarne, Alexander; DeRose, Joseph J.; Ailawadi, Gorav; Russo, Mark J.; Ascheim, Deborah D.; Parides, Michael K.; Rodriguez, Evelio; Bouchard, Denis; Taddei-Peters, Wendy C.; Geller, Nancy L.; Acker, Michael A.; Gelijns, Annetine C.

    2013-01-01

    Background Since the introduction of the cut-and-sew Cox-Maze procedure for atrial fibrillation (AF) there has been substantial innovation in techniques for ablation. Use of alternate energy sources for ablation simplified the procedure and has resulted in dramatic increase in the number of AF patients treated by surgical ablation. Despite its increasingly widespread adoption, there is lack of rigorous clinical evidence to establish this as an effective clinical therapy. Methods and Results This paper describes a comparative effectiveness randomized trial, supported by the Cardiothoracic Surgical Trials Network, of surgical ablation with left atrial appendage (LAA) closure versus LAA closure alone in patients with persistent and longstanding persistent AF undergoing mitral valve surgery. Nested within this trial, is a further randomized comparison of 2 different lesions sets: pulmonary vein isolation and full Maze lesion set. This paper addresses trial design challenges, including how to best characterize the target population, operationalize freedom from AF as a primary endpoint, account for the impact of anti-arrhythmic drugs, and measure and analyze secondary endpoints, such as post-operative AF load. Conclusions This paper concludes by discussing how insights that emerge from this trial may affect surgical practice and guide future research in this area. PMID:21616507

  20. Unilateral robotic hybrid mini-maze: a novel experimental approach.

    PubMed

    Moslemi, Mohammad; Rawashdeh, Badi; Meyer, Mark; Nguyen, Duy; Poston, Robert; Gharagozloo, Farid

    2016-03-01

    A complete Cox maze IV procedure is difficult to accomplish using current endoscopic and minimally invasive techniques. These techniques are hampered by inability to adequately dissect the posterior structures of the heart and place all necessary lesions. We present a novel approach, using robotic technology, that achieves placement of all the lesions of the complete maze procedure. In three cadaveric human models, the technical feasibility of using robotic instruments through the right chest to dissect the posterior structures of the heart and place all Cox maze lesions was performed. The entire posterior aspect of the heart was dissected in the cadaveric model facilitating successful placement of all Cox maze IV lesions with robotic assistance through minimally invasive incisions. The robotic Cox maze IV procedure through the novel right thoracic approach is feasible. This obviates the need for sternotomy and avoids the associated morbidity of the conventional Cox-maze procedure. Copyright © 2015 John Wiley & Sons, Ltd.

  1. Late Results of Cox Maze III Procedure in Patients with Atrial Fibrillation Associated with Structural Heart Disease

    PubMed Central

    Gomes, Gustavo Gir; Gali, Wagner Luis; Sarabanda, Alvaro Valentim Lima; da Cunha, Claudio Ribeiro; Kessler, Iruena Moraes; Atik, Fernando Antibas

    2017-01-01

    Background Cox-Maze III procedure is one of the surgical techniques used in the surgical treatment of atrial fibrillation (AF). Objectives To determine late results of Cox-Maze III in terms of maintenance of sinus rhythm, and mortality and stroke rates. Methods Between January 2006 and January 2013, 93 patients were submitted to the cut-and-sew Cox-Maze III procedure in combination with structural heart disease repair. Heart rhythm was determined by 24-hour Holter monitoring. Procedural success rates were determined by longitudinal methods and recurrence predictors by multivariate Cox regression models. Results Thirteen patients that obtained hospital discharge alive were excluded due to lost follow-up. The remaining 80 patients were aged 49.9 ± 12 years and 47 (58.7%) of them were female. Involvement of mitral valve and rheumatic heart disease were found in 67 (83.7%) and 63 (78.7%) patients, respectively. Seventy patients (87.5%) had persistent or long-standing persistent AF. Mean follow-up with Holter monitoring was 27.5 months. There were no hospital deaths. Sinus rhythm maintenance rates were 88%, 85.1% and 80.6% at 6 months, 24 months and 36 months, respectively. Predictors of late recurrence of AF were female gender (HR 3.52; 95% CI 1.21-10.25; p = 0.02), coronary artery disease (HR 4.73 95% CI 1.37-16.36; p = 0.01) and greater left atrium diameter (HR 1.05; 95% CI 1.01-1.09; p = 0.02). Actuarial survival was 98.5% at 12, 24 and 48 months and actuarial freedom from stroke was 100%, 100% and 97.5% in the same time frames. Conclusions The Cox-Maze III procedure, in our experience, is efficacious for sinus rhythm maintenance, with very low late mortality and stroke rates. PMID:28678926

  2. Feasibility of zero or near zero fluoroscopy during catheter ablation procedures.

    PubMed

    Haegeli, Laurent M; Stutz, Linda; Mohsen, Mohammed; Wolber, Thomas; Brunckhorst, Corinna; On, Chol-Jun; Duru, Firat

    2018-04-03

    Awareness of risks associated with radiation exposure to patients and medical staff has significantly increased. It has been reported before that the use of advanced three-dimensional electro-anatomical mapping (EAM) system significantly reduces fluoroscopy time, however this study aimed for zero or near zero fluoroscopy ablation to assess its feasibility and safety in ablation of atrial fibrillation (AF) and other tachyarrhythmias in a "real world" experience of a single tertiary care center. This was a single-center study where ablation procedures were attempted without fluoroscopy in 34 consecutive patients with different tachyarrhythmias under the support of EAM system. When transseptal puncture (TSP) was needed, it was attempted under the guidance of intracardiac echocardiography (ICE). Among 34 patients consecutively enrolled in this study, 28 (82.4%) patients were referred for radiofrequency ablation (RFA) of AF, 3 (8.8%) patients for ablation of right ventricular outflow tract (RVOT) ventricular extrasystole (VES), 1 (2.9%) patient for ablation of atrioventricular nodal reentry tachycardia (AVNRT), 2 (5.9%) patients for typical atrial flutter ablation. In 21 (62%) patients the entire procedure was carried out without the use of fluoroscopy. Among 28 AF patients, 15 (54%) patients underwent ablation without the use of fluoroscopy and among these 15 patients, 10 (67%) patients required TSP under ICE guidance while 5 (33%) patients the catheters were introduced to left atrium through a patent foramen ovale. In 13 AF patients, fluoroscopy was only required for double TSP. The total procedure time of AF ablation was 130 ± 50 min. All patients referred for atrial flutter, AVNRT, and VES of the RVOT ablation did not require any fluoroscopy. This study demonstrates the feasibility of zero or near zero fluoroscopy procedure including TSP with the support of EAM and ICE guidance in a "real world" experience of a single tertiary care center. When fluoroscopy was

  3. A New Era in the Surgical Treatment of Atrial Fibrillation

    PubMed Central

    Melby, Spencer J.; Zierer, Andreas; Bailey, Marci S.; Cox, James L.; Lawton, Jennifer S.; Munfakh, Nabil; Crabtree, Traves D.; Moazami, Nader; Huddleston, Charles B.; Moon, Marc R.; Damiano, Ralph J.

    2006-01-01

    Background/Objective: While the Cox-Maze procedure remains the gold standard for the surgical treatment of atrial fibrillation (AF), the use of ablation technology has revolutionized the field. To simplify the procedure, our group has replaced most of the incisions with bipolar radiofrequency ablation lines. The purpose of this study was to examine results using bipolar radiofrequency in 130 patients undergoing a full Cox-Maze procedure, a limited Cox-Maze procedure, or pulmonary vein isolation alone. Methods: A retrospective review was performed of patients who underwent a Cox-Maze procedure (n = 100), utilizing bipolar radiofrequency ablation, a limited Cox-Maze procedure (n = 7), or pulmonary vein isolation alone (n = 23). Follow-up was available on 129 of 130 patients (99%). Results: Pulmonary vein isolation was confirmed by intraoperative pacing in all patients. Cross-clamp time in the lone Cox-Maze procedure patients was 44 ± 21 minutes, and 104 ± 42 minutes for the Cox-Maze procedure with a concomitant procedure, which was shortened considerably from our traditional cut-and-sew Cox-Maze procedure times (P < 0.05). There were 4 postoperative deaths in the Cox-Maze procedure group and 1 in the pulmonary vein isolation group. The mean follow-up was 13 ± 10, 23 ± 15, and 9 ± 10 months for the Cox-Maze IV, the pulmonary vein isolation, and the limited Cox-Maze procedure groups, respectively. At last follow-up, freedom from AF was 90% (85 of 94), 86% (6 of 7), and 59% (10 of 17) in the in the Cox-Maze procedure group, limited Cox-Maze procedure group, and pulmonary vein isolation alone group, respectively. Conclusions: The use of bipolar radiofrequency ablation to replace Cox-Maze incisions was safe and effective at controlling AF. Pulmonary vein isolation alone was much less effective, and should be used cautiously in this population. PMID:16998367

  4. Biatrial reduction plasty with reef imbricate technique as an adjunct to maze procedure for permanent atrial fibrillation associated with giant left atria.

    PubMed

    Wang, William; Guo, L Ray; Martland, Anne Marie; Feng, Xiao-Dong; Ma, Jie; Feng, Xi Qing

    2010-04-01

    Success of the modified maze procedure after valvular operation with giant atria and permanent atrial fibrillation (AF) remains suboptimal. We report an aggressive approach for these patients utilizing biatrial reduction plasty with a reef imbricate suture technique concomitantly with valvular and maze procedure for AF. From January 1999 to December 2006, 122 consecutive Chinese patients with permanent AF and biatrial enlargement who required mitral valve+/-tricuspid valve (TV) surgery underwent aggressive left atrial reduction combined with radiofrequency bipolar full maze procedure. Left atrial dimensions were measured by TTE or TEE. There were 71 women (58.1%) and 51 men (41.9%) and their mean age was 45+/-9.5 years. Mean duration of AF was 48.4+/-21.4 months. All patients underwent left atrial reduction plasty with reef imbricate suture technique and full maze procedure. Their preoperative left atria measured 64+/-12 mm in the enlarged left atria (ELA) group and 86+/-17 mm in the giant left atria (GLA). Mitral valve replacement (MVR) combined with TV repair was performed in 102 patients (83%) while 21 patients underwent MVRs combined with aortic valve replacements (17%). Sixty-six (54%) patients required additional procedures and 61 (50%) of the patients also underwent left atrial appendage clot evacuation. Postoperative left atrial size was reduced to 49+/-8 mm (ELA) and 51+/-11 mm (GLA), respectively (P<0.05). Ninety-three of 122 (76%) patients were restored in normal sinus rhythm after one year clinical follow-up. Aggressive biatrial reduction plasty combined with full maze procedure is an effective treatment for patients with permanent AF undergoing concomitant valvular surgery. Further studies utilizing the reef imbricate suture technique for atrial reduction need to subsequently be evaluated.

  5. Ablation of atrial fibrillation with concomitant cardiac surgery.

    PubMed

    Gillinov, A Marc; Saltman, Adam E

    2007-01-01

    Atrial fibrillation is present in approximately 35% of patients presenting for mitral valve surgery and in 1 to 6% of adult patients undergoing other forms of cardiac surgery. If left untreated, atrial fibrillation is associated with increased morbidity, and, in some subgroups, increased mortality. Therefore, concomitant management of the arrhythmia is indicated in most cardiac surgery patients with preexisting atrial fibrillation. Although the cut-and-sew Cox-maze III procedure is extremely effective, it has been supplanted by newer operations that rely on alternate energy sources to create lines of conduction block. Early and mid-term results are good with a variety of technologies. Choice of lesion set remains a matter of debate, but results of ablation appear to be enhanced by a biatrial lesion set. Targeted areas for improvement in concomitant ablation include acceptance of uniform standards for reporting results, development of improved technology for ablation and intraoperative assessment, and creation of instrumentation that facilitates minimally invasive approaches.

  6. Microwave Ablation of Porcine Kidneys in vivo: Effect of two Different Ablation Modes ('Temperature Control' and 'Power Control') on Procedural Outcome

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Sommer, C. M., E-mail: christof.sommer@med.uni-heidelberg.de; Arnegger, F.; Koch, V.

    2012-06-15

    Purpose: This study was designed to analyze the effect of two different ablation modes ('temperature control' and 'power control') of a microwave system on procedural outcome in porcine kidneys in vivo. Methods: A commercially available microwave system (Avecure Microwave Generator; MedWaves, San Diego, CA) was used. The system offers the possibility to ablate with two different ablation modes: temperature control and power control. Thirty-two microwave ablations were performed in 16 kidneys of 8 pigs. In each animal, one kidney was ablated twice by applying temperature control (ablation duration set point at 60 s, ablation temperature set point at 96 Degree-Signmore » C, automatic power set point; group I). The other kidney was ablated twice by applying power control (ablation duration set point at 60 s, ablation temperature set point at 96 Degree-Sign C, ablation power set point at 24 W; group II). Procedural outcome was analyzed: (1) technical success (e.g., system failures, duration of the ablation cycle), and (2) ablation geometry (e.g., long axis diameter, short axis diameter, and circularity). Results: System failures occurred in 0% in group I and 13% in group II. Duration of the ablation cycle was 60 {+-} 0 s in group I and 102 {+-} 21 s in group II. Long axis diameter was 20.3 {+-} 4.6 mm in group I and 19.8 {+-} 3.5 mm in group II (not significant (NS)). Short axis diameter was 10.3 {+-} 2 mm in group I and 10.5 {+-} 2.4 mm in group II (NS). Circularity was 0.5 {+-} 0.1 in group I and 0.5 {+-} 0.1 in group II (NS). Conclusions: Microwave ablations performed with temperature control showed fewer system failures and were finished faster. Both ablation modes demonstrated no significant differences with respect to ablation geometry.« less

  7. Method for evaluation of predictive models of microwave ablation via post-procedural clinical imaging

    NASA Astrophysics Data System (ADS)

    Collins, Jarrod A.; Brown, Daniel; Kingham, T. Peter; Jarnagin, William R.; Miga, Michael I.; Clements, Logan W.

    2015-03-01

    Development of a clinically accurate predictive model of microwave ablation (MWA) procedures would represent a significant advancement and facilitate an implementation of patient-specific treatment planning to achieve optimal probe placement and ablation outcomes. While studies have been performed to evaluate predictive models of MWA, the ability to quantify the performance of predictive models via clinical data has been limited to comparing geometric measurements of the predicted and actual ablation zones. The accuracy of placement, as determined by the degree of spatial overlap between ablation zones, has not been achieved. In order to overcome this limitation, a method of evaluation is proposed where the actual location of the MWA antenna is tracked and recorded during the procedure via a surgical navigation system. Predictive models of the MWA are then computed using the known position of the antenna within the preoperative image space. Two different predictive MWA models were used for the preliminary evaluation of the proposed method: (1) a geometric model based on the labeling associated with the ablation antenna and (2) a 3-D finite element method based computational model of MWA using COMSOL. Given the follow-up tomographic images that are acquired at approximately 30 days after the procedure, a 3-D surface model of the necrotic zone was generated to represent the true ablation zone. A quantification of the overlap between the predicted ablation zones and the true ablation zone was performed after a rigid registration was computed between the pre- and post-procedural tomograms. While both model show significant overlap with the true ablation zone, these preliminary results suggest a slightly higher degree of overlap with the geometric model.

  8. Animal Studies of Epicardial Atrial Ablation

    PubMed Central

    Schuessler, Richard B.; Lee, Anson M.; Melby, Spencer J.; Voeller, Rochus K.; Gaynor, Sydney L.; Sakamoto, Shun-Ichiro; Damiano, Ralph J.

    2009-01-01

    The Cox-Maze procedure is an effective treatment for atrial fibrillation with a long-term freedom from recurrence of >90%. The original procedure was highly invasive and required cardiopulmonary bypass (CPB). Modifications of the procedure have been proposed so that the procedure can be done without CPB. These approaches proposed to use alternative energy sources, to replace cut and sew lesions with lines of ablation, made from the epicardium on the beating heart. This has been challenging because the atrial wall muscle thickness is extremely variable and can be covered with an epicardial layer of fat. Moreover, the circulating intracavitary blood acts as a potential heat sink, making transmural lesions difficult to obtain. In this report, we summarize the use of nine different unidirectional devices to create continuous transmural lines of ablation from the atrial epicardium in a porcine model. We define a unidirectional device as one in which all the energy is applied by a single transducer on a single heart surface. These include four radiofrequency, two microwave, two lasers, and one cryothermic device. The maximum penetration of any device was 8.3 mm. All devices except one, the Atricure IsolatorT pen, failed to penetrate 2.0 mm in some non-transmural sections. Future development of unidirectional energy sources should be directed at increasing the maximum depth and the consistency of penetration. PMID:19959142

  9. Thromboembolic Risks of the Procedural Process in Second-Generation Cryoballoon Ablation Procedures: Analysis From Real-Time Transcranial Doppler Monitoring.

    PubMed

    Miyazaki, Shinsuke; Watanabe, Tomonori; Kajiyama, Takatsugu; Iwasawa, Jin; Ichijo, Sadamitsu; Nakamura, Hiroaki; Taniguchi, Hiroshi; Hirao, Kenzo; Iesaka, Yoshito

    2017-12-01

    Atrial fibrillation ablation is associated with substantial risks of silent cerebral events (SCEs) or silent cerebral lesions. We investigated which procedural processes during cryoballoon procedures carried a risk. Forty paroxysmal atrial fibrillation patients underwent pulmonary vein isolation using second-generation cryoballoons with single 28-mm balloon 3-minute freeze techniques. Microembolic signals (MESs) were monitored by transcranial Doppler throughout all procedures. Brain magnetic resonance imaging was obtained pre- and post-procedure in 34 patients (85.0%). Of 158 pulmonary veins, 152 (96.2%) were isolated using cryoablation, and 6 required touch-up radiofrequency ablation. A mean of 5.0±1.2 cryoballoon applications was applied, and the left atrial dwell time was 76.7±22.4 minutes. The total MES counts/procedures were 522 (426-626). Left atrial access and Flexcath sheath insertion generated 25 (11-44) and 34 (24-53) MESs. Using radiofrequency ablation for transseptal access increased the MES count during transseptal punctures. During cryoapplications, MES counts were greatest during first applications (117 [81-157]), especially after balloon stretch/deflations (43 [21-81]). Pre- and post-pulmonary vein potential mapping with Lasso catheters generated 57 (21-88) and 61 (36-88) MESs. Reinsertion of once withdrawn cryoballoons and subsequent applications produced 205 (156-310) MESs. Touch-up ablation generated 32 (19-62) MESs, whereas electric cardioversion generated no MESs. SCEs and silent cerebral lesions were detected in 11 (32.3%) and 4 (11.7%) patients, respectively. The patients with SCEs were older than those without; however, there were no significant factors associated with SCEs. A significant number of MESs and SCE/silent cerebral lesion occurrences were observed during second-generation cryoballoon ablation procedures. MESs were recorded during a variety of steps throughout the procedure; however, the majority occurred during phases with a

  10. Clinical predictors of challenging atrioventricular node ablation procedure for rate control in patients with atrial fibrillation.

    PubMed

    Polin, Baptiste; Behar, Nathalie; Galand, Vincent; Auffret, Vincent; Behaghel, Albin; Pavin, Dominique; Daubert, Jean-Claude; Mabo, Philippe; Leclercq, Christophe; Martins, Raphael P

    2017-10-15

    Atrioventricular node (AVN) ablation is usually a simple procedure but may sometimes be challenging. We aimed at identifying pre-procedural clinical predictors of challenging AVN ablation. Patients referred for AVN ablation from 2009 to 2015 were retrospectively included. Baseline clinical data, procedural variables and outcomes of AVN ablation were collected. A "challenging procedure" was defined 1) total radiofrequency delivery to get persistent AVN block≥400s, 2) need for left-sided arterial approach or 3) failure to obtain AVN ablation. 200 patients were included (71±10years). A total of 37 (18.5%) patients had "challenging" procedures (including 9 failures, 4.5%), while 163 (81.5%) had "non-challenging" ablations. In multivariable analysis, male sex (Odds ratio (OR)=4.66, 95% confidence interval (CI): 1.74-12.46), body mass index (BMI, OR=1.08 per 1kg/m 2 , 95%CI 1.01-1.16), operator experience (OR=0.40, 95%CI 0.17-0.94), and moderate-to-severe tricuspid regurgitation (TR, OR=3.65, 95%CI 1.63-8.15) were significant predictors of "challenging" ablations. The proportion as a function of number of predictors was analyzed (from 0 to 4, including male sex, operator inexperience, a BMI>23.5kg/m 2 and moderate-to-severe TR). There was a gradual increase in the risk of "challenging" procedure with the number of predictors by patient (No predictor: 0%; 1 predictor: 6.3%; 2 predictors: 16.5%; 3 predictors: 32.5%; 4 predictors: 77.8%). Operator experience, male sex, higher BMI and the degree of TR were independent predictors of "challenging" AVN ablation procedure. The risk increases with the number of predictors by patient. Copyright © 2017. Published by Elsevier B.V.

  11. Modified Maze Procedure for Atrial Fibrillation as an Adjunct to Elective Cardiac Surgery: Predictors of Mid-Term Recurrence and Echocardiographic Follow-Up

    PubMed Central

    Alamanni, Francesco; Veglia, Fabrizio; Galli, Claudia; Parolari, Alessandro; Zanobini, Marco

    2015-01-01

    The radiofrequency maze procedure achieves sinus rhythm in 45%–95% of patients treated for atrial fibrillation. This retrospective study evaluates mid-term results of the radiofrequency maze—performed concomitant to elective cardiac surgery—to determine sinus-rhythm predictive factors, and describes the evolution of patients' echocardiographic variables. From 2003 through 2011, 247 patients (mean age, 64 ± 9.5 yr) with structural heart disease (79.3% mitral disease) and atrial fibrillation underwent a concomitant radiofrequency modified maze procedure. Patients were monitored by 24-hour Holter at 3, 6, 12, and 24 months, then annually. Eighty-four mitral-valve patients underwent regular echocardiographic follow-up. Univariate and multivariate analysis for risk factors of maze failure were identified. The in-hospital mortality rate was 1.2%. During a median follow-up of 39.4 months, the late mortality rate was 3.6%, and pacemaker insertion was necessary in 26 patients (9.4%). Sinus rhythm was present in 63% of patients at the latest follow-up. Predictive factors for atrial fibrillation recurrence were arrhythmia duration (hazard ratio [HR]=1.296, P=0.045) and atrial fibrillation at hospital discharge (HR=2.03, P=0.019). The monopolar device favored maze success (HR=0.191, P <0.0001). Left atrial area and indexed left ventricular end-diastolic volume showed significant decrease both in sinus rhythm and atrial fibrillation patients. Early sinus rhythm conversion was associated with improved left ventricular ejection fraction. Concomitant radiofrequency maze procedure provided remarkable outcomes. Shorter preoperative atrial fibrillation duration, monopolar device use, and prompt treatment of arrhythmia recurrences increase the midterm success rate. Early sinus rhythm restoration seems to result in better left ventricular ejection fraction recovery. PMID:26413016

  12. Peri-procedural interrupted oral anticoagulation for atrial fibrillation ablation: comparison of aspirin, warfarin, dabigatran, and rivaroxaban

    PubMed Central

    Winkle, Roger A.; Mead, R. Hardwin; Engel, Gregory; Kong, Melissa H.; Patrawala, Rob A.

    2014-01-01

    Aims Atrial fibrillation ablation requires peri-procedural oral anticoagulation (OAC) to prevent thromboembolic events. There are several options for OAC. We evaluate peri-procedural AF ablation complications using a variety of peri-procedural OACs. Methods and results We examined peri-procedural OAC and groin, bleeding, and thromboembolic complications for 2334 consecutive AF ablations using open irrigated-tip radiofrequency (RF) catheters. Pre-ablation OAC was warfarin in 1113 (47.7%), dabigatran 426 (18.3%), rivaroxaban 187 (8.0%), aspirin 472 (20.2%), and none 136 (5.8%). Oral anticoagulation was always interrupted and intraprocedural anticoagulation was unfractionated heparin (activated clotting time, ACT = 237 ± 26 s). Pre- and post-OAC drugs were the same for 1591 (68.2%) and were different for 743 (31.8%). Following ablation, 693 (29.7%) were treated with dabigatran and 291 (12.5%) were treated with rivaroxaban. There were no problems changing from one OAC pre-ablation to another post-ablation. Complications included 12 (0.51%) pericardial tamponades [no differences for dabigatran (P = 0.457) or rivaroxaban (P = 0.163) compared with warfarin], 12 (0.51%) groin complications [no differences for rivaroxaban (P = 0.709) and fewer for dabigatran (P = 0.041) compared with warfarin]. Only 5 of 2334 (0.21%) required blood transfusions. There were two strokes (0.086%) and no transient ischaemic attacks (TIAs) in the first 48 h post-ablation. Three additional strokes (0.13%), and two TIAs (0.086%) occurred from 48 h to 30 days. Only one stroke had a residual deficit. Compared with warfarin, the neurologic event rate was not different for dabigatran (P = 0.684) or rivaroxaban (P = 0.612). Conclusion Using interrupted OAC, low target intraprocedural ACT, and irrigated-tip RF, the rate of peri-procedural groin, haemorrhagic, and thromboembolic complications was extremely low. There were only minimal differences between OACs. Low-risk patients may remain on aspirin

  13. Late Results of Cox Maze III Procedure in Patients with Atrial Fibrillation Associated with Structural Heart Disease.

    PubMed

    Gomes, Gustavo Gir; Gali, Wagner Luis; Sarabanda, Alvaro Valentim Lima; Cunha, Claudio Ribeiro da; Kessler, Iruena Moraes; Atik, Fernando Antibas

    2017-07-01

    Cox-Maze III procedure is one of the surgical techniques used in the surgical treatment of atrial fibrillation (AF). To determine late results of Cox-Maze III in terms of maintenance of sinus rhythm, and mortality and stroke rates. Between January 2006 and January 2013, 93 patients were submitted to the cut-and-sew Cox-Maze III procedure in combination with structural heart disease repair. Heart rhythm was determined by 24-hour Holter monitoring. Procedural success rates were determined by longitudinal methods and recurrence predictors by multivariate Cox regression models. Thirteen patients that obtained hospital discharge alive were excluded due to lost follow-up. The remaining 80 patients were aged 49.9 ± 12 years and 47 (58.7%) of them were female. Involvement of mitral valve and rheumatic heart disease were found in 67 (83.7%) and 63 (78.7%) patients, respectively. Seventy patients (87.5%) had persistent or long-standing persistent AF. Mean follow-up with Holter monitoring was 27.5 months. There were no hospital deaths. Sinus rhythm maintenance rates were 88%, 85.1% and 80.6% at 6 months, 24 months and 36 months, respectively. Predictors of late recurrence of AF were female gender (HR 3.52; 95% CI 1.21-10.25; p = 0.02), coronary artery disease (HR 4.73 95% CI 1.37-16.36; p = 0.01) and greater left atrium diameter (HR 1.05; 95% CI 1.01-1.09; p = 0.02). Actuarial survival was 98.5% at 12, 24 and 48 months and actuarial freedom from stroke was 100%, 100% and 97.5% in the same time frames. The Cox-Maze III procedure, in our experience, is efficacious for sinus rhythm maintenance, with very low late mortality and stroke rates. A operação de Cox-Maze III é uma das variantes técnicas no tratamento cirúrgico da fibrilação atrial (FA). Estudar os resultados tardios da operação de Cox-Maze III, quanto à eficácia na manutenção de ritmo sinusal e taxas de mortalidade e acidente vascular cerebral (AVC). Entre janeiro de 2006 a janeiro de 2013, 93 pacientes

  14. The cox-maze procedure for lone atrial fibrillation: a single-center experience over 2 decades.

    PubMed

    Weimar, Timo; Schena, Stefano; Bailey, Marci S; Maniar, Hersh S; Schuessler, Richard B; Cox, James L; Damiano, Ralph J

    2012-02-01

    The Cox-Maze procedure (CMP) has achieved high success rates in the therapy of atrial fibrillation (AF) while becoming progressively less invasive. This report evaluates our experience with the CMP in the treatment of lone AF over 2 decades and compares the original cut-and-sew CMP-III to the ablation-assisted CMP-IV, which uses bipolar radiofrequency and cryoenergy to create the original lesion pattern. Data were collected prospectively on 212 consecutive patients (mean age, 53.5±10.4 years; 78% male) who underwent a stand-alone CMP from 1992 through 2010. The median duration of preoperative AF was 6 (interquartile range, 2.9-11.5) years, with 48% paroxysmal and 52% persistent or long-standing persistent AF. Univariate analysis with preoperative and perioperative variables used as covariates for the CMP-III (n=112) and the CMP-IV (n=100) was performed. Overall, 30-day mortality was 1.4%, with no intraoperative deaths. Freedom from AF was 93%, and freedom from AF off antiarrhythmics was 82%, at a mean follow-up time of 3.6±3.1 years. Freedom from symptomatic AF at 10 years was 85%. Only 1 late stroke occurred, with 80% of patients not receiving anticoagulation therapy. The less invasive CMP-IV had significantly shorter cross-clamp times (41±13 versus 92±26 minutes; P<0.001) while achieving high success rates, with 90% freedom from AF and 84% freedom from AF off antiarrhythmics at 2 years. The CMP, although simplified and shortened by alternative energy sources, has excellent results, even with improved follow-up and stricter definition of failure.

  15. Successful Repeat Catheter Ablation of Recurrent Longstanding Persistent Atrial Fibrillation With Rotor Elimination as the Procedural Endpoint: A Case Series.

    PubMed

    Sommer, Philipp; Kircher, Simon; Rolf, Sascha; John, Silke; Arya, Arash; Dinov, Borislav; Richter, Sergio; Bollmann, Andreas; Hindricks, Gerhard

    2016-03-01

    There remains a lack of consensus regarding the ideal ablation strategy for atrial fibrillation (AF), particularly in patients with persistent or longstanding persistent AF. Given increasing evidence from clinical imaging studies that rotors sustain AF, rotor elimination may be a desirable procedural endpoint. However, there is no description to date of the clinical outcomes using rotor elimination during ablation as the procedural endpoint. Moreover, a series of studies question whether procedural AF termination is a desirable endpoint for ablation after many forms of AF ablation. We report a single-center experience of rotor elimination during AF ablation using Focal Impulse and Rotor Mapping (FIRM), describing 20 consecutive patients with case descriptions of 3 patients with recurrent longstanding persistent AF after prior ablation. In all cases, endocardial mapping using a 64-electrode basket catheter was performed to identify rotors, which were eliminated using radiofrequency catheter ablation. After it was verified that all identified rotors were eliminated, standard ablation consisting of PV isolation was performed. Notably, persistent AF terminated in only 1/20 (5%) patients. However, after a follow-up of 6 months, single-procedure freedom from AF was 80% (16/20 patients) with only 1 patient on antiarrhythmic drugs. All three patients in the highlighted series are AF free despite the lack of acute procedural AF termination. Patients with persistent AF including those with unsuccessful prior ablation can be treated successfully by rotor targeted ablation, using the elimination of all rotors rather than acute AF termination as the procedural endpoint. © 2015 Wiley Periodicals, Inc.

  16. Is there still a role for the classical Cox-Maze III?

    PubMed

    Yap, Cheng-Hon; Prior, David; Kenny, James; Zimmet, Adam; Chao, Victor; Mooney, Donald; Yii, Michael

    2006-05-01

    The incidence of surgery for atrial fibrillation (AF) is rising, paralleled by an increase in the types of lesion sets and energy sources used. These alternate energy sources have simplified the surgery at the expense of increased cost of consumables. The classical Cox-Maze III is the gold standard therapy with a proven efficacy in curing AF. Our complete experience with this procedure is presented. All 28 patients undergoing the classical Cox-Maze III procedure at our institution underwent preoperative assessment and were followed prospectively. Twenty-eight patients underwent the Cox-Maze III procedure between January 2001 and May 2003. Their mean age was 65 years (range, 44-80 years). Twenty-five patients had concomitant cardiac procedures. Mean duration of AF was 8.3 years. Permanent AF was present in 82%. Mean follow-up time was 15 +/- 8 months (range, 4-30 months). There were no perioperative or late deaths, or thromboembolic events. Sixty-one per cent had early (<3 months) atrial arrhythmia. Freedom from AF at most recent clinical follow up was 93%. Freedom from late atrial arrhythmia was 82%. Freedom from late AF or atrial flutter by pacemaker interrogation or Holter assessment was 77%. Anti-arrhythmic medication use was reduced. New York Heart Association class improved from an average of 2.8 preoperatively to 1.3 postoperatively. The result of the present study shows the safety and efficacy of the classical Cox-Maze III procedure. With the advantage of proven long-term efficacy, demonstrable safety and avoidance of costly technology, the Cox-Maze III should not be discounted as a treatment option in patients because of its perceived complexity.

  17. Respiratory motion influence on catheter contact force during radio frequency ablation procedures

    NASA Astrophysics Data System (ADS)

    Koch, Martin; Brost, Alexander; Hornegger, Joachim; Strobel, Norbert

    2013-03-01

    Minimally invasive catheter ablation is a common treatment option for atrial fibrillation. A common treatment strategy is pulmonary vein isolation. In this case, individual ablation points need to be placed around the ostia of the pulmonary veins attached to the left atrium to generate transmural lesions and thereby block electric signals. To achieve a durable transmural lesion, the tip of the catheter has to be stable with a sufficient tissue contact during radio-frequency ablation. Besides the steerable interface operated by the physician, the movement of the catheter is also influenced by the heart and breathing motion - particularly during ablation. In this paper we investigate the influence of breathing motion on different areas of the endocardium during radio frequency ablation. To this end, we analyze the frequency spectrum of the continuous catheter contact force to identify areas with increased breathing motion using a classification method. This approach has been applied to clinical patient data acquired during three pulmonary vein isolation procedures. Initial findings show that motion due to respiration is more pronounced at the roof and around the right pulmonary veins.

  18. Remote magnetic navigation for accurate, real-time catheter positioning and ablation in cardiac electrophysiology procedures.

    PubMed

    Filgueiras-Rama, David; Estrada, Alejandro; Shachar, Josh; Castrejón, Sergio; Doiny, David; Ortega, Marta; Gang, Eli; Merino, José L

    2013-04-21

    New remote navigation systems have been developed to improve current limitations of conventional manually guided catheter ablation in complex cardiac substrates such as left atrial flutter. This protocol describes all the clinical and invasive interventional steps performed during a human electrophysiological study and ablation to assess the accuracy, safety and real-time navigation of the Catheter Guidance, Control and Imaging (CGCI) system. Patients who underwent ablation of a right or left atrium flutter substrate were included. Specifically, data from three left atrial flutter and two counterclockwise right atrial flutter procedures are shown in this report. One representative left atrial flutter procedure is shown in the movie. This system is based on eight coil-core electromagnets, which generate a dynamic magnetic field focused on the heart. Remote navigation by rapid changes (msec) in the magnetic field magnitude and a very flexible magnetized catheter allow real-time closed-loop integration and accurate, stable positioning and ablation of the arrhythmogenic substrate.

  19. Remote Magnetic Navigation for Accurate, Real-time Catheter Positioning and Ablation in Cardiac Electrophysiology Procedures

    PubMed Central

    Filgueiras-Rama, David; Estrada, Alejandro; Shachar, Josh; Castrejón, Sergio; Doiny, David; Ortega, Marta; Gang, Eli; Merino, José L.

    2013-01-01

    New remote navigation systems have been developed to improve current limitations of conventional manually guided catheter ablation in complex cardiac substrates such as left atrial flutter. This protocol describes all the clinical and invasive interventional steps performed during a human electrophysiological study and ablation to assess the accuracy, safety and real-time navigation of the Catheter Guidance, Control and Imaging (CGCI) system. Patients who underwent ablation of a right or left atrium flutter substrate were included. Specifically, data from three left atrial flutter and two counterclockwise right atrial flutter procedures are shown in this report. One representative left atrial flutter procedure is shown in the movie. This system is based on eight coil-core electromagnets, which generate a dynamic magnetic field focused on the heart. Remote navigation by rapid changes (msec) in the magnetic field magnitude and a very flexible magnetized catheter allow real-time closed-loop integration and accurate, stable positioning and ablation of the arrhythmogenic substrate. PMID:23628883

  20. Thermal Ablation of T1c Renal Cell Carcinoma: A Comparative Assessment of Technical Performance, Procedural Outcome, and Safety of Microwave Ablation, Radiofrequency Ablation, and Cryoablation.

    PubMed

    Zhou, Wenhui; Arellano, Ronald S

    2018-04-06

    To evaluate perioperative outcomes of thermal ablation with microwave (MW), radiofrequency (RF), and cryoablation for stage T1c renal cell carcinoma (RCC). A retrospective analysis of 384 patients (mean age, 71 y; range, 22-88 y) was performed between October 2006 and October 2016. Mean radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines; preoperative aspects and dimensions used for anatomic classification; and centrality index scores were 6.3, 7.9, and 2.7, respectively. Assessment of pre- and postablation serum blood urea nitrogen, creatinine, and estimated glomerular filtration rate was performed to assess functional outcomes. Linear regression analyses were performed to compare sedation medication dosages among the three treatment cohorts. Univariable and multivariable logistic regression analyses were performed to compare rates of residual disease and complications among treatment modalities. A total of 437 clinical stage T1N0M0 biopsy-proven RCCs measuring 1.2-6.9 cm were treated with computed tomography (CT)-guided MW ablation (n = 44; 10%), RF ablation (n = 347; 79%), or cryoablation (n = 46; 11%). There were no significant differences in patient demographic or tumor characteristics among cohorts. Complication rates and immediate renal function changes were similar among the three ablation modalities (P = .46 and P = .08, respectively). MW ablation was associated with significantly decreased ablation time (P < .05), procedural time (P < .05), and dosage of sedative medication (P < .05) compared with RF ablation and cryoablation. CT-guided percutaneous MW ablation is comparable to RF ablation or cryoablation for the treatment of stage T1N0M0 RCC with regard to treatment response and is associated with shorter treatment times and less sedation than RF ablation or cryoablation. In addition, the safety profile of CT-guided MW ablation is noninferior to those of RF ablation or

  1. Validation and scopolamine-reversal of latent learning in the water maze utilizing a revised direct platform placement procedure.

    PubMed

    Malin, David H; Schaar, Krystal L; Izygon, Jonathan J; Nghiem, Duyen M; Jabitta, Sikirat Y; Henceroth, Mallori M; Chang, Yu-Hsuan; Daggett, Jenny M; Ward, Christopher P

    2015-08-01

    The Morris water maze is routinely used to explore neurobiological mechanisms of working memory. Humans can often acquire working memory relevant to performing a task by mere sensory observation, without having to actually perform the task followed by reinforcement. This can be modeled in the water maze through direct placement of a rat on the escape platform so that it can observe the location, and then assessing the subject's performance in swimming back to the platform. However, direct placement procedures have hardly been studied for two decades, reflecting a controversy about whether direct placement resulted in sufficiently rapid and direct swims back to the platform. In the present study, utilizing revised training methods, a more comprehensive measure of trajectory directness, a more rigorous sham-trained control procedure and an optimal placement-test interval, rats swam almost directly back to the platform in under 4s, significantly more quickly and directly than sham-trained subjects. Muscarinic cholinergic mechanisms, which are inactivated by scopolamine, are essential to memory for standard learning paradigms in the water maze. This experiment determined whether this would also be true for latent learning. ANOVA revealed significant negative effects of scopolamine on both speed and accuracy of trajectory, as well as significant positive effects of direct placement training vs. sham-training. In a probe trial, placement-trained animals without scopolamine spent significantly more time and path length in the target quadrant than trained rats with scopolamine and sham-trained rats without scopolamine. Scopolamine impairments are likely due to effects on memory, since the same dose had little effect on performance with a visible platform. The revised direct placement model offers a means of further comparing the neural mechanisms of latent learning with those of standard instrumental learning. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Malignancy Associated Iatrogenic Iliopsoas Abscess -Venous Access Complication From Ablation Procedure.

    PubMed

    Iskandar, Sandia; Atoui, Moustapha; Rizwan Afzal, Muhammad; Lavu, Madhav; Reddy, Madhu; Lakkireddy, Dhanunjaya

    2016-01-01

    Iliopsoas abscess is a rare condition with a high rate of mortality and morbidity if left untreated. It can occur from hematogenous or lymphatic spread from distant structures or as a result of contiguous spread from adjacent structures. The disease typically occurs in patients with immunocompromised status and the symptoms can be non-specific.1,2 Generally, infectious complications from venous access during atrial fibrillation (AF) procedure are uncommon, and an iatrogenic iliopsoas abscess from percutaneous cardiac procedures has never been reported. We present the first case of iliopsoas abscess from an ablation procedure.

  3. Pulsed Dose Radiofrequency Before Ablation of Medial Branch of the Lumbar Dorsal Ramus for Zygapophyseal Joint Pain Reduces Post-procedural Pain.

    PubMed

    Arsanious, David; Gage, Emmanuel; Koning, Jonathon; Sarhan, Mazin; Chaiban, Gassan; Almualim, Mohammed; Atallah, Joseph

    2016-01-01

    One of the potential side effects with radiofrequency ablation (RFA) includes painful cutaneous dysesthesias and increased pain due to neuritis or neurogenic inflammation. This pain may require the prescription of opioids or non-opioid analgesics to control post-procedural pain and discomfort. The goal of this study is to compare post-procedural pain scores and post-procedural oral analgesic use in patients receiving continuous thermal radiofrequency ablation versus patients receiving pulsed dose radiofrequency immediately followed by continuous thermal radiofrequency ablation for zygopophaseal joint disease. This is a prospective, double-blinded, randomized, controlled trial. Patients who met all the inclusion criteria and were not subject to any of the exclusion criteria were required to have two positive diagnostic medial branch blocks prior to undergoing randomization, intervention, and analysis. University hospital. Eligible patients were randomized in a 1:1 ratio to either receive thermal radiofrequency ablation alone (standard group) or pulsed dose radiofrequency (PDRF) immediately followed by thermal radiofrequency ablation (investigational group), all of which were performed by a single Board Certified Pain Medicine physician. Post-procedural pain levels between the two groups were assessed using the numerical pain Scale (NPS), and patients were contacted by phone on post-procedural days 1 and 2 in the morning and afternoon regarding the amount of oral analgesic medications used in the first 48 hours following the procedure. Patients who received pulsed dose radiofrequency followed by continuous radiofrequency neurotomy reported statistically significantly lower post-procedural pain scores in the first 24 hours compared to patients who received thermal radiofrequency neurotomy alone. These patients also used less oral analgesic medication in the post-procedural period. These interventions were carried out by one board accredited pain physician at one

  4. Impact of a Novel Catheter Tracking System on Radiation Exposure during the Procedural Phases of Atrial Fibrillation and Flutter Ablation.

    PubMed

    Malliet, Nicolas; Andrade, Jason G; Khairy, Paul; Thanh, Hien Kiem Nguyen; Venier, Sandrine; Dubuc, Marc; Dyrda, Katia; Guerra, Peter; Mondésert, Blandine; Rivard, Léna; Tadros, Rafik; Talajic, Mario; Thibault, Bernard; Roy, Denis; Macle, Laurent

    2015-07-01

    Fluoroscopic guidance is used to position catheters during cardiac ablation. We evaluated the impact of a novel nonfluoroscopic sensor-guided electromagnetic navigation system (MG) on radiation exposure during catheter ablation of atrial fibrillation (AF) or atrial flutter (AFL). A total of 134 consecutive patients referred for ablation of AF (n = 44) or AFL (n = 90) ablation were prospectively enrolled. In one group the MG system was used for nonfluoroscopic catheter positioning, whereas in the conventional group standard fluoroscopy was utilized. Fluoroscopy times were assessed for each stage of procedure and total radiation exposure was quantified. Patient characteristics were similar between the groups. The procedural end point was achieved in all. Median (interquartile range [IQR]) fluoroscopy times were 12.5 minutes (7.6, 17.4) MG group versus 21.5 minutes (15.3, 23.0) conventional group (P < 0.0001) for AF ablation, and 0.8 minutes (0.4, 2.5) MG group versus 9.9 minutes (5.1, 22.5) conventional group (P < 0.0001) for AFL ablation. Median (IQR) total radiation exposure (μGy·m(2)) was 1,107 (906, 2,033) MG group versus 2,835 (1,688, 3,855) conventional group (P = 0.0001) for AF ablation, and 161 (65, 537) MG group versus 1,651 (796, 4,569) conventional group (P < 0.0001) for AFL ablation. No difference in total procedural time was seen. The use of a novel nonfluoroscopic catheter tracking system is associated with a significant reduction in radiation exposure during AF and AFL ablation (61% and 90% reduction, respectively). In the era of heightened awareness of the importance of radiation reduction, this system represents a safe and efficient tool to decrease radiation exposure during electrophysiological ablation procedures. ©2015 Wiley Periodicals, Inc.

  5. Harmine treatment enhances short-term memory in old rats: Dissociation of cognition and the ability to perform the procedural requirements of maze testing.

    PubMed

    Mennenga, Sarah E; Gerson, Julia E; Dunckley, Travis; Bimonte-Nelson, Heather A

    2015-01-01

    Harmine is a naturally occurring monoamine oxidase inhibitor that has recently been shown to selectively inhibit the dual-specificity tyrosine-(Y)-phosphorylation-regulated kinase 1A (DYRK1A). We investigated the cognitive effects of 1mg (low) Harmine and 5mg (high) Harmine using the delayed-match-to-sample (DMS) asymmetrical 3-choice water maze task to evaluate spatial working and recent memory, and the Morris water maze task (MM) to test spatial reference memory. Animals were also tested on the visible platform task, a water-escape task with the same motor, motivational, and reinforcement components as the other tasks used to evaluate cognition, but differing in its greater simplicity and that the platform was visible above the surface of the water. A subset of the Harmine-high treated animals showed clear motor impairments on all behavioral tasks, and the visible platform task confirmed a lack of competence to perform the procedural components of water maze testing. After excluding animals from the high dose group that could not perform the procedural components of a swim task, it was revealed that both high- and low-dose treatment with Harmine enhanced performance on the latter portion of DMS testing, but had no effect on MM performance. Thus, this study demonstrates the importance of confirming motor and visual competence when studying animal cognition, and verifies the one-day visible platform task as a reliable measure of ability to perform the procedural components necessary for completion of a swim task. Copyright © 2014. Published by Elsevier Inc.

  6. Post ablation recanalization of varicose veins of the limbs: Comparison ablation method of mechanochemical and laser procedure

    NASA Astrophysics Data System (ADS)

    Suhartono, R.; Irfan, W.; Wangge, G.; Moenadjat, Y.; Destanto, W. I.

    2017-08-01

    Endovenous ablation has been performed for varicose veins of the limbs in Indonesia since 2010. Endovenous laser ablation (EVLA) therapy has been performed in Cipto Mangunkusumo Hospital (RSCM) in Jakarta, and mechanochemical ablation (MOCA) has been conducted in Fatmawati Hospital. This was a descriptive analytical study, with a cross-sectional design to analyze post-ablation recanalization after MOCA and EVLA procedures. Patients who had undergone MOCA or EVLA treatment were interviewed 3-18 months after the procedures. All the patients underwent vascular ultrasonography (USG) of the operated limb to assess recanalization. Secondary presurgery data were obtained from the patients’ from patients’ medical records. The clinical characteristics of the subjects were recorded to compare the potential correlation between these characteristics and recanalization post-MOCA and EVLA procedures. All the data were analyzed using SPSS ver. 20.0. The study consisted of 43 limbs: 24 treated by MOCA and 19 treated by EVLA. Most subjects in the MOCA group were <60 years (20/24), and 16 of the subjects were women. In the EVLA group, nine patients were <60 years, and 19 were ≥60 years, 15 of whom were women. The body mass index (BMI) of the majority (18/24) of the subjects in the MOCA group was normal, whereas most of the patients in the EVLA (10/19) group were overweight. In the MOCA group, the largest diameter of the vena saphena magna (VSM) in 20/24 extremities prior to treatment was VSM 4-7 mm, whereas the largest diameter in the EVLA group prior to treatment was >7 mm in 13/19 extremities. In the MOCA group, total recanalization occurred in 2/24 extremities, and partial recanalization occurred in 8/24 extremities. In the EVLA group, total recanalization occurred in 1/19 extremities, and partial recanalization occurred in 3/19 extremities. The association between the clinical characteristics of the patients and recanalization was not statistically significant (p > 0

  7. Impact of catheter ablation with remote magnetic navigation on procedural outcomes in patients with persistent and long-standing persistent atrial fibrillation.

    PubMed

    Jin, Qi; Pehrson, Steen; Jacobsen, Peter Karl; Chen, Xu

    2015-11-01

    The objectives of this study were to assess the procedural outcomes of persistent and long-standing persistent atrial fibrillation (PsAF and L-PsAF) ablation guided by remote magnetic navigation (RMN), and to detect factors predicting acute restoration of sinus rhythm (SR) by ablation with RMN. A total of 313 patients (275 male, age 59 ± 9.5 years) with PsAF (187/313) or L-PsAF (126/313) undergoing ablation using RMN were included. Patients' disease history, pulmonary venous anatomy, left atrial (LA) volume, procedure time, mapping plus ablation time, radiofrequency (RF) ablation time, fluoroscopy time, radiation dose, and complications were assessed. Stepwise regression was used to predict which variable could best predict acute restoration from AF to SR by ablation. Compared to PsAF, procedure time and RF ablation time were significantly increased in patients with L-PsAF (P = 0.01 and P < 0.001, respectively). No major complications occurred during the procedures in either PsAF or L-PsAF patients. Fifty five of 313 patients converted directly to SR by ablation. Compared to L-PsAF, the rate of SR restoration was significantly higher in PsAF (21 vs 12%, P = 0.03). Stepwise regression analysis showed LA volume was the primary parameter affecting SR restoration (P = 0.01). The LA volume of patients without direct SR restoration by ablation was 24% greater than that of patients with SR restoration (P < 0.001). Catheter ablation using RMN is a safe and effective method for PsAF and L-PsAF. LA volume could be a predictor of direct restoration of SR from sustaining AF by ablation using RMN.

  8. Outcomes of repeat catheter ablation using magnetic navigation or conventional ablation.

    PubMed

    Akca, Ferdi; Theuns, Dominic A M J; Abkenari, Lara Dabiri; de Groot, Natasja M S; Jordaens, Luc; Szili-Torok, Tamas

    2013-10-01

    After initial catheter ablation, repeat procedures could be necessary. This study evaluates the efficacy of the magnetic navigation system (MNS) in repeat catheter ablation as compared with manual conventional techniques (MANs). The results of 163 repeat ablation procedures were analysed. Ablations were performed either using MNS (n = 84) or conventional manual ablation (n = 79). Procedures were divided into four groups based on the technique used during the initial and repeat ablation procedure: MAN-MAN (n = 66), MAN-MNS (n = 31), MNS-MNS (n = 53), and MNS-MAN (n = 13). Three subgroups were analysed: supraventricular tachycardias (SVTs, n = 68), atrial fibrillation (AF, n = 67), and ventricular tachycardias (VT, n = 28). Recurrences were assessed during 19 ± 11 months follow-up. Overall, repeat procedures using MNS were successful in 89.0% as compared with 96.2% in the MAN group (P = ns). The overall recurrence rate was significantly lower using MNS (25.0 vs. 41.4%, P = 0.045). Acute success and recurrence rates for the MAN-MAN, MAN-MNS, MNS-MNS, and MNS-MAN groups were comparable. For the SVT subgroup a higher acute success rate was achieved using MAN (87.9 vs. 100.0%, P = 0.049). The use of MNS for SVT is associated with longer procedure times (205 ± 82 vs. 172 ± 69 min, P = 0.040). For AF procedure and fluoroscopy times were longer (257 ± 72 vs. 185 ± 64, P = 0.001; 59.5 ± 19.3 vs. 41.1 ± 18.3 min, P < 0.001). Less fluoroscopy was used for MNS-guided VT procedures (22.8 ± 14.7 vs. 41.2 ± 10.9, P = 0.011). Our data suggest that overall MNS is comparable with MAN in acute success after repeat catheter ablation. However, MNS is related to fewer recurrences as compared with MAN.

  9. CT-guided bipolar and multipolar radiofrequency ablation (RF ablation) of renal cell carcinoma: specific technical aspects and clinical results.

    PubMed

    Sommer, C M; Lemm, G; Hohenstein, E; Bellemann, N; Stampfl, U; Goezen, A S; Rassweiler, J; Kauczor, H U; Radeleff, B A; Pereira, P L

    2013-06-01

    This study was designed to evaluate the clinical efficacy of CT-guided bipolar and multipolar radiofrequency ablation (RF ablation) of renal cell carcinoma (RCC) and to analyze specific technical aspects between both technologies. We included 22 consecutive patients (3 women; age 74.2 ± 8.6 years) after 28 CT-guided bipolar or multipolar RF ablations of 28 RCCs (diameter 2.5 ± 0.8 cm). Procedures were performed with a commercially available RF system (Celon AG Olympus, Berlin, Germany). Technical aspects of RF ablation procedures (ablation mode [bipolar or multipolar], number of applicators and ablation cycles, overall ablation time and deployed energy, and technical success rate) were analyzed. Clinical results (local recurrence-free survival and local tumor control rate, renal function [glomerular filtration rate (GFR)]) and complication rates were evaluated. Bipolar RF ablation was performed in 12 procedures and multipolar RF ablation in 16 procedures (2 applicators in 14 procedures and 3 applicators in 2 procedures). One ablation cycle was performed in 15 procedures and two ablation cycles in 13 procedures. Overall ablation time and deployed energy were 35.0 ± 13.6 min and 43.7 ± 17.9 kJ. Technical success rate was 100 %. Major and minor complication rates were 4 and 14 %. At an imaging follow-up of 15.2 ± 8.8 months, local recurrence-free survival was 14.4 ± 8.8 months and local tumor control rate was 93 %. GFR did not deteriorate after RF ablation (50.8 ± 16.6 ml/min/1.73 m(2) before RF ablation vs. 47.2 ± 11.9 ml/min/1.73 m(2) after RF ablation; not significant). CT-guided bipolar and multipolar RF ablation of RCC has a high rate of clinical success and low complication rates. At short-term follow-up, clinical efficacy is high without deterioration of the renal function.

  10. CT-Guided Microwave Ablation of 45 Renal Tumors: Analysis of Procedure Complexity Utilizing a Percutaneous Renal Ablation Complexity Scoring System.

    PubMed

    Mansilla, Alberto V; Bivins, Eugene E; Contreras, Francisco; Hernandez, Manuel A; Kohler, Nathan; Pepe, Julie W

    2017-02-01

    To develop a scoring system that stratifies complexity of percutaneous ablation of renal tumors. Analysis was performed of 36 consecutive patients (mean age, 64 y; range, 30-89 y) who underwent CT-guided microwave (MW) ablation of 45 renal tumors (mean tumor diameter, 2.4 cm; range, 1.2-4.0 cm). Technical success and effectiveness were determined based on intraprocedural and follow-up imaging studies. The RENAL score and the proposed percutaneous renal ablation complexity (P-RAC) score were calculated for each tumor. Technical success was 93.3% (n = 42). Biopsy of 38 of 45 renal tumors revealed 23 renal cell carcinomas. Median follow-up period was 9.7 months (range, 2.9-46.8 months). There were no tumor recurrences. One major complication, ureteropelvic junction stricture, occurred (2.6%). The P-RAC score was found to differ statistically from the RENAL score (t = 3.754, df = 44, P = .001). A positive correlation was found between the P-RAC score and number of antenna insertions (r = .378, n = 45, P = .011) and procedure duration (r = .328, n = 45, P = .028). No correlation was found between the RENAL score and number of MW antenna insertions (r = .110, n = 45, P = .472) or procedure duration (r = .263, n = 45, P = .081). Hydrodissection was significantly more common in the P-RAC high-complexity category than in low-complexity category (χ 2 = 12.073, df = 2, P = .002). The P-RAC score may be useful in stratifying percutaneous renal ablation complexity. Further studies with larger sample sizes are necessary to validate the P-RAC score and to determine if it can predict risk of complications. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  11. Atrial flutter after surgical maze: incidence, diagnosis, and management.

    PubMed

    Dresen, William; Mason, Pamela K

    2016-01-01

    The prevalence of atrial fibrillation is increasing and surgical ablation is becoming more common, both as a stand-alone procedure and when performed concomitantly with other cardiac surgery. Although surgical ablation is effective, with it unique challenges arise, including iatrogenic macroreentrant tachycardias that are often highly symptomatic and difficult to manage conservatively. Postsurgical ablation, localization of the arrhythmic circuit is difficult to determine using surface ECG alone because of alterations in the atrial myocardium, and multiple different pathways are often present. Most, however, localize to the left atrium, and percutaneous catheter ablation is emerging as an effective treatment modality. Patients with complex postoperative arrhythmias should be referred to a dedicated atrial fibrillation center when possible and symptomatic arrhythmias mapped and ablated. Knowledge of the previously performed surgical lesion set is of vital importance in understanding the mechanism of the arrhythmia and increasing procedural success rates. http://links.lww.com/HCO/A31.

  12. Radiation exposure to operator and patients during cardiac electrophysiology study, radiofrequency catheter ablation and cardiac device implantation procedures

    NASA Astrophysics Data System (ADS)

    Lee, C. H.; Cho, J. H.; Park, S. J.; Kim, J. S.; On, Y. K.; Huh, J.

    2015-10-01

    The purpose of this study was to measure the radiation exposure to operator and patient during cardiac electrophysiology study, radiofrequency catheter ablation and cardiac device implantation procedures and to calculate the allowable number of cases per year. We carried out 9 electrophysiology studies, 40 radiofrequency catheter ablation and 11 cardiac device implantation procedures. To measure occupational radiation dose and dose-area product (DAP), 13 photoluminescence glass dosimeters were placed at eyes (inside and outside lead glass), thyroids (inside and outside thyroid collar), chest (inside and outside lead apron), wrists, genital of the operator (inside lead apron), and 6 of photoluminescence glass dosimeters were placed at eyes, thyroids, chest and genital of the patient. Exposure time and DAP values were 11.7 ± 11.8 min and 23.2 ± 26.2 Gy cm2 for electrophysiology study; 36.5 ± 42.1 min and 822.4 ± 125.5 Gy cm2 for radiofrequency catheter ablation; 16.2 ± 9.3 min and 27.8 ± 16.5 Gy cm2 for cardiac device implantation procedure, prospectively. 4591 electrophysiology studies can be conducted within the occupational exposure limit for the eyes (150 mSv), and 658-electrophysiology studies with radiofrequency catheter ablation can be carried out within the occupational exposure limit for the hands (500 mSv). 1654 cardiac device implantation procedure can be conducted within the occupational exposure limit for the eyes (150 mSv). The amounts of the operator and patient's radiation exposure were comparatively small. So, electrophysiology study, radio frequency catheter ablation and cardiac device implantation procedures are safe when performed with modern equipment and optimized protective radiation protect equipment.

  13. Clinical Outcomes of an Optimized Prolate Ablation Procedure for Correcting Residual Refractive Errors Following Laser Surgery.

    PubMed

    Chung, Byunghoon; Lee, Hun; Choi, Bong Joon; Seo, Kyung Ryul; Kim, Eung Kwon; Kim, Dae Yune; Kim, Tae-Im

    2017-02-01

    The purpose of this study was to investigate the clinical efficacy of an optimized prolate ablation procedure for correcting residual refractive errors following laser surgery. We analyzed 24 eyes of 15 patients who underwent an optimized prolate ablation procedure for the correction of residual refractive errors following laser in situ keratomileusis, laser-assisted subepithelial keratectomy, or photorefractive keratectomy surgeries. Preoperative ophthalmic examinations were performed, and uncorrected distance visual acuity, corrected distance visual acuity, manifest refraction values (sphere, cylinder, and spherical equivalent), point spread function, modulation transfer function, corneal asphericity (Q value), ocular aberrations, and corneal haze measurements were obtained postoperatively at 1, 3, and 6 months. Uncorrected distance visual acuity improved and refractive errors decreased significantly at 1, 3, and 6 months postoperatively. Total coma aberration increased at 3 and 6 months postoperatively, while changes in all other aberrations were not statistically significant. Similarly, no significant changes in point spread function were detected, but modulation transfer function increased significantly at the postoperative time points measured. The optimized prolate ablation procedure was effective in terms of improving visual acuity and objective visual performance for the correction of persistent refractive errors following laser surgery.

  14. The imagination maze

    NASA Astrophysics Data System (ADS)

    Welty, Scott; Rylander, Jeff

    2001-05-01

    Working off of a 10,000 Toyota TAPESTRY grant, 80 physics students at Maine East High School in Park Ridge, Illinois, spent the 1999-2000 school year building a gaint pool ball maze in the school's stairwell. The maze sits in a 10 × 11 × 1 ft recess in the wall. It features an 11-ft screwlift operated by a crank accessible to the passing student to raise the balls to the top where they then meander down four possible trails of copper tubing, performing a variety of physics tricks along the way. The project was a great lesson in organization, engineering, building, quality control, and of course, the laws of physics. The maze is now the "property" of all future AP physics classes whose job it will be to fine-tune, repair, replace, and generally take care of the maze.

  15. Remotely controlled steerable sheath improves result and procedural parameters of atrial fibrillation ablation with magnetic navigation.

    PubMed

    Errahmouni, Abdelkarim; Latcu, Decebal Gabriel; Bun, Sok-Sithikun; Rijo, Nicolas; Dugourd, Céline; Saoudi, Nadir

    2015-07-01

    The magnetic navigation (MN) system may be coupled with a new advancement system that fully controls both the catheter and a robotic deflectable sheath (RSh) or with a fixed-curve sheath and a catheter-only advancement system (CAS). We aimed to compare these approaches for atrial fibrillation (AF) ablation. Atrial fibrillation ablation patients (45, 23 paroxysmal and 22 persistent) performed with MN-RSh (RSh group) were compared with a control group (37, 18 paroxysmal and19 persistent) performed with MN-CAS (CAS group). Setup duration was measured from the procedure's start to operator transfer to control room. Ablation step duration was defined as the time from the beginning of the first radiofrequency (RF) pulse to the end of the last one and was separately acquired for the left and the right pulmonary vein (PV) pairs. Clinical characteristics, left atrial size, and AF-type distribution were similar between the groups. Setup duration as well as mapping times was also similar. Ablation step duration for the left PVs was similar, but was shorter for the right PVs in RSh group (46 ± 9 vs. 63 ± 12 min, P < 0.0001). Radiofrequency delivery time (34 ± 9 vs. 40 ± 11 min, P = 0.007) and procedure duration (227 ± 36 vs. 254 ± 62 min, P = 0.01) were shorter in RSh group. No complication occurred in RSh group. During follow-up, there were five recurrences (11%) in RSh group and 11 (29%) in CAS group (P = 0.027). The use of the RSh for AF ablation with MN is safe and improves outcome. Right PV isolation is faster, RF delivery time and procedure time are reduced. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

  16. Remotely controlled steerable sheath improves result and procedural parameters of atrial fibrillation ablation with magnetic navigation

    PubMed Central

    Errahmouni, Abdelkarim; Latcu, Decebal Gabriel; Bun, Sok-Sithikun; Rijo, Nicolas; Dugourd, Céline; Saoudi, Nadir

    2015-01-01

    Aims The magnetic navigation (MN) system may be coupled with a new advancement system that fully controls both the catheter and a robotic deflectable sheath (RSh) or with a fixed-curve sheath and a catheter-only advancement system (CAS). We aimed to compare these approaches for atrial fibrillation (AF) ablation. Methods and results Atrial fibrillation ablation patients (45, 23 paroxysmal and 22 persistent) performed with MN–RSh (RSh group) were compared with a control group (37, 18 paroxysmal and19 persistent) performed with MN–CAS (CAS group). Setup duration was measured from the procedure's start to operator transfer to control room. Ablation step duration was defined as the time from the beginning of the first radiofrequency (RF) pulse to the end of the last one and was separately acquired for the left and the right pulmonary vein (PV) pairs. Clinical characteristics, left atrial size, and AF-type distribution were similar between the groups. Setup duration as well as mapping times was also similar. Ablation step duration for the left PVs was similar, but was shorter for the right PVs in RSh group (46 ± 9 vs. 63 ± 12 min, P < 0.0001). Radiofrequency delivery time (34 ± 9 vs. 40 ± 11 min, P = 0.007) and procedure duration (227 ± 36 vs. 254 ± 62 min, P = 0.01) were shorter in RSh group. No complication occurred in RSh group. During follow-up, there were five recurrences (11%) in RSh group and 11 (29%) in CAS group (P = 0.027). Conclusion The use of the RSh for AF ablation with MN is safe and improves outcome. Right PV isolation is faster, RF delivery time and procedure time are reduced. PMID:25662989

  17. A New Radiofrequency Ablation Procedure to Treat Sacroiliac Joint Pain.

    PubMed

    Cheng, Jianguo; Chen, See Loong; Zimmerman, Nicole; Dalton, Jarrod E; LaSalle, Garret; Rosenquist, Richard

    2016-01-01

    Low back pain may arise from disorders of the sacroiliac joint in up to 30% of patients. Radiofrequency ablation (RFA) of the nerves innervating the sacroiliac joint has been shown to be a safe and efficacious strategy. We aimed to develop a new RFA technique to relieve low back pain secondary to sacroiliac joint disorders. Methodology development with validation through prospective observational non-randomized trial (PONRT). Academic multidisciplinary health care system, Ohio, USA. We devised a guide-block to facilitate accurate placement of multiple electrodes to simultaneously ablate the L5 dorsal ramus and lateral branches of the S1, S2, and S3 dorsal rami. This was achieved by bipolar radiofrequency ablation (b-RFA) to create a strip lesion from the lateral border of the base of the sacral superior articular process (L5-S1 facet joint) to the lateral border of the S3 sacral foramen. We applied this technique in 31 consecutive patients and compared the operating time, x-ray exposure time and dose, and clinical outcomes with patients (n = 62) who have been treated with the cooled radiofrequency technique. Patients' level of pain relief was reported as < 50%, 50 - 80%, and > 80% pain relief at one, 3, 6, and 12 months after the procedure. The relationship between RFA technique and duration of pain relief was evaluated using interval-censored multivariable Cox regression. The new technique allowed reduction of operating time by more than 50%, x-ray exposure time and dose by more than 80%, and cost by more than $1,000 per case. The percent of patients who achieved > 50% pain reduction was significantly higher in the b-RFA group at 3, 6, and 12 months follow-up, compared to the cooled radiofrequency group. No complications were observed in either group. Although the major confounding factors were taken into account in the analysis, use of historical controls does not balance observed and unobserved potential confounding variables between groups so that the reported

  18. Maze-solving by chemotaxis

    NASA Astrophysics Data System (ADS)

    Reynolds, A. M.

    2010-06-01

    Here, we report on numerical simulations showing that chemotaxis will take a body through a maze via the shortest possible route to the source of a chemoattractant. This is a robust finding that does not depend on the geometrical makeup of the maze. The predictions are supported by recent experimental studies which have shown that by moving down gradients in pH , a droplet of organic solvent can find the shortest of multiple possible paths through a maze to an acid-soaked exit. They are also consistent with numerical and experimental evidence that plant-parasitic nematodes take the shortest route through the labyrinth of air-filled pores within soil to preferred host plants that produce volatile chemoattractants. The predictions support the view that maze-solving is a robust property of chemotaxis and is not specific to particular kinds of maze or to the fractal structure of air-filled channels within soils.

  19. Analysis of excimer laser radiant exposure effect toward corneal ablation volume at LASIK procedure

    NASA Astrophysics Data System (ADS)

    Adiati, Rima Fitria; Rini Rizki, Artha Bona; Kusumawardhani, Apriani; Setijono, Heru; Rahmadiansah, Andi

    2016-11-01

    LASIK (Laser Asissted In Situ Interlamelar Keratomilieusis) is a technique for correcting refractive disorders of the eye such as myopia and astigmatism using an excimer laser. This procedure use photoablation technique to decompose corneal tissues. Although preferred due to its efficiency, permanency, and accuracy, the inappropriate amount radiant exposure often cause side effects like under-over correction, irregular astigmatism and problems on surrounding tissues. In this study, the radiant exposure effect toward corneal ablation volume has been modelled through several processes. Data collecting results is laser data specifications with 193 nm wavelength, beam diameter of 0.065 - 0.65 cm, and fluence of 160 mJ/cm2. For the medical data, the myopia-astigmatism value, cornea size, corneal ablation thickness, and flap data are taken. The first modelling step is determining the laser diameter between 0.065 - 0.65 cm with 0.45 cm increment. The energy, power, and intensity of laser determined from laser beam area. Number of pulse and total energy is calculated before the radiant exposure of laser is obtained. Next is to determine the parameters influence the ablation volume. Regression method used to create the equation, and then the spot size is substituted to the model. The validation used is statistic correlation method to both experimental data and theory. By the model created, it is expected that any potential complications can be prevented during LASIK procedures. The recommendations can give the users clearer picture to determine the appropriate amount of radiant exposure with the corneal ablation volume necessary.

  20. Just add water: cannabinoid discrimination in a water T-maze with FAAH(-/-) and FAAH(+/+) mice.

    PubMed

    Wiley, Jenny L; Lefever, Timothy W; Pulley, Nikita S; Marusich, Julie A; Cravatt, Benjamin F; Lichtman, Aron H

    2016-08-01

    Incomplete overlap in the discriminative stimulus effects of Δ-tetrahydrocannabinol (THC) and the endocannabinoids, anandamide (AEA) and 2-arachidonoylglycerol has been reported in food-reinforced tasks. The aim of this study was to examine cannabinoid discriminative stimulus effects in a nonappetitive procedure. Adult male mice lacking the gene for AEA's major metabolic enzyme, fatty acid amide hydrolase (FAAH), and FAAH mice were trained to discriminate THC or AEA in a water T-maze, in which the response was swimming to an escape platform on the injection-appropriate side. JZL184, a monoacylglycerol lipase inhibitor, was also tested. FAAH mice showed faster acquisition than FAAH mice. THC and AEA fully substituted, with only minor cross-procedure potency variations. Incomplete substitution of JZL184 was observed in THC-trained FAAH mice in the water-maze task, as contrasted with full substitution in a food-reinforced nose-poke procedure. Stress-induced changes in AEA and/or 2-arachidonoylglycerol concentrations in the brain may have mediated this attenuation. JZL184 also partially substituted in AEA-trained FAAH mice in the water maze, suggesting incomplete overlap in the stimulus effects of AEA and JZL184. Through the use of a novel water-maze procedure, the present study supports the work of previous behavioral pharmacologists in showing the robustness of the discrimination paradigm.

  1. One-Dimensional Ablation with Pyrolysis Gas Flow Using a Full Newton's Method and Finite Control Volume Procedure

    NASA Technical Reports Server (NTRS)

    Amar, Adam J.; Blackwell, Ben F.; Edwards, Jack R.

    2007-01-01

    The development and verification of a one-dimensional material thermal response code with ablation is presented. The implicit time integrator, control volume finite element spatial discretization, and Newton's method for nonlinear iteration on the entire system of residual equations have been implemented and verified for the thermochemical ablation of internally decomposing materials. This study is a continuation of the work presented in "One-Dimensional Ablation with Pyrolysis Gas Flow Using a Full Newton's Method and Finite Control Volume Procedure" (AIAA-2006-2910), which described the derivation, implementation, and verification of the constant density solid energy equation terms and boundary conditions. The present study extends the model to decomposing materials including decomposition kinetics, pyrolysis gas flow through the porous char layer, and a mixture (solid and gas) energy equation. Verification results are presented for the thermochemical ablation of a carbon-phenolic ablator which involves the solution of the entire system of governing equations.

  2. Analysis of behavioral asymmetries in the elevated plus-maze and in the T-maze.

    PubMed

    Schwarting, Rainer K W; Borta, Andreas

    2005-02-15

    When studying functional asymmetries in normal laboratory rats, several behavioral tests have been applied and proven their utility, including turning in rotometers or open-fields, handedness in paw usage, T-maze alternation, and others. Here, we analyzed male Wistar rats in two tests, namely the elevated plus-maze and the T-maze. In these tests, behavioral asymmetries are rather likely to occur, since the animals have to show several types of turns towards the left or right when ambulating through these environments. In a first study using the plus-maze, we provide detailed data on (A) the types of turns which the animals showed when changing their direction within arms (i.e., 180 degrees turns), and (B) the types of turns when proceeding from one arm to an adjacent one (i.e., 90 degrees turns). With respect to asymmetry, we found moderate biases in favor of the right. On the 1st day of plus-maze testing, there was a trend for more rightward turns within arms. On the 2nd day of testing, there was a trend for turns towards the right when alternating between arms of the plus-maze. In a 2nd study, we asked for asymmetries in the plus-maze in animals, which had been treated acutely with the psychostimulatory amphetamine analogue 3,4-methylene-dioxymethamphetamine (MDMA). Psychostimulants drugs, especially amphetamine, have repeatedly been used before in work on functional asymmetry, since they can enhance or reveal asymmetries in normal rats. MDMA had dose-dependent effects on activity, which affected turns within arms, and turns between arms; however, there was only sparse evidence with respect to asymmetry. Interestingly, and if at all, asymmetry was in favor of the right. Finally, we present data for behavior in the T-maze, where we used a spontaneous test version, that is, the animals could explore the maze but had no task to solve. Asymmetries were measured as turns within the start arm (180 degrees), and as left- or rightward turns between arms (90 degrees ) at

  3. Second Language Learning with the Story Maze Task: Examining the Training Effect of Weaving through Stories

    ERIC Educational Resources Information Center

    Enkin, Elizabeth

    2016-01-01

    The maze task is a psycholinguistic experimental procedure that measures real-time incremental sentence processing. The task has recently been tested as a language learning tool with promising results. Therefore, the present study examines the merits of a contextualized version of this task: the story maze. The findings are consistent with…

  4. Long-term outcome of catheter ablation for left posterior fascicular ventricular tachycardia with the development of left posterior fascicular block and characteristics of repeat procedures.

    PubMed

    Luo, Bin; Zhou, Gongbu; Guo, Xiaogang; Liu, Xu; Yang, Jiandu; Sun, Qi; Ma, Jian; Zhang, Shu

    2017-06-01

    The present study aimed to retrospectively investigate long-term clinical outcomes of patients undergoing catheter ablation of left posterior fascicular ventricular tachycardia (LPF-VT) with the development of left posterior fascicular block (LPF block) and characteristics of repeat procedures. A total of 195 patients (mean age 29.76±1.03years, 16.4% females) who underwent catheter ablation for LPF-VT were consecutively enrolled. The earliest ventricular potential with a single fused Purkinje potential (PP) during VT and the PP located in the inferior-apical or mid-apical septum during SR were targeted for linear ablation. The endpoint of the procedure was noninducible VT and development of new-onset LPF block. Follow-up with clinic visits or telephonic interviews, electrocardiogram (ECG), or Holter monitoring was performed after the procedure. With a median follow-up of 85 (18,181) months, 20 patients were censored and 152 of 175 (86.86%) patients had long-term freedom from VT after a single procedure. No statistical difference in the outcome of catheter ablation of LPF-VT was found between inducible and non-inducible groups (P=0.89). Twenty-three patients exhibited recurrent LPF-VT. Seven of 23 patients developed new-onset left upper septal ventricular tachycardia that was successfully ablated. All the patients undergoing repeat procedures had freedom from VT. No procedural complications occurred. Ablation of LPF-VT using the development of LPF block as the endpoint is associated with a high procedural success rate. No difference in freedom from LPF-VT was found between inducible and non-inducible patients. New-onset LPF block recovery and non-early PP-QRS interval can be the predictors of LPF-VT repeat procedure. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Luminal esophageal temperature monitoring with a deflectable esophageal temperature probe and intracardiac echocardiography may reduce esophageal injury during atrial fibrillation ablation procedures: results of a pilot study.

    PubMed

    Leite, Luiz R; Santos, Simone N; Maia, Henrique; Henz, Benhur D; Giuseppin, Fábio; Oliverira, Anderson; Zanatta, André R; Peres, Ayrton K; Novakoski, Clarissa; Barreto, Jose R; Vassalo, Fabrício; d'Avila, Andre; Singh, Sheldon M

    2011-04-01

    Luminal esophageal temperature (LET) monitoring is one strategy to minimize esophageal injury during atrial fibrillation ablation procedures. However, esophageal ulceration and fistulas have been reported despite adequate LET monitoring. The objective of this study was to assess a novel approach to LET monitoring with a deflectable LET probe on the rate of esophageal injury in patients undergoing atrial fibrillation ablation. Forty-five consecutive patients undergoing an atrial fibrillation ablation procedure followed by esophageal endoscopy were included in this prospective observational pilot study. LET monitoring was performed with a 7F deflectable ablation catheter that was positioned as close as possible to the site of left atrial ablation using the deflectable component of the catheter guided by visualization of its position on intracardiac echocardiography. Ablation in the posterior left atrial was limited to 25 W and terminated when the LET increased 2°C from baseline. Endoscopy was performed 1 to 2 days after the procedure. All patients had at least 1 LET elevation >2°C necessitating cessation of ablation. Deflection of the LET probe was needed to accurately measure LET in 5% of patients when ablating near the left pulmonary veins, whereas deflection of the LET probe was necessary in 88% of patients when ablating near the right pulmonary veins. The average maximum increase in LET was 2.5±1.5°C. No patients had esophageal thermal injury on follow-up endoscopy. A strategy of optimal LET probe placement using a deflectable LET probe and intracardiac echocardiography guidance, combined with cessation of radiofrequency ablation with a 2°C rise in LET, may reduce esophageal thermal injury during left atrial ablation procedures.

  6. Long-term efficacy of single procedure remote magnetic catheter navigation for ablation of ischemic ventricular tachycardia: a retrospective study.

    PubMed

    Dinov, Borislav; Schönbauer, Robert; Wojdyla-Hordynska, Agnieska; Braunschweig, Frieder; Richter, Sergio; Altmann, David; Sommer, Philipp; Gaspar, Thomas; Bollmann, Andreas; Wetzel, Ulrike; Rolf, Sascha; Piorkowski, Christopher; Hindricks, Gerhard; Arya, Arash

    2012-05-01

    Remote magnetic navigation (RMN) aims to reduce some inherent limitations of manual radiofrequency (RF) ablation. However, data comparing the effectiveness of both methods are scarce. This study evaluated the acute and long-term success of RMN guided versus manual RF ablation in patients with ischemic sustained ventricular tachycardia (sVT). One hundred two consecutive patients (age 68 ± 10 years, LVEF 32 ± 12%, 88 men) with ischemic sVT were ablated with RMN (Stereotaxis; 49%) or manually (51%) using substrate and/or activation mapping (Carto) and open-irrigated-tip catheters. All received implantable defibrillators or loop recorders. Acute success was defined as noninducibility of any sVT at the end of the ablation procedure and long-term success as freedom from VT upon follow-up. There was no difference in the baseline characteristics between the groups. Three patients died in hospital. Acute success rate was similar for RMN and manual ablation (82% vs 71%, P = 0.246). RMN was associated with significantly shorter fluoroscopy time (13 ± 12 minutes vs 32 ± 17 minutes, P = 0.0001) and RF time (2337.59 ± 1248.22 seconds vs 1589.95 ± 1047.42 seconds, P = 0.049), although total procedure time was similar (157 ± 40 minutes vs 148 ± 50 minutes, P = 0.42). There was a nonsignificant trend toward better long-term success in RMN group: after a median of 13 (range 1-34) months, 63% in the RMN and 53% in the manual ablation group were free from VT recurrence (P = 0.206). RMN guided RF ablation of ischemic sustained VT is equally efficient compared with manual ablation in terms of acute and long-term success rate. These results are achieved with a significantly reduced fluoroscopy time and shorter RF time. © 2012 Wiley Periodicals, Inc.

  7. Catheter ablation of atrial fibrillation in patients with concomitant sinus bradycardia-Insights from the German Ablation Registry.

    PubMed

    Zylla, Maura M; Brachmann, Johannes; Lewalter, Thorsten; Hoffmann, Ellen; Kuck, Karl-Heinz; Andresen, Dietrich; Willems, Stephan; Hochadel, Matthias; Senges, Jochen; Katus, Hugo A; Thomas, Dierk

    2016-01-01

    This investigation addresses procedural characteristics of catheter ablation in patients with atrial fibrillation (AF) and sinus bradycardia. From the prospective, multi-center German Ablation Registry 1073 patients with sinus rhythm at the time of AF ablation were divided into two groups according to heart rate at start of procedure (A, <60 beats per minute (bpm), n=197; B, 60-99bpm, n=876). Acute procedural success was high (≥98%) and similar between groups. Procedure duration and energy application time were increased in group A (180min vs. 155min and 2561s vs. 1879s, respectively). Major complications were more frequent in group A (2.2% vs. 0.5%), and a greater proportion of these patients was discharged under antiarrhythmic medication (64% vs. 52%). Catheter ablation of AF with concomitant sinus bradycardia is associated with high procedural efficacy, longer procedure- and energy application durations, and a slightly elevated complication rate. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Low rate of asymptomatic cerebral embolism and improved procedural efficiency with the novel pulmonary vein ablation catheter GOLD: results of the PRECISION GOLD trial

    PubMed Central

    De Greef, Yves; Dekker, Lukas; Boersma, Lucas; Murray, Stephen; Wieczorek, Marcus; Spitzer, Stefan G.; Davidson, Neil; Furniss, Steve; Hocini, Mélèze; Geller, J. Christoph; Csanádi, Zoltan

    2016-01-01

    Abstract Aims This prospective, multicentre study (PRECISION GOLD) evaluated the incidence of asymptomatic cerebral embolism (ACE) after pulmonary vein isolation (PVI) using a new gold multi-electrode radiofrequency (RF) ablation catheter, pulmonary vein ablation catheter (PVAC) GOLD. Also, procedural efficiency of PVAC GOLD was compared with ERACE. The ERACE study demonstrated that a low incidence of ACE can be achieved with a platinum multi-electrode RF catheter (PVAC) combined with procedural manoeuvres to reduce emboli. Methods and results A total of 51 patients with paroxysmal atrial fibrillation (AF) (age 57 ± 9 years, CHA2DS2-VASc score 1.4 ± 1.4) underwent AF ablation with PVAC GOLD. Continuous oral anticoagulation using vitamin K antagonists, submerged catheter introduction, and heparinization (ACT ≥ 350 s prior to ablation) were applied. Cerebral magnetic resonance imaging (MRI) scans were performed within 48 h before and 16–72 h post-ablation. Cognitive function assessed by the Mini-Mental State Exam at baseline and 30 days post-ablation. New post-procedural ACE occurred in only 1 of 48 patients (2.1%) and was not detectable on MRI after 30 days. The average number of RF applications per patient to achieve PVI was lower in PRECISION GOLD (20.3 ± 10.0) than in ERACE (28.8 ± 16.1; P = 0.001). Further, PVAC GOLD ablations resulted in significantly fewer low-power (<3 W) ablations (15 vs. 23%, 5 vs. 10% and 2 vs. 7% in 4:1, 2:1, and 1:1 bipolar:unipolar energy modes, respectively). Mini-Mental State Exam was unchanged in all patients. Conclusion Atrial fibrillation ablation with PVAC GOLD in combination with established embolic lowering manoeuvres results in a low incidence of ACE. Pulmonary vein ablation catheter GOLD demonstrates improved biophysical efficiency compared with platinum PVAC. Trial registration ClinicalTrials.gov NCT01767558. PMID:26826134

  9. Global ablation techniques.

    PubMed

    Woods, Sarah; Taylor, Betsy

    2013-12-01

    Global endometrial ablation techniques are a relatively new surgical technology for the treatment of heavy menstrual bleeding that can now be used even in an outpatient clinic setting. A comparison of global ablation versus earlier ablation technologies notes no significant differences in success rates and some improvement in patient satisfaction. The advantages of the newer global endometrial ablation systems include less operative time, improved recovery time, and decreased anesthetic risk. Ablation procedures performed in an outpatient surgical or clinic setting provide advantages both of potential cost savings for patients and the health care system and improved patient convenience. Copyright © 2013. Published by Elsevier Inc.

  10. Sex Differences in a Human Analogue of the Radial Arm Maze: The ''17-Box Maze Test''

    ERIC Educational Resources Information Center

    Rahman, Q.; Abrahams, S.; Jussab, F.

    2005-01-01

    This study investigated sex differences in spatial memory using a human analogue of the Radial Arm Maze: a revision on the Nine Box Maze originally developed by Abrahams, Pickering, Polkey, and Morris (1997) called the 17-Box Maze Test herein. The task encourages allocentric spatial processing, dissociates object from spatial memory, and…

  11. [Catheter ablation for paroxysmal atrial fibrillation: new generation cryoballoon or contact force sensing radiofrequency ablation?].

    PubMed

    Nagy, Zsófia; Kis, Zsuzsanna; Som, Zoltán; Földesi, Csaba; Kardos, Attila

    2016-05-29

    Contact force sensing radiofrequency ablation and the new generation cryoballoon ablation are prevalent techniques for the treatment of paroxysmal atrial fibrillation. The authors aimed to compare the procedural and 1-year outcome of patients after radiofrequency and cryoballoon ablation. 96 patients with paroxysmal atrial fibrillation (radiofrequency ablation: 58, cryoballoon: 38 patients; 65 men and 31 women aged 28-70 years) were enrolled. At postprocedural 1, 3, 6 and 12 months ECG, Holter monitoring and telephone interviews were performed. Procedure and fluorosocopy time were: radiofrequency ablation, 118.5 ± 15 min and 15.8 ± 6 min; cryoballoon, 73.5 ± 16 min (p<0.05) and 13.8 ± 4.,1 min (p = 0.09), respectively. One year later freedom from atrial fibrillation was achieved in 76.5% of patients who underwent radiofrequency ablation and in 81% of patients treated with cryoballoon. Temporary phrenic nerve palsy occurred in two patients and pericardial tamponade developed in one patient. In this single center study freedom from paroxysmal atrial fibrillation was similar in the two groups with significant shorter procedure time in the cryoballoon group.

  12. Brain Emboli After Left Ventricular Endocardial Ablation.

    PubMed

    Whitman, Isaac R; Gladstone, Rachel A; Badhwar, Nitish; Hsia, Henry H; Lee, Byron K; Josephson, S Andrew; Meisel, Karl M; Dillon, William P; Hess, Christopher P; Gerstenfeld, Edward P; Marcus, Gregory M

    2017-02-28

    Catheter ablation for ventricular tachycardia and premature ventricular complexes (PVCs) is common. Catheter ablation of atrial fibrillation is associated with a risk of cerebral emboli attributed to cardioversions and numerous ablation lesions in the low-flow left atrium, but cerebral embolic risk in ventricular ablation has not been evaluated. We enrolled 18 consecutive patients meeting study criteria scheduled for ventricular tachycardia or PVC ablation over a 9-month period. Patients undergoing left ventricular (LV) ablation were compared with a control group of those undergoing right ventricular ablation only. Patients were excluded if they had implantable cardioverter defibrillators or permanent pacemakers. Radiofrequency energy was used for ablation in all cases and heparin was administered with goal-activated clotting times of 300 to 400 seconds for all LV procedures. Pre- and postprocedural brain MRI was performed on each patient within a week of the ablation procedure. Embolic infarcts were defined as new foci of reduced diffusion and high signal intensity on fluid-attenuated inversion recovery brain MRI within a vascular distribution. The mean age was 58 years, half of the patients were men, half had a history of hypertension, and the majority had no known vascular disease or heart failure. LV ablation was performed in 12 patients (ventricular tachycardia, n=2; PVC, n=10) and right ventricular ablation was performed exclusively in 6 patients (ventricular tachycardia, n=1; PVC, n=5). Seven patients (58%) undergoing LV ablation experienced a total of 16 cerebral emboli, in comparison with zero patients undergoing right ventricular ablation ( P =0.04). Seven of 11 patients (63%) undergoing a retrograde approach to the LV developed at least 1 new brain lesion. More than half of patients undergoing routine LV ablation procedures (predominately PVC ablations) experienced new brain emboli after the procedure. Future research is critical to understanding the

  13. Assessment of liver ablation using cone beam computed tomography.

    PubMed

    Abdel-Rehim, Mohamed; Ronot, Maxime; Sibert, Annie; Vilgrain, Valérie

    2015-01-14

    To investigate the feasibility and accuracy of cone beam computed tomography (CBCT) in assessing the ablation zone after liver tumor ablation. Twenty-three patients (17 men and 6 women, range: 45-85 years old, mean age 65 years) with malignant liver tumors underwent ultrasound-guided percutaneous tumor ablation [radiofrequency (n = 14), microwave (n = 9)] followed by intravenous contrast-enhanced CBCT. Baseline multidetector computed tomography (MDCT) and peri-procedural CBCT images were compared. CBCT image quality was assessed as poor, good, or excellent. Image fusion was performed to assess tumor coverage, and quality of fusion was rated as bad, good, or excellent. Ablation zone volumes on peri-procedural CBCT and post-procedural MDCT were compared using the non-parametric paired Wilcoxon t-test. Rate of primary ablation effectiveness was 100%. There were no complications related to ablation. Local tumor recurrence and new liver tumors were found 3 mo after initial treatment in one patient (4%). The ablation zone was identified in 21/23 (91.3%) patients on CBCT. The fusion of baseline MDCT and peri-procedural CBCT images was feasible in all patients and showed satisfactory tumor coverage (at least 5-mm margin). CBCT image quality was poor, good, and excellent in 2 (9%), 8 (35%), and 13 (56%), patients respectively. Registration quality between peri-procedural CBCT and post-procedural MDCT images was good to excellent in 17/23 (74%) patients. The median ablation volume on peri-procedural CBCT and post-procedural MDCT was 30 cm(3) (range: 4-95 cm(3)) and 30 cm(3) (range: 4-124 cm(3)), respectively (P-value > 0.2). There was a good correlation (r = 0.79) between the volumes of the two techniques. Contrast-enhanced CBCT after tumor ablation of the liver allows early assessment of the ablation zone.

  14. Atrial Tachycardias Following Atrial Fibrillation Ablation

    PubMed Central

    Sághy, László; Tutuianu, Cristina; Szilágyi, Judith

    2015-01-01

    One of the most important proarrhythmic complications after left atrial (LA) ablation is regular atrial tachycardia (AT) or flutter. Those tachycardias that occur after atrial fibrillation (AF) ablation can cause even more severe symptoms than those from the original arrhythmia prior to the index ablation procedure since they are often incessant and associated with rapid ventricular response. Depending on the method and extent of LA ablation and on the electrophysiological properties of underlying LA substrate, the reported incidence of late ATs is variable. To establish the exact mechanism of these tachycardias can be difficult and controversial but correlates with the ablation technique and in the vast majority of cases the mechanism is reentry related to gaps in prior ablation lines. When tachycardias occur, conservative therapy usually is not effective, radiofrequency ablation procedure is mostly successful, but can be challenging, and requires a complex approach. PMID:25308808

  15. Comparing energy sources for surgical ablation of atrial fibrillation: a Bayesian network meta-analysis of randomized, controlled trials.

    PubMed

    Phan, Kevin; Xie, Ashleigh; Kumar, Narendra; Wong, Sophia; Medi, Caroline; La Meir, Mark; Yan, Tristan D

    2015-08-01

    Simplified maze procedures involving radiofrequency, cryoenergy and microwave energy sources have been increasingly utilized for surgical treatment of atrial fibrillation as an alternative to the traditional cut-and-sew approach. In the absence of direct comparisons, a Bayesian network meta-analysis is another alternative to assess the relative effect of different treatments, using indirect evidence. A Bayesian meta-analysis of indirect evidence was performed using 16 published randomized trials identified from 6 databases. Rank probability analysis was used to rank each intervention in terms of their probability of having the best outcome. Sinus rhythm prevalence beyond the 12-month follow-up was similar between the cut-and-sew, microwave and radiofrequency approaches, which were all ranked better than cryoablation (respectively, 39, 36, and 25 vs 1%). The cut-and-sew maze was ranked worst in terms of mortality outcomes compared with microwave, radiofrequency and cryoenergy (2 vs 19, 34, and 24%, respectively). The cut-and-sew maze procedure was associated with significantly lower stroke rates compared with microwave ablation [odds ratio <0.01; 95% confidence interval 0.00, 0.82], and ranked the best in terms of pacemaker requirements compared with microwave, radiofrequency and cryoenergy (81 vs 14, and 1, <0.01% respectively). Bayesian rank probability analysis shows that the cut-and-sew approach is associated with the best outcomes in terms of sinus rhythm prevalence and stroke outcomes, and remains the gold standard approach for AF treatment. Given the limitations of indirect comparison analysis, these results should be viewed with caution and not over-interpreted. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  16. Electric Current Solves Mazes

    ERIC Educational Resources Information Center

    Ayrinhac, Simon

    2014-01-01

    We present in this work a demonstration of the maze-solving problem with electricity. Electric current flowing in a maze as a printed circuit produces Joule heating and the right way is instantaneously revealed with infrared thermal imaging. The basic properties of electric current can be discussed in this context, with this challenging question:…

  17. [Thoracoscopic, epicardial ablation of atrial fibrillation using the COBRA Fusion system as the first part of hybrid ablation].

    PubMed

    Budera, P; Osmančík, P; Talavera, D; Fojt, R; Kraupnerová, A; Žďárská, J; Vaněk, T; Straka, Z

    2017-01-01

    Treatment of persistent and long-standing persistent atrial fibrillation is not successfully managed by methods of catheter ablation or pharmacotherapy. Hybrid ablation (i.e. combination of minimally invasive surgical ablation, followed by electrophysiological assessment and subsequent endocardial catheter ablation to complete the entire intended procedure) presents an ever more used and very promising treatment method. Patients underwent thoracoscopic ablation of pulmonary veins and posterior wall of the left atrium (the box-lesion) with use of the COBRA Fusion catheter; thoracoscopic occlusion of the left atrial appendage using the AtriClip system was also done in later patients. After 23 months, electrophysiological assessment and catheter ablation followed. In this article we summarize a strategy of the surgical part of the hybrid procedure performed in our centre. We describe the surgery itself (including possible periprocedural complications) and we also present our short-term results, especially with respect to subsequent electrophysiological findings. Data of the first 51 patients were analyzed. The first 25 patients underwent unilateral ablation; the mean time of surgery was 102 min. Subsequent 26 patients underwent the bilateral procedure with the mean surgery time of 160 min. Serious complications included 1 stroke, 1 phrenic nerve palsy and 2 surgical re-explorations for bleeding. After 1 month, 65% of patients showed sinus rhythm. The box-lesion was found complete during electrophysiological assessment in 38% of patients and after catheter ablation, 96% of patients were discharged in sinus rhythm. The surgical part of the hybrid procedure with use of the minimally invasive approach and the COBRA Fusion catheter is a well-feasible method with a low number of periprocedural complications. For electrophysiologists, it provides a very good basis for successful completion of the hybrid ablation.Key words: atrial fibrillation hybrid ablation - thoracoscopy

  18. Comparison of remote magnetic navigation ablation and manual ablation of idiopathic ventricular arrhythmia after failed manual ablation.

    PubMed

    Kawamura, Mitsuharu; Scheinman, Melvin M; Tseng, Zian H; Lee, Byron K; Marcus, Gregory M; Badhwar, Nitish

    2017-01-01

    Catheter ablation for idiopathic ventricular arrhythmia (VA) is effective and safe, but efficacy is frequently limited due to an epicardial origin and difficult anatomy. The remote magnetic navigation (RMN) catheter has a flexible catheter design allowing access to difficult anatomy. We describe the efficacy of the RMN for ablation of idiopathic VA after failed manual ablation. Among 235 patients with idiopathic VA referred for catheter ablation, we identified 51 patients who were referred for repeat ablation after a failed manual ablation. We analyzed the clinical characteristics, including the successful ablation site and findings at electrophysiology study, in repeat procedures conducted using RMN as compared with manual ablation. Among these patients, 22 (43 %) underwent repeat ablation with the RMN and 29 (57 %) underwent repeat ablation with a manual ablation. Overall, successful ablation rate was significantly higher using RMN as compared with manual ablation (91 vs. 69 %, P = 0.02). Fluoroscopy time in the RMN was 17 ± 12 min as compared with 43 ± 18 min in the manual ablation (P = 0.009). Successful ablation rate in the posterior right ventricular outflow tract (RVOT) plus posterior-tricuspid annulus was higher with RMN as compared with manual ablation (92 vs. 50 %, P = 0.03). Neither groups exhibited any major complications. The RMN is more effective in selected patients with recurrent idiopathic VA after failed manual ablation and is associated with less fluoroscopy time. The RMN catheters have a flexible design enabling them to access otherwise difficult anatomy including the posterior tricuspid annulus and posterior RVOT.

  19. Low rate of asymptomatic cerebral embolism and improved procedural efficiency with the novel pulmonary vein ablation catheter GOLD: results of the PRECISION GOLD trial.

    PubMed

    De Greef, Yves; Dekker, Lukas; Boersma, Lucas; Murray, Stephen; Wieczorek, Marcus; Spitzer, Stefan G; Davidson, Neil; Furniss, Steve; Hocini, Mélèze; Geller, J Christoph; Csanádi, Zoltan

    2016-05-01

    This prospective, multicentre study (PRECISION GOLD) evaluated the incidence of asymptomatic cerebral embolism (ACE) after pulmonary vein isolation (PVI) using a new gold multi-electrode radiofrequency (RF) ablation catheter, pulmonary vein ablation catheter (PVAC) GOLD. Also, procedural efficiency of PVAC GOLD was compared with ERACE. The ERACE study demonstrated that a low incidence of ACE can be achieved with a platinum multi-electrode RF catheter (PVAC) combined with procedural manoeuvres to reduce emboli. A total of 51 patients with paroxysmal atrial fibrillation (AF) (age 57 ± 9 years, CHA2DS2-VASc score 1.4 ± 1.4) underwent AF ablation with PVAC GOLD. Continuous oral anticoagulation using vitamin K antagonists, submerged catheter introduction, and heparinization (ACT ≥ 350 s prior to ablation) were applied. Cerebral magnetic resonance imaging (MRI) scans were performed within 48 h before and 16-72 h post-ablation. Cognitive function assessed by the Mini-Mental State Exam at baseline and 30 days post-ablation. New post-procedural ACE occurred in only 1 of 48 patients (2.1%) and was not detectable on MRI after 30 days. The average number of RF applications per patient to achieve PVI was lower in PRECISION GOLD (20.3 ± 10.0) than in ERACE (28.8 ± 16.1; P = 0.001). Further, PVAC GOLD ablations resulted in significantly fewer low-power (<3 W) ablations (15 vs. 23%, 5 vs. 10% and 2 vs. 7% in 4:1, 2:1, and 1:1 bipolar:unipolar energy modes, respectively). Mini-Mental State Exam was unchanged in all patients. Atrial fibrillation ablation with PVAC GOLD in combination with established embolic lowering manoeuvres results in a low incidence of ACE. Pulmonary vein ablation catheter GOLD demonstrates improved biophysical efficiency compared with platinum PVAC. ClinicalTrials.gov NCT01767558. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.

  20. Analysis of iodinated contrast delivered during thermal ablation: is material trapped in the ablation zone?

    PubMed

    Wu, Po-Hung; Brace, Chris L

    2016-08-21

    Intra-procedural contrast-enhanced CT (CECT) has been proposed to evaluate treatment efficacy of thermal ablation. We hypothesized that contrast material delivered concurrently with thermal ablation may become trapped in the ablation zone, and set out to determine whether such an effect would impact ablation visualization. CECT images were acquired during microwave ablation in normal porcine liver with: (A) normal blood perfusion and no iodinated contrast, (B) normal perfusion and iodinated contrast infusion or (C) no blood perfusion and residual iodinated contrast. Changes in CT attenuation were analyzed from before, during and after ablation to evaluate whether contrast was trapped inside of the ablation zone. Visualization was compared between groups using post-ablation contrast-to-noise ratio (CNR). Attenuation gradients were calculated at the ablation boundary and background to quantitate ablation conspicuity. In Group A, attenuation decreased during ablation due to thermal expansion of tissue water and water vaporization. The ablation zone was difficult to visualize (CNR  =  1.57  ±  0.73, boundary gradient  =  0.7  ±  0.4 HU mm(-1)), leading to ablation diameter underestimation compared to gross pathology. Group B ablations saw attenuation increase, suggesting that iodine was trapped inside the ablation zone. However, because the normally perfused liver increased even more, Group B ablations were more visible than Group A (CNR  =  2.04  ±  0.84, boundary gradient  =  6.3  ±  1.1 HU mm(-1)) and allowed accurate estimation of the ablation zone dimensions compared to gross pathology. Substantial water vaporization led to substantial attenuation changes in Group C, though the ablation zone boundary was not highly visible (boundary gradient  =  3.9  ±  1.1 HU mm(-1)). Our results demonstrate that despite iodinated contrast being trapped in the ablation zone, ablation visibility

  1. Effects of nicergoline on age-related decrements in radial maze performance and acetylcholine levels.

    PubMed

    McArthur, R A; Carfagna, N; Banfi, L; Cavanus, S; Cervini, M A; Fariello, R; Post, C

    1997-01-01

    The effects of chronic oral administration of nicergoline (5.0 mg/kg; bid) on locomotor activity, eight-arm radial maze performance plus striatal, cortical, and hippocampal acetylcholine (ACh) levels were examined in young and aged Wistar rats. Chronic nicergoline administration did not modify either the locomotor activity or radial maze learning in young rats. Young rats learned the radial maze procedure rapidly and improved their performance throughout the successive training sessions. Radial maze performance in young rats was characterised by very few arm reentries. Aged rats were hypoactive and did not explore or enter the radial maze arms, and consequently performed poorly in the radial maze throughout the training sessions. Nicergoline treatment did not significantly modify locomotor activity in aged rats. Aged rats treated with nicergoline also performed poorly initially but improved with repeated training in the radial maze. This improvement was associated with an increasing number of arms being entered and very few arm reentries. Reduced acetylcholine (ACh) levels were also associated with age. Aged rats had significantly reduced levels of ACh in the straitum and cortex, but not the hippocampus as compared to young rats. Nicergoline treatment did not change ACh levels in young rats, but substantially restored the reduced ACh levels in aged rats. These results indicate that nicergoline is an effective cognitive enhancer in a learning model of age-related deficits and that these results may be related to changes in the cholinergic system.

  2. Left atrial function after Cox's maze operation concomitant with mitral valve operation.

    PubMed

    Itoh, T; Okamoto, H; Nimi, T; Morita, S; Sawazaki, M; Ogawa, Y; Asakura, T; Yasuura, K; Abe, T; Murase, M

    1995-08-01

    This study examined whether the atrial fibrillation that commonly occurs in patients with a mitral valve operation could be eliminated by a concomitant maze operation. Left atrial function after Cox's maze operation performed concomitantly with a mitral valve operation was evaluated in 10 patients ranging in age from 38 to 67 years (mean age, 54 years). Seven patients who had had coronary artery bypass grafting served as the control group. Using transthoracic echocardiography, the ratio between the peak speed of the early filling wave and that of the atrial contraction wave (A/E ratio) and the atrial filling fraction (AFF) were determined from transmitral flow measurements. These two indices have been considered to represent the contribution of left atrial active contraction to ventricular filling. The A/E ratio and the AFF were significantly lower in the maze group (0.35 +/- 0.17 versus 0.97 +/- 0.28 [p < 0.01] and 17.6% +/- 8.8% versus 36.8% +/- 6.4% [p < 0.01], respectively). The A/E ratio and the AFF correlated inversely with age (r = -0.72, p < 0.05 and r = 0.76, p < 0.05, respectively) in the maze group. In an angiographic study, the mean left atrial maximal volume index in the maze group was approximately three times larger than that in the control group (117.5 +/- 24.3 mL/m2 versus 35.3 +/- 6.6 mL/m2 [p < 0.01]). The left atrial active emptying volume index was significantly smaller in patients in the maze group (7.2 +/- 2.5 mL/m2 versus 13.1 +/- 4.6 mL/m2 [p < 0.01]). After the maze procedure performed concomitantly with a mitral valve operation in patients with a dilated left atrium, left atrial contraction is detectable but incomplete in the elderly.

  3. Robust tracking of a virtual electrode on a coronary sinus catheter for atrial fibrillation ablation procedures

    NASA Astrophysics Data System (ADS)

    Wu, Wen; Chen, Terrence; Strobel, Norbert; Comaniciu, Dorin

    2012-02-01

    Catheter tracking in X-ray fluoroscopic images has become more important in interventional applications for atrial fibrillation (AF) ablation procedures. It provides real-time guidance for the physicians and can be used as reference for motion compensation applications. In this paper, we propose a novel approach to track a virtual electrode (VE), which is a non-existing electrode on the coronary sinus (CS) catheter at a more proximal location than any real electrodes. Successful tracking of the VE can provide more accurate motion information than tracking of real electrodes. To achieve VE tracking, we first model the CS catheter as a set of electrodes which are detected by our previously published learning-based approach.1 The tracked electrodes are then used to generate the hypotheses for tracking the VE. Model-based hypotheses are fused and evaluated by a Bayesian framework. Evaluation has been conducted on a database of clinical AF ablation data including challenging scenarios such as low signal-to-noise ratio (SNR), occlusion and nonrigid deformation. Our approach obtains 0.54mm median error and 90% of evaluated data have errors less than 1.67mm. The speed of our tracking algorithm reaches 6 frames-per-second on most data. Our study on motion compensation shows that using the VE as reference provides a good point to detect non-physiological catheter motion during the AF ablation procedures.2

  4. Outcomes of Cryoballoon Ablation in High- and Low-Volume Atrial Fibrillation Ablation Centres: A Russian Pilot Survey

    PubMed Central

    Mikhaylov, Evgeny N.; Lebedev, Dmitry S.; Pokushalov, Evgeny A.; Davtyan, Karapet V.; Ivanitskii, Eduard A.; Nechepurenko, Anatoly A.; Kosonogov, Alexey Ya.; Kolunin, Grigory V.; Morozov, Igor A.; Termosesov, Sergey A.; Maykov, Evgeny B.; Khomutinin, Dmitry N.; Eremin, Sergey A.; Mayorov, Igor M.; Romanov, Alexander B.; Shabanov, Vitaliy V.; Shatakhtsyan, Victoria; Tsivkovskii, Viktor; Revishvili, Amiran Sh.; Shlyakhto, Evgeny V.

    2015-01-01

    Purpose. The results of cryoballoon ablation (CBA) procedure have been mainly derived from studies conducted in experienced atrial fibrillation (AF) ablation centres. Here, we report on CBA efficacy and complications resulting from real practice of this procedure at both high- and low-volume centres. Methods. Among 62 Russian centres performing AF ablation, 15 (24%) used CBA technology for pulmonary vein isolation. The centres were asked to provide a detailed description of all CBA procedures performed and complications, if encountered. Results. Thirteen sites completed interviews on all CBAs in their centres (>95% of CBAs in Russia). Six sites were high-volume AF ablation (>100 AF cases/year) centres, and 7 were low-volume AF ablation. There was no statistical difference in arrhythmia-free rates between high- and low-volume centres (64.6 versus 60.8% at 6 months). Major complications developed in 1.5% of patients and were equally distributed between high- and low-volume centres. Minor procedure-related events were encountered in 8% of patients and were more prevalent in high-volume centres. Total event and vascular access site event rates were higher in women than in men. Conclusions. CBA has an acceptable efficacy profile in real practice. In less experienced AF ablation centres, the major complication rate is equal to that in high-volume centres. PMID:26640789

  5. Maze Surgery

    MedlinePlus

    ... atrial fibrillation by creating a "maze" of new electrical pathways to let electrical impulses travel easily through the heart. En español Electrical impulses in your heart muscle (the myocardium) cause ...

  6. Glow discharge based device for solving mazes

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Dubinov, Alexander E., E-mail: dubinov-ae@yandex.ru; Mironenko, Maxim S.; Selemir, Victor D.

    2014-09-15

    A glow discharge based device for solving mazes has been designed and tested. The device consists of a gas discharge chamber and maze-transformer of radial-azimuth type. It allows changing of the maze pattern in a short period of time (within several minutes). The device has been tested with low pressure air. Once switched on, a glow discharge has been shown to find the shortest way through the maze from the very first attempt, even if there is a section with potential barrier for electrons on the way. It has been found that ionization waves (striations) can be excited in themore » maze along the length of the plasma channel. The dependancy of discharge voltage on the length of the optimal path through the maze has been measured. A reduction in discharge voltage with one or two potential barriers present has been found and explained. The dependency of the magnitude of discharge ignition voltage on the length of the optimal path through the maze has been measured. The reduction of the ignition voltage with the presence of one or two potential barriers has been observed and explained.« less

  7. Pheochromocytoma diagnosed after anticoagulation for atrial fibrillation ablation procedure: a giant in disguise.

    PubMed

    Galvão Braga, Carlos; Ribeiro, Sílvia; Martins, Juliana; Arantes, Carina; Ramos, Vítor; Primo, João; Magalhães, Sónia; Correia, Adelino

    2014-04-01

    Pheochromocytoma is a rare catecholamine-producing tumor, discovered incidentally in 50% of cases. We present the case of a 44-year-old male with a history of paroxysmal palpitations. Baseline ECG, transthoracic echocardiogram and ECG stress test showed no relevant alterations. Paroxysmal atrial fibrillation was detected on 24-hour Holter ECG. After antiarrhythmic therapy, the patient remained symptomatic, and was accordingly referred for electrophysiological study and atrial fibrillation ablation. Anticoagulation was initiated before the procedure. After ablation and still anticoagulated, he complained of hematospermia. The abdominal and pelvic imaging study showed a 10-cm left adrenal mass, predominantly cystic, compatible with pheochromocytoma, which was confirmed after biochemical tests (increased urine metanephrines and plasma catecholamines). Metaiodobenzylguanidine scintigraphy scanning confirmed localized disease in the adrenal gland, excluding other uptake foci. Following appropriate preoperative management, surgical resection of the giant mass was performed successfully and without complications. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  8. Voltage and pace-capture mapping of linear ablation lesions overestimates chronic ablation gap size.

    PubMed

    O'Neill, Louisa; Harrison, James; Chubb, Henry; Whitaker, John; Mukherjee, Rahul K; Bloch, Lars Ølgaard; Andersen, Niels Peter; Dam, Høgni; Jensen, Henrik K; Niederer, Steven; Wright, Matthew; O'Neill, Mark; Williams, Steven E

    2018-04-26

    Conducting gaps in lesion sets are a major reason for failure of ablation procedures. Voltage mapping and pace-capture have been proposed for intra-procedural identification of gaps. We aimed to compare gap size measured acutely and chronically post-ablation to macroscopic gap size in a porcine model. Intercaval linear ablation was performed in eight Göttingen minipigs with a deliberate gap of ∼5 mm left in the ablation line. Gap size was measured by interpolating ablation contact force values between ablation tags and thresholding at a low force cut-off of 5 g. Bipolar voltage mapping and pace-capture mapping along the length of the line were performed immediately, and at 2 months, post-ablation. Animals were euthanized and gap sizes were measured macroscopically. Voltage thresholds to define scar were determined by receiver operating characteristic analysis as <0.56 mV (acutely) and <0.62 mV (chronically). Taking the macroscopic gap size as gold standard, error in gap measurements were determined for voltage, pace-capture, and ablation contact force maps. All modalities overestimated chronic gap size, by 1.4 ± 2.0 mm (ablation contact force map), 5.1 ± 3.4 mm (pace-capture), and 9.5 ± 3.8 mm (voltage mapping). Error on ablation contact force map gap measurements were significantly less than for voltage mapping (P = 0.003, Tukey's multiple comparisons test). Chronically, voltage mapping and pace-capture mapping overestimated macroscopic gap size by 11.9 ± 3.7 and 9.8 ± 3.5 mm, respectively. Bipolar voltage and pace-capture mapping overestimate the size of chronic gap formation in linear ablation lesions. The most accurate estimation of chronic gap size was achieved by analysis of catheter-myocardium contact force during ablation.

  9. Caring for women undergoing cardiac ablation.

    PubMed

    Keegan, Beryl

    2008-09-01

    Radiofrequency cardiac ablation (RFCA) has become the treatment of choice for many cardiac arrhythmias that have not responded to medication. Complications of cardiac ablation include bleeding, thrombosis, pericardial tamponade, and stroke. Many complications are procedure specific, and several complications can be avoided with appropriate nursing care. Quality patient outcomes begin with competent nursing care. Therefore it is vital for a patient undergoing a percutaneous cardiac ablation procedure to receive supportive care and pre- and post-interventional patient education. This article discusses the nursing care of women undergoing RFCA.

  10. Sex differences in a human analogue of the Radial Arm Maze: the "17-Box Maze Test".

    PubMed

    Rahman, Qazi; Abrahams, Sharon; Jussab, Fardin

    2005-08-01

    This study investigated sex differences in spatial memory using a human analogue of the Radial Arm Maze: a revision on the Nine Box Maze originally developed by called the 17-Box Maze Test herein. The task encourages allocentric spatial processing, dissociates object from spatial memory, and incorporates a within-participants design to provide measures of location and object, working and reference memory. Healthy adult males and females (26 per group) were administered the 17-Box Maze Test, as well as mental rotation and a verbal IQ test. Females made significantly fewer errors on this task than males. However, post hoc analysis revealed that the significant sex difference was specific to object, rather than location, memory measures. These were medium to large effect sizes. The findings raise the issue of task- and component-specific sexual dimorphism in cognitive mapping.

  11. Approaches to catheter ablation for persistent atrial fibrillation.

    PubMed

    Verma, Atul; Jiang, Chen-yang; Betts, Timothy R; Chen, Jian; Deisenhofer, Isabel; Mantovan, Roberto; Macle, Laurent; Morillo, Carlos A; Haverkamp, Wilhelm; Weerasooriya, Rukshen; Albenque, Jean-Paul; Nardi, Stefano; Menardi, Endrj; Novak, Paul; Sanders, Prashanthan

    2015-05-07

    Catheter ablation is less successful for persistent atrial fibrillation than for paroxysmal atrial fibrillation. Guidelines suggest that adjuvant substrate modification in addition to pulmonary-vein isolation is required in persistent atrial fibrillation. We randomly assigned 589 patients with persistent atrial fibrillation in a 1:4:4 ratio to ablation with pulmonary-vein isolation alone (67 patients), pulmonary-vein isolation plus ablation of electrograms showing complex fractionated activity (263 patients), or pulmonary-vein isolation plus additional linear ablation across the left atrial roof and mitral valve isthmus (259 patients). The duration of follow-up was 18 months. The primary end point was freedom from any documented recurrence of atrial fibrillation lasting longer than 30 seconds after a single ablation procedure. Procedure time was significantly shorter for pulmonary-vein isolation alone than for the other two procedures (P<0.001). After 18 months, 59% of patients assigned to pulmonary-vein isolation alone were free from recurrent atrial fibrillation, as compared with 49% of patients assigned to pulmonary-vein isolation plus complex electrogram ablation and 46% of patients assigned to pulmonary-vein isolation plus linear ablation (P=0.15). There were also no significant differences among the three groups for the secondary end points, including freedom from atrial fibrillation after two ablation procedures and freedom from any atrial arrhythmia. Complications included tamponade (three patients), stroke or transient ischemic attack (three patients), and atrioesophageal fistula (one patient). Among patients with persistent atrial fibrillation, we found no reduction in the rate of recurrent atrial fibrillation when either linear ablation or ablation of complex fractionated electrograms was performed in addition to pulmonary-vein isolation. (Funded by St. Jude Medical; ClinicalTrials.gov number, NCT01203748.).

  12. An approach to ablate and pace:AV junction ablation and pacemaker implantation performed concurrently from the same venous access site.

    PubMed

    Issa, Ziad F

    2007-09-01

    Atrioventricular junction (AVJ) ablation combined with permanent pacemaker implantation (the "ablate and pace" approach) remains an acceptable alternative treatment strategy for symptomatic, drug-refractory atrial fibrillation (AF) with rapid ventricular response. This case series describes the feasibility and safety of catheter ablation of the AVJ via a superior vena caval approach performed during concurrent dual-chamber pacemaker implantation. A total of 17 consecutive patients with symptomatic, drug-refractory, paroxysmal AF underwent combined AVJ ablation and dual-chamber pacemaker implantation procedure using a left axillary venous approach. Two separate introducer sheaths were placed into the axillary vein. The first sheath was used for implantation of the pacemaker ventricular lead, which was then connected to the pulse generator. Subsequently, a standard ablation catheter was introduced through the second axillary venous sheath and used for radiofrequency (RF) ablation of the AVJ. After successful ablation, the catheter was withdrawn and the pacemaker atrial lead was advanced through that same sheath and implanted in the right atrium. Catheter ablation of the AVJ was successfully achieved in all patients. The median number of RF applications required to achieve complete AV block was three (range 1-10). In one patient, AV conduction recovered within the first hour after completion of the procedure, and AVJ ablation was then performed using the conventional femoral venous approach. There were no procedural complications. Catheter ablation of the AVJ can be performed successfully and safely via a superior vena caval approach in patients undergoing concurrent dual-chamber pacemaker implantation.

  13. Thermal Ablation for Benign Thyroid Nodules: Radiofrequency and Laser

    PubMed Central

    Lee, Jeong Hyun; Valcavi, Roberto; Pacella, Claudio M.; Rhim, Hyunchul; Na, Dong Gyu

    2011-01-01

    Although ethanol ablation has been successfully used to treat cystic thyroid nodules, this procedure is less effective when the thyroid nodules are solid. Radiofrequency (RF) ablation, a newer procedure used to treat malignant liver tumors, has been valuable in the treatment of benign thyroid nodules regardless of the extent of the solid component. This article reviews the basic physics, techniques, applications, results, and complications of thyroid RF ablation, in comparison to laser ablation. PMID:21927553

  14. Navigation for fluoroscopy-guided cryo-balloon ablation procedures of atrial fibrillation

    NASA Astrophysics Data System (ADS)

    Bourier, Felix; Brost, Alexander; Kleinoeder, Andreas; Kurzendorfer, Tanja; Koch, Martin; Kiraly, Attila; Schneider, Hans-Juergen; Hornegger, Joachim; Strobel, Norbert; Kurzidim, Klaus

    2012-02-01

    Atrial fibrillation (AFib), the most common arrhythmia, has been identified as a major cause of stroke. The current standard in interventional treatment of AFib is the pulmonary vein isolation (PVI). PVI is guided by fluoroscopy or non-fluoroscopic electro-anatomic mapping systems (EAMS). Either classic point-to-point radio-frequency (RF)- catheter ablation or so-called single-shot-devices like cryo-balloons are used to achieve electrically isolation of the pulmonary veins and the left atrium (LA). Fluoroscopy-based systems render overlay images from pre-operative 3-D data sets which are then merged with fluoroscopic imaging, thereby adding detailed 3-D information to conventional fluoroscopy. EAMS provide tracking and visualization of RF catheters by means of electro-magnetic tracking. Unfortunately, current navigation systems, fluoroscopy-based or EAMS, do not provide tools to localize and visualize single shot devices like cryo-balloon catheters in 3-D. We present a prototype software for fluoroscopy-guided ablation procedures that is capable of superimposing 3-D datasets as well as reconstructing cyro-balloon catheters in 3-D. The 3-D cyro-balloon reconstruction was evaluated on 9 clinical data sets, yielded a reprojected 2-D error of 1.72 mm +/- 1.02 mm.

  15. Hysterosalpingography After Radiofrequency Endometrial Ablation and Hysteroscopic Sterilization as a Concomitant Procedure.

    PubMed

    Hopkins, Matthew R; Laughlin-Tommaso, Shannon K; Wall, Darci J; Breitkopf, Daniel M; Creedon, Douglas J; El-Nashar, Sherif A; Famuyide, Abimbola O

    2015-09-01

    To evaluate the accuracy of hysterosalpingography (HSG) in patients who underwent concomitant radiofrequency endometrial ablation and hysteroscopic sterilization. This historical cohort study was conducted at a midwestern academic medical center. A total of 186 women (94 with combined procedure and 92 with sterilization alone) were identified as having undergone intervention between January 1, 2003, and June 30, 2011. Two reviewers blinded to the surgical procedure interpreted the standard clinically indicated HSGs in each group. The primary outcome assessed was the inability to rely on the microinserts for contraception based on HSG interpretation using manufacturers' guidelines (unsatisfactory HSG). Position of the devices and occlusion of tubes were assessed on all 3-month and, when available, all 6-month repeat HSGs. At the 3-month HSG, 5 of 76 (6.6%, 95% confidence interval [CI] 2.2-14.7%) in the sterilization-only group had unsatisfactory HSG compared with 13 of 71 (18.3%, 95% CI 10.1-29.3%) in the combined group (P=.03). After accounting for the seven patients who underwent repeat HSG at 6 months, 3 of 76 (3.95%, 95% CI 0.8-11.1%) in the sterilization-only group had unsatisfactory HSG compared with 13 of 71 (18.31%, 95% CI 10.1-29.3%) in the combined group (P=.005). After completing all clinically indicated HSGs, patients who undergo concomitant radiofrequency endometrial ablation and hysteroscopic sterilization have an approximate fivefold increase (odds ratio 5.45, 95% CI 1.48-20.0) in the rate of unsatisfactory HSG for purposes of documenting tubal occlusion. II.

  16. Persistent Atrial Fibrillation Ablation in Females: Insight from the MAGIC-AF Trial.

    PubMed

    Singh, Sheldon M; D'Avila, Andre; Aryana, Arash; Kim, Young-Hoon; Mangrum, J Michael; Michaud, Gregory F; Dukkipati, Srinivas R; Heist, E Kevin; Barrett, Conor D; Thorpe, Kevin E; Reddy, Vivek Y

    2016-07-27

    Atrial fibrillation (AF) ablation is less frequently performed in women when compared to men. There are conflicting data on the safety and efficacy of AF ablation in women. The objective of this study was to compare the clinical characteristics and outcomes in a contemporary cohort of men and women undergoing persistent AF ablation procedures. A total of 182 men and 53 women undergoing a first-ever persistent AF catheter ablation procedure in The Modified Ablation Guided by Ibutilide Use in Chronic Atrial Fibrillation (MAGIC-AF) trial were evaluated. Clinical and procedural characteristics were compared between each gender. The primary efficacy endpoint was the 1-year single procedure freedom from atrial arrhythmia off anti-arrhythmic drugs. Women undergoing catheter ablation procedures were older than men (P < 0.001). The duration of AF and associated co-morbidities were similar between both genders. Single procedure drug-free atrial arrhythmia recurrence occurred in 53% of the cohort with no difference based on gender (men = 54%, women = 53%; P = 1.0). Procedural (P = 0.04), fluoroscopic (P = 0.02), and ablation times (P = 0.003) were shorter in women compared to men. Periprocedural complications and postablation improvement in quality of life were similar between men and women. Women undergoing a first-ever persistent AF ablation procedure were older but had similar clinical outcomes and complications when compared with men. © 2016 Wiley Periodicals, Inc.

  17. Atrial Fibrillation Ablation and its Impact on Stroke.

    PubMed

    Graves, Kevin G; Jacobs, Victoria; May, Heidi T; Cutler, Michael J; Day, John D; Bunch, T Jared

    2018-01-24

    Atrial fibrillation (AF) is a commonly encountered arrhythmia, which is not yet fully understood. Catheter ablation has shown to be an effective strategy for rhythm management and several small or retrospective studies have shown that stroke rates are decreased in ablated AF patients compared to those medically managed. Several studies even show that ablation returns stroke risk to that of non-AF patients. Large scale, prospective trials will further illuminate this connection and provide mechanistic understanding of the role of the procedure versus the process of selection for the procedure and peri- and post-procedural therapy and management. Furthermore, modification of risk factors associated with AF show a significant increase in the sustained success of AF ablation and can also moderate the progression of AF.

  18. Persistent Atrial Fibrillation Ablation using the Tip-Versatile Ablation Catheter.

    PubMed

    Davies, Edward J; Clayton, Ben; Lines, Ian; Haywood, Guy A

    2016-07-01

    The mechanisms by which persistent atrial fibrillation (PsAF) develops are incompletely understood. Consequently, the optimal strategy for the ablative management of PsAF remains debated. Current methods are often time consuming, complex and non-reproducible. We assessed the Tip-Versatile Ablation Catheter (T-VAC) technique, a rapidly delivered, empirical technique based on the box-set concept using duty-cycled linear catheter ablation technology. Forty-four procedures in 40 patients undergoing PsAF ablation with the novel technique were prospectively entered onto a database: 27 de novo. Primary endpoint was freedom from arrhythmia at over two-year follow-up. Secondary endpoints were time to first arrhythmia recurrence, freedom from atrial fibrillation (AF) on and off antiarrhythmic drugs (AAD), procedural and fluoroscopy duration and complication rate. At mean follow-up of 33 months, absolute freedom from arrhythmia recurrence was 45% in the de novo group. Overall, at 33 (IQR 24-63) months, 60% of de novo patients were in sustained normal sinus rhythm and a further 15% reported only occasional paroxysms of AF at long-term follow-up. Procedure time was 192±25 mins, total energy delivered 2239±883s and fluoroscopy time was 60±10mins. In selected patients with persistent AF, a long-term rate of 60% arrhythmia free survival off AAD can be achieved using this novel T-VAC technique. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  19. Image-Guided Ablation of Adrenal Lesions

    PubMed Central

    Yamakado, Koichiro

    2014-01-01

    Although laparoscopic adrenalectomy has remained the standard of care for the treatment for adrenal tumors, percutaneous image-guided ablation therapy, such as chemical ablation, radiofrequency ablation, cryoablation, and microwave ablation, has been shown to be clinically useful in many nonsurgical candidates. Ablation therapy has been used to treat both functioning adenomas and malignant tumors, including primary adrenal carcinoma and metastasis. For patients with functioning adenomas, biochemical and symptomatic improvement is achieved in 96 to 100% after ablation; for patients with malignant adrenal neoplasms, however, the survival benefit from ablation therapy remains unclear, though good initial results have been reported. This article outlines the current role of ablation therapy for adrenal lesions, as well as identifying some of the technical considerations for this procedure. PMID:25049444

  20. Endometrial ablation: normal appearance and complications.

    PubMed

    Drylewicz, Monica R; Robinson, Kathryn; Siegel, Cary Lynn

    2018-03-14

    Global endometrial ablation is a commonly performed, minimally invasive technique aimed at improving/resolving abnormal uterine bleeding and menorrhagia in women. As non-resectoscopic techniques have come into existence, endometrial ablation performance continues to increase due to accessibility and decreased requirements for operating room time and advanced technical training. The increased utilization of this method translates into increased imaging of patients who have undergone the procedure. An understanding of the expected imaging appearances of endometrial ablation using different modalities is important for the abdominal radiologist. In addition, the frequent usage of the technique naturally comes with complications requiring appropriate imaging work-up. We review the expected appearance of the post-endometrial ablated uterus on multiple imaging modalities and demonstrate the more common and rare complications seen in the immediate post-procedural time period and remotely.

  1. Vdrive Evaluation of Remote Steering and Testing in Lasso Electrophysiology Procedures Study: The VERSATILE Study in Atrial Fibrillation Ablation.

    PubMed

    Nölker, Georg; Schwagten, Bruno; Deville, J Brian; Burkhardt, J David; Horton, Rodney P; Sha, Qun; Tomassoni, Gery

    2016-03-01

    Circular mapping catheters (CMC) are an essential tool in most atrial fibrillation ablation procedures. The Vdrive™ with V-Loop™ system enables a physician to remotely manipulate a CMC during electrophysiology studies. Our aim was to compare the clinical performance of the system to conventional CMC navigation according to efficiency and safety endpoints. A total of 120 patients scheduled to undergo a CMC study followed by pulmonary vein isolation (PVI) were included. Treatment allocation was randomized 2:1, remote navigation:manual navigation. The primary effectiveness endpoint was assessed based on both successful navigation to the targeted pulmonary vein (PV) and successful recording of PV electrograms. All PVs were treated independently within and between patients. The primary safety endpoint was assessed based on the occurrence of major adverse events (MAEs) through seven days after the study procedure. Primary effectiveness endpoints were achieved in 295/302 PVs in the Vdrive arm (97.7%) and 167/167 PVs in the manual arm (100%). Effectiveness analysis indicates Vdrive non-inferiority (pnon-inferiority = 0.0405; δ = -0.05) per the Cochran-Mantel-Haenszel test adjusted for PV correlation. Five MAEs related to the ablation procedure occurred (three in the Vdrive arm-3.9%; two in the manual arm-2.33%). No device-related MAEs were observed; safety analysis indicates Vdrive non-inferiority (pnon-inferiority = 0.0441; δ = 0.07) per the normal Z test. Remote navigation of a CMC is equivalent to manual in PVI in terms of safety and effectiveness. This allows for single-operator procedures in conjunction with a magnetically guided ablation catheter. © 2016 Wiley Periodicals, Inc.

  2. Image-Guided Spinal Ablation: A Review

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Tsoumakidou, Georgia, E-mail: gtsoumakidou@yahoo.com; Koch, Guillaume, E-mail: guillaume.koch@chru-strasbourg.fr; Caudrelier, Jean, E-mail: jean.caudrelier@chru-strasbourg.fr

    2016-09-15

    The image-guided thermal ablation procedures can be used to treat a variety of benign and malignant spinal tumours. Small size osteoid osteoma can be treated with laser or radiofrequency. Larger tumours (osteoblastoma, aneurysmal bone cyst and metastasis) can be addressed with radiofrequency or cryoablation. Results on the literature of spinal microwave ablation are scarce, and thus it should be used with caution. A distinct advantage of cryoablation is the ability to monitor the ice-ball by intermittent CT or MRI. The different thermal insulation, temperature and electrophysiological monitoring techniques should be applied. Cautious pre-procedural planning and intermittent intra-procedural monitoring of themore » ablation zone can help reduce neural complications. Tumour histology, patient clinical-functional status and life-expectancy should define the most efficient and least disabling treatment option.« less

  3. Rotary pin-in-maze discriminator

    DOEpatents

    Benavides, Gilbert L.

    1997-01-01

    A discriminator apparatus and method that discriminates between a unique signal and any other (incorrect) signal. The unique signal is a sequence of events; each event can assume one of two possible event states. Given the unique signal, a maze wheel is allowed to rotate fully in one direction. Given an incorrect signal, both the maze wheel and a pin wheel lock in position.

  4. State-of-the-art and emerging technologies for atrial fibrillation ablation.

    PubMed

    Dewire, Jane; Calkins, Hugh

    2010-03-01

    Catheter ablation is an important treatment modality for patients with atrial fibrillation (AF). Although the superiority of catheter ablation over antiarrhythmic drug therapy has been demonstrated in middle-aged patients with paroxysmal AF, the role the procedure in other patient subgroups-particularly those with long-standing persistent AF-has not been well defined. Furthermore, although AF ablation can be performed with reasonable efficacy and safety by experienced operators, long-term success rates for single procedures are suboptimal. Fortunately, extensive ongoing research will improve our understanding of the mechanisms of AF, and considerable funds are being invested in developing new ablation technologies to improve patient outcomes. These technologies include ablation catheters designed to electrically isolate the pulmonary veins with improved safety, efficacy, and speed, catheters designed to deliver radiofrequency energy with improved precision, robotic systems to address the technological demands of the procedure, improved imaging and electrical mapping systems, and MRI-guided ablation strategies. The tools, technologies, and techniques that will ultimately stand the test of time and become the standard approach to AF ablation in the future remain unclear. However, technological advances are sure to result in the necessary improvements in the safety and efficacy of AF ablation procedures.

  5. Radiofrequency and microwave energy sources in surgical ablation of atrial fibrillation: a comparative analysis.

    PubMed

    Topkara, Veli K; Williams, Mathew R; Barili, Fabio; Bastos, Renata; Liu, Judy F; Liberman, Elyse A; Russo, Mark J; Oz, Mehmet C; Argenziano, Michael

    2006-01-01

    Due to its complexity and risk of bleeding, the Maze III procedure has been largely replaced by surgical ablation for atrial fibrillation (AF) using alternative energy sources. Radiofrequency (RF) and microwave (MW) are the most commonly used energy forms. In this study, we sought to compare these energy modalities in terms of clinical outcomes. Two hundred five patients underwent surgical ablation of AF, from October 1999 to May 2004 at our institution via an endocardial approach. Patients were categorized into 2 groups: RF and MW. Baseline characteristics, operative details, and clinical outcomes were compared between the 2 groups. Rhythm success was defined as freedom from AF and atrial flutter as determined by postoperative electrocardiograms. One hundred twenty patients (58.5%) were ablated using RF, whereas 85 (41.5%) were ablated with MW. Most of the patients had persistent AF in both the RF and MW groups (85.7% versus 80.0%, respectively; P = .363). Intraoperative left atrial size was 6.4 +/- 1.7 cm for the RF group and 6.4 +/- 1.7 cm for the MW group (P = .820). Postoperative rhythm success at 6 and 12 months was 72.4% versus 71.4% (P +/- .611) and 75.0% versus 66.7% (P = .909) for the RF and MW groups, respectively. Hospital length of stay was comparable for both groups (15.4 +/- 14.0 versus 13.3 +/- 13.9 days; P = .307). Postoperative survival at 6 months, 1 year, and 3 years was 90.4%, 89.5%, and 86.1% for RF patients compared to 87.9%, 86.5%, and 84.4% for MW patients, respectively (log rank P = .490). RF and MW energy forms yield comparable postoperative rhythm success, hospital length of stay, and postoperative survival. Both sources are rapid, safe, and effective alternatives to "cut and sew" techniques for surgical treatment of AF.

  6. Guidance of aortic ablation using optical coherence tomography.

    PubMed

    Patel, Nirlep A; Li, Xingde; Stamper, Debra L; Fujimoto, James G; Brezinski, Mark E

    2003-04-01

    There is a significant need for an imaging modality that is capable of providing guidance for intravascular procedures, as current technologies suffer from significant limitations. In particular, laser ablation of in-stent restenosis, revascularization of chronic total occlusions, and pulmonary vein ablation could benefit from guidance. Optical coherence tomography (OCT), a recently introduced technology, is similar to ultrasound except that it measures the back-reflection of infrared light instead of sound. This study examines the ability of OCT to guide vascular laser ablation. Aorta samples underwent laser ablation using an argon laser at varying power outputs and were monitored with OCT collecting images at 4 frames. Samples were compared to the corresponding histopathology. Arterial layers could be differentiated in the images sequences. This allowed correlation of changes in the OCT image with power and duration in addition to histopathology. OCT provides real-time guidance of arterial ablation. At 4 frames, OCT was successfully able to show the microstructural changes in the vessel wall during laser ablation. Since current ablation procedures often injure surrounding tissue, the ability to minimize collateral damage to the adjoining tissue represents a useful advantage of this system. This study suggests a possible role for OCT in the guidance of intravascular procedures.

  7. Combination acetabular radiofrequency ablation and cementoplasty using a navigational radiofrequency ablation device and ultrahigh viscosity cement: technical note.

    PubMed

    Wallace, Adam N; Huang, Ambrose J; Vaswani, Devin; Chang, Randy O; Jennings, Jack W

    2016-03-01

    Percutaneous radiofrequency ablation and cementoplasty is an alternative palliative therapy for painful metastases involving axial load-bearing bones. This technical report describes the use of a navigational radiofrequency probe to ablate acetabular metastases from an anterior approach followed by instillation of ultrahigh viscosity cement under CT-fluoroscopic guidance. The tumor ablation databases of two institutions were retrospectively reviewed to identify patients who underwent combination acetabular radiofrequency ablation and cementoplasty using the STAR Tumor Ablation and StabiliT Vertebral Augmentation Systems (DFINE; San Jose, CA). Pre-procedure acetabular tumor volume was measured on cross-sectional imaging. Pre- and post-procedure pain scores were measured using the Numeric Rating Scale (10-point scale) and compared. Partial pain improvement was categorically defined as ≥ 2-point pain score reduction. Patients were evaluated for evidence of immediate complications. Electronic medical records were reviewed for evidence of delayed complications. During the study period, 12 patients with acetabular metastases were treated. The median tumor volume was 54.3 mL (range, 28.3-109.8 mL). Pre- and post-procedure pain scores were obtained from 92% (11/12) of the cohort. The median pre-procedure pain score was 8 (range, 3-10). Post-procedure pain scores were obtained 7 days (82%; 9/11), 11 days (9.1%; 1/11) or 21 days (9.1%; 1/11) after treatment. The median post-treatment pain score was 3 (range, 1-8), a statistically significant difference compared with pre-treatment (P = 0.002). Categorically, 73% (8/11) of patients reported partial pain relief after treatment. No immediate symptomatic complications occurred. Three patients (25%; 3/12) were discharged to hospice within 1 week of treatment. No delayed complications occurred in the remaining 75% (9/12) of patients during median clinical follow-up of 62 days (range, 14-178 days). Palliative percutaneous

  8. Rotary pin-in-maze discriminator

    DOEpatents

    Benavides, G.L.

    1997-05-06

    A discriminator apparatus and method that discriminates between a unique signal and any other (incorrect) signal are disclosed. The unique signal is a sequence of events; each event can assume one of two possible event states. Given the unique signal, a maze wheel is allowed to rotate fully in one direction. Given an incorrect signal, both the maze wheel and a pin wheel lock in position. 4 figs.

  9. A Maze Game on Android Using Growing Tree Method

    NASA Astrophysics Data System (ADS)

    Hendrawan, Y. F.

    2018-01-01

    A maze is a type of puzzle games where a player moves in complex and branched passages to find a particular target or location. One method to create a maze is the Growing Tree method. The method creates a tree that has branches which are the paths of a maze. This research explored three types of Growing Tree method implementations for maze generation on Android mobile devices. The layouts produced could be played in first and third-person perspectives. The experiment results showed that it took 17.3 seconds on average to generate 20 cells x 20 cells dynamic maze layouts.

  10. [Magnetic navigation for ablation of cardiac arrhythmias].

    PubMed

    Chen, Jian; Hoff, Per Ivar; Solheim, Eivind; Schuster, Peter; Off, Morten Kristian; Ohm, Ole-Jørgen

    2010-08-12

    The first use of magnetic navigation for radiofrequency ablation of supraventricular tachycardias, was published in 2004. Subsequently, the method has been used for treatment of most types of tachyarrhythmias. This paper provides an overview of the method, with special emphasis on usefulness of a new remote-controlled magnetic navigation system. The paper is based on our own scientific experience and literature identified through a non-systematic search in PubMed. The magnetic navigation system consists of two external electromagnets (to be placed on opposite sides of the patient), which guide an ablation catheter (with a small magnet at the tip of the catheter) to the target area in the heart. The accuracy of this procedure is higher than that with manual navigation. Personnel can be quickly trained to use remote magnetic navigation, but the procedure itself is time-consuming, particularly for patients with atrial fibrillation. The major advantage is a considerably lower radiation burden to both patient and operator, in some studies more than 50 %, and a corresponding reduction in physical strain on the operator. The incidence of procedure-related complications seems to be lower than that observed with use of manually operated ablation catheters. Work is ongoing to improve magnetic ablation catheters and methods that can simplify mapping procedures and improve efficacy of arrhythmia ablation. The basic cost for installing a complete magnetic navigation laboratory may be three times that of a conventional electrophysiological laboratory. The new magnetic navigation system has proved to be applicable during ablation for a variety of tachyarrhythmias, but is still under development.

  11. Optimization of Apparatus Design and Behavioral Measures for the Assessment of Visuo-Spatial Learning and Memory of Mice on the Barnes Maze

    ERIC Educational Resources Information Center

    O'Leary, Timothy P.; Brown, Richard E.

    2013-01-01

    We have previously shown that apparatus design can affect visual-spatial cue use and memory performance of mice on the Barnes maze. The present experiment extends these findings by determining the optimal behavioral measures and test procedure for analyzing visuo-spatial learning and memory in three different Barnes maze designs. Male and female…

  12. Randomized, Split-Face/Décolleté Comparative Trial of Procedure Enhancement System for Fractional non-Ablative Laser Resurfacing Treatment.

    PubMed

    Robinson, Deanne Mraz; Frulla, Ashton P

    2017-07-01

    INTRODUCTION: A topical proprietary procedural enhancement system (PES) containing a combination of active ingredients including a tripeptide and hexapeptide (TriHex Technology™, Alastin Procedure Enhancement Invasive System, ALASTIN Skincare™, Inc., Carlsbad, CA) has been used successfully to aid in healing and improve symptomatology following resurfacing procedures.

    METHODS: PES (Gentle Cleanser, Regenerating Skin Nectar with TriHex Technology™, Ultra Nourishing Moisturizer with TriHex Technology™, Soothe + Protect Recovery Balm, Broad Spectrum 30+ Sunscreen) was compared to a basic regimen (Aquaphor™, Cerave™ cleanser, Vanicream™, Alastin Broad Spectrum 30+ Sunscreen) in a split face/ décolleté trial following fractional non-ablative thulium-doped resurfacing treatment to the face or décolleté. The skin was pre-conditioned and treated during and after the procedure using the two regimens.

    RESULTS: A blinded investigator rated the PES statistically superior to the basic regimen on healing post-laser treatment on day 4 based on lentigines, texture, and Global Skin Quality. Subjects also reported 'better looking and feeling' skin on the PES side.

    CONCLUSION: PES appears to improve healing post-non ablative thulium-doped resurfacing treatment to the face/décolleté in comparison with standard of care.

    J Drugs Dermatol. 2017;16(7):707-710.

    .

  13. Microwave ablation versus radiofrequency ablation in the kidney: high-power triaxial antennas create larger ablation zones than similarly sized internally cooled electrodes.

    PubMed

    Laeseke, Paul F; Lee, Fred T; Sampson, Lisa A; van der Weide, Daniel W; Brace, Christopher L

    2009-09-01

    To determine whether microwave ablation with high-power triaxial antennas creates significantly larger ablation zones than radiofrequency (RF) ablation with similarly sized internally cooled electrodes. Twenty-eight 12-minute ablations were performed in an in vivo porcine kidney model. RF ablations were performed with a 200-W pulsed generator and either a single 17-gauge cooled electrode (n = 9) or three switched electrodes spaced 1.5 cm apart (n = 7). Microwave ablations were performed with one (n = 7), two (n = 3), or three (n = 2) 17-gauge triaxial antennas to deliver 90 W continuous power per antenna. Multiple antennas were powered simultaneously. Temperatures 1 cm from the applicator were measured during two RF and microwave ablations each. Animals were euthanized after ablation and ablation zone diameter, cross-sectional area, and circularity were measured. Comparisons between groups were performed with use of a mixed-effects model with P values less than .05 indicating statistical significance. No adverse events occurred during the procedures. Three-electrode RF (mean area, 14.7 cm(2)) and single-antenna microwave (mean area, 10.9 cm(2)) ablation zones were significantly larger than single-electrode RF zones (mean area, 5.6 cm(2); P = .001 and P = .0355, respectively). No significant differences were detected between single-antenna microwave and multiple-electrode RF. Ablation zone circularity was similar across groups (P > .05). Tissue temperatures were higher during microwave ablation (maximum temperature of 123 degrees C vs 100 degrees C for RF). Microwave ablation with high-power triaxial antennas created larger ablation zones in normal porcine kidneys than RF ablation with similarly sized applicators.

  14. Is AF Ablation Cost Effective?

    PubMed Central

    Martin-Doyle, William; Reynolds, Matthew R.

    2010-01-01

    The use of catheter ablation to treat AF is increasing rapidly, but there is presently an incomplete understanding of its cost-effectiveness. AF ablation procedures involve significant up-front expenditures, but multiple randomized trials have demonstrated that ablation is more effective than antiarrhythmic drugs at maintaining sinus rhythm in a second-line and possibly first-line rhythm control setting. Although truly long-term data are limited, ablation, as compared with antiarrrhythmic drugs, also appears associated with improved symptoms and quality of life and a reduction in downstream hospitalization and other health care resource utilization. Several groups have developed cost effectiveness models comparing AF ablation primarily to antiarrhythmic drugs and the model results suggest that ablation likely falls within the range generally accepted as cost-effective in developed nations. This paper will review available information on the cost-effectiveness of catheter ablation for the treatment of atrial fibrillation, and discuss continued areas of uncertainty where further research is required. PMID:20936083

  15. Burn, freeze, or photo-ablate?: comparative symptom profile in Barrett's dysplasia patients undergoing endoscopic ablation

    NASA Astrophysics Data System (ADS)

    Gill, Kanwar Rupinder S.; Gross, Seth A.; Greenwald, Bruce D.; Hemminger, Lois L.; Wolfsen, Herbert C.

    2009-06-01

    Background: There are few data available comparing endoscopic ablation methods for Barrett's esophagus with high-grade dysplasia (BE-HGD). Objective: To determine differences in symptoms and complications associated with endoscopic ablation. Design: Prospective observational study. Setting: Two tertiary care centers in USA. Patients: Consecutive patients with BE-HGD Interventions: In this pilot study, symptoms profile data were collected for BE-HGD patients among 3 endoscopic ablation methods: porfimer sodium photodynamic therapy, radiofrequency ablation and low-pressure liquid nitrogen spray cryotherapy. Main Outcome Measurements: Symptom profiles and complications from the procedures were assessed 1-8 weeks after treatment. Results: Ten BE-HGD patients were treated with each ablation modality (30 patients total; 25 men, median age: 69 years (range 53-81). All procedures were performed in the clinic setting and none required subsequent hospitalization. The most common symptoms among all therapies were chest pain, dysphagia and odynophagia. More patients (n=8) in the porfimer sodium photodynamic therapy group reported weight loss compared to radio-frequency ablactation (n=2) and cryotherapy (n=0). Four patients in the porfimer sodium photodynamic therapy group developed phototoxicity requiring medical treatment. Strictures, each requiring a single dilation, were found in radiofrequency ablactation (n=1) and porfimer sodium photodynamic therapy (n=2) patients. Limitations: Small sample size, non-randomized study. Conclusions: These three endoscopic therapies are associated with different types and severity of post-ablation symptoms and complications.

  16. Benign thyroid nodule unresponsive to radiofrequency ablation treated with laser ablation: a case report.

    PubMed

    Oddo, Silvia; Balestra, Margherita; Vera, Lara; Giusti, Massimo

    2018-05-11

    Radiofrequency ablation and laser ablation are safe and effective techniques for reducing thyroid nodule volume, neck symptoms, and cosmetic complaints. Therapeutic success is defined as a nodule reduction > 50% between 6 and 12 months after the procedure, but a percentage of nodules inexplicably do not respond to thermal ablation. We describe the case of a young Caucasian woman with a solid benign thyroid nodule who refused surgery and who had undergone radiofrequency ablation in 2013. The nodule did not respond in terms of either volume reduction or improvement in neck symptoms. After 2 years, given the patient's continued refusal of thyroidectomy, we proposed laser ablation. The nodule displayed a significant volume reduction (- 50% from radiofrequency ablation baseline volume, - 57% from laser ablation baseline), and the patient reported a significant improvement in neck symptoms (from 6/10 to 1/10 on a visual analogue scale). We conjecture that some benign thyroid nodules may be intrinsically resistant to necrosis when one specific ablation technique is used, but may respond to another technique. To the best of our knowledge, this is the first description of the effect of performing a different percutaneous ablation technique in a nodule that does not respond to radiofrequency ablation.

  17. Ablation of Rotor and Focal Sources Reduces Late Recurrence of Atrial Fibrillation Compared to Trigger Ablation Alone

    PubMed Central

    Narayan, Sanjiv M.; Baykaner, Tina; Clopton, Paul; Schricker, Amir; Lalani, Gautam; Krummen, David E.; Shivkumar, Kalyanam; Miller, John M.

    2014-01-01

    Objectives To determine if ablation that targets patient-specific AF-sustaining substrates (rotors or focal sources) is more durable than trigger ablation alone at preventing late AF recurrences. Background Late recurrence substantially limits the efficacy of pulmonary vein (PV) isolation for AF, and is associated with PV reconnection and the emergence of new triggers. Methods We performed 3 year follow-up of the CONFIRM trial, in which 92 consecutive AF patients (70.7% persistent) underwent novel computational mapping to reveal a median of 2 (IQR 1–2) rotors or focal sources in 97.7% of patients during AF. Ablation comprised source (Focal Impulse and Rotor Modulation, FIRM) then conventional ablation in n=27 (FIRM-guided), and conventional ablation alone in n=65 (FIRM-blinded). Patients were followed with implanted ECG monitors when possible (85.2% FIRM guided, 23.1% FIRM-blinded). Results On 890 days follow-up (median; IQR 224–1563) compared FIRM-blinded therapy, patients receiving FIRM-guided ablation maintained higher freedom from AF after 1.2±0.4 procedures (median 1, IQR 1–1) (77.8% vs 38.5%; p=0.001) and a single procedure (p>0.001), and higher freedom from all atrial arrhythmias (p=0.003). Freedom from AF was higher when ablation directly or coincidentally passed through sources than when it missed sources (p>0.001). CONCLUSIONS FIRM-guided ablation is more durable than conventional trigger-based ablation at preventing 3 year AF recurrence. Future studies should investigate how ablation of patient-specific AF-sustaining rotors and focal sources alters the natural history of arrhythmia recurrence. PMID:24632280

  18. Real-Time MRI-Guided Cardiac Cryo-Ablation: A Feasibility Study.

    PubMed

    Kholmovski, Eugene G; Coulombe, Nicolas; Silvernagel, Joshua; Angel, Nathan; Parker, Dennis; Macleod, Rob; Marrouche, Nassir; Ranjan, Ravi

    2016-05-01

    MRI-based ablation provides an attractive capability of seeing ablation-related tissue changes in real time. Here we describe a real-time MRI-based cardiac cryo-ablation system. Studies were performed in canine model (n = 4) using MR-compatible cryo-ablation devices built for animal use: focal cryo-catheter with 8 mm tip and 28 mm diameter cryo-balloon. The main steps of MRI-guided cardiac cryo-ablation procedure (real-time navigation, confirmation of tip-tissue contact, confirmation of vessel occlusion, real-time monitoring of a freeze zone formation, and intra-procedural assessment of lesions) were validated in a 3 Tesla clinical MRI scanner. The MRI compatible cryo-devices were advanced to the right atrium (RA) and right ventricle (RV) and their position was confirmed by real-time MRI. Specifically, contact between catheter tip and myocardium and occlusion of superior vena cava (SVC) by the balloon was visually validated. Focal cryo-lesions were created in the RV septum. Circumferential ablation of SVC-RA junction with no gaps was achieved using the cryo-balloon. Real-time visualization of freeze zone formation was achieved in all studies when lesions were successfully created. The ablations and presence of collateral damage were confirmed by T1-weighted and late gadolinium enhancement MRI and gross pathological examination. This study confirms the feasibility of a MRI-based cryo-ablation system in performing cardiac ablation procedures. The system allows real-time catheter navigation, confirmation of catheter tip-tissue contact, validation of vessel occlusion by cryo-balloon, real-time monitoring of a freeze zone formation, and intra-procedural assessment of ablations including collateral damage. © 2016 Wiley Periodicals, Inc.

  19. Intelligence-Augmented Rat Cyborgs in Maze Solving.

    PubMed

    Yu, Yipeng; Pan, Gang; Gong, Yongyue; Xu, Kedi; Zheng, Nenggan; Hua, Weidong; Zheng, Xiaoxiang; Wu, Zhaohui

    2016-01-01

    Cyborg intelligence is an emerging kind of intelligence paradigm. It aims to deeply integrate machine intelligence with biological intelligence by connecting machines and living beings via neural interfaces, enhancing strength by combining the biological cognition capability with the machine computational capability. Cyborg intelligence is considered to be a new way to augment living beings with machine intelligence. In this paper, we build rat cyborgs to demonstrate how they can expedite the maze escape task with integration of machine intelligence. We compare the performance of maze solving by computer, by individual rats, and by computer-aided rats (i.e. rat cyborgs). They were asked to find their way from a constant entrance to a constant exit in fourteen diverse mazes. Performance of maze solving was measured by steps, coverage rates, and time spent. The experimental results with six rats and their intelligence-augmented rat cyborgs show that rat cyborgs have the best performance in escaping from mazes. These results provide a proof-of-principle demonstration for cyborg intelligence. In addition, our novel cyborg intelligent system (rat cyborg) has great potential in various applications, such as search and rescue in complex terrains.

  20. Intelligence-Augmented Rat Cyborgs in Maze Solving

    PubMed Central

    Yu, Yipeng; Pan, Gang; Gong, Yongyue; Xu, Kedi; Zheng, Nenggan; Hua, Weidong; Zheng, Xiaoxiang; Wu, Zhaohui

    2016-01-01

    Cyborg intelligence is an emerging kind of intelligence paradigm. It aims to deeply integrate machine intelligence with biological intelligence by connecting machines and living beings via neural interfaces, enhancing strength by combining the biological cognition capability with the machine computational capability. Cyborg intelligence is considered to be a new way to augment living beings with machine intelligence. In this paper, we build rat cyborgs to demonstrate how they can expedite the maze escape task with integration of machine intelligence. We compare the performance of maze solving by computer, by individual rats, and by computer-aided rats (i.e. rat cyborgs). They were asked to find their way from a constant entrance to a constant exit in fourteen diverse mazes. Performance of maze solving was measured by steps, coverage rates, and time spent. The experimental results with six rats and their intelligence-augmented rat cyborgs show that rat cyborgs have the best performance in escaping from mazes. These results provide a proof-of-principle demonstration for cyborg intelligence. In addition, our novel cyborg intelligent system (rat cyborg) has great potential in various applications, such as search and rescue in complex terrains. PMID:26859299

  1. Characterization of Maze Performance in Adrenalectomized Sleep Disrupted Rats: A Comparison of Radial Arm Maze Performance between Adrenalectomized and Sham Adrenalectomized Sleep Disrupted Rats

    DTIC Science & Technology

    2007-01-01

    AFRL-HE-BR-TR-2007-0008 Characterization of Maze Performance in Adrenalectomized Sleep Disrupted Rats: A Comparison of Radial Arm Maze Performance ...Sept 2005-Dec 2006 To) 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Characterization of Maze Performance in Adrenalectomized Sleep Disrupted Rats...A Comparison of Radial Arm Maze Performance Between Adrenalectomized and Sham Adrenalectomized Sleep Disrupted Rats 5b. GRANT NUMBER FA86500-05

  2. Comparison of treatment outcomes between convergent procedure and catheter ablation for paroxysmal atrial fibrillation evaluated with implantable loop recorder monitoring.

    PubMed

    Jan, Matevž; Žižek, David; Geršak, Živa Miriam; Geršak, Borut

    2018-05-03

    While catheter ablation (CA) is an established treatment for symptomatic paroxysmal atrial fibrillation (AF), convergent epicardial and endocardial ablation procedure (CVP) has been primarily used to treat persistent AF. The aim of this single-center, prospective, randomized study was to compare treatment efficacy of CA and CVP in paroxysmal AF patients by monitoring AF, atrial tachycardia (AT), and atrial flutter (AFL) recurrence with Implantable Loop Recorder (ILR). Fifty patients (74% male) with history of paroxysmal AF were randomized between CA and CVP. Outcomes were determined by ILRs; every episode of AF/AT/AFL lasting 6 minutes or more was defined as a recurrence. AF burden (AFB) and required AF reinterventions (cardioversions and repeat ablations) were quantified after a 3-month blanking period. Total procedural (266 ± 44 vs. 242 ± 39 minutes) and ablation duration (52 ± 10 vs. 48 ± 12 minutes) was similar in both groups. Recurrence of AF/AT/AFL was more likely in the CA group compared to the CVP group (OR 3.78 (95% CI (1.17, 12.19), P  =  0.048)). During the follow-up period (mean 30.5 ± 6.9 months), higher AF burden and more reinterventions for recurrent AF were recorded in the CA group. There were more periprocedural complications in the CVP group (12.5%) compared to the CA group (0%). Treatment of paroxysmal AF with CVP showed less arrhythmia recurrence compared to CA. In addition, patients after CVP had fewer reinterventions and lower AF burden, but more periprocedural complications. © 2018 Wiley Periodicals, Inc.

  3. Emergency catheter ablation in critical patients

    PubMed Central

    Tebbenjohanns, Jürgen; Rühmkorf, Klaus

    2010-01-01

    Emergency catheter ablation is justified in critical patients with drug-refractory life-threatening arrhythmias. The procedure can be used for ablation of an accessory pathway in preexcitation syndrome with high risk of ventricular fibrillation and in patients with shock due to ischemic cardiomyopathy and incessant ventricular tachycardia. Emergency catheter ablation can also be justified in patients with an electrical storm of the implanted cardioverter-defibrillator or in patients with idiopathic ventricular fibrillation. PMID:20606793

  4. Is Cryoballoon Ablation Preferable to Radiofrequency Ablation for Treatment of Atrial Fibrillation by Pulmonary Vein Isolation? A Meta-Analysis

    PubMed Central

    Xu, Junxia; Huang, Yingqun; Cai, Hongbin; Qi, Yue; Jia, Nan; Shen, Weifeng; Lin, Jinxiu; Peng, Feng; Niu, Wenquan

    2014-01-01

    Objective Currently radiofrequency and cryoballoon ablations are the two standard ablation systems used for catheter ablation of atrial fibrillation; however, there is no universal consensus on which ablation is the optimal choice. We therefore sought to undertake a meta-analysis with special emphases on comparing the efficacy and safety between cryoballoon and radiofrequency ablations by synthesizing published clinical trials. Methods and Results Articles were identified by searching the MEDLINE and EMBASE databases before September 2013, by reviewing the bibliographies of eligible reports, and by consulting with experts in this field. Data were extracted independently and in duplicate. There were respectively 469 and 635 patients referred for cryoballoon and radiofrequency ablations from 14 qualified clinical trials. Overall analyses indicated that cryoballoon ablation significantly reduced fluoroscopic time and total procedure time by a weighted mean of 14.13 (95% confidence interval [95% CI]: 2.82 to 25.45; P = 0.014) minutes and 29.65 (95% CI: 8.54 to 50.77; P = 0.006) minutes compared with radiofrequency ablation, respectively, whereas ablation time in cryoballoon ablation was nonsignificantly elongated by a weighted mean of 11.66 (95% CI: −10.71 to 34.04; P = 0.307) minutes. Patients referred for cryoballoon ablation had a high yet nonsignificant success rate of catheter ablation compared with cryoballoon ablation (odds ratio; 95% CI; P: 1.34; 0.53 to 3.36; 0.538), and cryoballoon ablation was also found to be associated with the relatively low risk of having recurrent atrial fibrillation (0.75; 0.3 to 1.88; 0.538) and major complications (0.46; 0.11 to 1.83; 0.269). There was strong evidence of heterogeneity and low probability of publication bias. Conclusion Our findings demonstrate greater improvement in fluoroscopic time and total procedure duration for atrial fibrillation patients referred for cryoballoon ablation than those for

  5. LASER treatment for women with high-grade vaginal intraepithelial neoplasia: A propensity-matched analysis on the efficacy of ablative versus excisional procedures.

    PubMed

    Bogani, Giorgio; Ditto, Antonino; Martinelli, Fabio; Mosca, Lavinia; Chiappa, Valentina; Rossetti, Diego; Leone Roberti Maggiore, Umberto; Sabatucci, Ilaria; Lorusso, Domenica; Raspagliesi, Francesco

    2018-05-14

    To investigate the long-term effectiveness of LASER treatment in women affected by high-grade vaginal intra-epithelial neoplasia. Data of consecutive women treated for high-grade vaginal intra-epithelial neoplasia were retrieved. Efficacy and long-term effectiveness of ablative and excisional procedures were tested using a propensity-matched algorithm. Risk of recurrence over the time was assessed using Kaplan-Meier and Cox models. Overall, 204 patients met the inclusion criteria. LASER ablation and exicision were performed in 169 (82.8%) and 35 (17.2%) patients. A total of 41 (20%) patients developed high-grade vaginal intraepithelial neoplasia at a median follow-up of 65 (range, 6-120) months. We observed that only HPV persistence (HR: 2.37 [95%CI:1.03, 5.42]; P = 0.04) was associated with the risk of recurrence at multivariate analysis. Seven (3.4%) invasive cancers of the lower genital tract were observed in our population. Considering the efficacy of type of procedure (after we applied the propensity-matched analysis), we observed that type of procedure did not influence persistence of HPV infection (22.8% after excision and 15.7% after ablation; P = 0.424). Similarly, recurrence (17.1% vs. 18.6%; P = 1.00) and lower genital tract (2.8% vs. 1.4%; P = 1.00) rates were similar between groups. Women affected by high-grade vaginal intra-epithelial neoplasia are at high risk of recurrence. LASER ablation seems to be equivalent to excision in term of long-term effectiveness. Lasers Surg. Med. 9999:1-7, 2018. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

  6. Distinction between epigenic and hypogenic maze caves

    NASA Astrophysics Data System (ADS)

    Palmer, Arthur N.

    2011-11-01

    Certain caves formed by dissolution of bedrock have maze patterns composed of closed loops in which many intersecting fractures or pores have enlarged simultaneously. Their origin can be epigenic (by shallow circulation of meteoric groundwater) or hypogenic (by rising groundwater or production of deep-seated solutional aggressiveness). Epigenic mazes form by diffuse infiltration through a permeable insoluble caprock or by floodwater supplied by sinking streams. Most hypogenic caves involve deep sources of aggressiveness. Transverse hypogenic cave origin is a recently proposed concept in which groundwater of mainly meteoric origin rises across strata in the distal portions of large flow systems, to form mazes in soluble rock sandwiched between permeable but insoluble strata. The distinction between maze types is debated and is usually based on examination of diagnostic cave features and relation of caves to their regional setting. In this paper, the principles of mass transfer are applied to clarify the limits of each model, to show how cave origin is related to groundwater discharge, dissolution rate, and time. The results show that diffuse infiltration and floodwater can each form maze caves at geologically feasible rates (typically within 500 ka). Transverse hypogenic mazes in limestone, to enlarge significantly within 1 Ma, require an unusually high permeability of the non-carbonate beds (generally ≥ 10-4 cm/s), large discharge, and calcite saturation no greater than 90%, which is rare in deep diffuse flow in sedimentary rocks. Deep sources of aggressiveness are usually required. The origin of caves by transverse hypogenic flow is much more favorable in evaporite rocks than in carbonate rocks.

  7. Incidence and Cause of Hypertension During Adrenal Radiofrequency Ablation

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Yamakado, Koichiro, E-mail: yama@clin.medic.mie-u.ac.jp; Takaki, Haruyuki; Yamada, Tomomi

    Purpose: To evaluate the incidence and cause of hypertension prospectively during adrenal radiofrequency ablation (RFA). Methods: For this study, approved by our institutional review board, written informed consent was obtained from all patients. Patients who received RFA for adrenal tumors (adrenal ablation) and other abdominal tumors (nonadrenal ablation) were included in this prospective study. Blood pressure was monitored during RFA. Serum adrenal hormone levels including epinephrine, norepinephrine, dopamine, and cortisol levels were measured before and during RFA. The respective incidences of procedural hypertension (systolic blood pressure >200 mmHg) of the two patient groups were compared. Factors correlating with procedural systolicmore » blood pressure were evaluated by regression analysis.ResultsNine patients underwent adrenal RFA and another 9 patients liver (n = 5) and renal (n = 4) RFA. Asymptomatic procedural hypertension that returned to the baseline by injecting calcium blocker was found in 7 (38.9%) of 18 patients. The incidence of procedural hypertension was significantly higher in the adrenal ablation group (66.7%, 6/9) than in the nonadrenal ablation group (11.1%, 1/9, P < 0.0498). Procedural systolic blood pressure was significantly correlated with serum epinephrine (R{sup 2} = 0.68, P < 0.0001) and norepinephrine (R{sup 2} = 0.72, P < 0.0001) levels during RFA. The other adrenal hormones did not show correlation with procedural systolic blood pressure. Conclusion: Hypertension occurs frequently during adrenal RFA because of the release of catecholamine.« less

  8. Guiding brine shrimp through mazes by solving reaction diffusion equations

    NASA Astrophysics Data System (ADS)

    Singal, Krishma; Fenton, Flavio

    Excitable systems driven by reaction diffusion equations have been shown to not only find solutions to mazes but to also to find the shortest path between the beginning and the end of the maze. In this talk we describe how we can use the Fitzhugh-Nagumo model, a generic model for excitable media, to solve a maze by varying the basin of attraction of its two fixed points. We demonstrate how two dimensional mazes are solved numerically using a Java Applet and then accelerated to run in real time by using graphic processors (GPUs). An application of this work is shown by guiding phototactic brine shrimp through a maze solved by the algorithm. Once the path is obtained, an Arduino directs the shrimp through the maze using lights from LEDs placed at the floor of the Maze. This method running in real time could be eventually used for guiding robots and cars through traffic.

  9. Delayed-matching-to-place Task in a Dry Maze to Measure Spatial Working Memory in Mice.

    PubMed

    Feng, Xi; Krukowski, Karen; Jopson, Timothy; Rosi, Susanna

    2017-07-05

    The delayed-matching-to-place (DMP) dry maze test is a variant of DMP water maze (Steele and Morris, 1999; Faizi et al. , 2012) which measures spatial working/episodic-like learning and memory that depends on both hippocampal and cortical functions (Wang and Morris, 2010; Euston et al. , 2012). Using this test we can detect normal aging related spatial working memory decline, as well as trauma induced working memory deficits. Furthermore, we recently reported that fractionated whole brain irradiation does not affect working memory in mice (Feng et al. , 2016). Here we describe the experimental setup and procedures of this behavioral test.

  10. Arrhythmia Termination Versus Elimination of Dormant Pulmonary Vein Conduction as a Procedural End Point of Catheter Ablation for Paroxysmal Atrial Fibrillation: A Prospective Randomized Trial.

    PubMed

    Theis, Cathrin; Konrad, Torsten; Mollnau, Hanke; Sonnenschein, Sebastian; Kämpfner, Denise; Potstawa, Maik; Ocete, Blanca Quesada; Bock, Karsten; Himmrich, Ewald; Münzel, Thomas; Rostock, Thomas

    2015-10-01

    Pulmonary vein isolation (PVI) is still associated with a substantial number of arrhythmia recurrences in paroxysmal atrial fibrillation (AF). This prospective, randomized study aimed to compare 2 different procedural strategies. A total of 152 patients undergoing de novo ablation for paroxysmal AF were randomized to 2 different treatment arms. The procedure in group A consisted of PVI exclusively. In this group, all isolated PVs were challenged with adenosine to reveal and ablate dormant conduction. In group B, PVI was performed with the patient either in spontaneous or in induced AF. If AF did not terminate with PVI, ablation was continued by targeting extra-PV AF sources with the desired procedural end point of termination to sinus rhythm. Primary study end point was freedom from arrhythmia during 1-year follow-up. In group A, adenosine provoked dormant conduction in 31 (41%) patients with a mean of 1.6±0.8 transiently recovered PVs per patient. Termination of AF during PVI was observed in 31 (65%) patients, whereas AF persisted afterward in 17 (35%) patients. AF termination occurred in 13 (76%) patients by AF source ablation. After 1-year follow-up, significantly more group B patients were free of arrhythmia recurrences (87 versus 68%; P=0.006). During redo ablation, the rate of PV reconduction did not differ between both groups (group A: 55% versus group B: 61%; P=0.25). Elimination of extra-PV AF sources after PVI is superior to sole PV isolation with the adjunct of abolishing potential dormant conduction. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02238392. © 2015 The Authors.

  11. Atriocaval Rupture After Right Atrial Isthmus Ablation for Atrial Flutter.

    PubMed

    Vloka, Caroline; Nelson, Daniel W; Wetherbee, Jule

    2016-06-01

    A patient with symptomatic typical atrial flutter (AFL) underwent right atrial isthmus ablation with an 8-mm catheter. Eight months later, his typical AFL recurred. Ten months later, he underwent a repeat right atrial isthmus ablation with an irrigated tip catheter and an 8-mm tip catheter. Six weeks after his second procedure, while performing intense sprint intervals on a treadmill, he developed an abrupt onset of chest pain, hypotension, and cardiac tamponade. He underwent emergency surgery to repair an atriocaval rupture and has done well since. Our report suggests that an association of multiple radiofrequency ablations with increased risk for delayed atriocaval rupture occurring 1 to 3 months after ablation. In conclusion, although patients generally were advised to limit exercise for 1 to 2 weeks after AFL ablation procedures in the past, it may be prudent to avoid intense exercise for at least 3 months after procedure. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. CT thermometry for cone-beam CT guided ablation

    NASA Astrophysics Data System (ADS)

    DeStefano, Zachary; Abi-Jaoudeh, Nadine; Li, Ming; Wood, Bradford J.; Summers, Ronald M.; Yao, Jianhua

    2016-03-01

    Monitoring temperature during a cone-beam CT (CBCT) guided ablation procedure is important for prevention of over-treatment and under-treatment. In order to accomplish ideal temperature monitoring, a thermometry map must be generated. Previously, this was attempted using CBCT scans of a pig shoulder undergoing ablation.1 We are extending this work by using CBCT scans of real patients and incorporating more processing steps. We register the scans before comparing them due to the movement and deformation of organs. We then automatically locate the needle tip and the ablation zone. We employ a robust change metric due to image noise and artifacts. This change metric takes windows around each pixel and uses an equation inspired by Time Delay Analysis to calculate the error between windows with the assumption that there is an ideal spatial offset. Once the change map is generated, we correlate change data with measured temperature data at the key points in the region. This allows us to transform our change map into a thermal map. This thermal map is then able to provide an estimate as to the size and temperature of the ablation zone. We evaluated our procedure on a data set of 12 patients who had a total of 24 ablation procedures performed. We were able to generate reasonable thermal maps with varying degrees of accuracy. The average error ranged from 2.7 to 16.2 degrees Celsius. In addition to providing estimates of the size of the ablation zone for surgical guidance, 3D visualizations of the ablation zone and needle are also produced.

  13. Thermal protection during percutaneous thermal ablation procedures: interest of carbon dioxide dissection and temperature monitoring.

    PubMed

    Buy, Xavier; Tok, Chung-Hong; Szwarc, Daniel; Bierry, Guillaume; Gangi, Afshin

    2009-05-01

    Percutaneous image-guided thermal ablation of tumor is widely used, and thermal injury to collateral structures is a known complication of this technique. To avoid thermal damage to surrounding structures, several protection techniques have been reported. We report the use of a simple and effective protective technique combining carbon dioxide dissection and thermocouple: CO(2) displaces the nontarget structures, and its low thermal conductivity provides excellent insulation; insertion of a thermocouple in contact with vulnerable structures achieves continuous thermal monitoring. We performed percutaneous thermal ablation of 37 tumors in 35 patients (4 laser, 10 radiofrequency, and 23 cryoablations) with protection of adjacent vulnerable structures by using CO(2) dissection combined with continuous thermal monitoring with thermocouple. Tumor locations were various (19 intra-abdominal tumors including 4 livers and 9 kidneys, 18 musculoskeletal tumors including 11 spinal tumors). CO(2) volume ranged from 10 ml (epidural space) to 1500 ml (abdominal). Repeated insufflations were performed if necessary, depending on the information given by the thermocouple and imaging control. Dissection with optimal thermal protection was achieved in all cases except two patients where adherences (one postoperative, one arachnoiditis) blocked proper gaseous distribution. No complication referred to this technique was noted. This safe, cost-effective, and simple method increases the safety and the success rate of percutaneous thermal ablation procedures. It also offers the potential to increase the number of tumors that can be treated via a percutaneous approach.

  14. Kepler Corn Maze Reporter Package for TWAN

    NASA Image and Video Library

    2011-10-06

    The Dell'Osso Family Farm, located on the outskirts of Lathrop, California, held the grand opening of their corn maze that was designed with a NASA theme, in this case, the Kepler mission. The maze is part of a nation-wide group of farms that are honoring NASA's achievements called Space Farm 7.

  15. Integration of myocardial scar identified by preoperative delayed contrast-enhanced MRI into a high-resolution mapping system for planning and guidance of VT ablation procedures

    NASA Astrophysics Data System (ADS)

    Rettmann, M. E.; Suzuki, A.; Wang, S.; Pottinger, N.; Arter, J.; Netzer, A.; Parker, K.; Viker, K.; Packer, D. L.

    2017-03-01

    Myocardial scarring creates a substrate for reentrant circuits which can lead to ventricular tachycardia. In ventricular catheter ablation therapy, regions of myocardial scarring are targeted to interrupt arrhythmic electrical pathways. Low voltage regions are a surrogate for myocardial scar and are identified by generating an electro anatomic map at the start of the procedure. Recent efforts have focussed on integration of preoperative scar information generated from delayed contrast-enhanced MR imaging to augment intraprocedural information. In this work, we describe an initial feasibility study of integration of a preoperative MRI derived scar maps into a high-resolution mapping system to improve planning and guidance of VT ablation procedures.

  16. Barnes maze testing strategies with small and large rodent models.

    PubMed

    Rosenfeld, Cheryl S; Ferguson, Sherry A

    2014-02-26

    Spatial learning and memory of laboratory rodents is often assessed via navigational ability in mazes, most popular of which are the water and dry-land (Barnes) mazes. Improved performance over sessions or trials is thought to reflect learning and memory of the escape cage/platform location. Considered less stressful than water mazes, the Barnes maze is a relatively simple design of a circular platform top with several holes equally spaced around the perimeter edge. All but one of the holes are false-bottomed or blind-ending, while one leads to an escape cage. Mildly aversive stimuli (e.g. bright overhead lights) provide motivation to locate the escape cage. Latency to locate the escape cage can be measured during the session; however, additional endpoints typically require video recording. From those video recordings, use of automated tracking software can generate a variety of endpoints that are similar to those produced in water mazes (e.g. distance traveled, velocity/speed, time spent in the correct quadrant, time spent moving/resting, and confirmation of latency). Type of search strategy (i.e. random, serial, or direct) can be categorized as well. Barnes maze construction and testing methodologies can differ for small rodents, such as mice, and large rodents, such as rats. For example, while extra-maze cues are effective for rats, smaller wild rodents may require intra-maze cues with a visual barrier around the maze. Appropriate stimuli must be identified which motivate the rodent to locate the escape cage. Both Barnes and water mazes can be time consuming as 4-7 test trials are typically required to detect improved learning and memory performance (e.g. shorter latencies or path lengths to locate the escape platform or cage) and/or differences between experimental groups. Even so, the Barnes maze is a widely employed behavioral assessment measuring spatial navigational abilities and their potential disruption by genetic, neurobehavioral manipulations, or drug

  17. Long-term outcome of catheter ablation in atrial fibrillation patients with coexistent metabolic syndrome and obstructive sleep apnea: impact of repeat procedures versus lifestyle changes.

    PubMed

    Mohanty, Sanghamitra; Mohanty, Prasant; DI Biase, Luigi; Bai, Rong; Trivedi, Chintan; Santangeli, Pasquale; Santoro, Francesco; Hongo, Richard; Hao, Steven; Beheiry, Salwa; Burkhardt, David; Gallinghouse, Joseph G; Horton, Rodney; Sanchez, Javier E; Bailey, Shane; Hranitzky, Patrick M; Zagrodzky, Jason; Natale, Andrea

    2014-09-01

    Metabolic syndrome (MS) and obstructive sleep apnea (OSA) are well-known independent risk factors for atrial fibrillation (AF) recurrence. This study evaluated ablation outcome in AF patients with coexistent MS and OSA and influence of lifestyle modifications (LSM) on arrhythmia recurrence. We included 1,257 AF patients undergoing first catheter ablation (30% paroxysmal AF). Patients having MS + OSA were classified into Group 1 (n = 126; 64 ± 8 years; 76% male). Group 2 (n = 1,131; 62 ± 11 years; 72% male) included those with either MS (n = 431) or OSA (n = 112; no CPAP users) or neither of these comorbidities (n = 588). Patients experiencing recurrence after first procedure were divided into 2 subgroups; those having sporadic events (frequency < 2 months) remained on previously ineffective antiarrhythmic drugs (AAD) and aggressive LSM, while those with persistent arrhythmia (incessant or ≥2 months) underwent repeat ablation. After 34 ± 8 months of first procedure, 66 (52%) in Group 1 and 386 (34%) in Group 2 had recurrence (P < 0.001). Recurrence rate in only-MS, only-OSA, and without MS/OSA groups were 40%, 38%, and 29%, respectively. Patients with MS + OSA experienced substantially higher recurrence compared to those with lone MS or OSA (52% vs. 40% vs. 38%; P = 0.036). Of the 452 patients having recurrence, 250 underwent redo-ablation and 194 remained on AAD and LSM. At 20 ± 6 months, 76% of the redo group remained arrhythmia-free off AAD whereas 74% of the LSM group were free from recurrence (P = 0.71), 33% of which were off AAD. MS and OSA have additive negative effect on arrhythmia recurrence following single procedure. Repeat ablation or compliant LSM increase freedom from recurrent AF. © 2014 Wiley Periodicals, Inc.

  18. Delayed-matching-to-place Task in a Dry Maze to Measure Spatial Working Memory in Mice

    PubMed Central

    Feng, Xi; Krukowski, Karen; Jopson, Timothy; Rosi, Susanna

    2017-01-01

    The delayed-matching-to-place (DMP) dry maze test is a variant of DMP water maze (Steele and Morris, 1999; Faizi et al., 2012) which measures spatial working/episodic-like learning and memory that depends on both hippocampal and cortical functions (Wang and Morris, 2010; Euston et al., 2012). Using this test we can detect normal aging related spatial working memory decline, as well as trauma induced working memory deficits. Furthermore, we recently reported that fractionated whole brain irradiation does not affect working memory in mice (Feng et al., 2016). Here we describe the experimental setup and procedures of this behavioral test. PMID:28944261

  19. Robotic navigation and ablation.

    PubMed

    Malcolme-Lawes, L; Kanagaratnam, P

    2010-12-01

    Robotic technologies have been developed to allow optimal catheter stability and reproducible catheter movements with the aim of achieving contiguous and transmural lesion delivery. Two systems for remote navigation of catheters within the heart have been developed; the first is based on a magnetic navigation system (MNS) Niobe, Stereotaxis, Saint-Louis, Missouri, USA, the second is based on a steerable sheath system (Sensei, Hansen Medical, Mountain View, CA, USA). Both robotic and magnetic navigation systems have proven to be feasible for performing ablation of both simple and complex arrhythmias, particularly atrial fibrillation. Studies to date have shown similar success rates for AF ablation compared to that of manual ablation, with many groups finding a reduction in fluoroscopy times. However, the early learning curve of cases demonstrated longer procedure times, mainly due to additional setup times. With centres performing increasing numbers of robotic ablations and the introduction of a pressure monitoring system, lower power settings and instinctive driving software, complication rates are reducing, and fluoroscopy times have been lower than manual ablation in many studies. As the demand for catheter ablation for arrhythmias such as atrial fibrillation increases and the number of centres performing these ablations increases, the demand for systems which reduce the hand skill requirement and improve the comfort of the operator will also increase.

  20. Cognitive and Neural Determinants of Response Strategy in the Dual-Solution Plus-Maze Task

    ERIC Educational Resources Information Center

    De Leonibus, Elvira; Costantini, Vivian J. A.; Massaro, Antonio; Mandolesi, Georgia; Vanni, Valentina; Luvisetto, Siro; Pavone, Flaminia; Oliverio, Alberto; Mele, Andrea

    2011-01-01

    Response strategy in the dual-solution plus maze is regarded as a form of stimulus-response learning. In this study, by using an outcome devaluation procedure, we show that it can be based on both action-outcome and stimulus-response habit learning, depending on the amount of training that the animals receive. Furthermore, we show that…

  1. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation of liver tumours.

    PubMed

    Wijlemans, J W; Bartels, L W; Deckers, R; Ries, M; Mali, W P Th M; Moonen, C T W; van den Bosch, M A A J

    2012-09-28

    Recent decades have seen a paradigm shift in the treatment of liver tumours from invasive surgical procedures to minimally invasive image-guided ablation techniques. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) is a novel, completely non-invasive ablation technique that has the potential to change the field of liver tumour ablation. The image guidance, using MR imaging and MR temperature mapping, provides excellent planning images and real-time temperature information during the ablation procedure. However, before clinical implementation of MR-HIFU for liver tumour ablation is feasible, several organ-specific challenges have to be addressed. In this review we discuss the MR-HIFU ablation technique, the liver-specific challenges for MR-HIFU tumour ablation, and the proposed solutions for clinical translation.

  2. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation of liver tumours

    PubMed Central

    Bartels, L.W.; Deckers, R.; Ries, M.; Mali, W.P.Th.M.; Moonen, C.T.W.; van den Bosch, M.A.A.J.

    2012-01-01

    Abstract Recent decades have seen a paradigm shift in the treatment of liver tumours from invasive surgical procedures to minimally invasive image-guided ablation techniques. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) is a novel, completely non-invasive ablation technique that has the potential to change the field of liver tumour ablation. The image guidance, using MR imaging and MR temperature mapping, provides excellent planning images and real-time temperature information during the ablation procedure. However, before clinical implementation of MR-HIFU for liver tumour ablation is feasible, several organ-specific challenges have to be addressed. In this review we discuss the MR-HIFU ablation technique, the liver-specific challenges for MR-HIFU tumour ablation, and the proposed solutions for clinical translation. PMID:23022541

  3. Hippocampal activation during the recall of remote spatial memories in radial maze tasks.

    PubMed

    Schlesiger, Magdalene I; Cressey, John C; Boublil, Brittney; Koenig, Julie; Melvin, Neal R; Leutgeb, Jill K; Leutgeb, Stefan

    2013-11-01

    Temporally graded retrograde amnesia is observed in human patients with medial temporal lobe lesions as well as in animal models of medial temporal lobe lesions. A time-limited role for these structures in memory recall has also been suggested by the observation that the rodent hippocampus and entorhinal cortex are activated during the retrieval of recent but not of remote memories. One notable exception is the recall of remote memories for platform locations in the water maze, which requires an intact hippocampus and results in hippocampal activation irrespective of the age of the memory. These findings raise the question whether the hippocampus is always involved in the recall of spatial memories or, alternatively, whether it might be required for procedural computations in the water maze task, such as for calculating a path to a hidden platform. We performed spatial memory testing in radial maze tasks to distinguish between these possibilities. Radial maze tasks require a choice between spatial locations on a center platform and thus have a lesser requirement for navigation than the water maze. However, we used a behavioral design in the radial maze that retained other aspects of the standard water maze task, such as the use of multiple start locations and retention testing in a single trial. Using the immediate early gene c-fos as a marker for neuronal activation, we found that all hippocampal subregions were more activated during the recall of remote compared to recent spatial memories. In areas CA3 and CA1, activation during remote memory testing was higher than in rats that were merely reexposed to the testing environment after the same time interval. Conversely, Fos levels in the dentate gyrus were increased after retention testing to the extent that was also observed in the corresponding exposure control group. This pattern of hippocampal activation was also obtained in a second version of the task that only used a single start arm instead of multiple

  4. An automated maze task for assessing hippocampus-sensitive memory in mice☆

    PubMed Central

    Pioli, Elsa Y.; Gaskill, Brianna N.; Gilmour, Gary; Tricklebank, Mark D.; Dix, Sophie L.; Bannerman, David; Garner, Joseph P.

    2014-01-01

    Memory deficits associated with hippocampal dysfunction are a key feature of a number of neurodegenerative and psychiatric disorders. The discrete-trial rewarded alternation T-maze task is highly sensitive to hippocampal dysfunction. Normal mice have spontaneously high levels of alternation, whereas hippocampal-lesioned mice are dramatically impaired. However, this is a hand-run task and handling has been shown to impact crucially on behavioural responses, as well as being labour-intensive and therefore unsuitable for high-throughput studies. To overcome this, a fully automated maze was designed. The maze was attached to the mouse's home cage and the subject earned all of its food by running through the maze. In this study the hippocampal dependence of rewarded alternation in the automated maze was assessed. Bilateral hippocampal-lesioned mice were assessed in the standard, hand-run, discrete-trial rewarded alternation paradigm and in the automated paradigm, according to a cross-over design. A similarly robust lesion effect on alternation performance was found in both mazes, confirming the sensitivity of the automated maze to hippocampal lesions. Moreover, the performance of the animals in the automated maze was not affected by their handling history whereas performance in the hand-run maze was affected by prior testing history. By having more stable performance and by decreasing human contact the automated maze may offer opportunities to reduce extraneous experimental variation and therefore increase the reproducibility within and/or between laboratories. Furthermore, automation potentially allows for greater experimental throughput and hence suitability for use in assessment of cognitive function in drug discovery. PMID:24333574

  5. Unbiased classification of spatial strategies in the Barnes maze.

    PubMed

    Illouz, Tomer; Madar, Ravit; Clague, Charlotte; Griffioen, Kathleen J; Louzoun, Yoram; Okun, Eitan

    2016-11-01

    Spatial learning is one of the most widely studied cognitive domains in neuroscience. The Morris water maze and the Barnes maze are the most commonly used techniques to assess spatial learning and memory in rodents. Despite the fact that these tasks are well-validated paradigms for testing spatial learning abilities, manual categorization of performance into behavioral strategies is subject to individual interpretation, and thus to bias. We have previously described an unbiased machine-learning algorithm to classify spatial strategies in the Morris water maze. Here, we offer a support vector machine-based, automated, Barnes-maze unbiased strategy (BUNS) classification algorithm, as well as a cognitive score scale that can be used for memory acquisition, reversal training and probe trials. The BUNS algorithm can greatly benefit Barnes maze users as it provides a standardized method of strategy classification and cognitive scoring scale, which cannot be derived from typical Barnes maze data analysis. Freely available on the web at http://okunlab.wix.com/okunlab as a MATLAB application. eitan.okun@biu.ac.ilSupplementary information: Supplementary data are available at Bioinformatics online. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  6. Computerized Maze Navigation and On-Road Performance by Drivers With Dementia

    PubMed Central

    Ott, Brian R.; Festa, Elena K.; Amick, Melissa M.; Grace, Janet; Davis, Jennifer D.; Heindel, William C.

    2012-01-01

    This study examined the ability of computerized maze test performance to predict the road test performance of cognitively impaired and normal older drivers. The authors examined 133 older drivers, including 65 with probable Alzheimer disease, 23 with possible Alzheimer disease, and 45 control subjects without cognitive impairment. Subjects completed 5 computerized maze tasks employing a touch screen and pointer as well as a battery of standard neuropsychological tests. Parameters measured for mazes included errors, planning time, drawing time, and total time. Within 2 weeks, subjects were examined by a professional driving instructor on a standardized road test modeled after the Washington University Road Test. Road test total score was significantly correlated with total time across the 5 mazes. This maze score was significant for both Alzheimer disease subjects and control subjects. One maze in particular, requiring less than 2 minutes to complete, was highly correlated with driving performance. For the standard neuropsychological tests, highest correlations were seen with Trail Making A (TrailsA) and the Hopkins Verbal Learning Tests Trial 1 (HVLT1). Multiple regression models for road test score using stepwise subtraction of maze and neuropsychological test variables revealed significant independent contributions for total maze time, HVLT1, and TrailsA for the entire group; total maze time and HVLT1 for Alzheimer disease subjects; and TrailsA for normal subjects. As a visual analog of driving, a brief computerized test of maze navigation time compares well to standard neuropsychological tests of psychomotor speed, scanning, attention, and working memory as a predictor of driving performance by persons with early Alzheimer disease and normal elders. Measurement of maze task performance appears to be useful in the assessment of older drivers at risk for hazardous driving. PMID:18287166

  7. Contemporary Tools and Techniques for Substrate Ablation of Ventricular Tachycardia in Structural Heart Disease.

    PubMed

    Hutchinson, Mathew D; Garza, Hyon-He K

    2018-02-24

    As we have witnessed in other arenas of catheter-based therapeutics, ventricular tachycardia (VT) ablation has become increasingly anatomical in its execution. Multi-modality imaging provides anatomical detail in substrate characterization, which is often complex in nonischemic cardiomyopathy patients. Patients with intramural, intraseptal, and epicardial substrates provide challenges in delivering effective ablation to the critical arrhythmia substrate due to the depth of origin or the presence of adjacent critical structures. Novel ablation techniques such as simultaneous unipolar or bipolar ablation can be useful to achieve greater lesion depth, though at the expense of increasing collateral damage. Disruptive technologies like stereotactic radioablation may provide a tailored approach to these complex patients while minimizing procedural risk. Substrate ablation is a cornerstone of the contemporary VT ablation procedure, and recent data suggest that it is as effective and more efficient that conventional activation guided ablation. A number of specific targets and techniques for substrate ablation have been described, and all have shown a fairly high success in achieving their acute procedural endpoint. Substrate ablation also provides a novel and reproducible procedural endpoint, which may add predictive value for VT recurrence beyond conventional programmed stimulation. Extrapolation of outcome data to nonischemic phenotypes requires caution given both the variability in substrate nonischemic distribution and the underrepresentation of these patients in previous trials.

  8. Radiofrequency ablation versus electrocautery in tonsillectomy.

    PubMed

    Hall, Daniel J; Littlefield, Philip D; Birkmire-Peters, Deborah P; Holtel, Michael R

    2004-03-01

    The objective of this study was to compare the safety, difficulty of removal, and postoperative pain profile of radiofrequency ablation versus standard electrocautery removal of tonsils. A prospective, blinded study was designed to remove 1 tonsil with each of the 2 methods. Time of operation, estimated blood loss, difficulty of operation, postoperative pain, rate of postoperative hemorrhage, and the patient's preferred technique were evaluated. The operating time was significantly longer (P < 0.007) and the patients reported significantly less pain (P < 0.001) with radiofrequency ablation. There were no differences in blood loss, difficulty of operation, or postoperative hemorrhage rates. The patients preferred the radiofrequency ablation technique (P < 0.001). Radiofrequency ablation is a viable method to remove tonsillar tissue. Operating time for this procedure will likely decrease with experience. There was significantly less pain reported with radiofrequency ablation compared with standard electrocautery.

  9. Atrial fibrillation ablation using very short duration 50 W ablations and contact force sensing catheters.

    PubMed

    Winkle, Roger A; Moskovitz, Ryan; Hardwin Mead, R; Engel, Gregory; Kong, Melissa H; Fleming, William; Salcedo, Jonathan; Patrawala, Rob A; Tranter, John H; Shai, Isaac

    2018-06-01

    The optimal radiofrequency (RF) power and lesion duration using contact force (CF) sensing catheters for atrial fibrillation (AF) ablation are unknown. We evaluate 50 W RF power for very short durations using CF sensing catheters during AF ablation. We evaluated 51 patients with paroxysmal (n = 20) or persistent (n = 31) AF undergoing initial RF ablation. A total of 3961 50 W RF lesions were given (average 77.6 ± 19.1/patient) for an average duration of only 11.2 ± 3.7 s. As CF increased from < 10 to > 40 g, the RF application duration decreased from 13.7 ± 4.4 to 8.6 ± 2.5 s (p < 0.0005). Impedance drops occurred in all ablations, and for patients in sinus rhythm, there was loss of pacing capture during RF delivery suggesting lesion creation. Only 3% of the ablation lesions were at < 5 g and 1% at > 40 g of force. As CF increased, the force time integral (FTI) increased from 47 ± 24 to 376 ± 102 gs (p < 0.0005) and the lesion index (LSI) increased from 4.10 ± 0.51 to 7.63 ± 0.50 (p < 0.0005). Both procedure time (101 ± 19.7 min) and total RF energy time (895 ± 258 s) were very short. For paroxysmal AF, the single procedure freedom from AF was 86% at 1 and 2 years. For persistent AF, it was 83% at 1 year and 72% at 2 years. There were no complications. Short duration 50 W ablations using CF sensing catheters are safe and result in excellent long-term freedom from AF for both paroxysmal and persistent AF with short procedure times and small amounts of total RF energy delivery.

  10. Improving Thermal Ablation Delineation With Electrode Vibration Elastography Using a Bidirectional Wave Propagation Assumption

    PubMed Central

    DeWall, Ryan J.; Varghese, Tomy

    2013-01-01

    Thermal ablation procedures are commonly used to treat hepatic cancers and accurate ablation representation on shear wave velocity images is crucial to ensure complete treatment of the malignant target. Electrode vibration elastography is a shear wave imaging technique recently developed to monitor thermal ablation extent during treatment procedures. Previous work has shown good lateral boundary delineation of ablated volumes, but axial delineation was more ambiguous, which may have resulted from the assumption of lateral shear wave propagation. In this work, we assume both lateral and axial wave propagation and compare wave velocity images to those assuming only lateral shear wave propagation in finite element simulations, tissue-mimicking phantoms, and bovine liver tissue. Our results show that assuming bidirectional wave propagation minimizes artifacts above and below ablated volumes, yielding a more accurate representation of the ablated region on shear wave velocity images. Area overestimation was reduced from 13.4% to 3.6% in a stiff-inclusion tissue-mimicking phantom and from 9.1% to 0.8% in a radio-frequency ablation in bovine liver tissue. More accurate ablation representation during ablation procedures increases the likelihood of complete treatment of the malignant target, decreasing tumor recurrence. PMID:22293748

  11. Improving thermal ablation delineation with electrode vibration elastography using a bidirectional wave propagation assumption.

    PubMed

    DeWall, Ryan J; Varghese, Tomy

    2012-01-01

    Thermal ablation procedures are commonly used to treat hepatic cancers and accurate ablation representation on shear wave velocity images is crucial to ensure complete treatment of the malignant target. Electrode vibration elastography is a shear wave imaging technique recently developed to monitor thermal ablation extent during treatment procedures. Previous work has shown good lateral boundary delineation of ablated volumes, but axial delineation was more ambiguous, which may have resulted from the assumption of lateral shear wave propagation. In this work, we assume both lateral and axial wave propagation and compare wave velocity images to those assuming only lateral shear wave propagation in finite element simulations, tissue-mimicking phantoms, and bovine liver tissue. Our results show that assuming bidirectional wave propagation minimizes artifacts above and below ablated volumes, yielding a more accurate representation of the ablated region on shear wave velocity images. Area overestimation was reduced from 13.4% to 3.6% in a stiff-inclusion tissue-mimicking phantom and from 9.1% to 0.8% in a radio-frequency ablation in bovine liver tissue. More accurate ablation representation during ablation procedures increases the likelihood of complete treatment of the malignant target, decreasing tumor recurrence. © 2012 IEEE

  12. Advances in local ablation of malignant liver lesions

    PubMed Central

    Eisele, Robert M

    2016-01-01

    Local ablation of liver tumors matured during the recent years and is now proven to be an effective tool in the treatment of malignant liver lesions. Advances focus on the improvement of local tumor control by technical innovations, individual selection of imaging modalities, more accurate needle placement and the free choice of access to the liver. Considering data found in the current literature for conventional local ablative treatment strategies, virtually no single technology is able to demonstrate an unequivocal superiority. Hints at better performance of microwave compared to radiofrequency ablation regarding local tumor control, duration of the procedure and potentially achievable larger size of ablation areas favour the comparably more recent treatment modality; image fusion enables more patients to undergo ultrasound guided local ablation; magnetic resonance guidance may improve primary success rates in selected patients; navigation and robotics accelerate the needle placement and reduces deviation of needle positions; laparoscopic thermoablation results in larger ablation areas and therefore hypothetically better local tumor control under acceptable complication rates, but seems to be limited to patients with no, mild or moderate adhesions following earlier surgical procedures. Apart from that, most techniques appear technically feasible, albeit demanding. Which technology will in the long run become accepted, is subject to future work. PMID:27099433

  13. Microwave Ablation of Lung Tumors Near the Heart: A Retrospective Review of Short-Term Procedural Safety in Ten Patients.

    PubMed

    Maxwell, Aaron W P; Healey, Terrance T; Dupuy, Damian E

    2017-09-01

    To evaluate the rate of short-term complications associated with microwave ablation of lung tumors located near the heart. This HIPAA-compliant study was performed with a waiver for informed consent. Patients who underwent microwave ablation of lung tumors located 10 mm or less from the heart were identified by retrospective chart review. Both primary and metastatic tumors were included. Only tumors directly adjacent to one of the four cardiac chambers were included. All patients were treated in a single session using CT guidance with continuous electrocardiographic monitoring. Rates of new-onset arrhythmia and myocardial infarction (MI) within 90 days of the procedure were quantified, and evidence of cardiac or pericardiac injury was assessed for using post-ablation contrast-enhanced chest CT, electrocardiography (EKG), and-when available-echocardiography. Complications were graded using the Common Terminology Criteria for Adverse Events (CTCAE) system. Ten patients (four males, six females; mean age 73.1 ± 9.5 years) met all inclusion criteria. Mean tumor distance from the heart was 3 mm (range, 0-6 mm). New-onset arrhythmia was not observed during or following any of the microwave ablation treatments, and there were no documented 90-day MI events. CTCAE Grade 1 complications were observed by CT in eight patients, most commonly mild focal pericardial thickening. EKG and echocardiography were normal in all patients. No major complications (CTCAE Grade 3 or greater) were observed. Microwave ablation of lung tumors located 10 mm or less from the heart appears to have low associated short-term morbidity and may be appropriate in selected patients.

  14. Organized Atrial Tachycardias after Atrial Fibrillation Ablation

    PubMed Central

    Castrejón-Castrejón, Sergio; Ortega, Marta; Pérez-Silva, Armando; Doiny, David; Estrada, Alejandro; Filgueiras, David; López-Sendón, José L.; Merino, José L.

    2011-01-01

    The efficacy of catheter-based ablation techniques to treat atrial fibrillation is limited not only by recurrences of this arrhythmia but also, and not less importantly, by new-onset organized atrial tachycardias. The incidence of such tachycardias depends on the type and duration of the baseline atrial fibrillation and specially on the ablation technique which was used during the index procedure. It has been repeatedly reported that the more extensive the left atrial surface ablated, the higher the incidence of organized atrial tachycardias. The exact origin of the pathologic substrate of these trachycardias is not fully understood and may result from the interaction between preexistent regions with abnormal electrical properties and the new ones resultant from radiofrequency delivery. From a clinical point of view these atrial tachycardias tend to remit after a variable time but in some cases are responsible for significant symptoms. A precise knowledge of the most frequent types of these arrhythmias, of their mechanisms and components is necessary for a thorough electrophysiologic characterization if a new ablation procedure is required. PMID:21941669

  15. The evaluation of the neutron dose equivalent in the two-bend maze.

    PubMed

    Tóth, Á Á; Petrović, B; Jovančević, N; Krmar, M; Rutonjski, L; Čudić, O

    2017-04-01

    The purpose of this study was to explore the effect of the second bend of the maze, on the neutron dose equivalent, in the 15MV linear accelerator vault, with two bend maze. These two bends of the maze were covered by 32 points where the neutron dose equivalent was measured. There is one available method for estimation of the neutron dose equivalent at the entrance door of the two bend maze which was tested using the results of the measurements. The results of this study show that the neutron equivalent dose at the door of the two bend maze was reduced almost three orders of magnitude. The measured TVD in the first bend (closer to the inner maze entrance) is about 5m. The measured TVD result is close to the TVD values usually used in the proposed models for estimation of neutron dose equivalent at the entrance door of the single bend maze. The results also determined that the TVD in the second bend (next to the maze entrance door) is significantly lower than the TVD values found in the first maze bend. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  16. Cerebellar contribution to spatial event processing: involvement in procedural and working memory components.

    PubMed

    Mandolesi, L; Leggio, M G; Graziano, A; Neri, P; Petrosini, L

    2001-12-01

    Spatial function is one of the cognitive functions altered in the presence of cerebellar lesions. We investigated the cerebellar contribution to the acquisition of spatial procedural and working memory components by means of a radial maze. To establish whether a cerebellar lesion would cause a deficit in solving the radial maze, a first experiment was carried out by using a full-baited maze procedure in different experimental groups, with or without cerebellar lesion and with or without pretraining. Non-pretrained hemicerebellectomized (HCbed) animals exhibited impaired performances in all (motor, spatial and procedural) task aspects. Pre-trained HCbed animals performed similarly to control animals in the task aspects linked to the processing of spatial and procedural factors. To distinguish procedural from working memory components, a forced-choice paradigm of the radial maze was used in the second experiment. Non-pretrained HCbed rats continued to make a lot of errors and show severe perseverative tendencies, already observed in the first experiment, supporting a specific cerebellar role in acquiring new behaviours and in modifying them in relation to the context. Interestingly, hindered from putting the acquired explorative patterns into action and compelled to use only working memory abilities, the pretrained HCbed group exhibited a dramatic worsening of performance. In conclusion, the present findings demonstrate that cerebellar damage induces a specific behaviour in radial maze tasks, characterized by an inflexible use of the procedures (if indeed any procedure was acquired before the lesion) and by a severe impairment in working memory processes.

  17. Use of asymmetric bidirectional catheters with different curvature radius for catheter ablation of cardiac arrhythmias.

    PubMed

    Mantziari, Lilian; Suman-Horduna, Irina; Gujic, Marko; Jones, David G; Wong, Tom; Markides, Vias; Foran, John P; Ernst, Sabine

    2013-06-01

    The impact of recently introduced asymmetric bidirectional ablation catheters on procedural parameters and acute success rates of ablation procedures is unknown. We retrospectively analyzed data regarding ablations using a novel bidirectional catheter in a tertiary cardiac center and compared these in 1:5 ratio with a control group of procedures matched for age, gender, operator, and ablation type. A total of 50 cases and 250 controls of median age 60 (50-68) years were studied. Structural heart disease was equally prevalent in both groups (39%) while history of previous ablations was more common in the study arm (54% vs 30%, P = 0.001). Most of the ablation cases were for atrial fibrillation (46%), followed by atrial tachycardia (28%), supraventricular tachycardia (12%), and ventricular tachycardia (14%). Median procedure duration was 128 (52-147) minutes with the bidirectional, versus 143 (105-200) minutes with the conventional catheter (P = 0.232), and median fluoroscopy time was 17 (10-34) minutes versus 23 (12-39) minutes, respectively (P = 0.988). There was a trend toward a lower procedure duration for the atrial tachycardia ablations, 89 (52-147) minutes versus 130 (100-210) minutes, P = 0.064. The procedure was successfully completed in 96% of the bidirectional versus 84% of the control cases (P = 0.151). A negative correlation was observed between the relative fluoroscopy duration and the case number (r = -0.312, P = 0.028), reflecting the learning curve for the bidirectional catheter. The introduction of the bidirectional catheter resulted in no prolongation of procedure parameters and similar success rates, while there was a trend toward a lower procedure duration for atrial tachycardia ablations. ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.

  18. Atrial Fibrillation Ablation Guided by a Novel Nonfluoroscopic Navigation System.

    PubMed

    Ballesteros, Gabriel; Ramos, Pablo; Neglia, Renzo; Menéndez, Diego; García-Bolao, Ignacio

    2017-09-01

    Rhythmia is a new nonfluoroscopic navigation system that is able to create high-density electroanatomic maps. The aim of this study was to describe the acute outcomes of atrial fibrillation (AF) ablation guided by this system, to analyze the volume provided by its electroanatomic map, and to describe its ability to locate pulmonary vein (PV) reconnection gaps in redo procedures. This observational study included 62 patients who underwent AF ablation with Rhythmia compared with a retrospective cohort who underwent AF ablation with a conventional nonfluoroscopic navigation system (Ensite Velocity). The number of surface electrograms per map was significantly higher in Rhythmia procedures (12 125 ± 2826 vs 133 ± 21 with Velocity; P < .001), with no significant differences in the total procedure time. The Orion catheter was placed for mapping in 99.5% of PV (95.61% in the control group with a conventional circular mapping catheter; P = .04). There were no significant differences in the percentage of PV isolation between the 2 groups. In redo procedures, an ablation gap could be identified on the activation map in 67% of the reconnected PV (40% in the control group; P = .042). The measured left atrial volume was lower than that calculated by computed tomography (109.3 v 15.2 and 129.9 ± 13.2 mL, respectively; P < .001). There were no significant differences in the number of complications. The Rhythmia system is effective for AF ablation procedures, with procedure times and safety profiles similar to conventional nonfluoroscopic navigation systems. In redo procedures, it appears to be more effective in identifying reconnected PV conduction gaps. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  19. Assessment of anxiety in open field and elevated plus maze using infrared thermography.

    PubMed

    Lecorps, Benjamin; Rödel, Heiko G; Féron, Christophe

    2016-04-01

    Due to their direct inaccessibility, affective states are classically assessed by gathering concomitant physiological and behavioral measures. Although such a dual approach to assess emotional states is frequently used in different species including humans, the invasiveness of procedures for physiological recordings particularly in smaller-sized animals strongly restricts their application. We used infrared thermography, a non-invasive method, to assess physiological arousal during open field and elevated plus maze tests in mice. By measuring changes in surface temperature indicative of the animals' emotional response, we aimed to improve the inherently limited and still controversial information provided by behavioral parameters commonly used in these tests. Our results showed significant and consistent thermal responses during both tests, in accordance with classical physiological responses occurring in stressful situations. Besides, we found correlations between these thermal responses and the occurrence of anxiety-related behaviors. Furthermore, initial temperatures measured at the start of each procedure (open field, elevated plus maze), which can be interpreted as a measure of the animals' initial physiological arousal, predicted the levels of activity and of anxiety-related behaviors displayed during the tests. Our results stress the strong link between physiological correlates of emotions and behaviors expressed during unconditioned fear tests. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Microwave Tissue Ablation: Biophysics, Technology and Applications

    PubMed Central

    2010-01-01

    Microwave ablation is an emerging treatment option for many cancers, cardiac arrhythmias and other medical conditions. During treatment, microwaves are applied directly to tissues to produce rapid temperature elevations sufficient to produce immediate coagulative necrosis. The engineering design criteria for each application differ, with individual consideration for factors such as desired ablation zone size, treatment duration, and procedural invasiveness. Recent technological developments in applicator cooling, power control and system optimization for specific applications promise to increase the utilization of microwave ablation in the future. This article will review the basic biophysics of microwave tissue heating, provide an overview of the design and operation of current equipment, and outline areas for future research for microwave ablation. PMID:21175404

  1. Perioral Rejuvenation With Ablative Erbium Resurfacing.

    PubMed

    Cohen, Joel L

    2015-11-01

    Since the introduction of the scanning full-field erbium laser, misconceptions regarding ablative erbium resurfacing have resulted in its being largely overshadowed by ablative fractional resurfacing. This case report illustrates the appropriateness of full-field erbium ablation for perioral resurfacing. A patient with profoundly severe perioral photodamage etched-in lines underwent full-field ablative perioral resurfacing with an erbium laser (Contour TRL, Sciton Inc., Palo Alto, CA) that allows separate control of ablation and coagulation. The pre-procedure consultations included evaluation of the severity of etched-in lines, and discussion of patient goals, expectations, and appropriate treatment options, as well as a review of patient photos and post-treatment care required. The author generally avoids full-field erbium ablation in patients with Fitzpatrick type IV and above. For each of 2 treatment sessions (separated by approximately 4 months), the patient received (12 cc plain 2% lidodaine) sulcus blocks before undergoing 4 passes with the erbium laser at 150 μ ablation, no coagulation, and then some very focal 30 μ ablation to areas of residual lines still visualized through the pinpoint bleeding. Similarly, full-field ablative resurfacing can be very reliable for significant wrinkles and creping in the lower eyelid skin--where often a single treatment of 80 μ ablation, 50 μ coagulation can lead to a nice improvement. Standardized digital imaging revealed significant improvement in deeply etched rhytides without significant adverse events. For appropriately selected patients requiring perioral (or periorbital) rejuvenation, full-field ablative erbium resurfacing is safe, efficacious and merits consideration.

  2. Stand-Alone Pulmonary Vein Isolation Versus Pulmonary Vein Isolation With Additional Substrate Modification as Index Ablation Procedures in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation: The Randomized Alster-Lost-AF Trial (Ablation at St. Georg Hospital for Long-Standing Persistent Atrial Fibrillation).

    PubMed

    Fink, Thomas; Schlüter, Michael; Heeger, Christian-Hendrik; Lemes, Christine; Maurer, Tilman; Reissmann, Bruno; Riedl, Johannes; Rottner, Laura; Santoro, Francesco; Schmidt, Boris; Wohlmuth, Peter; Mathew, Shibu; Sohns, Christian; Ouyang, Feifan; Metzner, Andreas; Kuck, Karl-Heinz

    2017-07-01

    Pulmonary vein isolation (PVI) for persistent atrial fibrillation is associated with limited success rates and often requires multiple procedures to maintain stable sinus rhythm. In the prospective and randomized Alster-Lost-AF trial (Ablation at St. Georg Hospital for Long-Standing Persistent Atrial Fibrillation), we sought to assess, in patients with symptomatic persistent or long-standing persistent atrial fibrillation, the outcomes of initial ablative strategies comprising either stand-alone PVI (PVI-only approach) or a stepwise approach of PVI followed by complex fractionated atrial electrogram ablation and linear ablation (Substrate-modification approach). Patients were randomized 1:1 to stand-alone PVI or PVI plus substrate modification. The primary study end point was freedom from recurrence of any atrial tachyarrhythmia, outside a 90-day blanking period, at 12 months. A total of 124 patients were enrolled, with 118 patients included in the analysis (61 in the PVI-only group, 57 in the Substrate-modification group). Atrial tachyarrhythmias recurred in 28 PVI-only group patients and 24 Substrate-modification group patients, for 1-year freedom from tachyarrhythmia recurrence after a single ablation procedure of 54% (95% confidence interval, 43%-68%) in the PVI-only and 57% (95% confidence interval, 46%-72%) in the Substrate-modification group ( P =0.86). Twenty-four patients in the PVI-only group (39%) and 18 in the Substrate-modification group (32%) were without arrhythmia recurrence and off antiarrhythmic drug therapy at the end of the 12-month follow-up. In patients with persistent and long-standing persistent atrial fibrillation, no significant difference was observed in 12-month freedom from atrial tachyarrhythmias between an index ablative approach of stand-alone PVI and a stepwise approach of PVI plus complex fractionated atrial electrogram and linear ablation. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00820625. © 2017 American Heart

  3. Treatment of Atrial Fibrillation By The Ablation Of Localized Sources

    PubMed Central

    Narayan, Sanjiv M.; Krummen, David E.; Shivkumar, Kalyanam; Clopton, Paul; Rappel, Wouter-Jan; Miller, John M.

    2012-01-01

    Objectives We hypothesized that human atrial fibrillation (AF) may be sustained by localized sources (electrical rotors and focal impulses), whose elimination (Focal Impulse and Rotor Modulation, FIRM) may improve outcome from AF ablation. Background Catheter ablation for AF is a promising therapy, whose success is limited in part by uncertainty in the mechanisms that sustain AF. We developed a computational approach to map whether AF is sustained by several meandering waves (the prevailing hypothesis) or localized sources, then prospectively tested whether targeting patient-specific mechanisms revealed by mapping would improve AF ablation outcome. Methods We recruited 92 individuals during 107 consecutive ablation procedures for paroxysmal or persistent (72%) AF. Cases were prospectively treated, in a 2-arm 1:2 design, by ablation at sources (FIRM-Guided) followed by conventional ablation (n=36), or conventional ablation alone (n=71; FIRM-Blinded). Results Localized rotors or focal impulses were detected in 98 (97%) of 101 cases with sustained AF, each exhibiting 2.1±1.0 sources. The acute endpoint (AF termination or consistent slowing) was achieved in 86% of FIRM-guided versus 20% of FIRM-Blinded cases (p<0.001). FIRM ablation alone at the primary source terminated AF in 2.5 minutes (median; IQR 1.0–3.1). Total ablation time did not differ between groups (57.8±22.8 versus 52.1±17.8 minutes, p=0.16). During 273 days (median; IQR 132–681 days) after a single procedure, FIRM-Guided cases had higher freedom from AF (82.4% versus 44.9%; p<0.001) after a single procedure than FIRM-blinded cases with rigorous, often implanted, ECG monitoring. Adverse events did not differ between groups. CONCLUSIONS Localized electrical rotors and focal impulse sources are prevalent sustaining-mechanisms for human AF. FIRM ablation at patient-specific sources acutely terminated or slowed AF, and improved outcome. These results offer a novel mechanistic framework and treatment

  4. Single-ring ablation compared with standard circumferential pulmonary vein isolation using remote magnetic catheter navigation.

    PubMed

    Sohns, Christian; Bergau, Leonard; Seegers, Joachim; Lüthje, Lars; Vollmann, Dirk; Zabel, Markus

    2014-10-01

    In ablation of atrial fibrillation, the single-ring method aims for isolation of the posterior wall of the left atrium (LA) including the pulmonary veins (PVs) but avoiding posterior LA lesions. The aim of this randomized prospective study was to evaluate safety and efficacy of remote magnetic navigation (RMN)-guided single-ring ablation strategy as compared to standard RMN-guided circumferential PV ablation (PVA). Eighty consecutive patients undergoing PVA were enrolled prospectively and randomized equally into two study groups. RMN using the Stereotaxis system and open-irrigated 3.5-mm ablation catheters were used with a 3D mapping system in all procedures. Forty patients underwent RMN-guided single-ring ablation, and 40 patients received RMN-guided circumferential PVA. In the circumferential group, 3.3 ± 1.1 PVs were successfully isolated at the end of the procedure as compared to 3.1 ± 1.3 in the single-ring (box) group (p=0.38). All patients in the box group required additional posterior lesions in order to achieve electrical isolation of the PVs. Single-ring ablation was associated with longer procedure duration (p=0.01) and ablation time (p=0.001). After a single procedure, the proportion of patients free of any atrial tachycardia (AT)/atrial fibrillation (AF) episode at 12-month follow-up was 57 % in the box group and 58 % in the circ group. Using RMN, only minor complications have been observed. RMN-guided single-ring PVA provides comparable acute and long-term success rates as compared to RMN-guided circumferential PVA but requires additional posterior lesions to achieve PV isolation and increased procedure and ablation time. Procedural complication rates are low when using RMN.

  5. Sex differences and the role of acute stress in the open-field tower maze.

    PubMed

    Lipatova, Olga; Campolattaro, Matthew M; Dixon, Dawndra C; Durak, Ayse

    2018-05-15

    Many studies provide evidence that differences in spatial learning exist between males and females. However, it is necessary to consider non-mnemonic factors that may influence these findings. The present experiment investigated acquisition, retention, and the effects of stress on response- and place-learning in male and female rats. Rats were trained in an open-field tower maze. Procedures were used to minimize stress in the rats, and their ability to solve place- or response-learning in the maze was determined by analyzing a response variable (i.e., first choice correct response) that was not influenced by general locomotor activity. The results revealed that male and female rats acquire place- and response-learning at the same rate even though females moved significantly faster in the maze. However, females showed better retrieval of place-, but not response-learning compared to male rats. This effect appeared to be enhanced when the rats were tested immediately following an acute restraint stress. Furthermore, both female and male rats that were exposed to acute restraint stress showed less impairment than controls when subsequently tested in a novel situation. These findings have clinical implications that a mild physiological stress response can make one more cognitively resistant to adversities later in life. Copyright © 2018 Elsevier Inc. All rights reserved.

  6. The modified stepwise ablation guided by low-dose ibutilide in chronic atrial fibrillation trial (The MAGIC-AF Study).

    PubMed

    Singh, Sheldon M; d'Avila, Andre; Kim, Young-Hoon; Aryana, Arash; Mangrum, J Michael; Michaud, Gregory F; Dukkipati, Srinivas R; Barrett, Conor D; Heist, E Kevin; Parides, Michael K; Thorpe, Kevin E; Reddy, Vivek Y

    2016-05-21

    Complex fractionated atrial electrograms (CFAE) are targeted during persistent atrial fibrillation (AF) ablation. However, many CFAE sites are non-specific resulting in extensive ablation. Ibutilide has been shown to reduce left atrial surface area exhibiting CFAE. We hypothesized that ibutilide administration prior to CFAE ablation would identify sites critical for persistent AF maintenance allowing for improved procedural efficacy and long-term freedom from atrial arrhythmias. Two hundred patients undergoing a first-ever persistent AF catheter ablation procedure were randomly assigned to receive either 0.25 mg of intravenous ibutilide or saline placebo upon completion of pulmonary vein isolation. Complex fractionated atrial electrogram sites were then targeted with ablation. The primary efficacy endpoint was the 1-year single procedure freedom from atrial arrhythmia off anti-arrhythmic drugs. Similar procedural characteristics (procedure, fluoroscopy, and ablation times) were observed with both strategies despite a greater reduction in left atrial surface area with CFAE sites (8 vs. 1%, P < 0.0001) and AF termination during CFAE ablation with ibutilide compared with placebo (75 vs. 57%, P = 0.007). The primary efficacy endpoint was achieved in 56% of patients receiving ibutilide and 49% receiving placebo (P = 0.35). No significant differences in peri-procedural complications were observed in both groups. Despite a reduction in CFAE area and greater AF termination during CFAE ablation, procedural characteristics and clinical outcomes were unchanged when CFAE ablation was guided by ibutilide administration. ClinicalTrials.gov number: NCT01014741. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  7. Innovative approach for in-vivo ablation validation on multimodal images

    NASA Astrophysics Data System (ADS)

    Shahin, O.; Karagkounis, G.; Carnegie, D.; Schlaefer, A.; Boctor, E.

    2014-03-01

    Radiofrequency ablation (RFA) is an important therapeutic procedure for small hepatic tumors. To make sure that the target tumor is effectively treated, RFA monitoring is essential. While several imaging modalities can observe the ablation procedure, it is not clear how ablated lesions on the images correspond to actual necroses. This uncertainty contributes to the high local recurrence rates (up to 55%) after radiofrequency ablative therapy. This study investigates a novel approach to correlate images of ablated lesions with actual necroses. We mapped both intraoperative images of the lesion and a slice through the actual necrosis in a common reference frame. An electromagnetic tracking system was used to accurately match lesion slices from different imaging modalities. To minimize the liver deformation effect, the tracking reference frame was defined inside the tissue by anchoring an electromagnetic sensor adjacent to the lesion. A validation test was performed using a phantom and proved that the end-to-end accuracy of the approach was within 2mm. In an in-vivo experiment, intraoperative magnetic resonance imaging (MRI) and ultrasound (US) ablation images were correlated to gross and histopathology. The results indicate that the proposed method can accurately correlate invivo ablations on different modalities. Ultimately, this will improve the interpretation of the ablation monitoring and reduce the recurrence rates associated with RFA.

  8. Acute high dose of chlorpyrifos alters performance of rats in the elevated plus-maze and the elevated T-maze.

    PubMed

    López-Crespo, G A; Flores, P; Sánchez-Santed, F; Sánchez-Amate, M C

    2009-11-01

    Chlorpyrifos (CPF) is a broad spectrum organophosphate (OP) pesticide widely used in agriculture, industry and household. Several animal studies indicate emotional disturbances after CPF exposure, although the results are sometimes puzzling. Thus, both anxiolytic and anxiogenic effects of CPF have been reported in different animal models of anxiety [Sánchez-Amate MC, Flores P, Sánchez-Santed F. Effects of chlorpyrifos in the plus-maze model of anxiety. Behav Pharmacol 2001;12:285-92; Sánchez-Amate MC, Dávila E, Cañadas F, Flores P, Sánchez-Santed F. Chlorpyrifos shares stimulus properties with pentilenetetrazol as evaluated by and operant drug discrimination task. Neurotoxicology 2002;23:795-803; López-Crespo G, Carvajal F, Flores P, Sánchez-Santed F, Sánchez-Amate MC. Time-course of biochemical and behavioural effects of a single high dose of chlorpyrifos. Neurotoxicology 2007;28:541-7]. On the other hand, other behavioural effects of CPF are time-dependent [López-Crespo G, Carvajal F, Flores P, Sánchez-Santed F, Sánchez-Amate MC. Time-course of biochemical and behavioural effects of a single high dose of chlorpyrifos. Neurotoxicology 2007;28:541-7], raising the question that the effects of CPF could be task and post-administration time dependent. To test this hypothesis, three groups of rats were treated with a single high dose of CPF (250 mg/kg); one of the groups was tested on day 5 on the elevated plus-maze, to complete our previous study on day 2 [Sánchez-Amate MC, Flores P, Sánchez-Santed F. Effects of chlorpyrifos in the plus-maze model of anxiety. Behav Pharmacol 2001;12:285-92]. The remaining groups were tested on the elevated T-maze on days 2 and 5. CPF produced an increased open arm activity on the elevated plus-maze on day 5, an increased escape latency on the elevated T-maze on day 2 and an impaired inhibitory avoidance on day 5. Data are discussed taking together all studies carried out in our laboratory, confirming that CPF effects on

  9. Optimal approach for complete liver tumor ablation using radiofrequency ablation: a simulation study.

    PubMed

    Givehchi, Sogol; Wong, Yin How; Yeong, Chai Hong; Abdullah, Basri Johan Jeet

    2018-04-01

    To investigate the effect of radiofrequency ablation (RFA) electrode trajectory on complete tumor ablation using computational simulation. The RFA of a spherical tumor of 2.0 cm diameter along with 0.5 cm clinical safety margin was simulated using Finite Element Analysis software. A total of 86 points inside one-eighth of the tumor volume along the axial, sagittal and coronal planes were selected as the target sites for electrode-tip placement. The angle of the electrode insertion in both craniocaudal and orbital planes ranged from -90° to +90° with 30° increment. The RFA electrode was simulated to pass through the target site at different angles in combination of both craniocaudal and orbital planes before being advanced to the edge of the tumor. Complete tumor ablation was observed whenever the electrode-tip penetrated through the epicenter of the tumor regardless of the angles of electrode insertion in both craniocaudal and orbital planes. Complete tumor ablation can also be achieved by placing the electrode-tip at several optimal sites and angles. Identification of the tumor epicenter on the central slice of the axial images is essential to enhance the success rate of complete tumor ablation during RFA procedures.

  10. Acoustic radiation force impulse imaging for real-time observation of lesion development during radiofrequency ablation procedures

    NASA Astrophysics Data System (ADS)

    Fahey, Brian J.; Trahey, Gregg E.

    2005-04-01

    When performing radiofrequency ablation (RFA) procedures, physicians currently have little or no feedback concerning the success of the treatment until follow-up assessments are made days to weeks later. To be successful, RFA must induce a thermal lesion of sufficient volume to completely destroy a target tumor or completely isolate an aberrant cardiac pathway. Although ultrasound, computed tomography (CT), and CT-based fluoroscopy have found use in guiding RFA treatments, they are deficient in giving accurate assessments of lesion size or boundaries during procedures. As induced thermal lesion size can vary considerably from patient to patient, the current lack of real-time feedback during RFA procedures is troublesome. We have developed a technique for real-time monitoring of thermal lesion size during RFA procedures utilizing acoustic radiation force impulse (ARFI) imaging. In both ex vivo and in vivo tissues, ARFI imaging provided better thermal lesion contrast and better overall appreciation for lesion size and boundaries relative to conventional sonography. The thermal safety of ARFI imaging for use at clinically realistic depths was also verified through the use of finite element method models. As ARFI imaging is implemented entirely on a diagnostic ultrasound scanner, it is a convenient, inexpensive, and promising modality for monitoring RFA procedures in vivo.

  11. Breast-conservative surgery followed by radiofrequency ablation of margins decreases the need for a second surgical procedure for close or positive margins.

    PubMed

    Rubio, Isabel T; Landolfi, Stefania; Molla, Meritxell; Cortes, Javier; Xercavins, Jordi

    2014-10-01

    Excision of breast cancer followed by radiofrequency ablation (eRFA) is a technique designed to increase negative margins in breast-conservative surgical procedures. The objective of this study is to analyze the impact of eRFA in avoiding a second surgical procedure for close or positive margins after a breast-conservative surgical procedure. From February 2008 to May 2010, 20 patients were included. After lumpectomy, the eRFA was performed in the lumpectomy cavity, and biopsies from each margin from the radial ablated cavity walls were obtained. Biopsy samples were assessed for tumor viability. eRFA was successful in 19 of 20 patients. In all patients, the devitalized tissue extended beyond a 5- to 10-mm radial depth of the biopsy sample. Overall, 6 patients (31%) had margins < 2 mm, 4 of them with < 1 mm margin. All 6 of these patients had no tumor viability according to analysis of biopsy samples stained with 2,3,5-triphenyltetrazolium chloride. At a median follow-up of 46 months, no local recurrence had been found. This study supports the feasibility of eRFA treatment. In our study, the eRFA method has spared 31% of patients from undergoing a re-excision surgical procedure, and it may, in the long-term, reduce local recurrences. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Genetic ablation of the GluK4 kainate receptor subunit causes anxiolytic and antidepressant-like behavior in mice.

    PubMed

    Catches, Justin S; Xu, Jian; Contractor, Anis

    2012-03-17

    There is a clear link between dysregulation of glutamatergic signaling and mood disorders. Genetic variants in the glutamate receptor gene GRIK4, which encodes the kainate receptor subunit GluK4, alter the susceptibility for depression, bipolar disorder and schizophrenia. Here we demonstrate that Grik4(-/-) mice have reduced anxiety and an antidepressant-like phenotype. In the elevated zero-maze, a test for anxiety and risk taking behavior, Grik4(-/-) mice spent significantly more time exploring the open areas of the maze. In anxiogenic tests of marble-burying and novelty-induced suppression of feeding, anxiety-like behavior was consistently reduced in knockout animals. In the forced swim test, a test of learned helplessness that is used to determine depression-like behavior, knockout mice demonstrated significantly less immobility suggesting that Grik4 ablation has an antidepressant-like effect. Finally, in the sucrose preference test, a test for anhedonia in rodents, Grik4(-/-) mice demonstrated increased sucrose preference. Expression of the GluK4 receptor subunit in the forebrain is restricted to the CA3 region of the hippocampus and dentate gyrus regions where KARs are known to modulate synaptic plasticity. We tested whether Grik4 ablation had effects on mossy fiber (MF) plasticity and found there to be a significant impairment in LTP likely through a loss of KAR modulation of excitability of the presynaptic MF axons. These studies demonstrate a clear anxiolytic and antidepressant phenotype associated with ablation of Grik4 and a parallel disruption in hippocampal plasticity, providing support for the importance of this receptor subunit in mood disorders. Copyright © 2011 Elsevier B.V. All rights reserved.

  13. Genetic ablation of the GluK4 kainate receptor subunit causes anxiolytic and antidepressant-like behavior in mice

    PubMed Central

    Catches, Justin S.; Xu, Jian; Contractor, Anis

    2012-01-01

    There is a clear link between dysregulation of glutamatergic signaling and mood disorders. Genetic variants in the glutamate receptor gene GRIK4, which encodes the kainate receptor subunit GluK4, alter the susceptibility for depression, bipolar disorder and schizophrenia. Here we demonstrate that Grik4−/− mice have reduced anxiety and an antidepressant-like phenotype. In the elevated zero-maze, a test for anxiety and risk taking behavior, Grik4−/− mice spent significantly more time exploring the open areas of the maze. In anxiogenic tests of marble-burying and novelty-induced suppression of feeding, anxiety-like behavior was consistently reduced in knockout animals. In the forced swim test, a test of learned helplessness that is used to determine depression-like behavior, knockout mice demonstrated significantly less immobility suggesting that Grik4 ablation has an antidepressant-like effect. Finally, in the sucrose preference test, a test for anhedonia in rodents, Grik4−/− mice demonstrated increased sucrose preference. Expression of the GluK4 receptor subunit in the forebrain is restricted to the CA3 region of the hippocampus and dentate gyrus regions where KARs are known to modulate synaptic plasticity. We tested whether Grik4 ablation had effects on mossy fiber (MF) plasticity and found there to be a significant impairment in LTP likely through a loss of KAR modulation of excitability of the presynaptic MF axons. These studies demonstrate a clear anxiolytic and antidepressant phenotype associated with ablation of Grik4 and a parallel disruption in hippocampal plasticity, providing support for the importance of this receptor subunit in mood disorders. PMID:22203159

  14. Radiofrequency thermo-ablation of PVNS in the knee: initial results.

    PubMed

    Lalam, Radhesh K; Cribb, Gillian L; Cassar-Pullicino, Victor N; Cool, Wim P; Singh, Jaspreet; Tyrrell, Prudencia N M; Tins, Bernhard J; Winn, Naomi

    2015-12-01

    Pigmented villonodular synovitis (PVNS) is normally treated by arthroscopic or open surgical excision. We present our initial experience with radiofrequency thermo-ablation (RF ablation) of PVNS located in an inaccessible location in the knee. Review of all patients with histologically proven PVNS treated with RF ablation and with at least 2-year follow-up. Three patients met inclusion criteria and were treated with RF ablation. Two of the patients were treated successfully by one ablation procedure. One of the three patients had a recurrence which was also treated successfully by repeat RF ablation. There were no complications and all patients returned to their previous occupations following RF ablation. In this study we demonstrated the feasibility of performing RF ablation to treat PVNS in relatively inaccessible locations with curative intent. We have also discussed various post-ablation imaging appearances which can confound the assessment for residual/recurrent disease.

  15. Safe and rapid isolation of pulmonary veins using a novel circular ablation catheter and duty-cycled RF generator.

    PubMed

    Fredersdorf, Sabine; Weber, Stefan; Jilek, Clemens; Heinicke, Norbert; VON Bary, Christian; Jungbauer, Carsten; Riegger, Günter A; Hamer, Okka W; Jeron, Andreas

    2009-10-01

    Ablation of atrial fibrillation (AF) has been one of the most difficult and time-consuming electrophysiological procedures. Due to the rapidly increasing demand for ablation procedures, technical advances would be helpful to reduce complexity and procedure time in AF ablation. Therefore, we investigated the feasibility of a single-catheter technique for pulmonary vein (PV) isolation utilizing a decapolar catheter combined with a duty-cycled, unipolar-bipolar radiofrequency (RF) generator. AF mapping and ablation was performed in 21 consecutive patients (mean age 59 +/- 12 years, 9 males) with paroxysmal AF (n = 17) and persistent AF (n = 4). The ablation catheter was forwarded to the LA via single-transseptal puncture. All electrodes were energized in 2 to 5 applications per vein, followed by segmental RF applications, as needed, to achieve electrical isolation. To assess left atrial anatomy for purposes of catheter manipulation, and later evaluate the possibility of asymptomatic PV-stenosis, CT or MR imaging was performed both prior to ablation and at 6-month follow-up. Isolation could be achieved in 85/86 veins (99%). Procedure time for ablation was 81 +/- 13 minutes, and fluoroscopy time was 30 +/- 11 minutes. There were no procedural complications. Success rate at 6 months was 86% (18/21). MR or CT imaging excluded asymptomatic PV-stenosis. Mapping and ablation of PVs can be performed in a safe and efficient manner using a single-catheter technique, with short procedure times and minimal learning curve. Thus, this system may be of high interest not only for high volume but all centers performing AF ablation.

  16. Percutaneous intrapericardial echocardiography during catheter ablation: a feasibility study.

    PubMed

    Horowitz, Barbara Natterson; Vaseghi, Marmar; Mahajan, Aman; Cesario, David A; Buch, Eric; Valderrábano, Miguel; Boyle, Noel G; Ellenbogen, Kenneth A; Shivkumar, Kalyanam

    2006-11-01

    Percutaneous pericardial access, epicardial mapping, and ablation have been used successfully for catheter ablation procedures. The purpose of this study was to evaluate the safety and feasibility of closed-chest direct epicardial ultrasound imaging for aiding cardiac catheter ablation procedures. An intracardiac ultrasound catheter was used for closed-chest epicardial imaging of the heart in 10 patients undergoing percutaneous epicardial access for catheter ablation. All patients underwent concomitant intracardiac echocardiography and preprocedural transesophageal echocardiography. Using a double-wire technique, two sheaths were placed in the pericardium, and a phased-array ultrasound catheter was manipulated within the pericardial sinuses for imaging. Multiple images from varying angles were obtained for catheter navigation. Notably, image stability was excellent, and structures such as the left atrial appendage were seen in great detail. No complications resulting from use of the ultrasound catheter in the pericardium occurred, and no restriction of movement due to the presence of the additional catheter in the pericardial space was observed. Wall motion was correlated to voltage maps in five patients and showed that areas of scars correlated with wall-motion abnormalities. Normal wall-motion score correlated to sensed signals of 4.2 +/- 0.3 mV (normal myocardium >1.5 mV), and scores >1 correlated to areas with signals <0.5 mV in that territory). Intrapericardial imaging using an ultrasound catheter is feasible and safe and has the potential to provide additional valuable information for complex ablation procedures.

  17. Long‐term Outcomes of Catheter Ablation of Atrial Fibrillation: A Systematic Review and Meta‐analysis

    PubMed Central

    Ganesan, Anand N.; Shipp, Nicholas J.; Brooks, Anthony G.; Kuklik, Pawel; Lau, Dennis H.; Lim, Han S.; Sullivan, Thomas; Roberts‐Thomson, Kurt C.; Sanders, Prashanthan

    2013-01-01

    Background In the past decade, catheter ablation has become an established therapy for symptomatic atrial fibrillation (AF). Until very recently, few data have been available to guide the clinical community on the outcomes of AF ablation at ≥3 years of follow‐up. We aimed to systematically review the medical literature to evaluate the long‐term outcomes of AF ablation. Methods and Results A structured electronic database search (PubMed, Embase, Web of Science, Cochrane) of the scientific literature was performed for studies describing outcomes at ≥3 years after AF ablation, with a mean follow‐up of ≥24 months after the index procedure. The following data were extracted: (1) single‐procedure success, (2) multiple‐procedure success, and (3) requirement for repeat procedures. Data were extracted from 19 studies, including 6167 patients undergoing AF ablation. Single‐procedure freedom from atrial arrhythmia at long‐term follow‐up was 53.1% (95% CI 46.2% to 60.0%) overall, 54.1% (95% CI 44.4% to 63.4%) in paroxysmal AF, and 41.8% (95% CI 25.2% to 60.5%) in nonparoxysmal AF. Substantial heterogeneity (I2>50%) was noted for single‐procedure outcomes. With multiple procedures, the long‐term success rate was 79.8% (95% CI 75.0% to 83.8%) overall, with significant heterogeneity (I2>50%).The average number of procedures per patient was 1.51 (95% CI 1.36 to 1.67). Conclusions Catheter ablation is an effective and durable long‐term therapeutic strategy for some AF patients. Although significant heterogeneity is seen with single procedures, long‐term freedom from atrial arrhythmia can be achieved in some patients, but multiple procedures may be required. PMID:23537812

  18. Magnetic Resonance Mediated Radiofrequency Ablation.

    PubMed

    Hue, Yik-Kiong; Guimaraes, Alexander R; Cohen, Ouri; Nevo, Erez; Roth, Abraham; Ackerman, Jerome L

    2018-02-01

    To introduce magnetic resonance mediated radiofrequency ablation (MR-RFA), in which the MRI scanner uniquely serves both diagnostic and therapeutic roles. In MR-RFA scanner-induced RF heating is channeled to the ablation site via a Larmor frequency RF pickup device and needle system, and controlled via the pulse sequence. MR-RFA was evaluated with simulation of electric and magnetic fields to predict the increase in local specific-absorption-rate (SAR). Temperature-time profiles were measured for different configurations of the device in agar phantoms and ex vivo bovine liver in a 1.5 T scanner. Temperature rise in MR-RFA was imaged using the proton resonance frequency method validated with fiber-optic thermometry. MR-RFA was performed on the livers of two healthy live pigs. Simulations indicated a near tenfold increase in SAR at the RFA needle tip. Temperature-time profiles depended significantly on the physical parameters of the device although both configurations tested yielded temperature increases sufficient for ablation. Resected livers from live ablations exhibited clear thermal lesions. MR-RFA holds potential for integrating RF ablation tumor therapy with MRI scanning. MR-RFA may add value to MRI with the addition of a potentially disposable ablation device, while retaining MRI's ability to provide real time procedure guidance and measurement of tissue temperature, perfusion, and coagulation.

  19. Determination of excimer laser ablation rate of the human cornea using in vivo Scheimpflug videography.

    PubMed

    Huebscher, H J; Genth, U; Seiler, T

    1996-01-01

    To determine in vivo the amount of human corneal tissue removed by each excimer laser pulse, the so-called ablation rate, during photorefractive keratectomy (PRK). There is confusion in the literature because the experimentally determined ablation rate of 0.4 to 0.5 microns per pulse differs from the nominal ablation rate of 0.23 to 0.3 microns per pulse, which is the value used in clinical procedures. Eleven eyes of 11 patients were treated with PRK for correction of myopia. The corneal curvature was determined by Scheimpflug videography before and immediately after surgery. Starting from this curvature change, the authors calculated the real ablation rate. The real ablation rate is coincident with the nominal ablation rate and differs significantly from the ablation rate derived from deep keratectomy experiments. The outer layers of the cornea show significantly different ablation behavior than the deeper stroma. This information has clinical relevance for the predictability of intrastromal excimer laser procedures.

  20. Assessment of Ablative Therapies in Swine: Response of Respiratory Diaphragm to Varying Doses.

    PubMed

    Singal, Ashish; Mattison, Lars M; Soule, Charles L; Ballard, John R; Rudie, Eric N; Cressman, Erik N K; Iaizzo, Paul A

    2018-03-28

    Ablation is a common procedure for treating patients with cancer, cardiac arrhythmia, and other conditions, yet it can cause collateral injury to the respiratory diaphragm. Collateral injury can alter the diaphragm's properties and/or lead to respiratory dysfunction. Thus, it is important to understand the diaphragm's physiologic and biomechanical properties in response to ablation therapies, in order to better understand ablative modalities, minimize complications, and maximize the safety and efficacy of ablative procedures. In this study, we analyzed physiologic and biomechanical properties of swine respiratory diaphragm muscle bundles when exposed to 5 ablative modalities. To assess physiologic properties, we performed in vitro tissue bath studies and measured changes in peak force and baseline force. To assess biomechanical properties, we performed uniaxial stress tests, measuring force-displacement responses, stress-strain characteristics, and avulsion forces. After treating the muscle bundles with all 5 ablative modalities, we observed dose-dependent sustained reductions in peak force and transient increases in baseline force-but no consistent dose-dependent biomechanical responses. These data provide novel insights into the effects of various ablative modalities on the respiratory diaphragm, insights that could enable improvements in ablative techniques and therapies.

  1. Survival after Radiofrequency Ablation in 122 Patients with Inoperable Colorectal Lung Metastases

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Gillams, Alice, E-mail: alliesorting@gmail.com; Khan, Zahid; Osborn, Peter

    2013-06-15

    Purpose. To analyze the factors associated with favorable survival in patients with inoperable colorectal lung metastases treated with percutaneous image-guided radiofrequency ablation. Methods. Between 2002 and 2011, a total of 398 metastases were ablated in 122 patients (87 male, median age 68 years, range 29-90 years) at 256 procedures. Percutaneous CT-guided cool-tip radiofrequency ablation was performed under sedation/general anesthesia. Maximum tumor size, number of tumors ablated, number of procedures, concurrent/prior liver ablation, previous liver or lung resection, systemic chemotherapy, disease-free interval from primary resection to lung metastasis, and survival from first ablation were recorded prospectively. Kaplan-Meier analysis was performed, andmore » factors were compared by log rank test. Results. The initial number of metastases ablated was 2.3 (range 1-8); the total number was 3.3 (range 1-15). The maximum tumor diameter was 1.7 (range 0.5-4) cm, and the number of procedures was 2 (range 1-10). The major complication rate was 3.9 %. Overall median and 3-year survival rate were 41 months and 57 %. Survival was better in patients with smaller tumors-a median of 51 months, with 3-year survival of 64 % for tumors 2 cm or smaller versus 31 months and 44 % for tumors 2.1-4 cm (p = 0.08). The number of metastases ablated and whether the tumors were unilateral or bilateral did not affect survival. The presence of treated liver metastases, systemic chemotherapy, or prior lung resection did not affect survival. Conclusion. Three-year survival of 57 % in patients with inoperable colorectal lung metastases is better than would be expected with chemotherapy alone. Patients with inoperable but small-volume colorectal lung metastases should be referred for ablation.« less

  2. Magnetic navigation in ultrasound-guided interventional radiology procedures.

    PubMed

    Xu, H-X; Lu, M-D; Liu, L-N; Guo, L-H

    2012-05-01

    To evaluate the usefulness of magnetic navigation in ultrasound (US)-guided interventional procedures. Thirty-seven patients who were scheduled for US-guided interventional procedures (20 liver cancer ablation procedures and 17 other procedures) were included. Magnetic navigation with three-dimensional (3D) computed tomography (CT), magnetic resonance imaging (MRI), 3D US, and position-marking magnetic navigation were used for guidance. The influence on clinical outcome was also evaluated. Magnetic navigation facilitated applicator placement in 15 of 20 ablation procedures for liver cancer in which multiple ablations were performed; enhanced guidance in two small liver cancers invisible on conventional US but visible at CT or MRI; and depicted the residual viable tumour after transcatheter arterial chemoembolization for liver cancer in one procedure. In four of 17 other interventional procedures, position-marking magnetic navigation increased the visualization of the needle tip. Magnetic navigation was beneficial in 11 (55%) of 20 ablation procedures; increased confidence but did not change management in five (25%); added some information but did not change management in two (10%); and made no change in two (10%). In the other 17 interventional procedures, the corresponding numbers were 1 (5.9%), 2 (11.7%), 7 (41.2%), and 7 (41.2%), respectively (p=0.002). Magnetic navigation in US-guided interventional procedure provides solutions in some difficult cases in which conventional US guidance is not suitable. It is especially useful in complicated interventional procedures such as ablation for liver cancer. Copyright © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  3. Percutaneous Microwave Ablation of Renal Angiomyolipomas.

    PubMed

    Cristescu, Mircea; Abel, E Jason; Wells, Shane; Ziemlewicz, Timothy J; Hedican, Sean P; Lubner, Megan G; Hinshaw, J Louis; Brace, Christopher L; Lee, Fred T

    2016-03-01

    To evaluate the safety and efficacy of US-guided percutaneous microwave (MW) ablation in the treatment of renal angiomyolipoma (AML). From January 2011 to April 2014, seven patients (5 females and 2 males; mean age 51.4) with 11 renal AMLs (9 sporadic type and 2 tuberous sclerosis associated) with a mean size of 3.4 ± 0.7 cm (range 2.4-4.9 cm) were treated with high-powered, gas-cooled percutaneous MW ablation under US guidance. Tumoral diameter, volume, and CT/MR enhancement were measured on pre-treatment, immediate post-ablation, and delayed post-ablation imaging. Clinical symptoms and creatinine were assessed on follow-up visits. All ablations were technically successful and no major complications were encountered. Mean ablation parameters were ablation power of 65 W (range 60-70 W), using 456 mL of hydrodissection fluid per patient, over 4.7 min (range 3-8 min). Immediate post-ablation imaging demonstrated mean tumor diameter and volume decreases of 1.8% (3.4-3.3 cm) and 1.7% (27.5-26.3 cm(3)), respectively. Delayed imaging follow-up obtained at a mean interval of 23.1 months (median 17.6; range 9-47) demonstrated mean tumor diameter and volume decreases of 29% (3.4-2.4 cm) and 47% (27.5-12.1 cm(3)), respectively. Tumoral enhancement decreased on immediate post-procedure and delayed imaging by CT/MR parameters, indicating decreased tumor vascularity. No patients required additional intervention and no patients experienced spontaneous bleeding post-ablation. Our early experience with high-powered, gas-cooled percutaneous MW ablation demonstrates it to be a safe and effective modality to devascularize and decrease the size of renal AMLs.

  4. Artificial ascites and pneumoperitoneum to facilitate thermal ablation of liver tumors: a pictorial essay.

    PubMed

    Bhagavatula, Sharath K; Chick, Jeffrey F B; Chauhan, Nikunj R; Shyn, Paul B

    2017-02-01

    Image-guided percutaneous thermal ablation is increasingly utilized in the treatment of hepatic malignancies. Peripherally located hepatic tumors can be difficult to access or located adjacent to critical structures that can be injured. As a result, ablation of peripheral tumors may be avoided or may be performed too cautiously, leading to inadequate ablation coverage. In these cases, separating the tumor from adjacent critical structures can increase the efficacy and safety of procedures. Artificial ascites and artificial pneumoperitoneum are techniques that utilize fluid and gas, respectively, to insulate critical structures from the thermal ablation zone. Induction of artificial ascites and artificial pneumoperitoneum can enable complete ablation of otherwise inaccessible hepatic tumors, improve tumor visualization, minimize unintended thermal injury to surrounding organs, and reduce post-procedural pain. This pictorial essay illustrates and discusses the proper technique and clinical considerations for successful artificial ascites and pneumoperitoneum creation to facilitate safe peripheral hepatic tumor ablation.

  5. Laser ablation in analytical chemistry - A review

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Russo, Richard E.; Mao, Xianglei; Liu, Haichen

    Laser ablation is becoming a dominant technology for direct solid sampling in analytical chemistry. Laser ablation refers to the process in which an intense burst of energy delivered by a short laser pulse is used to sample (remove a portion of) a material. The advantages of laser ablation chemical analysis include direct characterization of solids, no chemical procedures for dissolution, reduced risk of contamination or sample loss, analysis of very small samples not separable for solution analysis, and determination of spatial distributions of elemental composition. This review describes recent research to understand and utilize laser ablation for direct solid sampling,more » with emphasis on sample introduction to an inductively coupled plasma (ICP). Current research related to contemporary experimental systems, calibration and optimization, and fractionation is discussed, with a summary of applications in several areas.« less

  6. Radio Frequency Ablation Registration, Segmentation, and Fusion Tool

    PubMed Central

    McCreedy, Evan S.; Cheng, Ruida; Hemler, Paul F.; Viswanathan, Anand; Wood, Bradford J.; McAuliffe, Matthew J.

    2008-01-01

    The Radio Frequency Ablation Segmentation Tool (RFAST) is a software application developed using NIH's Medical Image Processing Analysis and Visualization (MIPAV) API for the specific purpose of assisting physicians in the planning of radio frequency ablation (RFA) procedures. The RFAST application sequentially leads the physician through the steps necessary to register, fuse, segment, visualize and plan the RFA treatment. Three-dimensional volume visualization of the CT dataset with segmented 3D surface models enables the physician to interactively position the ablation probe to simulate burns and to semi-manually simulate sphere packing in an attempt to optimize probe placement. PMID:16871716

  7. Behavioral consequences of predator stress in the rat elevated T-maze.

    PubMed

    Bulos, Erika Mondin; Pobbe, Roger Luis Henschel; Zangrossi, Helio

    2015-07-01

    Analyses of the behavioral reactions of rodents to predators have greatly contributed to the understanding of defense-related human psychopathologies such as anxiety and panic.We here investigated the behavioral consequences of exposing male Wistar rats to a live cat using the elevated T-maze test of anxiety. This test allows the measurement of two defensive responses: inhibitory avoidance and escape, which in terms of pathology have been associated with generalized anxiety and panic disorders, respectively. For comparative reasons, the effects of exposure to the cat were also assessed in the elevated plus-maze. The results showed that a 5-min exposure to the cat selectively facilitated inhibitory avoidance acquisition, an anxiogenic effect, without affecting escape expression in the elevated T-maze. This was seen immediately but not 30 min after contact with the predator. This short-lived anxiogenic effect was also detected in the elevated plus-maze. Previous administration of the benzodiazepine anxiolytic diazepam (2 mg/kg) decreased the immediate avoidance response to the predator and the neophobic reaction to a dummy cat used as a control stimulus. The drug also impaired inhibitory avoidance acquisition in the elevated T-maze, indicating an anxiolytic effect, without affecting escape performance. The results indicate that the state of anxiety evoked during contact with the predator generalizes to both elevated plus- and T-mazes, impacting on defensive responses associated with generalized anxiety disorder.

  8. A randomized prospective long-term (>1 year) clinical trial comparing the efficacy and safety of radiofrequency ablation to 980 nm laser ablation of the great saphenous vein.

    PubMed

    Sydnor, Malcolm; Mavropoulos, John; Slobodnik, Natalia; Wolfe, Luke; Strife, Brian; Komorowski, Daniel

    2017-07-01

    Purpose To compare the short- and long-term (>1 year) efficacy and safety of radiofrequency ablation (ClosureFAST™) versus endovenous laser ablation (980 nm diode laser) for the treatment of superficial venous insufficiency of the great saphenous vein. Materials and methods Two hundred patients with superficial venous insufficiency of the great saphenous vein were randomized to receive either radiofrequency ablation or endovenous laser ablation (and simultaneous adjunctive therapies for surface varicosities when appropriate). Post-treatment sonographic and clinical assessment was conducted at one week, six weeks, and six months for closure, complications, and patient satisfaction. Clinical assessment of each patient was conducted at one year and then at yearly intervals for patient satisfaction. Results Post-procedure pain ( p < 0.0001) and objective post-procedure bruising ( p = 0.0114) were significantly lower in the radiofrequency ablation group. Improvements in venous clinical severity score were noted through six months in both groups (endovenous laser ablation 6.6 to 1; radiofrequency ablation 6.2 to 1) with no significant difference in venous clinical severity score ( p = 0.4066) or measured adverse effects; 89 endovenous laser ablation and 87 radiofrequency patients were interviewed at least 12 months out with a mean long-term follow-up of 44 and 42 months ( p = 0.1096), respectively. There were four treatment failures in each group, and every case was correctable with further treatment. Overall, there were no significant differences with regard to patient satisfaction between radiofrequency ablation and endovenous laser ablation ( p = 0.3009). There were no cases of deep venous thrombosis in either group at any time during this study. Conclusions Radiofrequency ablation and endovenous laser ablation are highly effective and safe from both anatomic and clinical standpoints over a multi-year period and neither modality achieved

  9. Catheter ablation in patients with persistent atrial fibrillation

    PubMed Central

    Kirchhof, Paulus; Calkins, Hugh

    2017-01-01

    Catheter ablation is increasingly offered to patients who suffer from symptoms due to atrial fibrillation (AF), based on a growing body of evidence illustrating its efficacy compared with antiarrhythmic drug therapy. Approximately one-third of AF ablation procedures are currently performed in patients with persistent or long-standing persistent AF. Here, we review the available information to guide catheter ablation in these more chronic forms of AF. We identify the following principles: Our clinical ability to discriminate paroxysmal and persistent AF is limited. Pulmonary vein isolation is a reasonable and effective first approach for catheter ablation of persistent AF. Other ablation strategies are being developed and need to be properly evaluated in controlled, multicentre trials. Treatment of concomitant conditions promoting recurrent AF by life style interventions and medical therapy should be a routine adjunct to catheter ablation of persistent AF. Early rhythm control therapy has a biological rationale and trials evaluating its value are underway. There is a clear need to generate more evidence for the best approach to ablation of persistent AF beyond pulmonary vein isolation in the form of adequately powered controlled multi-centre trials. PMID:27389907

  10. Contact forces during hybrid atrial fibrillation ablation: an in vitro evaluation.

    PubMed

    Lozekoot, Pieter W J; de Jong, Monique M J; Gelsomino, Sandro; Parise, Orlando; Matteucci, Francesco; Lucà, Fabiana; Kumar, N; Nijs, Jan; Czapla, Jens; Kwant, Paul; Bani, Daniele; Gensini, Gian Franco; Pison, Laurent; Crijns, Harry J G M; Maessen, Jos G; La Meir, Mark

    2016-03-01

    Data on epicardial contact force efficacy in dual epicardial-endocardial atrial fibrillation ablation procedures are lacking. We present an in vitro study on the importance of epicardial and endocardial contact forces during this procedure. The in vitro setup consists of two separate chambers, mimicking the endocardial and epicardial sides of the heart. A circuit, including a pump and a heat exchanger, circulates porcine blood through the endocardial chamber. A septum, with a cut out, allows the placement of a magnetically fixed tissue holder, securing porcine atrial tissue, in the middle of both chambers. Two trocars provide access to the epicardium and endocardium. Force transducers mounted on both catheter holders allow real-time contact force monitoring, while a railing system allows controlled contact force adjustment. We histologically assessed different combinations of epi-endocardial radiofrequency ablation contact forces using porcine atria, evaluating the ablation's diameters, area, and volume. An epicardial ablation with forces of 100 or 300 g, followed by an endocardial ablation with a force of 20 g did not achieve transmurality. Increasing endocardial forces to 30 and 40 g combined with an epicardial force ranging from 100 to 300 and 500 g led to transmurality with significant increases in lesion's diameters, area, and volumes. Increased endocardial contact forces led to larger ablation lesions regardless of standard epicardial pressure forces. In order to gain transmurality in a model of a combined epicardial-endocardial procedure, a minimal endocardial force of 30 g combined with an epicardial force of 100 g is necessary.

  11. Randomized ablation strategies for the treatment of persistent atrial fibrillation: RASTA study.

    PubMed

    Dixit, Sanjay; Marchlinski, Francis E; Lin, David; Callans, David J; Bala, Rupa; Riley, Michael P; Garcia, Fermin C; Hutchinson, Mathew D; Ratcliffe, Sarah J; Cooper, Joshua M; Verdino, Ralph J; Patel, Vickas V; Zado, Erica S; Cash, Nancy R; Killian, Tony; Tomson, Todd T; Gerstenfeld, Edward P

    2012-04-01

    The single-procedure efficacy of pulmonary vein isolation (PVI) is less than optimal in patients with persistent atrial fibrillation (AF). Adjunctive techniques have been developed to enhance single-procedure efficacy in these patients. We conducted a study to compare 3 ablation strategies in patients with persistent AF. Subjects were randomized as follows: arm 1, PVI + ablation of non-PV triggers identified using a stimulation protocol (standard approach); arm 2, standard approach + empirical ablation at common non-PV AF trigger sites (mitral annulus, fossa ovalis, eustachian ridge, crista terminalis, and superior vena cava); or arm 3, standard approach + ablation of left atrial complex fractionated electrogram sites. Patients were seen at 6 weeks, 6 months, and 1 year; transtelephonic monitoring was performed at each visit. Antiarrhythmic drugs were discontinued at 3 to 6 months. The primary study end point was freedom from atrial arrhythmias off antiarrhythmic drugs at 1 year after a single-ablation procedure. A total of 156 patients (aged 59±9 years; 136 males; AF duration, 47±50 months) participated (arm 1, 55 patients; arm 2, 50 patients; arm 3, 51 patients). Procedural outcomes (procedure, fluoroscopy, and PVI times) were comparable between the 3 arms. More lesions were required to target non-PV trigger sites than a complex fractionated electrogram (33±9 versus 22±9; P<0.001). The primary end point was achieved in 71 patients and was worse in arm 3 (29%) compared with arm 1 (49%; P=0.04) and arm 2 (58%; P=0.004). These data suggest that additional substrate modification beyond PVI does not improve single-procedure efficacy in patients with persistent AF. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00379301.

  12. Initial clinical experience with a remote magnetic catheter navigation system for ablation of cavotricuspid isthmus-dependent right atrial flutter.

    PubMed

    Arya, Arash; Kottkamp, Hans; Piorkowski, Christopher; Bollmann, Andreas; Gerdes-Li, Jin-Hong; Riahi, Sam; Esato, Masahiro; Hindricks, Gerhard

    2008-05-01

    A remote magnetic navigation system (MNS) is available and has been used with a 4-mm-tip magnetic catheter for radiofrequency (RF) ablation of some supraventricular and ventricular arrhythmias; however, it has not been evaluated for the ablation of cavotricuspid isthmus-dependent right atrial flutter (AFL). The present study evaluates the feasibility and efficiency of this system and the newly available 8-mm-tip magnetic catheter to perform RF ablation in patients with AFL. Twenty-six consecutive patients (23 men, mean age 64.6 +/- 9.6 years) underwent RF ablation using a remote MNS. RF ablation was performed with an 8-mm-tip magnetic catheter (70 degrees C, maximum power 70 W, 90 seconds). The endpoint of ablation was complete bidirectional isthmus block. To assess a possible learning curve, procedural data were compared between the first 14 (group 1) and the rest (group 2) of the patients. The initial rhythm during ablation was AFL in 20 (19 counterclockwise and 1 clockwise) and sinus rhythm in six patients. Due to technical issues, the ablation in the 18th patient could not be done with the MNS, and so we switched to conventional ablation. The remote magnetic navigation and ablation procedure was successful in 24 of the 25 (96%) remaining patients with AFL. In one patient (patient 2), conventional catheter was used to complete the isthmus block after termination of AFL. The procedure, preparation, ablation, and fluoroscopy times (median [range]) were 53 (30-130) minutes, 28 (10-65) minutes, 25 (12-78) minutes, and 7.5 (3.2-20.8) minutes, respectively. Patients in group 2 had shorter procedure (45 [30-70] min vs 80 [57-130] min, P = 0.0001), preparation (25 [10-30] min vs 42 [30-65] min, P = 0.0001), ablation (20 [12-40] min vs 31 [20-78] min, P = 0.002), and fluoroscopy (7.2 [3.2-12.2] min vs 11.0 [5.4-20.8] min, P = 0.014) times. No complication occurred during the procedure. Using a remote MNS and an 8-mm-tip magnetic catheter, ablation of AFL is feasible

  13. Self-organization of maze-like structures via guided wrinkling.

    PubMed

    Bae, Hyung Jong; Bae, Sangwook; Yoon, Jinsik; Park, Cheolheon; Kim, Kibeom; Kwon, Sunghoon; Park, Wook

    2017-06-01

    Sophisticated three-dimensional (3D) structures found in nature are self-organized by bottom-up natural processes. To artificially construct these complex systems, various bottom-up fabrication methods, designed to transform 2D structures into 3D structures, have been developed as alternatives to conventional top-down lithography processes. We present a different self-organization approach, where we construct microstructures with periodic and ordered, but with random architecture, like mazes. For this purpose, we transformed planar surfaces using wrinkling to directly use randomly generated ridges as maze walls. Highly regular maze structures, consisting of several tessellations with customized designs, were fabricated by precisely controlling wrinkling with the ridge-guiding structure, analogous to the creases in origami. The method presented here could have widespread applications in various material systems with multiple length scales.

  14. Skin pre-ablation and laser assisted microjet injection for deep tissue penetration.

    PubMed

    Jang, Hun-Jae; Yeo, Seonggu; Yoh, Jack J

    2017-04-01

    For conventional needless injection, there still remain many unresolved issues such as the potential for cross-contamination, poor reliability of targeted delivery dose, and significantly painstaking procedures. As an alternative, the use of microjets generated with Er:YAG laser for delivering small doses with controlled penetration depths has been reported. In this study, a new system with two stages is evaluated for effective transdermal drug delivery. First, the skin is pre-ablated to eliminate the hard outer layer and second, laser-driven microjet penetrates the relatively weaker and freshly exposed epidermis. Each stage of operation shares a single Er:YAG laser that is suitable for skin ablation as well as for the generation of a microjet. In this study, pig skin is selected for quantification of the injection depth based on the two-stage procedure, namely pre-ablation and microjet injection. The three types of pre-ablation devised here consists of bulk ablation, fractional ablation, and fractional-rotational ablation. The number of laser pulses are 12, 18, and 24 for each ablation type. For fractional-rotational ablation, the fractional beams are rotated by 11.25° at each pulse. The drug permeation in the skin is evaluated using tissue marking dyes. The depth of penetration is quantified by a cross sectional view of the single spot injections. Multi-spot injections are also carried out to control the dose and spread of the drug. The benefits of a pre-ablation procedure prior to the actual microjet injection to the penetration is verified. The four possible combinations of injection are (a) microjet only; (b) bulk ablation and microjet injection; (c) fractional ablation and microjet injection; and (d) fractional-rotational ablation and microjet injection. Accordingly, the total depth increases with injection time for all cases. In particular, the total depth of penetration attained via fractional pre-ablation increased by 8 ∼ 11% and that of fractional

  15. Selective Angiography Using the Radiofrequency Catheter: An Alternative Technique for Mapping and Ablation in the Aortic Cusps.

    PubMed

    Roca-Luque, Ivo; Rivas, Nuria; Francisco, Jaume; Perez, Jordi; Acosta, Gabriel; Oristrell, Gerard; Terricabres, Maria; Garcia-Dorado, David; Moya, Angel

    2017-01-01

    Ablation in aortic cusps could be necessary in up to 15% of the patients, especially in para-Hisian atrial tachycardia and ventricular arrhythmias arising from outflow tracts. Risk of coronary damage has led to recommendation of systematic coronary angiography (CA) during the procedure. Other image tests as intravascular (ICE) or transesophageal echocardiography (TEE) have been proposed. Both methods have limitations: additional vascular access for ICE and need for additional CA in some patients in case of TEE. We describe an alternative method to assess relation of catheter tip and coronary ostia during ablation in aortic cusps without additional vascular accesses by performing selective angiography with the ablation catheter. We prospectively evaluated 12 consecutive patients (69.3 ± 8.5, 6 female) who underwent ablation in right (1), left (5), and noncoronary cusps (6). We performed angiography through the ablation cooled tip radiofrequency catheter at the ablation site. Ablation was effective in 91.6% of the patients (3 patients needed additional ablation out of coronary cusps: pulmonary cusp, right ventricular outflow tract (RVOT), and coronary sinus and 1 patient underwent a second procedure because recurrence). No complications occurred neither during procedure nor follow-up (6.2 ± 3.8 months). No technical problems occurred with the ablation catheter after contrast injection. Selective angiography through a cooled-tip radiofrequency ablation catheter is feasible to assess relation of coronary ostia and ablation site when ablation in aortic cusps. It allows continuous real-time assessment of this relation, avoids the need for additional vascular accesses and no complications occurred in our series. © 2016 Wiley Periodicals, Inc.

  16. Left Atrial Anatomy Relevant to Catheter Ablation

    PubMed Central

    Sánchez-Quintana, Damián; Cabrera, José Angel; Saremi, Farhood

    2014-01-01

    The rapid development of interventional procedures for the treatment of arrhythmias in humans, especially the use of catheter ablation techniques, has renewed interest in cardiac anatomy. Although the substrates of atrial fibrillation (AF), its initiation and maintenance, remain to be fully elucidated, catheter ablation in the left atrium (LA) has become a common therapeutic option for patients with this arrhythmia. Using ablation catheters, various isolation lines and focal targets are created, the majority of which are based on gross anatomical, electroanatomical, and myoarchitectual patterns of the left atrial wall. Our aim was therefore to review the gross morphological and architectural features of the LA and their relations to extracardiac structures. The latter have also become relevant because extracardiac complications of AF ablation can occur, due to injuries to the phrenic and vagal plexus nerves, adjacent coronary arteries, or the esophageal wall causing devastating consequences. PMID:25057427

  17. Generalizability Theory Analysis of CBM Maze Reliability in Third- through Fifth-Grade Students

    ERIC Educational Resources Information Center

    Mercer, Sterett H.; Dufrene, Brad A.; Zoder-Martell, Kimberly; Harpole, Lauren Lestremau; Mitchell, Rachel R.; Blaze, John T.

    2012-01-01

    Despite growing use of CBM Maze in universal screening and research, little information is available regarding the number of CBM Maze probes needed for reliable decisions. The current study extends existing research on the technical adequacy of CBM Maze by investigating the number of probes and assessment durations (1-3 min) needed for reliable…

  18. Role of Rotors in the Ablative Therapy of Persistent Atrial Fibrillation

    PubMed Central

    Schricker, Amir A; Zaman, Junaid; Narayan, Sanjiv M

    2015-01-01

    Atrial fibrillation (AF) ablation is increasingly used to maintain sinus rhythm yet its results are sub-optimal, especially in patients with persistent AF or prior unsuccessful procedures. Attempts at improvement have often targeted substrates that sustain AF after it is triggered, yet those mechanisms are debated. Many studies now challenge the concept that AF is driven by self-sustaining disordered wavelets, showing instead that localised drivers (rotors) may drive disorder via a process known as fibrillatory conduction. Novel mapping using wide-area recordings, physiological filtering and phase analysis demonstrates rotors in human AF. Contact mapping with focal impulse and rotor modulation (FIRM) shows that localised ablation at sources can improve procedural success in many populations on long-term follow up and some newer approaches to rotor mapping are qualitatively similar. This review critically evaluates the data on rotor mapping and ablation, which advances our conceptual understanding of AF and holds the promise of substantially improving ablative outcomes in patients with persistent AF. PMID:26835100

  19. Safety and feasibility of single-catheter ablation using remote magnetic navigation for treatment of slow-fast atrioventricular nodal reentrant tachycardia compared to conventional ablation strategies.

    PubMed

    Akca, Ferdi; Schwagten, Bruno; Theuns, Dominic A J; Takens, Marieke; Musters, Paul; Szili-Torok, Tamas

    2013-12-01

    Ablation of atrioventricular nodal re-entrant tachycardia (AVNRT) is a highly effective procedure both with radiofrequency (RF) and cryoenergy (CE). Conventionally, it requires several diagnostic catheters and hospital admission. This study assessed the safety and efficacy of a highly simplified approach using the magnetic navigation system (MNS) compared to CE and manual RF ablation (MAN). In the MNS group a single magnetic-guided quadripolar catheter was inserted through the internal jugular vein to perform ablation. In the CE group cryomapping preceded ablation and for MAN procedures conventional ablation was performed. The following parameters were analysed: success- and recurrence rate, procedure-, fluoroscopy- and total application time. In total 69 eligible patients were treated with MNS (n = 26), CE (n = 25) and MAN (n = 16). The success rates were 100%, 100% and 94%, respectively (p = ns). The mean procedural time was 83 +/- 25 min for MNS, 117 +/- 47 min for CE and 117 +/- 55 min for MAN (P < 0.01). Total radiation time was significantly lower for MNS [0.0 min (IQR 0.0-0.0)] compared to CE [15.1 min (IQR 9.1-23.8), P < 0.001] and MAN [17.5 min (IQR 7.0-31.3), P < 0.001]. The total application time was comparable for both RF groups: 357 +/- 315 s (MNS) vs 204 +/- 177 s (MAN) (P = 0.14). No major adverse events occurred. After 3 months follow-up similar PR intervals were recorded for all patients. During a follow-up of 26 +/- 5 months recurrence rates were 3.8%, 4.0% and 6.3%, respectively, for each group. The MNS-guided single-catheter approach is a feasible and safe technique for the treatment of patients with typical AVNRT.

  20. Pigeons (Columba livia) plan future moves on computerized maze tasks.

    PubMed

    Miyata, Hiromitsu; Fujita, Kazuo

    2008-07-01

    Planning, the internal process of formulating an organized method about one's future behavior, should be advantageous for non-human animals as well as for humans. However, little is known about this process in avian species. We examined planning processes in pigeons (Columba livia) using a computerized maze task. In Experiment 1, we found that the pigeons plan their next one step, and in some cases even correctly adjust their actions after change of goal locations, while performing on a plus-shaped maze. We also showed that the pigeons might even plan two steps on familiar, well-practiced mazes. In Experiment 2, we discovered that the subjects plan the direction they would go first before starting to solve a four-arm shuriken (a Japanese traditional throwing knife)-shaped maze. The birds also corrected their previously planned actions after change of goal locations. Our results from these experiments suggest that planning ahead is within the cognitive capacity of a "bird brain", and that it may be more widespread in the animal kingdom than has been presumed.

  1. Cone-beam computed tomography fusion and navigation for real-time positron emission tomography-guided biopsies and ablations: a feasibility study.

    PubMed

    Abi-Jaoudeh, Nadine; Mielekamp, Peter; Noordhoek, Niels; Venkatesan, Aradhana M; Millo, Corina; Radaelli, Alessandro; Carelsen, Bart; Wood, Bradford J

    2012-06-01

    To describe a novel technique for multimodality positron emission tomography (PET) fusion-guided interventions that combines cone-beam computed tomography (CT) with PET/CT before the procedure. Subjects were selected among patients scheduled for a biopsy or ablation procedure. The lesions were not visible with conventional imaging methods or did not have uniform uptake on PET. Clinical success was defined by adequate histopathologic specimens for molecular profiling or diagnosis and by lack of enhancement on follow-up imaging for ablation procedures. Time to target (time elapsed between the completion of the initial cone-beam CT scan and first tissue sample or treatment), total procedure time (time from the moment the patient was on the table until the patient was off the table), and number of times the needle was repositioned were recorded. Seven patients underwent eight procedures (two ablations and six biopsies). Registration and procedures were completed successfully in all cases. Clinical success was achieved in all biopsy procedures and in one of the two ablation procedures. The needle was repositioned once in one biopsy procedure only. On average, the time to target was 38 minutes (range 13-54 min). Total procedure time was 95 minutes (range 51-240 min, which includes composite ablation). On average, fluoroscopy time was 2.5 minutes (range 1.3-6.2 min). An integrated cone-beam CT software platform can enable PET-guided biopsies and ablation procedures without the need for additional specialized hardware. Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.

  2. Cost Analysis of Periprocedural Imaging in Patients Undergoing Catheter Ablation for Atrial Fibrillation

    PubMed Central

    Pokorney, Sean D.; Hammill, Bradley G.; Qualls, Laura G.; Steinberg, Benjamin A.; Curtis, Lesley H.; Piccini, Jonathan P.

    2014-01-01

    Cardiovascular imaging is an important part of procedural planning and safety for catheter ablation of atrial fibrillation (AF). However, the costs of imaging surrounding catheter ablation of AF have not been described. Medicare fee-for-service data were used to evaluate Medicare expenditures before, during, and after catheter ablation for AF from July 2007 to December 2009. Among 11,525 patients who underwent catheter ablation for AF, the mean overall expenditure on the day of the procedure was $14,455 (SD $7,441). The mean imaging expenditure in the periprocedural period, which included the 30 days before the catheter ablation and the day of the ablation itself, was $884 (SD $455). Periprocedural imaging expenditures varied by the imaging strategy used, ranging from a mean of $557 (SD $269) for patients with electroanatomic mapping only to $1,234 (SD $461) for patients with electroanatomic mapping, transesophageal echocardiogram, and computed tomography or magnetic resonance imaging. Mean patient-level imaging expenditures varied by provider (mean $872, SD $249). Periprocedural imaging expenditures also varied by patient risk, with mean expenditures of $862 (SD $444) for patients with a CHADS2 score of ≥2 compared with $907 (SD $466) for CHADS2 score <2 (p <0.001). In conclusion, peri-procedural imaging accounts for approximately 6% of mean Medicare expenditures for catheter ablation of AF. The expenditures for periprocedural imaging vary both at the patient and at the provider level and they are inversely related to stroke risk by CHADS2 score. PMID:24952929

  3. Incidence and Risk Factors for Liver Abscess After Thermal Ablation of Liver Neoplasm

    PubMed Central

    Su, Xiu-Feng; Li, Na; Chen, Xu-Fang; Zhang, Lei; Yan, Ming

    2016-01-01

    Background Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most frequently used thermal ablation methods for the treatment of liver cancer. Liver abscess is a common and severe complication of thermal ablation treatment. Objectives The objective of this study was to determine the incidence and risk factors of liver abscess formation after thermal ablation of liver cancer. Materials and Methods The clinical data of 423 patients who underwent 691 thermal ablation procedures for liver cancer were collected in order to retrospectively analyze the basic characteristics, incidence, and risk factors associated with liver abscess formation. Patients with multiple risk factors for liver abscess formation were enrolled in a risk factor group, and patients with no risk factors were enrolled in a control group. The chi-square test and multiple logistic regression analysis were used to analyze the relationship between the occurrence of liver abscesses and potential risk factors. Results Two hundred and eight patients underwent 385 RFA procedures, and 185 patients underwent 306 MWA procedures. The total incidence of liver abscesses was 1.7%, while the rates in the RFA group (1.8%) and MWA groups (1.6%) were similar (P > 0.05). The rates of liver abscesses in patients who had child-pugh class B and class C cirrhosis (P = 0.0486), biliary tract disease (P = 0.0305), diabetes mellitus (P = 0.0344), and porta hepatis tumors (P = 0.0123) were 4.0%, 6.7%, 6.5%, and 13.0%, respectively. There was a statistically significant difference between these four groups and the control group (all P < 0.05). The incidence of liver abscesses in the combined ablation and percutaneous ethanol injection (PEI) group (P = 0.0026) was significantly lower than that of the ablation group (P < 0.05). Conclusions The incidence of liver abscesses after liver cancer thermal ablation is low. Child-Pugh Class B and Class C cirrhosis, biliary tract disease, diabetes mellitus, and porta hepatis

  4. Photoacoustic characterization of radiofrequency ablation lesions

    NASA Astrophysics Data System (ADS)

    Bouchard, Richard; Dana, Nicholas; Di Biase, Luigi; Natale, Andrea; Emelianov, Stanislav

    2012-02-01

    Radiofrequency ablation (RFA) procedures are used to destroy abnormal electrical pathways in the heart that can cause cardiac arrhythmias. Current methods relying on fluoroscopy, echocardiography and electrical conduction mapping are unable to accurately assess ablation lesion size. In an effort to better visualize RFA lesions, photoacoustic (PA) and ultrasonic (US) imaging were utilized to obtain co-registered images of ablated porcine cardiac tissue. The left ventricular free wall of fresh (i.e., never frozen) porcine hearts was harvested within 24 hours of the animals' sacrifice. A THERMOCOOLR Ablation System (Biosense Webster, Inc.) operating at 40 W for 30-60 s was used to induce lesions through the endocardial and epicardial walls of the cardiac samples. Following lesion creation, the ablated tissue samples were placed in 25 °C saline to allow for multi-wavelength PA imaging. Samples were imaged with a VevoR 2100 ultrasound system (VisualSonics, Inc.) using a modified 20-MHz array that could provide laser irradiation to the sample from a pulsed tunable laser (Newport Corp.) to allow for co-registered photoacoustic-ultrasound (PAUS) imaging. PA imaging was conducted from 750-1064 nm, with a surface fluence of approximately 15 mJ/cm2 maintained during imaging. In this preliminary study with PA imaging, the ablated region could be well visualized on the surface of the sample, with contrasts of 6-10 dB achieved at 750 nm. Although imaging penetration depth is a concern, PA imaging shows promise in being able to reliably visualize RF ablation lesions.

  5. Correlative anatomy for the electrophysiologist: ablation for atrial fibrillation. Part II: regional anatomy of the atria and relevance to damage of adjacent structures during AF ablation.

    PubMed

    Macedo, Paula G; Kapa, Suraj; Mears, Jennifer A; Fratianni, Amy; Asirvatham, Samuel J

    2010-07-01

    Ablation procedures for atrial fibrillation have become an established and increasingly used option for managing patients with symptomatic arrhythmia. The anatomic structures relevant to the pathogenesis of atrial fibrillation and ablation procedures are varied and include the pulmonary veins, other thoracic veins, the left atrial myocardium, and autonomic ganglia. Exact regional anatomic knowledge of these structures is essential to allow correlation with fluoroscopy and electrograms and, importantly, to avoid complications from damage of adjacent structures within the chest. We present this information as a series of 2 articles. In a prior issue, we have discussed the thoracic vein anatomy relevant to paroxysmal atrial fibrillation. In the present article, we focus on the atria themselves, the autonomic ganglia, and anatomic issues relevant for minimizing complications during atrial fibrillation ablation.

  6. Radiofrequency Ablation for Tumor-Related Massive Hematuria

    PubMed Central

    Neeman, Ziv; Sarin, Shawn; Coleman, Jonathan; Fojo, Tito; Wood, Bradford J.

    2008-01-01

    To determine whether radiofrequency (RF) ablation targeting the tumor-collecting system interface has a durable effect in patients with transfusion-dependent kidney tumor-related hematuria, four patients aged 61-71 years were successfully treated with RF ablation, with a mean follow up of 12 months. Baseline creatinine levels varied from 2.0 mg/dL to 3.7 mg/dL. All patients had received red blood cell transfusions in the days and hours before RF ablation. No subsequent surgical or interventional procedures were required for management of hematuria. Gross hematuria resolved in 24-48 hours in all four patients. Two of the patients are alive with stable renal function and two died of causes unrelated to treatment. RF ablation may be an effective therapeutic option for transfusion-dependent cancer-related hematuria in patients with renal insufficiency, solitary kidney, or comorbidities, or after failed conventional therapies in patients who are not candidates for surgery. PMID:15758142

  7. Radiofrequency ablation for tumor-related massive hematuria.

    PubMed

    Neeman, Ziv; Sarin, Shawn; Coleman, Jonathan; Fojo, Tito; Wood, Bradford J

    2005-03-01

    To determine whether radiofrequency (RF) ablation targeting the tumor-collecting system interface has a durable effect in patients with transfusion-dependent kidney tumor-related hematuria, four patients aged 61-71 years were successfully treated with RF ablation, with a mean follow up of 12 months. Baseline creatinine levels varied from 2.0 mg/dL to 3.7 mg/dL. All patients had received red blood cell transfusions in the days and hours before RF ablation. No subsequent surgical or interventional procedures were required for management of hematuria. Gross hematuria resolved in 24-48 hours in all four patients. Two of the patients are alive with stable renal function and two died of causes unrelated to treatment. RF ablation may be an effective therapeutic option for transfusion-dependent cancer-related hematuria in patients with renal insufficiency, solitary kidney, or comorbidities, or after failed conventional therapies in patients who are not candidates for surgery.

  8. [Left versus bi-atrial radiofrequency ablation in the treatment of atrial fibrillation].

    PubMed

    Wang, Jian-Gang; Meng, Xu; Li, Hui

    2008-11-25

    To evaluate the effectiveness of radiofrequency modified maze operation for the treatment of atrial fibrillation (AF) and compare the results of the left versus bi-atrial procedures. 305 patients of organic heart disease combined with AF, 117 males and 188 females, aged (53 +/- 10), that underwent cardiac valve operation (n = 293) and/or coronary artery bypass graft surgery (n = 14), received concomitant atrial fibrillation, bi-atrial (n = 160) or left atrial (n = 145) with a mean duration of (36 +/- 43) months. Follow-up was conducted for (28 +/- 5) (3 - 42) months. Thirteen patients (4.3%) died postoperatively: 7 died of multisystem and organ failure, 3 of low cardiac output, 1 of rupture of left ventricle, 1 of arrhythmia, and 1 of sudden death. During the follow-up, 1 patient died of heart failure, 1 of encephalorrhagia and 1 of unknown reason in the bi-atrial group. At the end of the procedure 223 patients (73.1%) had sinus rhythm, with a sinus rhythm rate of 66.9% (107/160) in the bi-atrial group, significant lower than that in the left atrial group (80.0%, 116/145, P < 0.05). At late follow-up, 215 of the 266 patients (80.8%) were in stable sinus rhythm. Sinus rhythm rate of the bi-atrial group was 80.0%, not significantly different from that of the left atrial group (81.9%, P > 0.05). The Kaplan-Meier survival analysis showed there was no significant difference in the AF rhythm rate between these 2 groups (P = 0.33). Logistic regression analysis showed that the left atrial diameter of >/= 80 mm was an independent predictor of AF recurrence. Both the left and bi-atrial procedures are successful in terms of restoring sinus rhythm. Left atrial ablation in severe cases and where the incision of right atrium is not needed is a reasonable choice.

  9. Universal Screening of Reading in Late Elementary School: R-CBM versus CBM Maze

    ERIC Educational Resources Information Center

    Graney, Suzanne Bamonto; Martinez, Rebecca S.; Missall, Kristen N.; Aricak, O. Tolga

    2010-01-01

    Two curriculum-based measurement tools are commonly used to assess progress in reading in elementary school: R-CBM and CBM maze. R-CBM is used in practice more frequently than CBM maze is, although CBM maze is more time efficient to administer than R-CBM is. The technical adequacy of each of these measures has been reported in the literature;…

  10. Planning in human children (Homo sapiens) assessed by maze problems on the touch screen.

    PubMed

    Miyata, Hiromitsu; Itakura, Shoji; Fujita, Kazuo

    2009-02-01

    The authors examined how human children perform on maze tasks on the touch screen and whether the children plan the solution of the mazes. In Experiment 1, the authors exposed children around 3 years of age to a maze having an L-shaped line as a barrier that can be solved by moving an illustration of a dog (the target) to that of a bone (the goal) with their fingers. The participants successfully solved the maze by taking efficient routes more frequently than chance, although the authors found no evidence that a preview of the maze before starting to solve the task facilitated their performance. In Experiment 2, using a plus-shaped maze, the authors found that 3- and 4-year-old children plan and adjust their moves while solving the maze, with 4-year-olds showing more advanced and higher-level planning than 3-year-olds. Similarity of these results to what the authors previously found in pigeons tested in the same tasks may suggest an analogy for planning capacity in the behavioral level across taxa and developmental stages. Copyright 2009 APA, all rights reserved.

  11. Attitudes toward Catheter Ablation for Atrial Fibrillation: A Nationwide Survey among Danish Cardiologists.

    PubMed

    Vadmann, Henrik; Pedersen, Susanne S; Nielsen, Jens Cosedis; Rodrigo-Domingo, Maria; Pehrson, Steen; Johannessen, Arne; Hansen, Peter Steen; Johansen, Jens Brock; Riahi, Sam

    2015-10-01

    Catheter ablation for atrial fibrillation (AF) is an important but expensive procedure that is the subject of some debate. Physicians' attitudes toward catheter ablation may influence promotion and patient acceptance. This is the first study to examine the attitudes of Danish cardiologists toward catheter ablation for AF, using a nationwide survey. We developed a purpose-designed questionnaire to evaluate attitudes toward catheter ablation for AF that was sent to all Danish cardiologists (n = 401; response n = 272 (67.8%)). There was no association between attitudes toward ablation and the experience or age of the cardiologist with respect to patients with recurrent AF episodes with a duration of <48 hours or >7 days and/or need for cardioversion. The majority (69%) expected a recurrence of AF after catheter ablation in more than 30% of the cases. For patients with persistent longstanding AF with a duration of >1 year, the attitude toward ablation for longstanding AF was more likely to be positive with increasing age (P < 0.01) and years of experience of the cardiologist (P = 0.002). Danish cardiologists generally have a positive attitude toward catheter ablation for AF, maintain up-to-date knowledge of the procedure, and are aware what information on ablation treatment should be given to patients with AF. The cardiologists had a positive attitude toward ablation for AF in patients with AF episodes <48 hours and patients with episodes >7 days, or those who needed medical/electrical conversion, but a more negative attitude toward treating longstanding AF patients. © 2015 Wiley Periodicals, Inc.

  12. Mechanochemical endovenous ablation versus radiofrequency ablation in the treatment of primary small saphenous vein insufficiency (MESSI trial): study protocol for a randomized controlled trial.

    PubMed

    Boersma, Doeke; van Eekeren, Ramon R J P; Kelder, Hans J C; Werson, Debora A B; Holewijn, Suzanne; Schreve, Michiel A; Reijnen, Michel M P J; de Vries, Jean Paul P M

    2014-10-29

    Minimally invasive endothermal techniques, for example, radiofrequency ablation (RFA), have revolutionized the treatment of insufficient truncal veins and are associated with an excellent outcome. The use of thermal energy requires the instillation of tumescent anesthesia around the vein. Mechanochemical endovenous ablation (MOCA™) combines mechanical endothelial damage, using a rotating wire, with simultaneous infusion of a liquid sclerosans. Tumescent anesthesia is not required as no heat is used. Prospective studies using MOCA™ in both great and small saphenous veins showed good anatomical and clinical results with fast postoperative recovery. The MESSI trial (Mechanochemical Endovenous ablation versus radiofrequency ablation in the treatment of primary Small Saphenous vein Insufficiency) is a multicenter randomized controlled trial in which a total of 160 patients will be randomized (1:1) to MOCA™ or RFA. Consecutive patients with primary small saphenous vein incompetence, who meet the eligibility criteria, will be invited to participate in this trial. The primary endpoint is anatomic success, defined as occlusion of the treated veins objectified with duplex ultrasonography at 1 year follow-up. Secondary endpoints are post-procedural pain, initial technical success, clinical success, complications and the duration of the procedure. Initial technical success is defined as the ability to position the device adequately, treat the veins as planned and occlude the treated vein directly after the procedure has been proven by duplex ultrasonography. Clinical success is defined as an objective improvement of clinical outcome after treatment, measured with the Venous Clinical Severity Score (VCSS). Power analyses are conducted for anatomical success and post-procedural pain.Both groups will be evaluated on an intention-to-treat principle. The hypothesis of the MESSI trial is that the anatomic success rate of MOCA™ is not inferior to RFA. The second hypothesis is

  13. Real-time rotational ICE imaging of the relationship of the ablation catheter tip and the esophagus during atrial fibrillation ablation.

    PubMed

    Helms, Adam; West, J Jason; Patel, Amit; Mounsey, J Paul; DiMarco, John P; Mangrum, J Michael; Ferguson, John D

    2009-02-01

    Atrioesophageal fistula is a rare complication of atrial fibrillation (AF) ablation that should be avoided. We investigated whether rotational intracardiac echocardiography (ICE) can help to minimize ablation close to the esophagus. We studied 41 patients referred for catheter ablation of refractory AF. A rotational ICE catheter was inserted into the (LA) to determine the location of the esophagus. The esophagus was identified to be either adjacent to the pulmonary vein (PV) ostium or to a cuff 2 cm outside the ostium. Circumferential ablation was performed at the PV ostium, with the exact ablation location determined by ICE. The relationship of the catheter tip to the esophagus was imaged during energy delivery, allowing interruption when respiration moved the tip closer to the esophagus. Out of 41 patients, the esophagus was seen near left-sided PVs in 32 and near right-sided PVs in three patients. The median distance from LA endocardium to esophagus was 2.2 mm (range, 1.4-6 mm). In 21 of 35 patients with a closely related esophagus, ablation over the esophagus was avoided by ablating either lateral or medial to the esophagus. In 14 patients, the esophagus could not be avoided, and risk was minimized by limiting lesion size. Significant movement (>10 mm) of the esophagus during the procedure occurred in 3/41 cases. Rotational ICE can accurately determine the distance of ablation sites from the esophagus. Real-time imaging of the relationship of the ablation catheter tip to the esophagus may reduce the incidence of esophageal injury.

  14. Estimating Effective Dose from Phantom Dose Measurements in Atrial Fibrillation Ablation Procedures and Comparison of MOSFET and TLD Detectors in a Small Animal Dosimetry Setting

    NASA Astrophysics Data System (ADS)

    Anderson-Evans, Colin David

    Two different studies will be presented in this work. The first involves the calculation of effective dose from a phantom study which simulates an atrial fibrillation (AF) ablation procedure. The second involves the validation of metal-oxide semiconducting field effect transistors (MOSFET) for small animal dosimetry applications as well as improved characterization of the animal irradiators on Duke University's campus. Atrial Fibrillation is an ever increasing health risk in the United States. The most common type of cardiac arrhythmia, AF is associated with increased mortality and ischemic cerebrovascular events. Managing AF can include, among other treatments, an interventional procedure called catheter ablation. The procedure involves the use of biplane fluoroscopy during which a patient can be exposed to radiation for as much as two hours or more. The deleterious effects of radiation become a concern when dealing with long fluoroscopy times, and because the AF ablation procedure is elective, it makes relating the risks of radiation ever more essential. This study hopes to quantify the risk through the derivation of dose conversion coefficients (DCCs) from the dose-area product (DAP) with the intent that DCCs can be used to provide estimates of effective dose (ED) for typical AF ablation procedures. A bi-plane fluoroscopic and angiographic system was used for the simulated AF ablation procedures. For acquisition of organ dose measurements, 20 diagnostic MOSFET detectors were placed at selected organs in a male anthropomorphic phantom, and these detectors were attached to 4 bias supplies to obtain organ dose readings. The DAP was recorded from the system console and independently validated with an ionization chamber and radiochromic film. Bi-plane fluoroscopy was performed on the phantom for 10 minutes to acquire the dose rate for each organ, and the average clinical procedure time was multiplied by each organ dose rate to obtain individual organ doses. The

  15. Clinical Implications of Ablation of Drivers for Atrial Fibrillation: A Systematic Review and Meta-Analysis.

    PubMed

    Baykaner, Tina; Rogers, Albert J; Meckler, Gabriela L; Zaman, Junaid; Navara, Rachita; Rodrigo, Miguel; Alhusseini, Mahmood; Kowalewski, Christopher A B; Viswanathan, Mohan N; Narayan, Sanjiv M; Clopton, Paul; Wang, Paul J; Heidenreich, Paul A

    2018-05-01

    The outcomes from pulmonary vein isolation (PVI) for atrial fibrillation (AF) are suboptimal, but the benefits of additional lesion sets remain unproven. Recent studies propose ablation of AF drivers improves outcomes over PVI, yet with conflicting reports in the literature. We undertook a systematic literature review and meta-analysis to determine outcomes from ablation of AF drivers in addition to PVI or as a stand-alone procedure. Database search was done using the terms atrial fibrillation and ablation or catheter ablation and driver or rotor or focal impulse or FIRM (Focal Impulse and Rotor Modulation). We pooled data using random effects model and assessed heterogeneity with I 2 statistic. Seventeen studies met inclusion criteria, in a cohort size of 3294 patients. Adding AF driver ablation to PVI reported freedom from AF of 72.5% (confidence interval [CI], 62.1%-81.8%; P <0.01) and from all arrhythmias of 57.8% (CI, 47.5%-67.7%; P <0.01). AF driver ablation when added to PVI or as stand-alone procedure compared with controls produced an odds ratio of 3.1 (CI, 1.3-7.7; P =0.02) for freedom from AF and an odds ratio of 1.8 (CI, 1.2-2.7; P <0.01) for freedom from all arrhythmias in 4 controlled studies. AF termination rate was 40.5% (CI, 30.6%-50.9%) and predicted favorable outcome from ablation( P <0.05). In controlled studies, the addition of AF driver ablation to PVI supports the possible benefit of a combined approach of AF driver ablation and PVI in improving single-procedure freedom from all arrhythmias. However, most studies are uncontrolled and are limited by substantial heterogeneity in outcomes. Large multicenter randomized trials are needed to precisely define the benefits of adding driver ablation to PVI. © 2018 American Heart Association, Inc.

  16. Technique for CT Fluoroscopy-Guided Lumbar Medial Branch Blocks and Radiofrequency Ablation.

    PubMed

    Amrhein, Timothy J; Joshi, Anand B; Kranz, Peter G

    2016-09-01

    The purpose of this study is to describe the procedure for CT fluoroscopy-guided lumbar medial branch blocks and facet radiofrequency ablation. CT fluoroscopic guidance allows more-precise needle tip positioning and is an alternative method for performing medial branch blocks and facet radiofrequency ablation.

  17. Percutaneous laser ablation of benign and malignant thyroid nodules.

    PubMed

    Papini, Enrico; Bizzarri, Giancarlo; Pacella, Claudio M

    2008-10-01

    Percutaneous image-guided procedures, largely based on thermal ablation, are at present under investigation for achieving a nonsurgical targeted cytoreduction in benign and malignant thyroid lesions. In several uncontrolled clinical trials and in two randomized clinical trials, laser ablation has demonstrated a good efficacy and safety for the shrinkage of benign cold thyroid nodules. In hyperfunctioning nodules, laser ablation induced a nearly 50% volume reduction with a variable frequency of normalization of thyroid-stimulating hormone levels. Laser ablation has been tested for the palliative treatment of poorly differentiated thyroid carcinomas, local recurrences or distant metastases. Laser ablation therapy is indicated for the shrinkage of benign cold nodules in patients with local pressure symptoms who are at high surgical risk. The treatment should be performed only by well trained operators and after a careful cytological evaluation. Laser ablation does not seem to be consistently effective in the long-term control of hyperfunctioning thyroid nodules and is not an alternative treatment to 131I therapy. Laser ablation may be considered for the cytoreduction of tumor tissue prior to external radiation therapy or chemotherapy of local or distant recurrences of thyroid malignancy that are not amenable to surgical or radioiodine treatment.

  18. The Effect of Atrial Fibrillation Ablation Techniques on P Wave Duration and P Wave Dispersion.

    PubMed

    Furniss, Guy O; Panagopoulos, Dimitrios; Kanoun, Sadeek; Davies, Edward J; Tomlinson, David R; Haywood, Guy A

    2018-02-14

    A reduction in surface electrocardiogram (ECG) P wave duration and dispersion is associated with improved outcomes in atrial fibrillation ablation. We investigated the effects of different ablation strategies on P wave duration and dispersion, hypothesising that extensive left atrial (LA) ablation with left atrial posterior wall isolation would give a greater reduction in P wave duration than more limited ablation techniques. A retrospective analysis of ECGs from patients who have undergone atrial fibrillation (AF) ablation was performed and pre-procedural sinus rhythm ECGs were compared with the post procedure ECGs. Maximal P wave duration was measured in leads I or II, minimum P wave duration in any lead and values were calculated for P wave duration and dispersion. Left atrial dimensions and medications at the time of ECG were documented. Ablation strategies compared were; pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) and the persistent AF (PsAF) ablation strategies of pulmonary vein isolation plus additional linear lesions (Lines), left atrial posterior wall isolation via catheter (PWI) and left atrial posterior wall isolation via staged surgical and catheter ablation (Hybrid). Sixty-nine patients' ECGs were analysed: 19 PVI, 21 Lines, 14 PWI, 15 Hybrid. Little correlation was seen between pre-procedure left atrial size and P wave duration (r=0.24) but LA size and P wave duration was larger in PsAF patients. A significant difference was seen in P wave reduction driven by Hybrid AF ablation (p<0.005) and Lines (<0.02). There was no difference amongst P wave dispersion between groups but the largest reduction was seen in the Hybrid ablation group. P wave duration increased with duration of continuous atrial fibrillation. Hybrid AF ablation significantly reduced P wave duration and dispersion compared to other ablation strategies including posterior wall isolation via catheter despite this being the same lesion set. Copyright © 2018

  19. Automated planning of ablation targets in atrial fibrillation treatment

    NASA Astrophysics Data System (ADS)

    Keustermans, Johannes; De Buck, Stijn; Heidbüchel, Hein; Suetens, Paul

    2011-03-01

    Catheter based radio-frequency ablation is used as an invasive treatment of atrial fibrillation. This procedure is often guided by the use of 3D anatomical models obtained from CT, MRI or rotational angiography. During the intervention the operator accurately guides the catheter to prespecified target ablation lines. The planning stage, however, can be time consuming and operator dependent which is suboptimal both from a cost and health perspective. Therefore, we present a novel statistical model-based algorithm for locating ablation targets from 3D rotational angiography images. Based on a training data set of 20 patients, consisting of 3D rotational angiography images with 30 manually indicated ablation points, a statistical local appearance and shape model is built. The local appearance model is based on local image descriptors to capture the intensity patterns around each ablation point. The local shape model is constructed by embedding the ablation points in an undirected graph and imposing that each ablation point only interacts with its neighbors. Identifying the ablation points on a new 3D rotational angiography image is performed by proposing a set of possible candidate locations for each ablation point, as such, converting the problem into a labeling problem. The algorithm is validated using a leave-one-out-approach on the training data set, by computing the distance between the ablation lines obtained by the algorithm and the manually identified ablation points. The distance error is equal to 3.8+/-2.9 mm. As ablation lesion size is around 5-7 mm, automated planning of ablation targets by the presented approach is sufficiently accurate.

  20. Robotic assistance and general anaesthesia improve catheter stability and increase signal attenuation during atrial fibrillation ablation.

    PubMed

    Malcolme-Lawes, Louisa C; Lim, Phang Boon; Koa-Wing, Michael; Whinnett, Zachary I; Jamil-Copley, Shahnaz; Hayat, Sajad; Francis, Darrel P; Kojodjojo, Pipin; Davies, D Wyn; Peters, Nicholas S; Kanagaratnam, Prapa

    2013-01-01

    Recurrent arrhythmias after ablation procedures are often caused by recovery of ablated tissue. Robotic catheter manipulation systems increase catheter tip stability which improves energy delivery and could produce more transmural lesions. We tested this assertion using bipolar voltage attenuation as a marker of lesion quality comparing robotic and manual circumferential pulmonary vein ablation for atrial fibrillation (AF). Twenty patients were randomly assigned to robotic or manual AF ablation at standard radiofrequency (RF) settings for our institution (30 W 60 s manual, 25 W 30 s robotic, R30). A separate group of 10 consecutive patients underwent robotic ablation at increased RF duration, 25 W for 60 s (R60). Lesions were marked on an electroanatomic map before and after ablation to measure distance moved and change in bipolar electrogram amplitude during RF. A total of 1108 lesions were studied (761 robotic, 347 manual). A correlation was identified between voltage attenuation and catheter movement during RF (Spearman's rho -0.929, P < 0.001). The ablation catheter was more stable during robotic RF; 2.9 ± 2.3 mm (R30) and 2.6 ± 2.2 mm (R60), both significantly less than the manual group (4.3 ± 3.0 mm, P < 0.001). Despite improved stability, there was no difference in signal attenuation between the manual and R30 group. However, there was increased signal attenuation in the R60 group (52.4 ± 19.4%) compared with manual (47.7 ± 25.4%, P = 0.01). When procedures under general anaesthesia (GA) and conscious sedation were analysed separately, the improvement in signal attenuation in the R60 group was only significant in the procedures under GA. Robotically assisted ablation has the capability to deliver greater bipolar voltage attenuation compared with manual ablation with appropriate selection of RF parameters. General anaesthesia confers additional benefits of catheter stability and greater signal attenuation. These findings may have a significant impact on

  1. Cone beam computed tomography images fusion in predicting lung ablation volumes: a feasibility study.

    PubMed

    Ierardi, Anna Maria; Petrillo, Mario; Xhepa, Genti; Laganà, Domenico; Piacentino, Filippo; Floridi, Chiara; Duka, Ejona; Fugazzola, Carlo; Carrafiello, Gianpaolo

    2016-02-01

    Recently different software with the ability to plan ablation volumes have been developed in order to minimize the number of attempts of positioning electrodes and to improve a safe overall tumor coverage. To assess the feasibility of three-dimensional cone beam computed tomography (3D CBCT) fusion imaging with "virtual probe" positioning, to predict ablation volume in lung tumors treated percutaneously. Pre-procedural computed tomography contrast-enhanced scans (CECT) were merged with a CBCT volume obtained to plan the ablation. An offline tumor segmentation was performed to determine the number of antennae and their positioning within the tumor. The volume of ablation obtained, evaluated on CECT performed after 1 month, was compared with the pre-procedural predicted one. Feasibility was assessed on the basis of accuracy evaluation (visual evaluation [VE] and quantitative evaluation [QE]), technical success (TS), and technical effectiveness (TE). Seven of the patients with lung tumor treated by percutaneous thermal ablation were selected and treated on the basis of the 3D CBCT fusion imaging. In all cases the volume of ablation predicted was in accordance with that obtained. The difference in volume between predicted ablation volumes and obtained ones on CECT at 1 month was 1.8 cm(3) (SD ± 2, min. 0.4, max. 0.9) for MW and 0.9 cm(3) (SD ± 1.1, min. 0.1, max. 0.7) for RF. Use of pre-procedural 3D CBCT fusion imaging could be useful to define expected ablation volumes. However, more patients are needed to ensure stronger evidence. © The Foundation Acta Radiologica 2015.

  2. Three-dimensional atrial wall thickness maps to inform catheter ablation procedures for atrial fibrillation.

    PubMed

    Bishop, Martin; Rajani, Ronak; Plank, Gernot; Gaddum, Nicholas; Carr-White, Gerry; Wright, Matt; O'Neill, Mark; Niederer, Steven

    2016-03-01

    Transmural lesion formation is critical to success in atrial fibrillation ablation and is dependent on left atrial wall thickness (LAWT). Pre- and peri-procedural planning may benefit from LAWT measurements. To calculate the LAWT, the Laplace equation was solved over a finite element mesh of the left atrium derived from the segmented computed tomographic angiography (CTA) dataset. Local LAWT was then calculated from the length of field lines derived from the Laplace solution that spanned the wall from the endocardium or epicardium. The method was validated on an atrium phantom and retrospectively applied to 10 patients who underwent routine coronary CTA for standard clinical indications at our institute. The Laplace wall thickness algorithm was validated on the left atrium phantom. Wall thickness measurements had errors of <0.2 mm for thicknesses of 0.5-5.0 mm that are attributed to image resolution and segmentation artefacts. Left atrial wall thickness measurements were performed on 10 patients. Successful comprehensive LAWT maps were generated in all patients from the coronary CTA images. Mean LAWT measurements ranged from 0.6 to 1.0 mm and showed significant inter and intra patient variability. Left atrial wall thickness can be measured robustly and efficiently across the whole left atrium using a solution of the Laplace equation over a finite element mesh of the left atrium. Further studies are indicated to determine whether the integration of LAWT maps into pre-existing 3D anatomical mapping systems may provide important anatomical information for guiding radiofrequency ablation. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  3. Surgical treatment of atrial fibrillation.

    PubMed

    Pagé, Pierre; Skanes, Allan C

    2005-09-01

    Surgery aims to eliminate atrial fibrillation (AF) through direct modification of the arrhythmogenic substratum. The Maze procedure, developed two decades ago, has proven to be clearly effective in restoring sinus rhythm in AF patients with or without associated organic cardiac disorders. Indications for surgery may be tailored to the clinical situation involved. In patients with continuous AF associated with structural heart disease (eg, valvular, congenital or coronary artery disease), the performance of a concomitant AF ablation procedure proven to add minimal morbidity to the operation may be highly beneficial to patient outcome. It is likely, although not entirely proven, that the restoration and maintenance of sinus rhythm after mitral valve surgery promotes survival by preventing tachycardia-induced cardiomyopathy and stroke. Novel strategies for AF surgery involve the use of alternate energy sources to create the lines of block in the atria and the simplification of the lesion pattern compared with the earlier Cox-Maze procedure. Published clinical data support the contention that left atrial ablation techniques performed concomitantly with valvular and/or coronary artery bypass surgery are likely to result in a 70% to 90% cure rate of AF in patients with preoperatively documented AF. Despite the lack of evidence for long-term outcome benefit, intraoperative pulmonary vein ablation, feasible with minimal morbidity, clearly appears to be an improvement over simply ignoring AF in patients undergoing cardiac surgery. Left atrial appendectomy appears warranted in patients with chronic persistent AF.

  4. Evaluation of a novel high-resolution mapping technology for ablation of recurrent scar-related atrial tachycardias.

    PubMed

    Anter, Elad; McElderry, Thomas H; Contreras-Valdes, Fernando M; Li, Jianqing; Tung, Patricia; Leshem, Eran; Haffajee, Charles I; Nakagawa, Hiroshi; Josephson, Mark E

    2016-10-01

    Rhythmia is a new technology capable of rapid and high-resolution mapping. However, its potential advantage over existing technologies in mapping complex scar-related atrial tachycardias (ATs) has not yet been evaluated. The purpose of this study was to examine the utility of Rhythmia for mapping scar-related ATs in patients who had failed previous ablation procedure(s). This multicenter study included 20 patients with recurrent ATs within 2 years after a previous ablation procedure (1.8 ± 0.7 per patient). In all cases, the ATs could not be adequately mapped during the index procedure because of scar with fractionated electrograms, precluding accurate time annotation, frequent change in the tachycardia in response to pacing, and/or degeneration into atrial fibrillation. These patients underwent repeat mapping and ablation procedure with Rhythmia. From a total of 28 inducible ATs, 24 were successfully mapped. Eighteen ATs (75%) terminated during radiofrequency ablation and 4 (16.6%) with catheter pressure or entrainment from the site of origin or isthmus. Two ATs that were mapped to the interatrial septum slowed but did not terminate with ablation. In 21 of 24 ATs the mechanism was macroreentry, while in 3 of 24 the mechanism was focal. Interestingly, in 5 patients with previously failed ablation of an allegedly "focal" tachycardia, high-resolution mapping demonstrated macroreentrant arrhythmia. The mean mapping time was 28.6 ± 17 minutes, and the mean radiofrequency ablation time to arrhythmia termination was 3.2 ± 2.6 minutes. During a mean follow-up of 7.5 ± 3.1 months, 15 of 20 patients (75%) were free of AT recurrences. The Rhythmia mapping system may be advantageous for mapping complex scar-related ATs. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  5. Effect of Radiofrequency Endometrial Ablation on Dysmenorrhea.

    PubMed

    Wyatt, Sabrina N; Banahan, Taylor; Tang, Ying; Nadendla, Kavita; Szychowski, Jeff M; Jenkins, Todd R

    To examine rates of dysmenorrhea after radiofrequency endometrial ablation in patients with and without known dysmenorrhea symptoms prior to the procedure in a diverse population. Retrospective cohort study (Canadian Task Force classification II-2). Academic gynecology practice. A total of 307 women underwent endometrial ablation between 2007 and 2013 at our institution. Patients who had preoperative and postoperative pain symptom assessments as well as a description of pain timing recorded were included in our analysis. Exclusion criteria were age <19 years and operative biopsy findings consistent with complex atypical hyperplasia. The difference in preoperative and postoperative rates of dysmenorrhea was evaluated. Demographic information and other outcome variables were used to evaluate factors associated with resolution of dysmenorrhea. A total of 307 patients who underwent radiofrequency endometrial ablation were identified. After exclusions, 296 charts were examined, and 144 patients met our enrollment criteria. The mean age of the study cohort was 45.4 ± 6.2 years; 57 patients (40%) were African American, 16 (11%) had a body mass index (BMI) > 40, and 41 (29%) were of normal weight. Preoperative dysmenorrhea was reported by 100 patients (69%); 48 of these patients (48%) experienced resolution of symptoms postoperatively. Only 3 of the 44 patients (7%) without preoperative dysmenorrhea reported new-onset dysmenorrhea postoperatively. Significantly fewer patients had dysmenorrhea after compared to before radiofrequency ablation (55 of 144 [38%] vs 100 of 144 [69%]; p < .001). Resolution of dysmenorrhea after ablation was associated with reduction in bleeding volume (p = .048) but not with a reduction in frequency of bleeding (p = .12). Approximately one-half of women who undergo radiofrequency endometrial ablation to treat heavy menstrual bleeding who also have preoperative dysmenorrhea exhibit documented pain resolution after the procedure

  6. Surgical Ablation of Atrial Fibrillation Using Energy Sources.

    PubMed

    Brick, Alexandre Visconti; Braile, Domingo Marcolino

    2015-01-01

    Surgical ablation, concomitant with other operations, is an option for treatment in patients with chronic atrial fibrillation. The aim of this study is to present a literature review on surgical ablation of atrial fibrillation in patients undergoing cardiac surgery, considering energy sources and return to sinus rhythm. A comprehensive survey was performed in the literature on surgical ablation of atrial fibrillation considering energy sources, sample size, study type, outcome (early and late), and return to sinus rhythm. Analyzing studies with immediate results (n=5), the percentage of return to sinus rhythm ranged from 73% to 96%, while those with long-term results (n=20) (from 12 months on) ranged from 62% to 97.7%. In both of them, there was subsequent clinical improvement of patients who underwent ablation, regardless of the energy source used. Surgical ablation of atrial fibrillation is essential for the treatment of this arrhythmia. With current technology, it may be minimally invasive, making it mandatory to perform a procedure in an attempt to revert to sinus rhythm in patients requiring heart surgery.

  7. Air-kerma evaluation at the maze entrance of HDR brachytherapy facilities.

    PubMed

    Pujades, M C; Granero, D; Vijande, J; Ballester, F; Perez-Calatayud, J; Papagiannis, P; Siebert, F A

    2014-12-01

    In the absence of procedures for evaluating the design of brachytherapy (BT) facilities for radiation protection purposes, the methodology used for external beam radiotherapy facilities is often adapted. The purpose of this study is to adapt the NCRP 151 methodology for estimating the air-kerma rate at the door in BT facilities. Such methodology was checked against Monte Carlo (MC) techniques using the code Geant4. Five different facility designs were studied for (192)Ir and (60)Co HDR applications to account for several different bunker layouts.For the estimation of the lead thickness needed at the door, the use of transmission data for the real spectra at the door instead of the ones emitted by (192)Ir and (60)Co will reduce the lead thickness by a factor of five for (192)Ir and ten for (60)Co. This will significantly lighten the door and hence simplify construction and operating requirements for all bunkers.The adaptation proposed in this study to estimate the air-kerma rate at the door depends on the complexity of the maze: it provides good results for bunkers with a maze (i.e. similar to those used for linacs for which the NCRP 151 methodology was developed) but fails for less conventional designs. For those facilities, a specific Monte Carlo study is in order for reasons of safety and cost-effectiveness.

  8. Modeling and Validation of Microwave Ablations with Internal Vaporization

    PubMed Central

    Chiang, Jason; Birla, Sohan; Bedoya, Mariajose; Jones, David; Subbiah, Jeyam; Brace, Christopher L.

    2014-01-01

    Numerical simulation is increasingly being utilized for computer-aided design of treatment devices, analysis of ablation growth, and clinical treatment planning. Simulation models to date have incorporated electromagnetic wave propagation and heat conduction, but not other relevant physics such as water vaporization and mass transfer. Such physical changes are particularly noteworthy during the intense heat generation associated with microwave heating. In this work, a numerical model was created that integrates microwave heating with water vapor generation and transport by using porous media assumptions in the tissue domain. The heating physics of the water vapor model was validated through temperature measurements taken at locations 5, 10 and 20 mm away from the heating zone of the microwave antenna in homogenized ex vivo bovine liver setup. Cross-sectional area of water vapor transport was validated through intra-procedural computed tomography (CT) during microwave ablations in homogenized ex vivo bovine liver. Iso-density contours from CT images were compared to vapor concentration contours from the numerical model at intermittent time points using the Jaccard Index. In general, there was an improving correlation in ablation size dimensions as the ablation procedure proceeded, with a Jaccard Index of 0.27, 0.49, 0.61, 0.67 and 0.69 at 1, 2, 3, 4, and 5 minutes. This study demonstrates the feasibility and validity of incorporating water vapor concentration into thermal ablation simulations and validating such models experimentally. PMID:25330481

  9. Magnetic Resonance Imaging-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids: Effect of Bowel Interposition on Procedure Feasibility and a Unique Bowel Displacement Technique.

    PubMed

    Kim, Young-Sun; Lim, Hyo Keun; Rhim, Hyunchul

    2016-01-01

    To evaluate the effect of bowel interposition on assessing procedure feasibility, and the usefulness and limiting conditions of bowel displacement techniques in magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) ablation of uterine fibroids. Institutional review board approved this study. A total of 375 screening MR exams and 206 MR-HIFU ablations for symptomatic uterine fibroids performed between August 2010 and March 2015 were retrospectively analyzed. The effect of bowel interposition on procedure feasibility was assessed by comparing pass rates in periods before and after adopting a unique bowel displacement technique (bladder filling, rectal filling and subsequent bladder emptying; BRB maneuver). Risk factors for BRB failure were evaluated using logistic regression analysis. Overall pass rates of pre- and post-BRB periods were 59.0% (98/166) and 71.7% (150/209), and in bowel-interposed cases they were 14.6% (7/48) and 76.4% (55/72), respectively. BRB maneuver was technically successful in 81.7% (49/60). Through-the-bladder sonication was effective in eight of eleven BRB failure cases, thus MR-HIFU could be initiated in 95.0% (57/60). A small uterus on treatment day was the only significant risk factor for BRB failure (B = 0.111, P = 0.017). The BRB maneuver greatly reduces the fraction of patients deemed ineligible for MR-HIFU ablation of uterine fibroids due to interposed bowels, although care is needed when the uterus is small.

  10. Visualising the procedures in the influence of water on the ablation of dental hard tissue with erbium:yttrium-aluminium-garnet and erbium, chromium:yttrium-scandium-gallium-garnet laser pulses.

    PubMed

    Mir, Maziar; Gutknecht, Norbert; Poprawe, Reinhart; Vanweersch, Leon; Lampert, Friedrich

    2009-05-01

    The exact mechanism of the ablation of tooth hard tissue with most common wavelengths, which are 2,940 nm and 2,780 nm, is not yet clear. There are several different theories, but none of them has yet been established. Concepts and methods of looking at these mechanisms have been based on heat formation and transformation, and mathematical calculations evaluating the outcome of ablation, such as looking at the shape of cuts. This study provides a new concept, which is the monitoring of the direct interactions between laser light, water and enamel, with a high-speed camera. For this purpose, both the above-mentioned wavelengths were examined. Bovine anterior teeth were prepared as thin slices. Each imaged slice had a thickness close to that of the beam diameter so that the ablation effect could be shown in two dimensional pictures. The single images were extracted from the video-clips and then were animated. The following steps, explaining the ablation procedures during each pulse, were seen and reported: (1) low-output energy intensity in the first pulses that did not lead to an ablative effect; (2) bubble formation with higher output energy density; (3) the tooth surface during the pulse was covered with the plume of vapour (comparable with a cloud), and the margins of ablation on the tooth were not clear; (4) when the vapour bubble (cloud) was collapsing, an additional ablative process at the surface could be seen.

  11. Foley catheter balloon endometrial ablation: successful treatment of three cases.

    PubMed

    Api, Murat; Api, Olus

    2012-03-01

    Endometrial ablation is one of the most effective methods for treatment of dysfunctional uterine bleeding (DUB). Balloon devices with circulating hot water inside or electrodes on the outer surface and radiofrequency-induced thermal destructors are the most recently introduced available tools for endometrial ablation. All of these methods are effective and simple but expensive technologies. The aim of this brief report is to evaluate the effectiveness and safety of a new, simple and money-saving procedure, namely foley catheter balloon endometrial ablation (FCBEA), for treatment of DUB. We present our experience with FCBEA performed on 3 women with severe meno-metrorrhagia unresponsive to medical therapy. There were no procedure-related complications with achievement of complete amenorrhea for a 19 months follow-up period. Although FCBA has yielded encouraging results, there exists a need for further investigation and validation on larger groups, before its universal application.

  12. Glue septal ablation: A promising alternative to alcohol septal ablation

    PubMed Central

    Aytemir, Kudret; Oto, Ali

    2016-01-01

    Hypertrophic cardiomyopathy (HCM) is defined as myocardial hypertrophy in the absence of another cardiac or systemic disease capable of producing the magnitude of present hypertrophy. In about 70% of patients with HCM, there is left ventricular outflow tract (LVOT) obstruction (LVOTO) and this is known as obstructive type of hypertrophic cardiomyopathy (HOCM). Cases refractory to medical treatment have had two options either surgical septal myectomy or alcohol septal ablation (ASA) to alleviate LVOT gradient. ASA may cause some life-threatening complications including conduction disturbances and complete heart block, hemodynamic compromise, ventricular arrhythmias, distant and massive myocardial necrosis. Glue septal ablation (GSA) is a promising technique for the treatment of HOCM. Glue seems to be superior to alcohol due to some intrinsic advantageous properties of glue such as immediate polymerization which prevents the leak into the left anterior descending coronary artery and it is particularly useful in patients with collaterals to the right coronary artery in whom alcohol ablation is contraindicated. In our experience, GSA is effective and also a safe technique without significant complications. GSA decreases LVOT gradient immediately after the procedure and this reduction persists during 12 months of follow-up. It improves New York Heart Association functional capacity and decrease interventricular septal wall thickness. Further studies are needed in order to assess the long-term efficacy and safety of this technique. PMID:27011786

  13. Clinical impact of rotor ablation in atrial fibrillation: a systematic review.

    PubMed

    Parameswaran, Ramanathan; Voskoboinik, Aleksandr; Gorelik, Alexandra; Lee, Geoffrey; Kistler, Peter M; Sanders, Prashanthan; Kalman, Jonathan M

    2018-01-11

    Rotor mapping and ablation have gained favour over the recent years as an emerging ablation strategy targeting drivers of atrial fibrillation (AF). Their efficacy, however, has been a topic of great debate with variable outcomes across centres. The aim of this study was to systematically review the recent medical literature to determine the medium-term outcomes of rotor ablation in patients with paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PeAF). A systematic search of the contemporary scientific literature (PubMed and EMBASE) was performed in August 2017. Only studies assessing arrhythmia-free survival from rotor ablation of AF were included. We used the random-effects model to assess the primary outcome of pooled medium-term single-procedure AF-free survival for both PAF and PeAF. Success rates from multiple procedures and complication rates were also examined. We included 11 observational studies (4 PAF and 10 PeAF) with a total of 556 patients (166 PAF and 390 PeAF). Pooled single-procedure freedom from AF was 37.8% [95% confidence interval 5.6-86.3%] at a mean follow-up period of 13.8 ± 1.8 months for PAF and 59.2% (95% CI 41.4-74.9%) at a mean follow-up period of 12.9 ± 6 months for PeAF. There was a marked heterogeneity between studies (I2 = 93.8% for PAF and 88.3% for PeAF). The mean complication rate of rotor ablation among the reported studies was 3.4%. The wide variability in success rate between different centres performing rotor ablations suggests that the optimal ablation strategy, particularly targeting rotors, is unclear. Results from randomized studies are necessary before this technique can be considered as an established clinical tool. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.

  14. Gastrodia elata Bl. Attenuated learning deficits induced by forced-swimming stress in the inhibitory avoidance task and Morris water maze.

    PubMed

    Chen, Pei-Ju; Liang, Keng-Chen; Lin, Hui-Chen; Hsieh, Ching-Liang; Su, Kuan-Pin; Hung, Mei-Chu; Sheen, Lee-Yan

    2011-06-01

    This study adopted the forced-swimming paradigm to induce depressive symptoms in rats and evaluated the effects on learning and memory processing. Furthermore, the effects of the water extract of Gastrodia elata Bl., a well-known Chinese traditional medicine, on amnesia in rats subjected to the forced-swimming procedure were studied. Rats were subjected to the forced-swimming procedure, and the inhibitory avoidance task and Morris water maze were used to assess learning and memory performance. The acquisition of the two tasks was mostly impaired after the 15-minute forced-swimming procedure. Administration of the water extract of G. elata Bl. for 21 consecutive days at a dosage of 0.5 or 1.0 g/kg of body weight significantly improved retention in the inhibitory avoidance test, and the lower dose showed a better effect than the higher one and the antidepressant fluoxetine (18 mg/kg of body weight). In the Morris water maze, the lower dose of the water extract of G. elata Bl. significantly improved retention by shortening escape latency in the first test session and increasing the time in searching the target zone during the probe test. These findings suggest that water extracts of G. elata Bl. ameliorate the learning and memory deficits induced by forced swimming.

  15. Pain control requirements for percutaneous ablation of renal tumors: cryoablation versus radiofrequency ablation--initial observations.

    PubMed

    Allaf, Mohamad E; Varkarakis, Ioannis M; Bhayani, Sam B; Inagaki, Takeshi; Kavoussi, Louis R; Solomon, Stephen B

    2005-10-01

    To retrospectively compare the pain control requirements of patients undergoing computed tomography (CT)-guided percutaneous radiofrequency (RF) ablation with those of patients undergoing CT-guided percutaneous cryoablation of small (< or = 4-cm) renal tumors. The study was HIPAA compliant and received institutional review board exemption; informed consent was not required. Medical and procedure records of patients who underwent RF ablation and cryoablation of renal tumors from June 19, 2003, to February 28, 2004, were retrospectively reviewed for clinical data, tumor characteristics, and anesthesia information. During the study period, 10 men (mean age, 66.5 years) underwent cryoablation of 11 renal lesions, and 14 patients (11 men, four women; mean age, 68.1 years) underwent RF ablation of 15 renal tumors. Analgesic and sedative requirements during the procedure were compared. Standard anesthesia consisted of 5 mL of 1% lidocaine injected locally, and conscious sedation consisted of 50 microg of fentanyl and 1 mg of midazolam administered intravenously. The Fisher exact test and Student t test were used to compare clinical factors and drug requirements between the two groups. There was no difference in terms of patient demographics, tumor diameter, or distribution of central versus noncentral lesions between the two groups. Cryoablation was associated with a significantly lower dose of fentanyl (165.0 microg [RF group] vs 75.0 microg [cryoablation group]; P < .001) and midazolam (2.9 mg [RF group] vs 1.6 mg [cryoablation group]; P = .026). In the RF group, one patient required general anesthesia, one patient required supplemental narcotics (5 mg of oxycodone) and sedatives (1 mg lorezapam), and one patient became apneic for a brief interval after receiving additional narcotics for pain during the procedure. An additional RF session was terminated early in one patient because of pain, and further medication could not be administered owing to bradycardia. No

  16. Surgical outcome of Fontan conversion and arrhythmia surgery: Need a pacemaker?

    PubMed

    Terada, Takafumi; Sakurai, Hajime; Nonaka, Toshimichi; Sakurai, Takahisa; Sugiura, Junya; Taneichi, Tetsuyoshi; Ohtsuka, Ryohei

    2014-07-01

    Atrial tachyarrhythmias are frequent complications in the late period after the Fontan procedure, and important risk factors for a poor prognosis. The impact of Fontan conversion and arrhythmia surgery in failed Fontan patients has been described in many reports. We evaluated our experience with Fontan conversion procedures, concomitant arrhythmia surgery, and pacemaker implantation. We reviewed the hospital records of 25 consecutive patients who underwent a Fontan conversion procedure from January 2004 to March 2012. Twenty-four patients had arrhythmia surgery using cryoablation and radiofrequency ablation at the time of conversion. A bilateral atrial maze procedure was performed in 6 patients, right-side maze in 15, and isthmus block in 3. Three patients with a diagnosis of corrected transposition of the great arteries underwent simultaneous pacemaker implantation electively. There was no early death and one late death during a mean follow-up period of 21.2 months. Three tachyarrhythmia recurrences developed, and there were 4 occurrences of sinus bradycardia. Five of these patients required postoperative pacemaker implantation. The mid-term results of Fontan conversion and arrhythmia surgery in our institute were satisfactory. The occurrence of unexpected postoperative pacemaker requirement was high in the patients who underwent a right atrial or bilateral atrial maze procedure. Pacemaker or lead implantation is recommended for patients planned to undergo a right-side or full maze procedure. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  17. Current status of the surgical treatment of atrial fibrillation.

    PubMed

    Geha, Alexander S; Abdelhady, Khaled

    2008-03-01

    Atrial fibrillation (AF) affects several million patients worldwide and is associated with a number of heart conditions, particularly coronary artery disease, rheumatic heart disease, hypertension, and congestive heart failure. The treatment of AF and its complications is quite costly. Atrial fibrillation usually results from multiple macro-re-entrant circuits in the left atrium. Very frequently, particularly in association with mitral valve disease, these circuits arise from the area of the junction of the pulmonary venous endothelium and the left atrial endocardium. Pharmacological therapy is at best 50% effective. Therapeutic options for AF include antiarrhythmic drugs, cardioversion, atrioventricular (A-V) node block, pacemaker insertion, and ablative surgery. In 1987, Cox developed an effective surgical procedure to achieve ablation. Current ablative procedures include the classic cut-and-sew Maze operation or a modification of it, namely through catheter ablation, namely, cryoablation, radiofrequency ablation (dry or irrigated), and other forms of ablation (e.g., laser, microwave). These procedures will be described, along with the indications, advantages and disadvantages of each. Special emphasis on the alternative means to cutting and sewing to achieve appropriate effective atrial scars will be stressed, and our experience with these approaches in 50 patients with AF and associated cardiac lesions and their outcomes is presented.

  18. Microembolism and catheter ablation I: a comparison of irrigated radiofrequency and multielectrode-phased radiofrequency catheter ablation of pulmonary vein ostia.

    PubMed

    Haines, David E; Stewart, Mark T; Dahlberg, Sarah; Barka, Noah D; Condie, Cathy; Fiedler, Gary R; Kirchhof, Nicole A; Halimi, Franck; Deneke, Thomas

    2013-02-01

    Cerebral diffusion-weighted MRI lesions have been observed after catheter ablation of atrial fibrillation. We hypothesized that conditions predisposing to microembolization could be identified using a porcine model of pulmonary vein ablation and an extracorporeal circulation loop. Ablations of the pulmonary veins were performed in 18 swine with echo monitoring. The femoral artery and vein were cannulated and an extracorporeal circulation loop with 2 ultrasonic bubble detectors and a 73-μm filter were placed in series. Microemboli and microbubbles were compared between ablation with an irrigated radiofrequency system (Biosense-Webster) and a phased radiofrequency multielectrode system (pulmonary vein ablation catheter [PVAC], Medtronic, Inc, Carlsbad, CA) in unipolar and 3 blended unipolar/bipolar modes. Animal pathology was examined. The size and number of microbubbles observed during ablation ranged from 30 to 180 μm and 0 to 3253 bubbles per ablation. Microbubble volumes with PVAC (29.1 nL) were greater than with irrigated radiofrequency (0.4 nL; P=0.045), and greatest with type II or III microbubbles on transesophageal echocardiography. Ablation with the PVAC showed fewest microbubbles in the unipolar mode (P=0.012 versus bipolar). The most occurred during bipolar energy delivery with overlap of proximal and distal electrodes (median microbubble volume, 1744 nL; interquartile range, 737-4082 nL; maximum, 19 516 nL). No cerebral MRI lesions were seen, but 2 animals had renal embolization. Left atrial ablation with irrigated radiofrequency and PVAC catheters in swine is associated with microbubble and microembolus production. Avoiding overlap of electrodes 1 and 10 on PVAC should reduce the microembolic burden associated with this procedure.

  19. The ablation threshold of Er;Cr:YSGG laser radiation in bone tissue

    NASA Astrophysics Data System (ADS)

    Benetti, Carolina; Zezell, Denise Maria

    2015-06-01

    In laser cut clinical applications, the use of energy densities lower than the ablation threshold causes increase of temperature of the irradiated tissue, which might result in an irreversible thermal damage. Hence, knowing the ablation threshold is crucial for insuring the safety of these procedures. The aim of this study was to determine the ablation threshold of the Er,Cr:YSGG laser in bone tissue. Bone pieces from jaws of New Zealand rabbits were cut as blocks of 5 mm × 8 mm and polished with sandpaper. The Er,Cr:YSGG laser used in this study had wavelength of 2780 nm, 20 Hz of frequency, and the irradiation condition was chosen so as to simulate the irradiation during a surgical procedure. The laser irradiation was performed with 12 different values of laser energy densities, between 3 J/cm2 and 42 J/cm2, during 3 seconds, resulting in the overlap of 60 pulses. This process was repeated in each sample, for all laser energy densities. After irradiation, the samples were analyzed by scanning electron microscope (SEM), and it was measured the crater diameter for each energy density. By fitting a curve that related the ablation threshold with the energy density and the corresponding diameter of ablation crater, it was possible to determine the ablation threshold. The results showed that the ablation threshold of the Er,Cr:YSGG in bone tissue was 1.95+/-0.42 J/cm2.

  20. Atrial Fibrillation Radiofrequency Ablation: Safety Using Contact Force Catheter In A Low-Volume Centre.

    PubMed

    Vaccari Md, Diego; Giacopelli MSc, Daniele; Rocchetto MSc, Eros; Vittadello Md, Sabina; Mantovan Md, Roberto; Neri Md, Gianfilippo

    2014-01-01

    The tip-to-tissue contact force (CF) has been identified as a potential determinant of lesion quality during radiofrequency (RF) ablation. The aim of this paper is to report the experience of a single low-volume centre in the atrial fibrillation (AF) ablation procedure with an RF catheter capable of measuring this parameter. CF data and their possible implications on patient safety are presented. Thirty-nine consecutive patients suffering of paroxysmal or permanent AF received percutaneous ablation with the novel catheter studied. Procedural characteristics, CF applied and safety events related to the procedure were reported. During RF application the mean CF value was 17 ± 3 g, with a maximum mean value of 37 ± 8 g. CF value never exceeded 62 g and in the 74% of the RF applications ranged between 10 g and 30 g. No complication related to the catheter manipulation or to the energy delivered was observed. This study of a single centre with a low level of experience in AF ablation suggests that the ability to measure CF may provide additional useful information to the operator. It ensures uniform ablations, with little variability in the catheter manipulations, and it avoids excessive contact forces increasing the patient safety.

  1. Use of the Open Field Maze to measure locomotor and anxiety-like behavior in mice.

    PubMed

    Seibenhener, Michael L; Wooten, Michael C

    2015-02-06

    Animal models have proven to be invaluable to researchers trying to answer questions regarding the mechanisms of behavior. The Open Field Maze is one of the most commonly used platforms to measure behaviors in animal models. It is a fast and relatively easy test that provides a variety of behavioral information ranging from general ambulatory ability to data regarding the emotionality of the subject animal. As it relates to rodent models, the procedure allows the study of different strains of mice or rats both laboratory bred and wild-captured. The technique also readily lends itself to the investigation of different pharmacological compounds for anxiolytic or anxiogenic effects. Here, a protocol for use of the open field maze to describe mouse behaviors is detailed and a simple analysis of general locomotor ability and anxiety-related emotional behaviors between two strains of C57BL/6 mice is performed. Briefly, using the described protocol we show Wild Type mice exhibited significantly less anxiety related behaviors than did age-matched Knock Out mice while both strains exhibited similar ambulatory ability.

  2. General Model for Multicomponent Ablation Thermochemistry

    NASA Technical Reports Server (NTRS)

    Milos, Frank S.; Marschall, Jochen; Rasky, Daniel J. (Technical Monitor)

    1994-01-01

    A previous paper (AIAA 94-2042) presented equations and numerical procedures for modeling the thermochemical ablation and pyrolysis of thermal protection materials which contain multiple surface species. This work describes modifications and enhancements to the Multicomponent Ablation Thermochemistry (MAT) theory and code for application to the general case which includes surface area constraints, rate limited surface reactions, and non-thermochemical mass loss (failure). Detailed results and comparisons with data are presented for the Shuttle Orbiter reinforced carbon-carbon oxidation protection system which contains a mixture of sodium silicate (Na2SiO3), silica (SiO2), silicon carbide (SiC), and carbon (C).

  3. Global microwave endometrial ablation for menorrhagia treatment

    NASA Astrophysics Data System (ADS)

    Fallahi, Hojjatollah; Å ebek, Jan; Frattura, Eric; Schenck, Jessica; Prakash, Punit

    2017-02-01

    Thermal ablation is a dominant therapeutic option for minimally invasive treatment of menorrhagia. Compared to other energy modalities for ablation, microwaves offer the advantages of conformal energy delivery to tissue within short times. The objective of endometrial ablation is to destroy the endometrial lining of the uterine cavity, with the clinical goal of achieving reduction in bleeding. Previous efforts have demonstrated clinical use of microwaves for endometrial ablation. A considerable shortcoming of most systems is that they achieve ablation of the target by translating the applicator in a point-to-point fashion. Consequently, treatment outcome may be highly dependent on physician skill. Global endometrial ablation (GEA) not only eliminates this operator dependence and simplifies the procedure but also facilitates shorter and more reliable treatments. The objective of our study was to investigate antenna structures and microwave energy delivery parameters to achieve GEA. Another objective was to investigate a method for automatic and reliable determination of treatment end-point. A 3D-coupled FEM electromagnetic and heat transfer model with temperature and frequency dependent material properties was implemented to characterize microwave GEA. The unique triangular geometry of the uterus where lateral narrow walls extend from the cervix to the fundus forming a wide base and access afforded through an endocervical approach limit the overall diameter of the final device. We investigated microwave antenna designs in a deployed state inside the uterus. The impact of ablation duration on treatment outcome was investigated. Prototype applicators were fabricated and experimentally evaluated in ex vivo tissue to verify the simulation results and demonstrate proof-of-concept.

  4. Tests of the Aversive Summation Hypothesis in Rats: Effects of Restraint Stress on Consummatory Successive Negative Contrast and Extinction in the Barnes Maze

    ERIC Educational Resources Information Center

    Ortega, Leonardo A.; Prado-Rivera, Mayerli A.; Cardenas-Poveda, D. Carolina; McLinden, Kristina A.; Glueck, Amanda C.; Gutierrez, German; Lamprea, Marisol R.; Papini, Mauricio R.

    2013-01-01

    The present research explored the effects of restraint stress on two situations involving incentive downshift: consummatory successive negative contrast (cSNC) and extinction of escape behavior in the Barnes maze. First, Experiment 1 confirmed that the restraint stress procedure used in these experiments increased levels of circulating…

  5. Aniracetam improves radial maze performance in rats.

    PubMed

    Martin, J R; Cumin, R; Aschwanden, W; Moreau, J L; Jenck, F; Haefely, W E

    1992-01-01

    The memory enhancing effect of the pyrrolidinone derivative aniracetam was investigated in rats trained in a delayed-response task in an 8-arm radial maze. Oral administration of aniracetam (100, 200, 400, or 800 mg kg-1) 16 h and again 1 h prior to a first trial of exposure to a given configuration of 4 baited arms resulted in a significant improvement in performance during a second trial in the maze given 3 h later in which there was access to all 8 arms but only the other 4 arms were baited. The pattern of baited arms was varied daily. The performance enhancement was greatest for the highest doses. These results extend the demonstration of the cognition enhancing effects of aniracetam to a spatial memory task in rats.

  6. Towards computer-assisted TTTS: Laser ablation detection for workflow segmentation from fetoscopic video.

    PubMed

    Vasconcelos, Francisco; Brandão, Patrick; Vercauteren, Tom; Ourselin, Sebastien; Deprest, Jan; Peebles, Donald; Stoyanov, Danail

    2018-06-27

    Intrauterine foetal surgery is the treatment option for several congenital malformations. For twin-to-twin transfusion syndrome (TTTS), interventions involve the use of laser fibre to ablate vessels in a shared placenta. The procedure presents a number of challenges for the surgeon, and computer-assisted technologies can potentially be a significant support. Vision-based sensing is the primary source of information from the intrauterine environment, and hence, vision approaches present an appealing approach for extracting higher level information from the surgical site. In this paper, we propose a framework to detect one of the key steps during TTTS interventions-ablation. We adopt a deep learning approach, specifically the ResNet101 architecture, for classification of different surgical actions performed during laser ablation therapy. We perform a two-fold cross-validation using almost 50 k frames from five different TTTS ablation procedures. Our results show that deep learning methods are a promising approach for ablation detection. To our knowledge, this is the first attempt at automating photocoagulation detection using video and our technique can be an important component of a larger assistive framework for enhanced foetal therapies. The current implementation does not include semantic segmentation or localisation of the ablation site, and this would be a natural extension in future work.

  7. [Catheter ablation of atrial fibrillation: Health Technology Assessment Report from the Italian Association of Arrhythmology and Cardiac Pacing (AIAC)].

    PubMed

    Themistoclakis, Sakis; Tritto, Massimo; Bertaglia, Emanuele; Berto, Patrizia; Bongiorni, Maria Grazia; Catanzariti, Domenico; De Fabrizio, Giuseppe; De Ponti, Roberto; Grimaldi, Massimo; Pandozi, Claudio; Tondo, Claudio; Gulizia, Michele

    2011-11-01

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and significantly impact patients' quality of life, morbidity and mortality. The number of affected patients is expected to increase as well as the costs associated with AF management, mainly driven by hospitalizations. Over the last decade, catheter ablation techniques targeting pulmonary vein isolation have demonstrated to be effective in treating AF and preventing AF recurrence. This Health Technology Assessment report of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) aims to define the current role of catheter ablation of AF in terms of effectiveness, efficiency and appropriateness. On the basis of an extensive review of the available literature, this report provides (i) an overview of the epidemiology, clinical impact and socio-economic burden of AF; (ii) an evaluation of therapeutic options other than catheter ablation of AF; and (iii) a detailed presentation of clinical outcomes and cost-benefit ratio associated with catheter ablation. The costs of catheter ablation of AF in Italy were obtained using a bottom-up analysis of a resource utilization survey of 52 hospitals that were considered a representative sample, including 4 Centers that contributed with additional unit cost information in a separate questionnaire. An analysis of budget impact was also performed to evaluate the impact of ablation on the management costs of AF. Results of this analysis show that (1) catheter ablation is effective, safe and superior to antiarrhythmic drug therapy in maintaining sinus rhythm; (2) the cost of an ablation procedure in Italy typically ranges from €8868 to €9455, though current reimbursement remains insufficient, covering only about 60% of the costs; (3) the costs of follow-up are modest (about 8% of total costs); (4) assuming an adjustment of reimbursement to the real cost of an ablation procedure and a 5-10% increase in the annual rate of ablation procedures, after

  8. Ablation, Thermal Response, and Chemistry Program for Analysis of Thermal Protection Systems

    NASA Technical Reports Server (NTRS)

    Milos, Frank S.; Chen, Yih-Kanq

    2010-01-01

    In previous work, the authors documented the Multicomponent Ablation Thermochemistry (MAT) and Fully Implicit Ablation and Thermal response (FIAT) programs. In this work, key features from MAT and FIAT were combined to create the new Fully Implicit Ablation, Thermal response, and Chemistry (FIATC) program. FIATC is fully compatible with FIAT (version 2.5) but has expanded capabilities to compute the multispecies surface chemistry and ablation rate as part of the surface energy balance. This new methodology eliminates B' tables, provides blown species fractions as a function of time, and enables calculations that would otherwise be impractical (e.g. 4+ dimensional tables) such as pyrolysis and ablation with kinetic rates or unequal diffusion coefficients. Equations and solution procedures are presented, then representative calculations of equilibrium and finite-rate ablation in flight and ground-test environments are discussed.

  9. Ablation for Atrial Fibrillation

    PubMed Central

    2006-01-01

    increasing success rates associated with the ablation procedure. PMID:23074498

  10. Disentangling the cognitive components supporting Austin Maze performance in left versus right temporal lobe epilepsy.

    PubMed

    Hocking, Julia; Thomas, Hannah J; Dzafic, Ilvana; Williams, Rebecca J; Reutens, David C; Spooner, Donna M

    2013-12-01

    Neuropsychological tests requiring patients to find a path through a maze can be used to assess visuospatial memory performance in temporal lobe pathology, particularly in the hippocampus. Alternatively, they have been used as a task sensitive to executive function in patients with frontal lobe damage. We measured performance on the Austin Maze in patients with unilateral left and right temporal lobe epilepsy (TLE), with and without hippocampal sclerosis, compared to healthy controls. Performance was correlated with a number of other neuropsychological tests to identify the cognitive components that may be associated with poor Austin Maze performance. Patients with right TLE were significantly impaired on the Austin Maze task relative to patients with left TLE and controls, and error scores correlated with their performance on the Block Design task. The performance of patients with left TLE was also impaired relative to controls; however, errors correlated with performance on tests of executive function and delayed recall. The presence of hippocampal sclerosis did not have an impact on maze performance. A discriminant function analysis indicated that the Austin Maze alone correctly classified 73.5% of patients as having right TLE. In summary, impaired performance on the Austin Maze task is more suggestive of right than left TLE; however, impaired performance on this visuospatial task does not necessarily involve the hippocampus. The relationship of the Austin Maze task with other neuropsychological tests suggests that differential cognitive components may underlie performance decrements in right versus left TLE. © 2013.

  11. Noninvasive Assessment of Tissue Heating During Cardiac Radiofrequency Ablation Using MRI Thermography

    PubMed Central

    Kolandaivelu, Aravindan; Zviman, Menekhem M.; Castro, Valeria; Lardo, Albert C.; Berger, Ronald D.; Halperin, Henry R.

    2010-01-01

    Background Failure to achieve properly localized, permanent tissue destruction is a common cause of arrhythmia recurrence after cardiac ablation. Current methods of assessing lesion size and location during cardiac radiofrequency ablation are unreliable or not suited for repeated assessment during the procedure. MRI thermography could be used to delineate permanent ablation lesions because tissue heating above 50°C is the cause of permanent tissue destruction during radiofrequency ablation. However, image artifacts caused by cardiac motion, the ablation electrode, and radiofrequency ablation currently pose a challenge to MRI thermography in the heart. In the current study, we sought to demonstrate the feasibility of MRI thermography during cardiac ablation. Methods and Results An MRI-compatible electrophysiology catheter and filtered radiofrequency ablation system was used to perform ablation in the left ventricle of 6 mongrel dogs in a 1.5-T MRI system. Fast gradient-echo imaging was performed before and during radiofrequency ablation, and thermography images were derived from the preheating and postheating images. Lesion extent by thermography was within 20% of the gross pathology lesion. Conclusions MR thermography appears to be a promising technique for monitoring lesion formation and may allow for more accurate placement and titration of ablation, possibly reducing arrhythmia recurrences. PMID:20657028

  12. Characterization of the rat exploratory behavior in the elevated plus-maze with Markov chains.

    PubMed

    Tejada, Julián; Bosco, Geraldine G; Morato, Silvio; Roque, Antonio C

    2010-11-30

    The elevated plus-maze is an animal model of anxiety used to study the effect of different drugs on the behavior of the animal. It consists of a plus-shaped maze with two open and two closed arms elevated 50cm from the floor. The standard measures used to characterize exploratory behavior in the elevated plus-maze are the time spent and the number of entries in the open arms. In this work, we use Markov chains to characterize the exploratory behavior of the rat in the elevated plus-maze under three different conditions: normal and under the effects of anxiogenic and anxiolytic drugs. The spatial structure of the elevated plus-maze is divided into squares, which are associated with states of a Markov chain. By counting the frequencies of transitions between states during 5-min sessions in the elevated plus-maze, we constructed stochastic matrices for the three conditions studied. The stochastic matrices show specific patterns, which correspond to the observed behaviors of the rat under the three different conditions. For the control group, the stochastic matrix shows a clear preference for places in the closed arms. This preference is enhanced for the anxiogenic group. For the anxiolytic group, the stochastic matrix shows a pattern similar to a random walk. Our results suggest that Markov chains can be used together with the standard measures to characterize the rat behavior in the elevated plus-maze. Copyright © 2010 Elsevier B.V. All rights reserved.

  13. Intrahepatic radiofrequency ablation versus electrochemical treatment in vivo.

    PubMed

    Czymek, Ralf; Nassrallah, Jan; Gebhard, Maximilian; Schmidt, Andreas; Limmer, Stefan; Kleemann, Markus; Bruch, Hans-Peter; Hildebrand, Philipp

    2012-06-01

    Radiofrequency ablation (RFA) and electrochemical treatment (ECT) are two methods of local liver tumour ablation. The objective of this study was to compare these methods when applied in proximity to vessels in vivo. In a total of ten laparotomised pigs, we used ECT (Group A, four animals) and RFA (Group B, four animals) to create four areas of ablation per animal under ultrasound guidance within 10 mm of a vessel. Group C consisted of two control animals. Chemical laboratory tests were performed immediately before and after each procedure and on days 1, 3 and 7 after surgery. Following the last tests, the livers were harvested for morphological evaluation. The mean duration of surgery was 5 h 40 min in Group A (ECT), 2 h 47 min in Group B (RFA), and 2 h 30 min in Group C (control animals). After ECT, the harvested livers showed a mean volume of necrosis of 1.84 cm(3) ± 0.88 at the anode and 2.59 cm(3) ± 1.06 at the cathode. The presence of vessels did not influence the formation of necrotic zones. Ablation time was 67 min when a charge of 200 coulombs was delivered. We measured pH values of 1.2 (range: 0.9-1.7) at the anode and 11.7 (range: 11.0-12.1) at the cathode. In one of the 16 RFA ablations (6%), the target temperature was not reached and the procedure was discontinued. After 14 of 16 RFA procedures (88%), morphological analysis showed incomplete ablation in perivascular sites. Both ECT and RFA were associated with a reversible increase in monocyte, C-reactive protein (CRP) and aspartate aminotransferase (AST) levels. There was no significant increase in interleukin-1β (IL-1β), tumour necrosis factor-α (TNF-α) and IL-6. In the majority of cases, intrahepatic RFA in vivo leads to incomplete necrosis in proximity to vessels and the presence of histologically intact perivascular cells. Without a reduction in liver perfusion, the central application of RFA should be considered problematic. ECT is a safe alternative. It is not associated

  14. Optimal Navigation of Self-Propelled Colloids in Microstructured Mazes

    NASA Astrophysics Data System (ADS)

    Yang, Yuguang; Bevan, Michael

    Controlling navigation of self-propelled microscopic `robots' subject to random Brownian motion in complex microstructured environments (e.g., porous media, tumor vasculature) is important to many emerging applications (e.g., enhanced oil recovery, drug delivery). In this work, we design an optimal feedback policy to navigate an active self-propelled colloidal rod in complex mazes with various obstacle types. Actuation of the rods is modelled based on a light-controlled osmotic flow mechanism, which produces different propulsion velocities along the rod's long axis. Actuator-parameterized Langevin equations, with soft rod-obstacle repulsive interactions, are developed to describe the system dynamics. A Markov decision process (MDP) framework is used for optimal policy calculations with design goals of colloidal rods reaching target end points in minimum time. Simulations show that optimal MDP-based policies are able to control rod trajectories to reach target regions order-of-magnitudes faster than uncontrolled rods, which diverges as maze complexity increases. An efficient multi-graph based implementation for MDP is also presented, which scales linearly with the maze dimension.

  15. Cholecystokinin-Assisted Hydrodissection of the Gallbladder Fossa during FDG PET/CT-guided Liver Ablation

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Tewari, Sanjit O., E-mail: tewaris@mskcc.org; Petre, Elena N., E-mail: petree@mskcc.org; Osborne, Joseph, E-mail: osbornej@mskcc.org

    2013-12-15

    A 68-year-old female with colorectal cancer developed a metachronous isolated fluorodeoxyglucose-avid (FDG-avid) segment 5/6 gallbladder fossa hepatic lesion and was referred for percutaneous ablation. Pre-procedure computed tomography (CT) images demonstrated a distended gallbladder abutting the segment 5/6 hepatic metastasis. In order to perform ablation with clear margins and avoid direct puncture and aspiration of the gallbladder, cholecystokinin was administered intravenously to stimulate gallbladder contraction before hydrodissection. Subsequently, the lesion was ablated successfully with sufficient margins, of greater than 1.0 cm, using microwave with ultrasound and FDG PET/CT guidance. The patient tolerated the procedure very well and was discharged home themore » next day.« less

  16. Imaging Features of Radiofrequency Ablation with Heat-Deployed Liposomal Doxorubicin in Hepatic Tumors

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Hong, Cheng William, E-mail: williamhongcheng@gmail.com; Chow, Lucy, E-mail: lucychow282@gmail.com; Turkbey, Evrim B., E-mail: evrimbengi@yahoo.com

    2016-03-15

    IntroductionThe imaging features of unresectable hepatic malignancies in patients who underwent radiofrequency ablation (RFA) in combination with lyso-thermosensitive liposomal doxorubicin (LTLD) were determined.Materials and MethodsA phase I dose escalation study combining RFA with LTLD was performed with peri- and post- procedural CT and MRI. Imaging features were analyzed and measured in terms of ablative zone size and surrounding penumbra size. The dynamic imaging appearance was described qualitatively immediately following the procedure and at 1-month follow-up. The control group receiving liver RFA without LTLD was compared to the study group in terms of imaging features and post-ablative zone size dynamics atmore » follow-up.ResultsPost-treatment scans of hepatic lesions treated with RFA and LTLD have distinctive imaging characteristics when compared to those treated with RFA alone. The addition of LTLD resulted in a regular or smooth enhancing rim on T1W MRI which often correlated with increased attenuation on CT. The LTLD-treated ablation zones were stable or enlarged at follow-up four weeks later in 69 % of study subjects as opposed to conventional RFA where the ablation zone underwent involution compared to imaging acquired immediately after the procedure.ConclusionThe imaging features following RFA with LTLD were different from those after standard RFA and can mimic residual or recurrent tumor. Knowledge of the subtle findings between the two groups can help avoid misinterpretation and proper identification of treatment failure in this setting. Increased size of the LTLD-treated ablation zone after RFA suggests the ongoing drug-induced biological effects.« less

  17. Laser Guidance in C-Arm Cone-Beam CT-Guided Radiofrequency Ablation of Osteoid Osteoma Reduces Fluoroscopy Time

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Kroes, Maarten W., E-mail: Maarten.Kroes@radboudumc.nl; Busser, Wendy M. H.; Hoogeveen, Yvonne L.

    PurposeTo assess whether laser guidance can reduce fluoroscopy and procedure time of cone-beam computed tomography (CBCT)-guided radiofrequency (RF) ablations of osteoid osteoma compared to freehand CBCT guidance.Materials and Methods32 RF ablations were retrospectively analyzed, 17 laser-guided and 15 procedures using the freehand technique. Subgroup selection of 18 ablations in the hip–pelvic region with a similar degree of difficulty was used for a direct comparison. Data are presented as median (ranges).ResultsComparison of all 32 ablations resulted in fluoroscopy times of 365 s (193–878 s) for freehand and 186 s (75–587 s) for laser-guided procedures (p = 0.004). Corresponding procedure times were 56 min (35–97 min) and 52 min (30–85 min) (p = 0.355).more » The subgroup showed comparable target sizes, needle path lengths, and number of scans between groups. Fluoroscopy times were lower for laser-guided procedures, 215 s (75–413 s), compared to 384 s (193–878 s) for freehand (p = 0.012). Procedure times were comparable between groups, 51 min (30–72 min) for laser guidance and 58 min (35–79 min) for freehand (p = 0.172).ConclusionAdding laser guidance to CBCT-guided osteoid osteoma RF ablations significantly reduced fluoroscopy time without increasing procedure time.Level of EvidenceLevel 4, case series.« less

  18. Left Septal Slow Pathway Ablation for Atrioventricular Nodal Reentrant Tachycardia.

    PubMed

    Katritsis, Demosthenes G; John, Roy M; Latchamsetty, Rakesh; Muthalaly, Rahul G; Zografos, Theodoros; Katritsis, George D; Stevenson, William G; Efimov, Igor R; Morady, Fred

    2018-03-01

    Immunohistochemistry studies suggest that the anatomic substrate of the slow pathway in atrioventricular nodal reentrant tachycardia (AVNRT) is the left inferior nodal extension. We hypothesized that slow pathway ablation from the left septum is an effective alternative to right-sided ablation. We analyzed our databases of AVNRT in search of cases that had used slow pathway ablation from the left septum because of failure of right septal ablation, and then prospectively subjected consenting patients to a left septal-only procedure. Of 1342 patients subjected to right septal slow pathway ablation for AVNRT, 15 patients, 11 with typical and 4 with atypical AVNRT, had a left septal approach after unsuccessful right-sided ablation (R+L group). Eleven patients were subjected to a left septal-only approach for slow pathway ablation without a previous right septal attempt (L group). Fluoroscopy times in the R+L and L groups were 30.5 (21.0-44.0) and 20.0 (17.0-25.0) minutes, respectively ( P =0.061), and radiofrequency current delivery times were 11.3 (5.0-19.1) and 10.0 (7.0-12.0) minutes, respectively ( P =0.897). There was no need for additional ablation lesions at other anatomic sites in either group, and no cases of atrioventricular block were encountered. Recurrence rates of the arrhythmia for the R+L and L groups were 6.7% and 0%, respectively, in the 3 months after ablation ( P =1.000). Left septal ablation at the anatomic site of the left inferior nodal extension is an alternative for ablation of both typical and atypical AVNRT when ablation at the right posterior septum is ineffective. © 2018 American Heart Association, Inc.

  19. Tracked 3D ultrasound in radio-frequency liver ablation

    NASA Astrophysics Data System (ADS)

    Boctor, Emad M.; Fichtinger, Gabor; Taylor, Russell H.; Choti, Michael A.

    2003-05-01

    Recent studies have shown that radio frequency (RF) ablation is a simple, safe and potentially effective treatment for selected patients with liver metastases. Despite all recent therapeutic advancements, however, intra-procedural target localization and precise and consistent placement of the tissue ablator device are still unsolved problems. Various imaging modalities, including ultrasound (US) and computed tomography (CT) have been tried as guidance modalities. Transcutaneous US imaging, due to its real-time nature, may be beneficial in many cases, but unfortunately, fails to adequately visualize the tumor in many cases. Intraoperative or laparoscopic US, on the other hand, provides improved visualization and target imaging. This paper describes a system for computer-assisted RF ablation of liver tumors, combining navigational tracking of a conventional imaging ultrasound probe to produce 3D ultrasound imaging with a tracked RF ablation device supported by a passive mechanical arm and spatially registered to the ultrasound volume.

  20. Atrial fibrillation ablation using cryoballoon technology: Recent advances and practical techniques.

    PubMed

    Chen, Shaojie; Schmidt, Boris; Bordignon, Stefano; Bologna, Fabrizio; Perrotta, Laura; Nagase, Takahiko; Chun, K R Julian

    2018-04-16

    Atrial fibrillation (AF) affects 1-2% of the population, and its prevalence is estimated to double in the next 50 years as the population ages. AF results in impaired patients' life quality, deteriorated cardiac function, and even increased mortality. Antiarrhythmic drugs frequently fail to restore sinus rhythm. Catheter ablation is a valuable treatment approach for AF, even as a first-line therapy strategy in selected patients. Effective electrical pulmonary vein isolation (PVI) is the cornerstone of all AF ablation strategies. Use of radiofrequency (RF) catheter in combination of a three-dimensional electroanatomical mapping system is the most established ablation approach. However, catheter ablation of AF is challenging even sometimes for experienced operators. To facilitate catheter ablation of AF without compromising the durability of the pulmonary vein isolation, "single shot" ablation devices have been developed; of them, cryoballoon ablation, is by far the most widely investigated. In this report, we review the current knowledge of AF and discuss the recent evidence in catheter ablation of AF, particularly cryoballoon ablation. Moreover, we review relevant data from the literature as well as our own experience and summarize the key procedural practical techniques in PVI using cryoballoon technology, aiming to shorten the learning curve of the ablation technique and to contribute further to reduction of the disease burden. © 2018 Wiley Periodicals, Inc.

  1. Clinical impact of an open-irrigated radiofrequency catheter with direct force measurement on atrial fibrillation ablation.

    PubMed

    Martinek, Martin; Lemes, Christine; Sigmund, Elisabeth; Derndorfer, Michael; Aichinger, Josef; Winter, Siegmund; Nesser, Hans-Joachim; Pürerfellner, Helmut

    2012-11-01

    Electrode-tissue contact is crucial for adequate lesion formation in radiofrequency catheter ablation (RFCA). We assessed the impact of direct catheter force measurement on acute procedural parameters during RFCA of atrial fibrillation (AF). Fifty consecutive patients (28 male) with paroxysmal AF who underwent their first procedure of circumferential pulmonary vein (PV) isolation (PVI) were assigned to either RFCA using (1) a standard 3.5-mm open-irrigated-tip catheter or (2) a catheter with contact force measurement capabilities. Using the endpoint of PVI with entry and exit block, acute procedural parameters were assessed. Procedural data showed a remarkable decline in ablation time (radiofrequency time needed for PVI) from 50.5 ± 15.9 to 39.0 ± 11.0 minutes (P = 0.007) with a reduction in overall procedure duration from 185 ± 46 to 154 ± 39 minutes (P = 0.022). In parallel, the total energy delivered could be significantly reduced from 70,926 ± 19,470 to 58,511 ± 14,655 Ws (P = 0.019). The number of acute PV reconnections declined from 36% to 12% (P = 0.095). The use of contact force sensing technology is able to significantly reduce ablation and procedure times in PVI. In addition, energy delivery is substantially reduced by avoiding radiofrequency ablation in positions with insufficient surface contact. Procedural efficacy and safety of this new feature have to be evaluated in larger cohorts. ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

  2. Place and direction learning in a spatial T-maze task by neonatal piglets

    PubMed Central

    Elmore, Monica R. P.; Dilger, Ryan N.; Johnson, Rodney W.

    2013-01-01

    Pigs are a valuable animal model for studying neurodevelopment in humans due to similarities in brain structure and growth. The development and validation of behavioral tests to assess learning and memory in neonatal piglets are needed. The present study evaluated the capability of 2-wk old piglets to acquire a novel place and direction learning spatial T-maze task. Validity of the task was assessed by the administration of scopolamine, an anti-cholinergic drug that acts on the hippocampus and other related structures, to impair spatial memory. During acquisition, piglets were trained to locate a milk reward in a constant place in space, as well as direction (east or west), in a plus-shaped maze using extra-maze visual cues. Following acquisition, reward location was reversed and piglets were re-tested to assess learning and working memory. The performance of control piglets in the maze improved over time (P < 0.0001), reaching performance criterion (80% correct) on day 5 of acquisition. Correct choices decreased in the reversal phase (P < 0.0001), but improved over time. In a separate study, piglets were injected daily with either phosphate buffered saline (PBS; control) or scopolamine prior to testing. Piglets administered scopolamine showed impaired performance in the maze compared to controls (P = 0.03), failing to reach performance criterion after 6 days of acquisition testing. Collectively, these data demonstrate that neonatal piglets can be tested in a spatial T-maze task to assess hippocampal-dependent learning and memory. PMID:22526690

  3. Feasibility of Real-Time Intraprocedural Temperature Control during Bone Metastasis Thermal Microwave Ablation: A Bicentric Retrospective Study.

    PubMed

    Kastler, Adrian; Krainik, Alexandre; Sakhri, Linda; Mousseau, Mireille; Kastler, Bruno

    2017-03-01

    To evaluate feasibility of using a thermocouple for temperature monitoring during microwave (MW) ablation of metastatic bone disease. This retrospective study comprised 16 patients (8 men with mean age 63 y and 8 women with mean age 59 y) with 18 bone metastases treated with MW ablation using a thermocouple between March 2012 and October 2015. The mean maximum tumor size was 29.5 mm. MW ablation power was set between 15 W and 40 W and applied for 1-6 minutes. Thermocouple placements were as follows: epidural space (n = 7 cases), nerve roots (n = 9 cases), pleura (n = 1), and pericardium (n = 1). The procedure was considered technically successful when the MW and the thermocouple probes were accurately placed and thermoablation was initiated. Clinical success was defined as a 50% visual analog scale score decrease at 1 month as assessed by the operators. Mean MW ablation time was 4.3 minutes with a mean energy of 30 W. Procedural success was 100%. In 16 cases with neural structure monitoring, temperature did not increase > 43°C. In 8 cases, MW ablation had to be discontinued because of temperature reaching 42°C. Efficacy of the procedure in regard to pain was achieved in 17 of 18 ablation sessions at 1 month. Use of a thermocouple during bone MW ablation is a feasible technique and may be a potentially useful tool to help avoid nontarget ablation surrounding tumors. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  4. Slime mold solves maze in one pass, assisted by gradient of chemo-attractants.

    PubMed

    Adamatzky, Andrew

    2012-06-01

    Plasmodium of Physarum polycephalum is a large cell, visible by unaided eye, which exhibits sophisticated patterns of foraging behaviour. The plasmodium's behaviour is well interpreted in terms of computation, where data are spatially extended configurations of nutrients and obstacles, and results of computation are networks of protoplasmic tubes formed by the plasmodium. In laboratory experiments and numerical simulation we show that if plasmodium of P. polycephalum is inoculated in a maze's peripheral channel and an oat flake (source of attractants) in a the maze's central chamber then the plasmodium grows toward target oat flake and connects the flake with the site of original inoculation with a pronounced protoplasmic tube. The protoplasmic tube represents a path in the maze. The plasmodium solves maze in one pass because it is assisted by a gradient of chemo-attractants propagating from the target oat flake.

  5. Radiofrequency ablation versus cryoablation for atrioventricular nodal re-entrant tachycardia in children: a value comparison.

    PubMed

    Oster, Matthew E; Yang, Zhou; Stewart-Huey, Kay; Glanville, Michelle; Porter, Arlene; Campbell, Robert; Webb, Brad; Strieper, Margaret

    2017-03-01

    It is unclear whether cryoablation or radiofrequency ablation offers better value for treating atrioventricular nodal re-entrant tachycardia in children. We aimed to compare the value of these procedures for treating atrioventricular nodal re-entrant tachycardia in children, with value being outcomes relative to costs. We performed a retrospective cohort study of all atrioventricular nodal re-entrant tachycardia ablations for children (age⩽18 years) from July, 2009 to June, 2011 at our institution. Costs included fixed costs, miscellaneous hospital costs, and labour costs, and key outcomes were acute and long-term success (6 months) of the ablations. We conducted T-tests and regression analyses to investigate the associations between the ablation procedure type and the cost and success of the ablations. Of 96 unique cases performed by three paediatric electrophysiologists, 48 were cryoablation only, 42 radiofrequency ablation only, and six were a combination. Acute success was 100% for the cryoablation only and radiofrequency ablation only cases and 83% for the combination cases. There were no notable adverse events. The average total cost was $9636 for cryoablation cases, $9708 for radiofrequency ablation cases, and $10,967 for combination cases (p=0.51 for cryoablation only versus radiofrequency ablation only). The long-term success rate was 79.1% for cryoablation only, 92.8% for radiofrequency ablation only, and 66.7% for the combination (p=0.01 for cryoablation only versus radiofrequency ablation only), but long-term success varied notably by provider. Cryoablation and radiofrequency ablation offer similar value in the short term for the treatment of atrioventricular nodal re-entrant tachycardia in children. Differences in long-term success may vary substantially by physician, and thus may lead to differences in long-term value.

  6. Radial maze performance in three strains of mice - Role of the fimbria/fornix

    NASA Technical Reports Server (NTRS)

    Reinstein, D. K.; Deboissiere, T.; Robinson, N.; Wurtman, R. J.

    1983-01-01

    Three strains of mice were tested on an 8-arm radial maze, an index of hippocampus-dependent spatial memory. Levels of performance differed betweens strains with C57Br/cdj greater than Balb/cj greater than C57B1/6j. Lesions of the fimbria/fornix disrupted performance in the C57Br and Balb strains: the C57Bl mice never performed better than chance before or after surgery. Choline acetyltransferase activity in hippocampus was not correlated with radial maze performance. These findings suggest a possible genetic contribution towards radial maze behavior.

  7. Impact of radiofrequency ablation geometry on electrical conduction

    NASA Astrophysics Data System (ADS)

    Rivas, Rhiana N.; Lye, Theresa H.; Hendon, Christine P.

    2018-02-01

    The gold standard of current treatment for atrial fibrillation is radiofrequency ablation (RFA). Single RFA procedures have low long-term, single-procedure success rates, which can be attributed to factors including inability to measure and visualize lesion depth in real time and incomplete knowledge of how atrial fibrillation manifests and persists. One way to address this problem is to develop a heart model that accurately fits lesion dimensions and depth using OCT to extract structural information. Twenty-three lesions of varying transmurality in left and right swine atrial tissue have been imaged with a Thorlabs OCT system with 6.5-micron axial resolution and a custom Ultra High Resolution system with 2.5-micron axial resolution. The boundaries of the ablation lesions were identified by the appearance of the birefringence artifact to identify areas of un-ablated tissue, as well as by changes to depth penetration and structural features, including decreased contrast between the endocardium and myocardium and disappearance of collagen fibers within the ablation lesion. Using these features, the lateral positions of the lesion boundaries were identified. An algorithm that fit ellipses to the lesion contours modeled the ablation geometry in depth. Lesion dimensions and shape were confirmed by comparison with trichrome histological processing. Finite-element models were fitted with these parameters and electrophysiological simulations were run with the Continuity 6 package. Next steps include correlating lesion geometry to conduction velocity, and including further tissue complexity such as varying tissue composition and fiber orientation. Additional models of linear lesions with gaps and adjacent lesions created with non-perpendicular contact will be created. This work will provide insight into how lesion geometry, tissue composition, and fiber organization impact electrophysiological propagation.

  8. Automated microwave ablation therapy planning with single and multiple entry points

    NASA Astrophysics Data System (ADS)

    Liu, Sheena X.; Dalal, Sandeep; Kruecker, Jochen

    2012-02-01

    Microwave ablation (MWA) has become a recommended treatment modality for interventional cancer treatment. Compared with radiofrequency ablation (RFA), MWA provides more rapid and larger-volume tissue heating. It allows simultaneous ablation from different entry points and allows users to change the ablation size by controlling the power/time parameters. Ablation planning systems have been proposed in the past, mainly addressing the needs for RFA procedures. Thus a planning system addressing MWA-specific parameters and workflows is highly desirable to help physicians achieve better microwave ablation results. In this paper, we design and implement an automated MWA planning system that provides precise probe locations for complete coverage of tumor and margin. We model the thermal ablation lesion as an ellipsoidal object with three known radii varying with the duration of the ablation and the power supplied to the probe. The search for the best ablation coverage can be seen as an iterative optimization problem. The ablation centers are steered toward the location which minimizes both un-ablated tumor tissue and the collateral damage caused to the healthy tissue. We assess the performance of our algorithm using simulated lesions with known "ground truth" optimal coverage. The Mean Localization Error (MLE) between the computed ablation center in 3D and the ground truth ablation center achieves 1.75mm (Standard deviation of the mean (STD): 0.69mm). The Mean Radial Error (MRE) which is estimated by comparing the computed ablation radii with the ground truth radii reaches 0.64mm (STD: 0.43mm). These preliminary results demonstrate the accuracy and robustness of the described planning algorithm.

  9. Atrial Fibrillation and Pulmonary Venous Electrical Conduction Recovery After Full Surgical Resection and Anastomosis of the Pulmonary Veins: Insights From Follow-Up and Ablation Procedures in Lung Transplant Recipients.

    PubMed

    Hussein, Ayman A; Panchabhai, Tanmay S; Budev, Marie M; Tarakji, Khaldoun; Barakat, Amr F; Saliba, Walid; Lindsay, Bruce; Wazni, Oussama M

    2017-06-01

    The authors report their experience with atrial fibrillation (AF) rates and ablation findings in lung transplant recipients. Pulmonary venous (PV) conduction recovery accounts for most failed atrial fibrillation (AF) catheter ablation procedures. Lung transplantation involves full surgical resection and replacement of the recipient's PVs with donor's PVs, which may represent the ultimate PV ablation. They followed 755 consecutive lung transplant recipients categorized based on transplant status (unilateral vs. bilateral) and pre-transplant AF. In patients without pre-transplant AF (n = 704), late AF (beyond 6 months after transplant) occurred in 2.5% and 3.3% of unilateral or bilateral lung transplants, respectively. In patients with pre-transplant AF (n = 51), AF recurred in 19.4% and 25.0% of bilateral and unilateral transplants, respectively. In a subset of patients who underwent left atrial ablations after transplant for recurrent refractory AF (n = 8), PV conduction recovery across the surgical anastomoses lines was observed in 22 of 26 previously disconnected PVs. Conduction recovery was observed in ≥1 vein in all but 1 patient. Re-isolation of the veins with additional substrate modification/flutter ablations successfully restored and maintained sinus rhythm in 7 of 8 patients. In lung transplant recipients who undergo full surgical resection of the PVs, a prior history of AF was associated with late AF, regardless of whether patients underwent single or bilateral lung transplantation. PV conduction recovery still occurred and was observed in most patients who underwent left atrial ablation procedures for recurrent AF. Copyright © 2017. Published by Elsevier Inc.

  10. The Impact of Context and Word Type on Students' Maze Task Accuracy

    ERIC Educational Resources Information Center

    January, Stacy-Ann A.; Ardoin, Scott P.

    2012-01-01

    Despite evidence that the maze is a reliable measure of reading comprehension, existing research suggests potential problems with the manner in which maze probes are developed. Specifically, research suggests students may be able to respond accurately to a large portion of target words without having to comprehend what they are reading. The…

  11. Mathematical methods to model rodent behavior in the elevated plus-maze.

    PubMed

    Arantes, Rafael; Tejada, Julián; Bosco, Geraldine G; Morato, Silvio; Roque, Antonio C

    2013-11-15

    The elevated plus maze is a widely used experimental test to study anxiety-like rodent behavior. It is made of four arms, two open and two closed, connected at a central area forming a plus shaped maze. The whole apparatus is elevated 50 cm from the floor. The anxiety of the animal is usually assessed by the number of entries and duration of stay in each arm type during a 5-min period. Different mathematical methods have been proposed to model the mechanisms that control the animal behavior in the maze, such as factor analysis, statistical inference on Markov chains and computational modeling. In this review we discuss these methods and propose possible extensions of them as a direction for future research. Copyright © 2013 Elsevier B.V. All rights reserved.

  12. Ablation article and method

    NASA Technical Reports Server (NTRS)

    Erickson, W. D.; Sullivan, E. M. (Inventor)

    1973-01-01

    An ablation article, such as a conical heat shield, having an ablating surface is provided with at least one discrete area of at least one seed material, such as aluminum. When subjected to ablation conditions, the seed material is ablated. Radiation emanating from the ablated seed material is detected to analyze ablation effects without disturbing the ablation surface. By providing different seed materials having different radiation characteristics, the ablating effects on various areas of the ablating surface can be analyzed under any prevailing ablation conditions. The ablating article can be provided with means for detecting the radiation characteristics of the ablated seed material to provide a self-contained analysis unit.

  13. Multipolar hepatic radiofrequency ablation using up to six applicators: preliminary results.

    PubMed

    Bruners, P; Schmitz-Rode, T; Günther, R W; Mahnken, A

    2008-03-01

    To evaluate the clinical feasibility and safety of hepatic radiofrequency (RF) ablation using a multipolar RF system permitting the simultaneous use of up to six electrodes. Ten patients (3 female, 7 male, mean age 61) suffering from 29 hepatic metastases (range: 1 - 5) of different tumors were treated with a modified multipolar RF system (CelonLab Power, Celon Medical Instruments, Teltow, Germany) operating four to six needle-shaped internally cooled RF applicators. The procedure duration, applied energy and generator output were recorded during the intervention. The treatment result and procedure-related complications were analyzed. The achieved coagulation volume was calculated on the basis of contrast-enhanced CT scans 24 hours after RF ablation. Complete tumor ablation was achieved in all cases as determined by the post-interventional lack of contrast enhancement in the target region using four applicators in five patients, five applicators in one patient and six applicators in four patients. A mean energy deposition of 353.9 +/- 176.2 kJ resulted in a mean coagulation volume of 115.9 +/- 79.5 cm (3). The mean procedure duration was 74.9 +/- 21.2 minutes. Four patients showed an intraabdominal hemorrhage which necessitated further interventional treatment (embolization; percutaneous histoacryl injection) in two patients. Multipolar RF ablation of hepatic metastasis with up to six applicators was clinically feasible. In our patient population it was associated with an increased risk of intraabdominal bleeding probably due to the multiple punctures associated with the use of multiple applicators.

  14. Three-dimension finite-element analyses of multiple electrodes bipolar RF global endometrial ablation

    NASA Astrophysics Data System (ADS)

    Hu, Tao; Panhao, Tang; Xiao, Jiahua

    2015-03-01

    Radio-frequency ablation (RFA) is a minimally invasive surgical procedure to thermally ablate the targeted diseased tissue. There have been many finite-element method (FEM) studies of cardiac and hepatic RFA, but hardly find any FEM study on endometrial ablation for abnormal uterine bleeding. In this paper, a FEM model was generated to analyze the temperature distribution of bipolar RF global endometrial ablation with three pairs of bipolar electrodes placed at the perimeter of the uterine cavity. COMSOL was utilized to calculate the RF electric fields and temperature fields by numerically solving the bioheat equation in the triangle uterine cavity range. The 55°C isothermal surfaces show the shape of the ablation dimensions (depth and width), which reasonably matched the experimental results.

  15. 12-month efficacy of a single radiofrequency ablation on autonomously functioning thyroid nodules.

    PubMed

    Bernardi, Stella; Stacul, Fulvio; Michelli, Andrea; Giudici, Fabiola; Zuolo, Giulia; de Manzini, Nicolò; Dobrinja, Chiara; Zanconati, Fabrizio; Fabris, Bruno

    2017-09-01

    Radiofrequency ablation has been advocated as an alternative to radioiodine and/or surgery for the treatment of autonomously functioning benign thyroid nodules. However, only a few studies have measured radiofrequency ablation efficacy on autonomously functioning benign thyroid nodules. The aim of this work was to evaluate the 12-month efficacy of a single session of radiofrequency ablation (performed with the moving shot technique) on solitary autonomously functioning benign thyroid nodules. Thirty patients with a single, benign autonomously functioning benign thyroid nodules, who were either unwilling or ineligible to undergo surgery and radioiodine, were treated with radiofrequency ablation between April 2012 and May 2015. All the patients underwent a single radiofrequency ablation, performed with the 18-gauge needle and the moving shot technique. Clinical, laboratory, and ultrasound evaluations were scheduled at baseline, and after 1, 3, 6, and 12 months from the procedure. A single radiofrequency ablation reduced thyroid nodule volume by 51, 63, 69, and 75 % after 1, 3, 6, and 12 months, respectively. This was associated with a significant improvement of local cervical discomfort and cosmetic score. As for thyroid function, 33 % of the patients went into remission after 3 months, 43 % after 6 months, and 50 % after 12 months from the procedure. This study demonstrates that a single radiofrequency ablation allowed us to withdraw anti-thyroid medication in 50 % of the patients, who remained euthyroid afterwards. This study shows that a single radiofrequency ablation was effective in 50 % of patients with autonomously functioning benign thyroid nodules. Patients responded gradually to the treatment. It is possible that longer follow-up studies might show greater response rates.

  16. Spatial water maze learning using celestial cues by the meadow vole, Microtus pennsylvanicus.

    PubMed

    Kavaliers, M; Galea, L A

    1994-03-31

    The Morris water maze is widely used to evaluate to evaluate the spatial learning ability of rodents under laboratory settings. The present study demonstrates that reproductive male meadow voles, Microtus pennsylvanicus, are able to acquire and retain a spatial water maze task using celestial cues. Voles were able to acquire a modified outdoor Morris water maze task over 4 trials per day, whereby they had to learn and remember the location of a submerged hidden platform, using the position of the sun and associated celestial cues. Their proficiency on this task was related to the availability of the celestial cues, with voles displaying significantly poorer spatial navigation on overcast than clear days and when the testing time (and position of the sun and associated celestial cues) was shifted from morning to afternoon. These findings with meadow voles support the ecological relevance of the water maze task.

  17. [Endoscopic radiofrequency ablation for liver metastasis of colorectal cancer].

    PubMed

    Takahashi, Masahiro; Nitta, Hiroyuki; Sasaki, Akira; Fujita, Tomohiro; Obuchi, Toru; Hoshikawa, Koichi; Otsuka, Koki; Kawamura, Hidenobu; Higuchi, Taro; Asahi, Hiroshi; Saito, Kazuyoshi

    2005-10-01

    The application of radiofrequency ablation (RFA) for liver metastasis of colorectal cancer has not yet acquired an established status in clinical cancer therapy research. Removing as much tumor tissue as possible is desirable, but some cases do not allow optimal surgical ablation due to general condition of the patient and tumor status. We introduced endoscopic RFA for liver cancer in 2003, and have applied the procedure to 6 cases with H1 or H2 liver metastases of colorectal cancer to which surgical ablation could not be applied due to the poor general health of patients. Mean tumor diameter was 22.9 mm, and mean number of tumors per patient was 1.2. Tumor location was: S4, n = 2; S5, n = 1; S4, n = 1; S7, n = 2; and S8, n = 1. Mean frequency of session was 3.0. No complications occurred in any cases, and no reoperations were required. Although no recurrence of tumors in the vicinity of ablation was observed, 2 cases of each lung metastasis and intrahepatic recurrence were identified. Intrahepatic recurrence underwent hepatic arterial infusion (HAI) chemotherapy for simultaneous metastatic hepatic tumors (H2) prior to RFA, and relapses occurred in the metastatic focus where the efficacy of HAI was observed. At this point, 2 deaths were reported, 1 each from cancer and other diseases, and mean duration of survival after the procedure was 451.2 days. These results indicate that endoscopic RFA with good local control should be an available treatment for cases involving colorectal cancer with metastasis to the liver in which surgical ablation is difficult to apply.

  18. Percutaneous Radiofrequency Ablation of a Small Renal Mass Complicated by Appendiceal Perforation

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Boone, Judith, E-mail: j.boone@amc.uva.nl; Bex, Axel, E-mail: a.bex@nki.nl; Prevoo, Warner, E-mail: w.prevoo@nki.nl

    2012-06-15

    Percutaneous radiofrequency ablation (RFA) has gained wide acceptance as nephron-sparing therapy for small renal masses in select patients. Generally, it is a safe procedure with minor morbidity and acceptable short-term oncologic outcome. However, as a result of the close proximity of vital structures, such as the bowel, ureter, and large vessels, to the ablative field, complications regarding these structures may occur. This is the first article describing appendiceal perforation as a complication of computed tomography-guided RFA despite hydrodissection. When performing this innovative and promising procedure one should be aware of the possibility of particular minor and even major complications.

  19. Measurement of intrahepatic pressure during radiofrequency ablation in porcine liver.

    PubMed

    Kawamoto, Chiaki; Yamauchi, Atsushi; Baba, Yoko; Kaneko, Keiko; Yakabi, Koji

    2010-04-01

    To identify the most effective procedures to avoid increased intrahepatic pressure during radiofrequency ablation, we evaluated different ablation methods. Laparotomy was performed in 19 pigs. Intrahepatic pressure was monitored using an invasive blood pressure monitor. Radiofrequency ablation was performed as follows: single-step standard ablation; single-step at 30 W; single-step at 70 W; 4-step at 30 W; 8-step at 30 W; 8-step at 70 W; and cooled-tip. The array was fully deployed in single-step methods. In the multi-step methods, the array was gradually deployed in four or eight steps. With the cooled-tip, ablation was performed by increasing output by 10 W/min, starting at 40 W. Intrahepatic pressure was as follows: single-step standard ablation, 154.5 +/- 30.9 mmHg; single-step at 30 W, 34.2 +/- 20.0 mmHg; single-step at 70 W, 46.7 +/- 24.3 mmHg; 4-step at 30 W, 42.3 +/- 17.9 mmHg; 8-step at 30 W, 24.1 +/- 18.2 mmHg; 8-step at 70 W, 47.5 +/- 31.5 mmHg; and cooled-tip, 114.5 +/- 16.6 mmHg. The radiofrequency ablation-induced area was spherical with single-step standard ablation, 4-step at 30 W, and 8-step at 30 W. Conversely, the ablated area was irregular with single-step at 30 W, single-step at 70 W, and 8-step at 70 W. The ablation time was significantly shorter for the multi-step method than for the single-step method. Increased intrahepatic pressure could be controlled using multi-step methods. From the shapes of the ablation area, 30-W 8-step expansions appear to be most suitable for radiofrequency ablation.

  20. Contact force sensing for ablation of persistent atrial fibrillation: A randomized, multicenter trial.

    PubMed

    Conti, Sergio; Weerasooriya, Rukshen; Novak, Paul; Champagne, Jean; Lim, Hong Euy; Macle, Laurent; Khaykin, Yaariv; Pantano, Alfredo; Verma, Atul

    2018-02-01

    Impact of contact force sensing (CFS) on ablation of persistent atrial fibrillation (PeAF) is unknown. The purpose of the TOUCH AF (Therapeutic Outcomes Using Contact force Handling during Ablation of Persistent Atrial Fibrillation) randomized trial was to compare CFS-guided ablation to a CFS-blinded strategy. Patients (n = 128) undergoing first-time ablation for persistent AF were randomized to a CFS-guided vs CFS-blinded strategy. In the CFS-guided procedure, operators visualized real-time force data. In the blinded procedure, force data were hidden. Wide antral pulmonary vein isolation plus a roof line were performed. Patients were followed at 3, 6, 9, and 12 months with clinical visit, ECG, and 48-hour Holter monitoring. The primary endpoint was cumulative radiofrequency (RF) time for all procedures. Atrial arrhythmia >30 seconds after 3 months was a recurrence. PeAF was continuous for 26 weeks (interquartile range [IQR] 13-52), and left atrial size was 45 ± 5 mm. Force in the CFS-blinded and CFS-guided arms was 12 g [IQR 6-20] and 14 g [IQR 9-20] (P = .10), respectively. Total RF time did not differ between CFS-guided and CFS-blinded groups (49 ± 14 min vs 50 ± 20 min, respectively; P = .70). Single procedure freedom from atrial arrhythmia was 60% in the CFS-guided arm and 63% in the CFS-blinded arm off drugs. Lesions with gaps were associated with significantly less force (11.4 g [IQR 6-19] vs 13.2 g [IQR 8-20], respectively; P = .0007) and less force-time integral (174 gs [IQR 91-330] vs 210 gs [IQR 113-388], respectively; P <.001). CFS-guided ablation resulted in no difference to RF time or 12-month outcome. Lower force/force-time integral was associated with significantly more gaps. Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  1. Post-procedural evaluation of catheter contact force characteristics

    NASA Astrophysics Data System (ADS)

    Koch, Martin; Brost, Alexander; Kiraly, Atilla; Strobel, Norbert; Hornegger, Joachim

    2012-03-01

    Minimally invasive catheter ablation of electric foci, performed in electrophysiology labs, is an attractive treatment option for atrial fibrillation (AF) - in particular if drug therapy is no longer effective or tolerated. There are different strategies to eliminate the electric foci inducing the arrhythmia. Independent of the particular strategy, it is essential to place transmural lesions. The impact of catheter contact force on the generated lesion quality has been investigated recently, and first results are promising. There are different approaches to measure catheter-tissue contact. Besides traditional haptic feedback, there are new technologies either relying on catheter tip-to-tissue contact force or on local impedance measurements at the tip of the catheter. In this paper, we present a novel tool for post-procedural ablation point evaluation and visualization of contact force characteristics. Our method is based on localizing ablation points set during AF ablation procedures. The 3-D point positions are stored together with lesion specific catheter contact force (CF) values recorded during the ablation. The force records are mapped to the spatial 3-D positions, where the energy has been applied. The tracked positions of the ablation points can be further used to generate a 3-D mesh model of the left atrium (LA). Since our approach facilitates visualization of different force characteristics for post-procedural evaluation and verification, it has the potential to improve outcome by highlighting areas where lesion quality may be less than desired.

  2. The first clinical application of planning software for laparoscopic microwave thermosphere ablation of malignant liver tumours.

    PubMed

    Berber, Eren

    2015-07-01

    Liver tumour ablation is an operator-dependent procedure. The determination of the optimum needle trajectory and correct ablation parameters could be challenging. The aim of this study was to report the utility of a new, procedure planning software for microwave ablation (MWA) of liver tumours. This was a feasibility study in a pilot group of five patients with nine metastatic liver tumours who underwent laparoscopic MWA. Pre-operatively, parameters predicting the desired ablation zones were calculated for each tumour. Intra-operatively, this planning strategy was followed for both antenna placement and energy application. Post-operative 2-week computed tomography (CT) scans were performed to evaluate complete tumour destruction. The patients had an average of two tumours (range 1-4), measuring 1.9 ± 0.4 cm (range 0.9-4.4 cm). The ablation time was 7.1 ± 1.3 min (range 2.5-10 min) at 100W. There were no complications or mortality. The patients were discharged home on post-operative day (POD) 1. At 2-week CT scans, there were no residual tumours, with a complete ablation demonstrated in all lesions. This study describes and validates pre-treatment planning software for MWA of liver tumours. This software was found useful to determine precisely the ablation parameters and needle placement to create a predicted zone of ablation. © 2015 International Hepato-Pancreato-Biliary Association.

  3. Pelvic denervation procedures for dysmenorrhea.

    PubMed

    Ramirez, Christina; Donnellan, Nicole

    2017-08-01

    Chronic pelvic pain and dysmenorrhea are common conditions affecting reproductive-age women. Surgical pelvic denervation procedures may be a treatment option for women with midline dysmenorrhea, in which medical management is declined by the patient, ineffective at managing symptoms, or medically contraindicated. This review describes the surgical techniques and complications associated with pelvic denervation procedures as well as the current evidence for these procedures in women with primary dysmenorrhea and dysmenorrhea secondary to endometriosis. Presacral neurectomy is the preferred pelvic denervation procedure in patients with primary dysmenorrhea and midline chronic pelvic pain associated with endometriosis. In patients with endometriosis presacral neurectomy is a useful adjunct to excision or ablation of all endometrial lesions to improve postoperative pain relief. There is no additional patient benefit of performing combined presacral neurectomy and uterine nerve ablation procedures. Pelvic denervation procedures can be performed safely and quickly with a low risk of complication if the surgeon is knowledgeable and skilled in operating in the presacral space. Patients should be adequately counseled on expected success rates and potential complications associated with pelvic denervation procedures.

  4. A robust animal model of state anxiety: fear-potentiated behaviour in the elevated plus-maze.

    PubMed

    Korte, S Mechiel; De Boer, Sietse F

    2003-02-28

    Fear (i.e., decreased percentage time spent on open-arm exploration) in the elevated plus-maze can be potentiated by prior inescapable stressor exposure, but not by escapable stress. The use of fear-potentiated plus-maze behaviour has several advantages as compared to more traditional animal models of anxiety. (a) In contrast to the traditional (spontaneous) elevated plus-maze, which measures innate fear of open spaces, fear-potentiated plus-maze behaviour reflects an enhanced anxiety state (allostatic state). This "state anxiety" can be defined as an unpleasant emotional arousal in face of threatening demands or dangers. A cognitive appraisal of threat is a prerequisite for the experience of this type of emotion. (b) Depending on the stressor used (e.g., fear of shock, predator odour, swim stress, restraint, social defeat, predator stress (cat)), this enhanced anxiety state can last from 90 min to 3 weeks. Stress effects are more severe when rats are isolated in comparison to group housing. (c) Drugs can be administered in the absence of the original stressor and after stressor exposure. As a consequence, retrieval mechanisms are not affected by drug treatment. (d) Fear-potentiated plus-maze behaviour is sensitive to proven/putative anxiolytics and anxiogenics which act via mechanisms related to the benzodiazepine-gamma-aminobutyric acid receptor, but it is also sensitive to corticotropin-releasing receptor antagonists and glucocorticoid receptor antagonists and serotonin receptor agonists/antagonists complex (high predictive validity). (e) Fear-potentiated plus-maze behaviour is very robust, and experiments can easily be replicated in other labs. (f) Fear-potentiated plus-maze behaviour can be measured both in males and females. (g) Neural mechanisms involved in contextual fear conditioning, fear potentiation and state anxiety can be studied.Thus, fear-potentiated plus-maze behaviour may be a valuable measure in the understanding of neural mechanisms involved in

  5. Tumor abolition and antitumor immunostimulation by physico-chemical tumor ablation.

    PubMed

    Keisari, Yona

    2017-01-01

    Tumor ablation by thermal, chemical and radiological sources has received substantial attention for the treatment of many localized malignancies. The primary goal of most ablation procedures is to eradicate all viable malignant cells within a designated target volume through the application of energy or chemicals. Methods such as radiotherapy, chemical and biological ablation, photodynamic therapy, cryoablation, high-temperature ablation (radiofrequency, microwave, laser, and ultrasound), and electric-based ablation have been developed for focal malignancies. In recent years a large volume of data emerged on the effect of in situ tumor destruction (ablation) on inflammatory and immune components resulting in systemic anti-tumor reactions. It is evident that in situ tumor ablation can involve tumor antigen release, cross presentation and the release of DAMPS and make the tumor its own cellular vaccine. Tumor tissue destruction by in situ ablation may stimulate antigen-specific cellular immunity engendered by an inflammatory milieu. Dendritic cells (DCs) attracted to this microenvironment, will undergo maturation after internalizing cellular debris containing tumor antigens and will be exposed to damage associated molecular pattern (DAMP). Mature DCs can mediate antigen-specific cellular immunity via presentation of processed antigens to T cells. The immunomodulatory properties, exhibited by in situ ablation could portend a future collaboration with immunotherapeutic measures. In this review are summarized and discuss the preclinical and clinical studies pertinent to the phenomena of stimulation of specific anti-tumor immunity by various ablation modalities and the immunology related measures used to boost this response.

  6. Optimal contact forces to minimize cardiac perforations before, during, and/or after radiofrequency or cryothermal ablations.

    PubMed

    Quallich, Stephen G; Van Heel, Michael; Iaizzo, Paul A

    2015-02-01

    Catheter perforations remain a major clinical concern during ablation procedures for treatment of atrial arrhythmias and may lead to life-threatening cardiac tamponade. Radiofrequency (RF) ablation alters the biomechanical properties of cardiac tissue, ultimately allowing for perforation to occur more readily. Studies on the effects of cryoablation on perforation force as well as studies defining the perforation force of human tissue are limited. The purpose of this study was to investigate the required force to elicit perforation of cardiac atrial tissue after or during ablation procedures. Effects of RF or cryothermal ablations on catheter perforation forces for both swine (n = 83 animals, 530 treatments) and human (n = 8 specimens, 136 treatments) cardiac tissue were investigated. Overall average forces resulting in perforation of healthy unablated tissue were 406g ± 170g for swine and 591g ± 240g for humans. Post-RF ablation applications considerably reduced these forces to 246g ± 118g for swine and 362 ± 185g for humans (P <.001). Treatments with cryoablation did not significantly alter forces required to induce perforations. Decreasing catheter sizes resulted in a reduction in forces required to perforate the atrial wall (P <.001). Catheter perforations occurred over an array of contact forces with a minimum of 38g being observed. The swine model likely underestimates the required perforation forces relative to those of human tissues. We provide novel insights related to the comparative effects of RF and cryothermal ablations on the potential for inducing undesired punctures, with RF ablation reducing perforation force significantly. These data are insightful for physicians performing ablation procedures as well as for medical device designers. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  7. Younger apes and human children plan their moves in a maze task.

    PubMed

    Völter, Christoph J; Call, Josep

    2014-02-01

    Planning defined as the predetermination of a sequence of actions towards some goal is crucial for complex problem solving. To shed light on the evolution of executive functions, we investigated the ontogenetic and phylogenetic origins of planning. Therefore, we presented all four great apes species (N=12) as well as 4- and 5-year-old human preschoolers (N=24) with a vertical maze task. To gain a reward placed on the uppermost level of the maze, subjects had to move the reward to the bottom through open gaps situated at each level of the maze. In total, there were ten gaps located over three of the maze's levels, and free passage through these gaps could be flexibly blocked using multiple traps. Due to the decision tree design of the maze, the subjects had to plan their actions depending on the trap configuration up to two steps ahead to successfully retrieve the reward. We found that (1) our measure of planning was negatively correlated with age in nonhuman apes, (2) younger apes as well as 5-year-old children planned their moves up to two steps ahead whereas 4-year-olds were limited to plan one step ahead, and (3) similar performance but different underlying limitations between apes and children. Namely, while all species of nonhuman apes were limited by a lack of motor control, human children exhibited a shortage in shifting their attention across a sequence of subgoals. Copyright © 2013 Elsevier B.V. All rights reserved.

  8. Reasons for recurrent ventricular tachycardia after catheter ablation of post-infarction ventricular tachycardia.

    PubMed

    Yokokawa, Miki; Desjardins, Benoit; Crawford, Thomas; Good, Eric; Morady, Fred; Bogun, Frank

    2013-01-08

    The purpose of this study was to assess the determinants of ventricular tachycardia (VT) recurrence in patients who underwent VT ablation for post-infarction VT. The factors that predict recurrence of VT after catheter ablation in patients with prior infarctions are not well described. Catheter ablation was performed in 98 consecutive patients (88 males [90%]; mean age 67 ± 10 years; ejection fraction 27 ± 13%) with post-infarction VT. Electrograms from the implantable cardioverter-defibrillator were analyzed, and VTs were classified as clinical, nonclinical, or new clinical. A total of 725 VTs were induced during the ablation procedure. All VTs were targeted. In 76 patients, 105 clinical VTs were inducible. Critical sites were identified with entrainment mapping and pace-mapping (≥10 of 12 matching leads) for 75 of 105 clinical VTs (71%) and for 278 of 620 nonclinical VTs (45%). Post-ablation, the clinical VT was not inducible in any patient, and all VTs were rendered noninducible in 63% of the patients. Over a mean follow-up period of 35 ± 23 months, 65 of 98 patients (66%) had no recurrent VTs and 33 (34%) had VT recurrence. A new VT occurred in 26 of 33 patients (79%), and a prior clinical VT recurred in 7 patients (21%). Patients with recurrent VT had a larger scar area as assessed by electroanatomic mapping compared with patients without recurrent VTs (93 ± 40 cm(2) vs. 69 ± 30 cm(2); p = 0.002). In patients with repeat procedures, the majority of inducible VTs for which a critical area could be identified were at a distance of 6 ± 3 mm to the prior ablation lesions. Patients with recurrent VTs have a larger scar as assessed by electroanatomic mapping. Most recurrent VTs were new, and the majority of these VTs were mapped to the vicinity of prior ablation lesions in patients with repeat procedures. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  9. The use of a novel method of endovenous steam ablation in treatment of great saphenous vein insufficiency: own experiences.

    PubMed

    Mlosek, R K; Woźniak, W; Gruszecki, L; Stapa, R Z

    2014-02-01

    Endovascular procedures are gaining more and more popularity as treatment of great saphenous vein (GSV) incompetence. The purpose of the present study was to assess the efficacy of steam GSV ablation. Steam ablation using the steam vein sclerosis system (CERMA, France) was performed in 20 patients with GSV incompetence. The efficacy of the procedure was evaluated using ultrasound and the following parameters were assessed: changes in lumen diameter, GSV wall thickness, reflux and presence/absence of blood flow. The GSV steam ablation resulted in the obliteration of the vein lumen in all patients - reflux or blood flow were not observed in any subject. A significant decrease of GSV lumen diameter and an increase of GSV wall thickness were also observed in all subjects following the procedure. No postoperative complications were noted. The steam ablation technique was also positively assessed by the patients. Steam ablation is an endovascular surgical technique, which can become popular and widely used due to its efficacy and safety. It is also easy to use and patient-friendly. The research on its use should be continued.

  10. Intracardiac echo-facilitated 3D electroanatomical mapping of ventricular arrhythmias from the papillary muscles: assessing the 'fourth dimension' during ablation.

    PubMed

    Proietti, Riccardo; Rivera, Santiago; Dussault, Charles; Essebag, Vidal; Bernier, Martin L; Ayala-Paredes, Felix; Badra-Verdu, Mariano; Roux, Jean-François

    2017-01-01

    Ventricular arrhythmias (VA) originating from a papillary muscle (PM) have recently been described as a distinct clinical entity with peculiar features that make its treatment with catheter ablation challenging. Here, we report our experience using an intracardiac echo-facilitated 3D electroanatomical mapping approach in a case series of patients undergoing ablation for PM VA. Sixteen patients who underwent catheter ablation for ventricular tachycardia (VT) or symptomatic premature ventricular contractions originating from left ventricular PMs were included in the study. A total of 24 procedures (mean 1.5 per patient) were performed: 15 using a retrograde aortic approach and 9 using a transseptal approach. Integrated intracardiac ultrasound for 3D electroanatomical mapping was used in 15 of the 24 procedures. The posteromedial PM was the most frequent culprit for the clinical arrhythmia, and the body was the part of the PM most likely to be the successful site for ablation. The site of ablation was identified based on the best pace map matching the clinical arrhythmia and the site of earliest the activation. At a mean follow-up of 10.5 ± 7 months, only two patients had recurrent arrhythmias following a repeat ablation procedure. An echo-facilitated 3D electroanatomical mapping allows for real-time creation of precise geometries of cardiac chambers and endocavitary structures. This is useful during procedures such as catheter ablation of VAs originating from PMs, which require detailed representation of anatomical landmarks. Routine adoption of this technique should be considered to improve outcomes of PM VA ablation. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  11. Interventional MSK procedures: the hip.

    PubMed

    Dodré, Emilie; Lefebvre, Guillaume; Cockenpot, Eric; Chastanet, Patrick; Cotten, Anne

    2016-01-01

    Percutaneous musculoskeletal procedures are widely accepted as low invasive, highly effective, efficient and safe methods in a vast amount of hip pathologies either in diagnostic or in therapeutic management. Hip intra-articular injections are used for the symptomatic treatment of osteoarthritis. Peritendinous or intrabursal corticosteroid injections can be used for the symptomatic treatment of greater trochanteric pain syndrome and anterior iliopsoas impingement. In past decades, the role of interventional radiology has rapidly increased in metastatic disease, thanks to the development of many ablative techniques. Image-guided percutaneous ablation of skeletal metastases provides a minimally invasive treatment option that appears to be a safe and effective palliative treatment for localized painful lytic lesion. Methods of tumour destruction based on temperature, such as radiofrequency ablation (RFA) and cryotherapy, are performed for the management of musculoskeletal metastases. MR-guided focused ultrasound surgery provides a non-invasive alternative to these ablative methods. Cementoplasty is now widely used for pain management and consolidation of acetabular metastases and can be combined with RFA. RFA is also used to treat benign tumours, namely osteoid osteomas. New interventional procedures such as percutaneous screw fixation are also proposed to treat non-displaced or minimally displaced acetabular roof fractures.

  12. Plasma-mediated radiofrequency ablation followed by percutaneous cementoplasty under fluoro-CT guidance: a case report

    PubMed Central

    Laganà, Domenico; Ianniello, Andrea; Fontana, Federico; Mangini, Monica; Mocciardini, Lucia; Spanò, Emanuela; Piacentino, Filippo; Cuffari, Salvatore; Fugazzola, Carlo

    2009-01-01

    We report a case of a 81-year-old Caucasian man with colorectal carcinoma, treated by surgery in 1998, referred for palliative treatment of a refractory painful caused by osteolytic metastases of 2.5 cm in back-upper ilium spine. Plasma-mediated radiofrequency ablation was performed under conscious sedation, using Fluoroscopic Computer Tomography guidance. After completing the ablation phase of the procedure, a mixture of bone cement and Biotrace sterile barium sulfate was injected into the ablated cavity. Patient was evaluated by using the Brief Pain Inventory and considering pain interference with daily living at day 1 and 3 and week 1, 2, 3, 4 by means of a telephone interview. A post-procedure Computer Tomography scan was performed to examine the distribution of cement deposition few minutes after the procedure. The plasma mediated RFA and cementoplasty were well tolerated by the patient who did not develop any complication. PMID:19918385

  13. Plasma-mediated radiofrequency ablation followed by percutaneous cementoplasty under fluoro-CT guidance: a case report.

    PubMed

    Carrafiello, Gianpaolo; Laganà, Domenico; Ianniello, Andrea; Fontana, Federico; Mangini, Monica; Mocciardini, Lucia; Spanò, Emanuela; Piacentino, Filippo; Cuffari, Salvatore; Fugazzola, Carlo

    2009-08-17

    We report a case of a 81-year-old Caucasian man with colorectal carcinoma, treated by surgery in 1998, referred for palliative treatment of a refractory painful caused by osteolytic metastases of 2.5 cm in back-upper ilium spine. Plasma-mediated radiofrequency ablation was performed under conscious sedation, using Fluoroscopic Computer Tomography guidance. After completing the ablation phase of the procedure, a mixture of bone cement and Biotrace sterile barium sulfate was injected into the ablated cavity.Patient was evaluated by using the Brief Pain Inventory and considering pain interference with daily living at day 1 and 3 and week 1, 2, 3, 4 by means of a telephone interview. A post-procedure Computer Tomography scan was performed to examine the distribution of cement deposition few minutes after the procedure. The plasma mediated RFA and cementoplasty were well tolerated by the patient who did not develop any complication.

  14. Navigational Guidance and Ablation Planning Tools for Interventional Radiology.

    PubMed

    Sánchez, Yadiel; Anvari, Arash; Samir, Anthony E; Arellano, Ronald S; Prabhakar, Anand M; Uppot, Raul N

    Image-guided biopsy and ablation relies on successful identification and targeting of lesions. Currently, image-guided procedures are routinely performed under ultrasound, fluoroscopy, magnetic resonance imaging, or computed tomography (CT) guidance. However, these modalities have their limitations including inadequate visibility of the lesion, lesion or organ or patient motion, compatibility of instruments in an magnetic resonance imaging field, and, for CT and fluoroscopy cases, radiation exposure. Recent advances in technology have resulted in the development of a new generation of navigational guidance tools that can aid in targeting lesions for biopsy or ablations. These navigational guidance tools have evolved from simple hand-held trajectory guidance tools, to electronic needle visualization, to image fusion, to the development of a body global positioning system, to growth in cone-beam CT, and to ablation volume planning. These navigational systems are promising technologies that not only have the potential to improve lesion targeting (thereby increasing diagnostic yield of a biopsy or increasing success of tumor ablation) but also have the potential to decrease radiation exposure to the patient and staff, decrease procedure time, decrease the sedation requirements, and improve patient safety. The purpose of this article is to describe the challenges in current standard image-guided techniques, provide a definition and overview for these next-generation navigational devices, and describe the current limitations of these, still evolving, next-generation navigational guidance tools. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Laparoscopic Ultrasound-Guided Radiofrequency Ablation of Uterine Fibroids

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Milic, Andrea; Asch, Murray R.; Hawrylyshyn, Peter A.

    Four patients with symptomatic uterine fibroids measuring less than 6 cm underwent laparoscopic ultrasound-guided radiofrequency ablation (RFA) using multiprobe-array electrodes. Follow-up of the treated fibroids was performed with gadolinium-enhanced magnetic resonance imaging (MRI) and patients' symptoms were assessed by telephone interviews. The procedure was initially technically successful in 3 of the 4 patients and MRI studies at 1 month demonstrated complete fibroid ablation. Symptom improvement, including a decrease in menstrual bleeding and pain, was achieved in 2 patients at 3 months. At 7 months, 1 of these 2 patients experienced symptom worsening which correlated with recurrent fibroid on MRI. Themore » third, initially technically successfully treated patient did not experience any symptom relief after the procedure and was ultimately diagnosed with adenomyosis. Our preliminary results suggest that RFA is a technically feasible treatment for symptomatic uterine fibroids in appropriately selected patients.« less

  16. Consensus for the Treatment of Varicose Vein with Radiofrequency Ablation

    PubMed Central

    Joh, Jin Hyun; Kim, Woo-Shik; Jung, In Mok; Park, Ki-Hyuk; Lee, Taeseung; Kang, Jin Mo

    2014-01-01

    The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. Indication: anatomic or pathophysiologic indication includes venous diameter within 2–20 mm, reflux time ≥0.5 seconds and distance from the skin ≥5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis ≥class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles’ ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks. PMID:26217628

  17. Global Endometrial Ablation in the Presence of Essure® Microinserts

    PubMed Central

    Aldape, Diana; Chudnoff, Scott G; Levie, Mark D

    2013-01-01

    Abnormal uterine bleeding (AUB) affects 30% of women at some time during their reproductive years and is one of the most common reasons a woman sees a gynecologist. Many women are turning to endometrial ablation to manage their AUB. This article reviews the data relating to the available endometrial ablation techniques performed with hysteroscopic sterilization, and focuses on data from patients who had Essure® (Conceptus, San Carlos, CA) coils placed prior to performance of endometrial ablation. Reviewed specifically are data regarding safety and efficacy of these two procedures when combined. Data submitted to the US Food and Drug Administration for the three devices currently approved are reviewed, as well as all published case series. Articles included were selected based on a PubMed search for endometrial ablation (also using the brand names of the different techniques currently available), hysteroscopic sterilization, and Essure. PMID:24358407

  18. Pathological effects of lung radiofrequency ablation that contribute to pneumothorax, using a porcine model.

    PubMed

    Izaaryene, Jean; Cohen, Frederic; Souteyrand, Philippe; Rolland, Pierre-Henri; Vidal, Vincent; Bartoli, Jean-Michel; Secq, Veronique; Gaubert, Jean-Yves

    2017-11-01

    The incidence of pneumothorax is 7 times higher after lung radiofrequency ablation (RFA) than after lung biopsy. The reasons for such a difference have never been objectified. The histopathologic changes in lung tissue are well-studied and established for RF in the ablation zone. However, it has not been previously described what the nature of thermal injury might be along the shaft of the RF electrode as it traverses through normal lung tissue to reach the ablation zone. The purpose of this study was to determine the changes occurring around the RF needle along the pathway between the ablated zone and the pleura. In 3 anaesthetised and ventilated swine, 6 RFA procedures (right and left lungs) were performed using a 14-gauge unipolar multi-tined retractable 3 cm radiofrequency LeVeen probe with a coaxial introducer positioned under CT fluoroscopic guidance. In compliance with literature guidelines, we implemented a gradually increasing thermo-ablation protocol using a RF generator. Helical CT images were acquired pre- and post-RFA procedure to detect and evaluate pneumothorax. Four percutaneous 19-gauge lung biopsies were also performed on the fourth swine under CT guidance. Swine were sacrificed for lung ex vivo examinations, scanning electron microscopy (SEM) and pathological analysis. Three severe (over 50 ml) pneumothorax were detected after RFA. In each one of them, pathological examination revealed a fistulous tract between ablation zone and pleura. No fistulous tract was observed after biopsies. In the 3 cases of severe pneumothorax, the tract was wide open and clearly visible on post procedure CT images and SEM examinations. The RFA tract differed from the needle biopsy tract. The histological changes that are usually found in the ablated zone were observed in the RFA tract's wall and were related to thermal lesions. These modifications caused the creation of a coagulated pulmonary parenchyma rim between the thermo-ablation zone and the pleural space

  19. A Barnes maze for juvenile rats delineates the emergence of spatial navigation ability.

    PubMed

    McHail, Daniel G; Valibeigi, Nazanin; Dumas, Theodore C

    2018-03-01

    The neural bases of cognition may be greatly informed by relating temporally defined developmental changes in behavior with concurrent alterations in neural function. A robust improvement in performance in spatial learning and memory tasks occurs at 3 wk of age in rodents. We reported that the developmental increase of spontaneous alternation in a Y-maze was related to changes in temporal dynamics of fast glutamatergic synaptic transmission in the hippocampus. We also showed that, during allothetic behaviors in the Y-maze, network oscillation power increased at frequency bands known to support spatial learning and memory in adults. However, there are no discrete learning and memory phases during free exploration in the Y-maze. Thus, we adapted the Barnes maze for use with juvenile rats. Following a single platform exposure in dim light on the day before training (to encourage exploration), animals were trained on the subsequent 2 d in bright light to find a hidden escape box and then underwent a memory test 24 h later. During escape training, the older animals learned the task in 1 d, while the younger animals required 2 d and did not reach the performance of older animals. Long-term memory performance was also superior in the older animals. Thus, we have validated the use of the Barnes maze for this developmental period and established a timeline for the ontogeny of spatial navigation ability in this maze around 3 wk of age. Subsequent work will pair in vivo recording of hippocampal oscillations and single units with this task to help identify how hippocampal maturation might relate to performance improvements. © 2018 McHail et al.; Published by Cold Spring Harbor Laboratory Press.

  20. Comparison of resource utilization of pulmonary vein isolation: cryoablation versus RF ablation with three-dimensional mapping in the Value PVI Study.

    PubMed

    DeVille, J Brian; Svinarich, J Thomas; Dan, Dan; Wickliffe, Andrew; Kantipudi, Charan; Lim, Hae W; Plummer, Lisa; Baker, James; Kowalski, Marcin; Baydoun, Hassan; Jenkins, Mark; Chang-Sing, Peter

    2014-06-01

    Point-to-point focal radiofrequency (RF) catheter ablation for aberrant pulmonary vein triggers that manifest into atrial fibrillation (AF) is the traditional method for treating symptomatic drug-resistant paroxysmal AF (PAF) when an ablation procedure is warranted. More recently, pulmonary vein isolation (PVI) using the cryoballoon has been demonstrated to be safe and effective (STOP AF clinical trial). Currently, two small studies have reviewed the procedural efficiency when comparing cryoballoon to focal RF catheter ablation procedures; however, no multicenter study has yet reported on this comparison of the two types of ablation catheters. A multicenter retrospective chart extraction and evaluation was conducted at seven geographically mixed cardiac care centers. The study examined procedural variables during ablation for PVI in PAF patients. In several procedural measurements, the two modalities were comparable in efficiencies, including: acute PVI >96%; length of hospital stay at approximately 27 hours; and about 30% usage of adenosine after procedural testing. However, when compared to RF catheters, the cryoballoon procedure demonstrated a 13% reduction in laboratory occupancy time (247 min vs 283 min), a 13% reduction in procedure time (174 min vs 200 min), and a 21% reduction in fluoroscopy time (33 min vs 42 min). Additionally, when comparing the material usage of both cryoballoon and RF catheters, the cryoballoon used more radiopaque contrast agent (78 cc vs 29 cc) while using less intraprocedural saline (1234 cc vs 2386 cc), intracardiac echocardiography (88% vs 99%), three-dimensional electroanatomic mapping (30% vs 87%), and fewer transseptal punctures (1.5 vs 1.9). This study is the first United States multicenter examination to report the procedural comparisons between the cryoballoon and focal RF catheters when used for the treatment of PAF patients. In this hospital chart review study, potential advantages were found when operating the cryoballoon

  1. Place and Response Learning in the Open-field Tower Maze.

    PubMed

    Lipatova, Olga; Campolattaro, Matthew M; Toufexis, Donna J; Mabry, Erin A

    2015-10-28

    This protocol describes how the Open-field Tower Maze (OFTM) paradigm is used to study spatial learning in rodents. This maze is especially useful for examining how rats learn to use a place- or response-learning to successfully navigate in an open-field arena. Additionally, this protocol describes how the OFTM differs from other behavioral maze paradigms that are commonly used to study spatial learning in rodents. The OFTM described in this article was adapted from the one previously described by Cole, Clipperton, and Walt (2007). Specifically, the OFTM was created to test spatial learning in rodents without the experimenter having to consider how "stress" might play a role as a confounding variable. Experiments have shown that stress-alone can significantly affect cognitive function(1). The representative results section contains data from an experiment that used the OFTM to examine the effects of estradiol treatment on place- and response-learning in adult female Sprague Dawley rats(2). Future studies will be designed to examine the role of the hippocampus and striatum in place- and response-learning in the OFTM.

  2. What Does the CBM-Maze Test Measure?

    ERIC Educational Resources Information Center

    Muijselaar, Marloes M. L.; Kendeou, Panayiota; de Jong, Peter F.; van den Broek, Paul W.

    2017-01-01

    In this study, we identified the code-related (decoding, fluency) and language comprehension (vocabulary, listening comprehension) demands of the CBM-Maze test, a formative assessment, and compared them to those of the Gates-MacGinitie test, a standardized summative assessment. The demands of these reading comprehension tests and their…

  3. Nonequilibrium Ablation of Phenolic Impregnated Carbon Ablator

    NASA Technical Reports Server (NTRS)

    Milos, Frank S.; Chen, Yih K.; Gokcen, Tahir

    2012-01-01

    In previous work, an equilibrium ablation and thermal response model for Phenolic Impregnated Carbon Ablator was developed. In general, over a wide range of test conditions, model predictions compared well with arcjet data for surface recession, surface temperature, in-depth temperature at multiple thermocouples, and char depth. In this work, additional arcjet tests were conducted at stagnation conditions down to 40 W/sq cm and 1.6 kPa. The new data suggest that nonequilibrium effects become important for ablation predictions at heat flux or pressure below about 80 W/sq cm or 10 kPa, respectively. Modifications to the ablation model to account for nonequilibrium effects are investigated. Predictions of the equilibrium and nonequilibrium models are compared with the arcjet data.

  4. Scar Homogenization Versus Limited-Substrate Ablation in Patients With Nonischemic Cardiomyopathy and Ventricular Tachycardia.

    PubMed

    Gökoğlan, Yalçın; Mohanty, Sanghamitra; Gianni, Carola; Santangeli, Pasquale; Trivedi, Chintan; Güneş, Mahmut F; Bai, Rong; Al-Ahmad, Amin; Gallinghouse, G Joseph; Horton, Rodney; Hranitzky, Patrick M; Sanchez, Javier E; Beheiry, Salwa; Hongo, Richard; Lakkireddy, Dhanunjaya; Reddy, Madhu; Schweikert, Robert A; Dello Russo, Antonio; Casella, Michela; Tondo, Claudio; Burkhardt, J David; Themistoclakis, Sakis; Di Biase, Luigi; Natale, Andrea

    2016-11-01

    Scar homogenization improves long-term ventricular arrhythmia-free survival compared with standard limited-substrate ablation in patients with post-infarction ventricular tachycardia (VT). Whether such benefit extends to patients with nonischemic cardiomyopathy and scar-related VT is unclear. The aim of this study was to assess the long-term efficacy of an endoepicardial scar homogenization approach compared with standard ablation in this population. Consecutive patients with dilated nonischemic cardiomyopathy (n = 93), scar-related VTs, and evidence of low-voltage regions on the basis of pre-defined criteria on electroanatomic mapping (i.e., bipolar voltage <1.5 mV) underwent either standard VT ablation (group 1 [n = 57]) or endoepicardial ablation of all abnormal potentials within the electroanatomic scar (group 2 [n = 36]). Acute procedural success was defined as noninducibility of any VT at the end of the procedure; long-term success was defined as freedom from any ventricular arrhythmia at follow-up. Acute procedural success rates were 69.4% and 42.1% after scar homogenization and standard ablation, respectively (p = 0.01). During a mean follow-up period of 14 ± 2 months, single-procedure success rates were 63.9% after scar homogenization and 38.6% after standard ablation (p = 0.031). After multivariate analysis, scar homogenization and left ventricular ejection fraction were predictors of long-term success. During follow-up, the rehospitalization rate was significantly lower in the scar homogenization group (p = 0.035). In patients with dilated nonischemic cardiomyopathy, scar-related VT, and evidence of low-voltage regions on electroanatomic mapping, endoepicardial homogenization of the scar significantly increased freedom from any recurrent ventricular arrhythmia compared with a standard limited-substrate ablation. However, the success rate with this approach appeared to be lower than previously reported with ischemic cardiomyopathy, presumably

  5. Visualizing ex vivo radiofrequency and microwave ablation zones using electrode vibration elastography

    PubMed Central

    DeWall, Ryan J.; Varghese, Tomy; Brace, Chris L.

    2012-01-01

    Purpose: Electrode vibration elastography is a new shear wave imaging technique that can be used to visualize thermal ablation zones. Prior work has shown the ability of electrode vibration elastography to delineate radiofrequency ablations; however, there has been no previous study of delineation of microwave ablations or radiological–pathological correlations using multiple observers. Methods: Radiofrequency and microwave ablations were formed in ex vivo bovine liver tissue. Their visualization was compared on shear wave velocity and maximum displacement images. Ablation dimensions were compared to gross pathology. Elastographic imaging and gross pathology overlap and interobserver variability were quantified using similarity measures. Results: Elastographic imaging correlated with gross pathology. Correlation of area estimates was better in radiofrequency than in microwave ablations, with Pearson coefficients of 0.79 and 0.54 on shear wave velocity images and 0.90 and 0.70 on maximum displacement images for radiofrequency and microwave ablations, respectively. The absolute relative difference in area between elastographic imaging and gross pathology was 18.9% and 22.9% on shear wave velocity images and 16.0% and 23.1% on maximum displacement images for radiofrequency and microwave ablations, respectively. Conclusions: Statistically significant radiological–pathological correlation was observed in this study, but correlation coefficients were lower than other modulus imaging techniques, most notably in microwave ablations. Observers provided similar delineations for most thermal ablations. These results suggest that electrode vibration elastography is capable of imaging thermal ablations, but refinement of the technique may be necessary before it can be used to monitor thermal ablation procedures clinically. PMID:23127063

  6. Histopathology of cryoballoon ablation-induced phrenic nerve injury.

    PubMed

    Andrade, Jason G; Dubuc, Marc; Ferreira, Jose; Guerra, Peter G; Landry, Evelyn; Coulombe, Nicolas; Rivard, Lena; Macle, Laurent; Thibault, Bernard; Talajic, Mario; Roy, Denis; Khairy, Paul

    2014-02-01

    Hemi-diaphragmatic paralysis is the most common complication associated with cryoballoon ablation for atrial fibrillation, yet the histopathology of phrenic nerve injury has not been well described. A preclinical randomized study was conducted to characterize the histopathology of phrenic nerve injury induced by cryoballoon ablation and assess the potential for electromyographic (EMG) monitoring to limit phrenic nerve damage. Thirty-two dogs underwent cryoballoon ablation of the right superior pulmonary vein with the objective of inducing phrenic nerve injury. Animals were randomized 1:1 to standard monitoring (i.e., interruption of ablation upon reduction in diaphragmatic motion) versus EMG guidance (i.e., cessation of ablation upon a 30% reduction in the diaphragmatic compound motor action potential [CMAP] amplitude). The acute procedural endpoint was achieved in all dogs. Phrenic nerve injury was characterized by Wallerian degeneration, with subperineural injury to large myelinated axons and evidence of axonal regeneration. The degree of phrenic nerve injury paralleled the reduction in CMAP amplitude (P = 0.007). Animals randomized to EMG guidance had a lower incidence of acute hemi-diaphragmatic paralysis (50% vs 100%; P = 0.001), persistent paralysis at 30 days (21% vs 75%; multivariate odds ratio 0.12, 95% confidence interval [0.02, 0.69], P = 0.017), and a lesser severity of histologic injury (P = 0.001). Mature pulmonary vein ablation lesion characteristics, including circumferentiality and transmurality, were similar in both groups. Phrenic nerve injury induced by cryoballoon ablation is axonal in nature and characterized by Wallerian degeneration, with potential for recovery. An EMG-guided approach is superior to standard monitoring in limiting phrenic nerve damage. © 2013 Wiley Periodicals, Inc.

  7. Experimental Evaluation of the Heat Sink Effect in Hepatic Microwave Ablation.

    PubMed

    Ringe, Kristina I; Lutat, Carolin; Rieder, Christian; Schenk, Andrea; Wacker, Frank; Raatschen, Hans-Juergen

    2015-01-01

    To demonstrate and quantify the heat sink effect in hepatic microwave ablation (MWA) in a standardized ex vivo model, and to analyze the influence of vessel distance and blood flow on lesion volume and shape. 108 ex vivo MWA procedures were performed in freshly harvested pig livers. Antennas were inserted parallel to non-perfused and perfused (700,1400 ml/min) glass tubes (diameter 5mm) at different distances (10, 15, 20mm). Ablation zones (radius, area) were analyzed and compared (Kruskal-Wallis Test, Dunn's multiple comparison Test). Temperature changes adjacent to the tubes were measured throughout the ablation cycle. Maximum temperature decreased significantly with increasing flow and distance (p<0.05). Compared to non-perfused tubes, ablation zones were significantly deformed by perfused tubes within 15 mm distance to the antenna (p<0.05). At a flow rate of 700 ml/min ablation zone radius was reduced to 37.2% and 80.1% at 10 and 15 mm tube distance, respectively; ablation zone area was reduced to 50.5% and 89.7%, respectively. Significant changes of ablation zones were demonstrated in a pig liver model. Considerable heat sink effect was observed within a diameter of 15 mm around simulated vessels, dependent on flow rate. This has to be taken into account when ablating liver lesions close to vessels.

  8. Experimental Evaluation of the Heat Sink Effect in Hepatic Microwave Ablation

    PubMed Central

    Ringe, Kristina I.; Lutat, Carolin; Rieder, Christian; Schenk, Andrea; Wacker, Frank; Raatschen, Hans-Juergen

    2015-01-01

    Purpose To demonstrate and quantify the heat sink effect in hepatic microwave ablation (MWA) in a standardized ex vivo model, and to analyze the influence of vessel distance and blood flow on lesion volume and shape. Materials and Methods 108 ex vivo MWA procedures were performed in freshly harvested pig livers. Antennas were inserted parallel to non-perfused and perfused (700,1400 ml/min) glass tubes (diameter 5mm) at different distances (10, 15, 20mm). Ablation zones (radius, area) were analyzed and compared (Kruskal-Wallis Test, Dunn’s multiple comparison Test). Temperature changes adjacent to the tubes were measured throughout the ablation cycle. Results Maximum temperature decreased significantly with increasing flow and distance (p<0.05). Compared to non-perfused tubes, ablation zones were significantly deformed by perfused tubes within 15mm distance to the antenna (p<0.05). At a flow rate of 700ml/min ablation zone radius was reduced to 37.2% and 80.1% at 10 and 15mm tube distance, respectively; ablation zone area was reduced to 50.5% and 89.7%, respectively. Conclusion Significant changes of ablation zones were demonstrated in a pig liver model. Considerable heat sink effect was observed within a diameter of 15mm around simulated vessels, dependent on flow rate. This has to be taken into account when ablating liver lesions close to vessels. PMID:26222431

  9. Pneumothorax as a complication of percutaneous radiofrequency ablation for lung neoplasms.

    PubMed

    Yamagami, Takuji; Kato, Takeharu; Hirota, Tatsuya; Yoshimatsu, Rika; Matsumoto, Tomohiro; Nishimura, Tsunehiko

    2006-10-01

    The present study was performed to determine the frequency of the complication of pneumothorax after radiofrequency (RF) ablation for lung neoplasms and risk factors affecting such pneumothoraces. The study was based on 129 consecutive sessions of percutaneous RF ablation of lung neoplasms under real-time computed tomographic fluoroscopic guidance performed in a single institution between May 2003 and November 2005 in 41 patients (17 women, 24 men; mean age, 63 years; age range, 29-82 y). Correlation was determined between the incidence of pneumothorax after RF ablation and multiple factors: sex, age, presence of emphysema, lesion size, lesion depth, contact of tumor with pleura, number of punctures, maximum power of RF generator, period of ablation, tissue temperature at the end of the RF ablation session, and patient position during the procedure. Management of each case of iatrogenic pneumothorax was reviewed. Pneumothorax after RF ablation occurred in 38 of 129 RF ablation sessions (29.5%). Fourteen of the 38 cases were treated by manual aspiration, and 24 were simply observed. In five cases (3.9%), chest tube placement was required as therapy for pneumothorax. The risk of pneumothorax was significantly increased in patients with pulmonary emphysema. The frequency of pneumothorax after RF ablation in our experience is similar to the frequency of pneumothorax after lung biopsy reported in the literature. Various conditions for RF ablation did not influence the incidence of pneumothorax. Emphysema was the only individual factor that correlated significantly with the development of iatrogenic pneumothorax.

  10. Impact of steerable sheaths on contact forces and reconnection sites in ablation for persistent atrial fibrillation.

    PubMed

    Ullah, Waqas; Hunter, Ross J; McLean, Ailsa; Dhinoja, Mehul; Earley, Mark J; Sporton, Simon; Schilling, Richard J

    2015-03-01

    In preclinical studies, catheter contact force (CF) during radiofrequency ablation correlates with the subsequent lesion size. We investigated the impact of steerable sheaths on ablation CF, its consistency, and wide area circumferential ablation (WACA) line reconnection sites. Five thousand and sixty-four ablations were analyzed across 60 patients undergoing first-time ablation for persistent AF using a CF-sensing catheter: 19 manual nonsteerable sheath (Manual-NSS), 11 manual steerable sheath, and 30 robotic steerable sheath (Sensei, Hansen Medical Inc.) procedures were studied. Ablation CFs were higher in the steerable sheath groups for all left atrial ablations and also WACA ablations specifically (P < 0.006), but less consistent per WACA segment (P < 0.005). There were significant differences in the CFs around both WACAs by group: in the left WACA CFs were lower with Manual-NSS, other than at the anterior-inferior and posterior-superior regions, and lower in the right WACA, other than the anterior-superior region. There was a difference in the proportion of segments chronically reconnecting across groups: Manual-NSS 26.5%, manual steerable sheath 4.6%, robotic 12% (P < 0.0005). The left atrial appendage/PV ridge and right posterior wall were common sites of reconnection in all groups. Steerable sheaths increased ablation CF; however, there were region-specific heterogeneities in the extent of increment, with some segments where they failed to increase CF. Steerable sheath use was associated with reduced WACA-segment reconnection. It may be that the benefits of steerable sheath use in terms of higher CFs could be translated to improved clinical outcomes if regional weaknesses of this technology are taken into account during ablation procedures. © 2014 Wiley Periodicals, Inc.

  11. Anatomic Guidance For Ablation: Atrial Flutter, Fibrillation, and Outflow Tract Ventricular Tachycardia

    PubMed Central

    Sehar, Nandini; Mears, Jennifer; Bisco, Susan; Patel, Sandeep; Lachman, Nirusha; Asirvatham, Samuel J

    2010-01-01

    After initial documentation of excellent efficacy with radiofrequency ablation, this procedure is being performed increasingly in more complex situations and for more difficult arrhythmia. In these circumstances, an accurate knowledge of the anatomic basis for the ablation procedure will help maintain this efficacy and improve safety. In this review, we discuss the relevant anatomy for electrophysiology interventions for typical right atrial flutter, atrial fibrillation, and outflow tract ventricular tachycardia. In the pediatric population, maintaining safety is a greater challenge, and here again, knowing the neighboring and regional anatomy of the arrhythmogenic substrate for these arrhythmias may go a long way in preventing complications. PMID:20811537

  12. Right atrium positioning for exposure of right pulmonary veins during off-pump atrial fibrillation ablation.

    PubMed

    Suwalski, Grzegorz; Emery, Robert; Mróz, Jakub; Kaczejko, Kamil; Gryszko, Leszek; Cwetsch, Andrzej; Skrobowski, Andrzej

    2017-06-01

    Concomitant surgical ablation of atrial fibrillation (AF) is recommended for patients undergoing off-pump coronary revascularization in the presence of this arrhythmia. Achievement of optimal visualization of pulmonary veins while maintaining stable haemodynamic conditions is crucial for proper completion of the ablation procedure. This study evaluates the safety and feasibility of right atrial positioning using a suction-based cardiac positioner as opposed to compressive manoeuvres for exposure during off-pump surgical ablation for AF. Thirty-four consecutive patients underwent pulmonary vein isolation, ganglionated plexi ablation and left atrial appendage occlusion during off-pump coronary artery bypass grafting. Right atrial suction positioning was used to visualize right pulmonary veins. Safety and feasibility end points were analysed intraoperatively and in the early postoperative course. In all patients, right atrial positioning created optimal conditions to complete transverse and oblique sinus blunt dissection, correct placement of a bipolar ablation probe, detection and ablation of ganglionated plexi and conduction block assessment. In all patients, this entire right-sided ablation procedure was completed with a single exposure manoeuvre. Feasibility end points were achieved in all study patients. This report documents the safety and feasibility of right atrial exposure using a suction-based cardiac positioner to complete ablation for AF concomitant with off-pump coronary revascularization. This technique may be widely adopted to create stable haemodynamic conditions and optimal visualization of the right pulmonary veins. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  13. The first clinical application of planning software for laparoscopic microwave thermosphere ablation of malignant liver tumours

    PubMed Central

    Berber, Eren

    2015-01-01

    Background Liver tumour ablation is an operator-dependent procedure. The determination of the optimum needle trajectory and correct ablation parameters could be challenging. The aim of this study was to report the utility of a new, procedure planning software for microwave ablation (MWA) of liver tumours. Methods This was a feasibility study in a pilot group of five patients with nine metastatic liver tumours who underwent laparoscopic MWA. Pre-operatively, parameters predicting the desired ablation zones were calculated for each tumour. Intra-operatively, this planning strategy was followed for both antenna placement and energy application. Post-operative 2-week computed tomography (CT) scans were performed to evaluate complete tumour destruction. Results The patients had an average of two tumours (range 1–4), measuring 1.9 ± 0.4 cm (range 0.9–4.4 cm). The ablation time was 7.1 ± 1.3 min (range 2.5–10 min) at 100W. There were no complications or mortality. The patients were discharged home on post-operative day (POD) 1. At 2-week CT scans, there were no residual tumours, with a complete ablation demonstrated in all lesions. Conclusions This study describes and validates pre-treatment planning software for MWA of liver tumours. This software was found useful to determine precisely the ablation parameters and needle placement to create a predicted zone of ablation. PMID:25980481

  14. Flexible microwave ablation applicator for the treatment of pulmonary malignancies

    NASA Astrophysics Data System (ADS)

    Pfannenstiel, Austin; Keast, Tom; Kramer, Steve; Wibowo, Henky; Prakash, Punit

    2017-02-01

    Microwave ablation (MWA) is an emerging minimally invasive treatment option for malignant lung tumors. Compared to other energy modalities, such as radiofrequency ablation, MWA offers the advantages of deeper penetration within high impedance tissues such as aerated lung, shorter treatment times, and less susceptibility to the cooling heat-sink effects of air and blood flow. Previous studies have demonstrated clinical use of MWA for treating lung tumors; however, these procedures have relied upon the percutaneous application of rigid microwave antennas. The objective of our work was to develop and characterize a novel flexible microwave applicator which could be integrated with a bronchoscopic imaging and software guidance platform to expand the use of MWA as a treatment option for small (< 2cm) pulmonary tumors. This applicator would allow physicians an even less invasive, immediate treatment option for lung tumors identified within the scope of current medical procedures. It may also improve applicator placement accuracy and increase efficacy while minimizing the risk of procedural complications. A 2D-axisymmetric coupled FEM electromagnetic-heat transfer model was implemented to characterize expected antenna radiation patterns, ablation size and shape, and optimize antenna design for lung tissue. A prototype device was fabricated and evaluated in ex vivo tissues to verify simulation results and serve as proof-of-concept. Additional experiments were conducted in an in vivo animal model to further characterize the proposed system.

  15. Radiofrequency ablation for hepatic hemangiomas: A consensus from a Chinese panel of experts

    PubMed Central

    Gao, Jun; Fan, Rui-Fang; Yang, Jia-Yin; Cui, Yan; Ji, Jian-Song; Ma, Kuan-Sheng; Li, Xiao-Long; Zhang, Long; Xu, Chong-Liang; Kong, Xin-Liang; Ke, Shan; Ding, Xue-Mei; Wang, Shao-Hong; Yang, Meng-Meng; Song, Jin-Jin; Zhai, Bo; Nin, Chun-Ming; Guo, Shi-Gang; Xin, Zong-Hai; Lu, Jun; Dong, Yong-Hong; Zhu, Hua-Qiang; Sun, Wen-Bing

    2017-01-01

    Recent studies have shown that radiofrequency (RF) ablation therapy is a safe, feasible, and effective procedure for hepatic hemangiomas, even huge hepatic hemangiomas. RF ablation has the following advantages in the treatment of hepatic hemangiomas: minimal invasiveness, definite efficacy, high safety, fast recovery, relatively simple operation, and wide applicability. It is necessary to formulate a widely accepted consensus among the experts in China who have extensive expertise and experience in the treatment of hepatic hemangiomas using RF ablation, which is important to standardize the application of RF ablation for the management of hepatic hemangiomas, regarding the selection of patients with suitable indications to receive RF ablation treatment, the technical details of the techniques, therapeutic effect evaluations, management of complications, etc. A final consensus by a Chinese panel of experts who have the expertise of using RF ablation to treat hepatic hemangiomas was reached by means of literature review, comprehensive discussion, and draft approval. PMID:29093616

  16. Efficacy and survival analysis of percutaneous radiofrequency versus microwave ablation for hepatocellular carcinoma: an Egyptian multidisciplinary clinic experience.

    PubMed

    Abdelaziz, Ashraf; Elbaz, Tamer; Shousha, Hend Ibrahim; Mahmoud, Sherif; Ibrahim, Mostafa; Abdelmaksoud, Ahmed; Nabeel, Mohamed

    2014-12-01

    Hepatocellular carcinoma (HCC) is a primary tumor of the liver with poor prognosis. For early stage HCC, treatment options include surgical resection, liver transplantation, and percutaneous ablation. Percutaneous ablative techniques (radiofrequency and microwave techniques) emerged as best therapeutic options for nonsurgical patients. We aimed to determine the safety and efficacy of radiofrequency and microwave procedures for ablation of early stage HCC lesions and prospectively follow up our patients for survival analysis. One Hundred and 11 patients with early HCC are managed in our multidisciplinary clinic using either radiofrequency or microwave ablation. Patients are assessed for efficacy and safety. Complete ablation rate, local recurrence, and overall survival analysis are compared between both procedures. Radiofrequency ablation group (n = 45) and microwave ablation group (n = 66) were nearly comparable as regards the tumor and patients characteristics. Complete ablation was achieved in 94.2 and 96.1% of patients managed by radiofrequency and microwave ablation techniques, respectively (p value 0.6) with a low rate of minor complications (11.1 and 3.2, respectively) including subcapsular hematoma, thigh burn, abdominal wall skin burn, and pleural effusion. Ablation rates did not differ between ablated lesions ≤ 3 and 3-5 cm. A lower incidence of local recurrence was observed in microwave group (3.9 vs. 13.5% in radiofrequency group, p value 0.04). No difference between both groups as regards de novo lesions, portal vein thrombosis, and abdominal lymphadenopathy. The overall actuarial probability of survival was 91.6% at 1 year and 86.1% at 2 years with a higher survival rates noticed in microwave group but still without significant difference (p value 0.49). Radiofrequency and microwave ablations led to safe and equivalent ablation and survival rates (with superiority for microwave ablation as regards the incidence of local recurrence).

  17. Complications associated with radiofrequency ablation of pulmonary veins.

    PubMed

    Madrid Pérez, J M; García Barquín, P M; Villanueva Marcos, A J; García Bolao, J I; Bastarrika Alemañ, G

    Radiofrequency ablation is an efficacious alternative in patients with symptomatic atrial fibrillation who do not respond to or are intolerant to at least one class I or class III antiarrhythmic drug. Although radiofrequency ablation is a safe procedure, complications can occur. Depending on the location, these complications can be classified into those that affect the pulmonary veins themselves, cardiac complications, extracardiac intrathoracic complications, remote complications, and those that result from vascular access. The most common complications are hematomas, arteriovenous fistulas, and pseudoaneurysms at the puncture site. Some complications are benign and transient, such as gastroparesis or diaphragmatic elevation, whereas others are potentially fatal, such as cardiac tamponade. Radiologists must be familiar with the complications that can occur secondary to pulmonary vein ablation to ensure early diagnosis and treatment. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Optimization of the generator settings for endobiliary radiofrequency ablation.

    PubMed

    Barret, Maximilien; Leblanc, Sarah; Vienne, Ariane; Rouquette, Alexandre; Beuvon, Frederic; Chaussade, Stanislas; Prat, Frederic

    2015-11-10

    To determine the optimal generator settings for endobiliary radiofrequency ablation. Endobiliary radiofrequency ablation was performed in live swine on the ampulla of Vater, the common bile duct and in the hepatic parenchyma. Radiofrequency ablation time, "effect", and power were allowed to vary. The animals were sacrificed two hours after the procedure. Histopathological assessment of the depth of the thermal lesions was performed. Twenty-five radiofrequency bursts were applied in three swine. In the ampulla of Vater (n = 3), necrosis of the duodenal wall was observed starting with an effect set at 8, power output set at 10 W, and a 30 s shot duration, whereas superficial mucosal damage of up to 350 μm in depth was recorded for an effect set at 8, power output set at 6 W and a 30 s shot duration. In the common bile duct (n = 4), a 1070 μm, safe and efficient ablation was obtained for an effect set at 8, a power output of 8 W, and an ablation time of 30 s. Within the hepatic parenchyma (n = 18), the depth of tissue damage varied from 1620 μm (effect = 8, power = 10 W, ablation time = 15 s) to 4480 μm (effect = 8, power = 8 W, ablation time = 90 s). The duration of the catheter application appeared to be the most important parameter influencing the depth of the thermal injury during endobiliary radiofrequency ablation. In healthy swine, the currently recommended settings of the generator may induce severe, supratherapeutic tissue damage in the biliary tree, especially in the high-risk area of the ampulla of Vater.

  19. Optimization of the generator settings for endobiliary radiofrequency ablation

    PubMed Central

    Barret, Maximilien; Leblanc, Sarah; Vienne, Ariane; Rouquette, Alexandre; Beuvon, Frederic; Chaussade, Stanislas; Prat, Frederic

    2015-01-01

    AIM: To determine the optimal generator settings for endobiliary radiofrequency ablation. METHODS: Endobiliary radiofrequency ablation was performed in live swine on the ampulla of Vater, the common bile duct and in the hepatic parenchyma. Radiofrequency ablation time, “effect”, and power were allowed to vary. The animals were sacrificed two hours after the procedure. Histopathological assessment of the depth of the thermal lesions was performed. RESULTS: Twenty-five radiofrequency bursts were applied in three swine. In the ampulla of Vater (n = 3), necrosis of the duodenal wall was observed starting with an effect set at 8, power output set at 10 W, and a 30 s shot duration, whereas superficial mucosal damage of up to 350 μm in depth was recorded for an effect set at 8, power output set at 6 W and a 30 s shot duration. In the common bile duct (n = 4), a 1070 μm, safe and efficient ablation was obtained for an effect set at 8, a power output of 8 W, and an ablation time of 30 s. Within the hepatic parenchyma (n = 18), the depth of tissue damage varied from 1620 μm (effect = 8, power = 10 W, ablation time = 15 s) to 4480 μm (effect = 8, power = 8 W, ablation time = 90 s). CONCLUSION: The duration of the catheter application appeared to be the most important parameter influencing the depth of the thermal injury during endobiliary radiofrequency ablation. In healthy swine, the currently recommended settings of the generator may induce severe, supratherapeutic tissue damage in the biliary tree, especially in the high-risk area of the ampulla of Vater. PMID:26566429

  20. Catheter ablation of ventricular tachycardias using remote magnetic navigation: a consecutive case-control study.

    PubMed

    Szili-Torok, Tamas; Schwagten, Bruno; Akca, Ferdi; Bauernfeind, Tamas; Abkenari, Lara Dabiri; Haitsma, David; Van Belle, Yves; Groot, Natasja D E; Jordaens, Luc

    2012-09-01

    Remote Magnetic Navigation for VT Ablation. This study aimed to compare acute and late outcomes of VT ablation using the magnetic navigation system (MNS) to manual techniques (MAN) in patients with (SHD) and without (NSHD) structural heart disease. Ablation data of 113 consecutive patients (43 SHD, 70 NSHD) with ventricular tachycardia treated with catheter ablation at our center were analyzed. Success rate, complications, procedure, fluoroscopy, and ablation times, and recurrence rates were systematically recorded for all patients. A total of 72 patients were included in the MNS group and 41 patients were included in the MAN group. Patient age, gender, and right ventricular and left ventricular VT were equally distributed. Acute success was achieved in 59 patients in the MNS group (82%) versus 27 (66%) patients in the MAN group (P = 0.046). Overall procedural time (177 ± 79 vs 232 ± 99 minutes, P < 0.01) and mean patient fluoroscopy time (27 ± 19 vs 56 ± 32 minutes, P < 0.001) were all significantly lower using MNS. In NSHD pts, higher acute success was achieved with MNS (83,7% vs 61.9%, P = 0.049), with shorter procedure times (151 ± 57 vs 210 ± 96, P = 0.011), whereas in SHD-VT these were not significantly different. No major complications occurred in the MNS group (0%) versus 1 cardiac tamponade and 1 significantly damaged ICD lead in the MAN group (4.9%, NS). After follow-up (20 ± 11 vs 20 ± 10 months, NS), VT recurred in 14 pts (23.7%) in the MNS group versus 12 pts (44.4%) in the MAN group (P = 0.047). The use of MNS offers advantages for ablation of NSHD-VT, while it offers similar efficacy for SHD-VT. (J Cardiovasc Electrophysiol, Vol. 23, pp. 948-954, September 2012). © 2012 Wiley Periodicals, Inc.

  1. [Ablation on the undersurface of a LASIK flap. Instrument and method for continuous eye tracking].

    PubMed

    Taneri, S; Azar, D T

    2007-02-01

    The risk of iatrogenic keratectasia after laser in situ keratomileusis (LASIK) increases with thinner posterior stromal beds. Ablations on the undersurface of a LASIK flap could only be performed without the guidance of an eye tracker, which may lead to decentration. A new method for laser ablation with flying spot lasers on the undersurface of a LASIK flap was developed that enables the use of an active eye tracker by utilizing a novel instrument. The first clinical results are reported. Patients wishing an enhancement procedure were eligible for a modified repeat LASIK procedure if the flaps cut in the initial procedure were thick enough to perform the intended additional ablation on the undersurface leaving at least 90 microm of flap thickness behind. (1) The horizontal axis and the center of the entrance pupil were marked on the epithelial side of the flap using gentian violet dye. (2) The flap was reflected on a newly designed flap holder which had a donut-shaped black marking. (3) The eye tracker was centered on the mark visible in transparency on the flap. (4) Ablation with a flying spot Bausch & Lomb Technolas 217z laser was performed on the undersurface of the flap with a superior hinge taking into account that in astigmatic ablations the cylinder axis had to be mirrored according to the formula: axis on the undersurface=180 degrees -axis on the stromal bed. (5) The flap was repositioned. Detection of the marking on the modified flap holder and continuous tracking instead of the real pupil was possible in all of the 12 eyes treated with this technique. It may be necessary to cover the real pupil during ablation in order not to confuse the eye tracker. Ablation could be performed without decentration or loss of best spectacle-corrected visual acuity. Refractive results in minor corrections were good without nomogram adjustment. Using this novel flap holder with a marking that is tracked instead of the real pupil, centered ablations with a flying spot laser

  2. A comparative analysis of clinical outcomes and disposable costs of different catheter ablation methods for the treatment of atrioventricular nodal reentrant tachycardia

    PubMed Central

    Berman, Adam E; Rivner, Harold; Chalkley, Robin; Heboyan, Vahé

    2017-01-01

    Background Catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) is a commonly performed electrophysiology (EP) procedure. Few data exist comparing conventional (CONV) versus novel ablation strategies from both clinical and direct cost perspectives. We sought to investigate the disposable costs and clinical outcomes associated with three different ablation methodologies used in the ablation of AVNRT. Methods We performed a retrospective review of AVNRT ablations performed at Augusta University Medical Center from 2006 to 2014. A total of 183 patients were identified. Three different ablation techniques were compared: CONV manual radiofrequency (RF) (n=60), remote magnetic navigation (RMN)-guided RF (n=67), and cryoablation (CRYO) (n=56). Results Baseline demographics did not differ between the three groups except for a higher prevalence of cardiomyopathy in the RMN group (p<0.01). The clinical end point of interest was recurrent AVNRT following the index ablation procedure. A significantly higher number of recurrent AVNRT cases occurred in the CRYO group as compared to CONV and RMN (p=0.003; OR =7.75) groups. Cost-benefit analysis showed both CONV and RMN to be dominant compared to CRYO. Cost-minimization analysis demonstrated the least expensive ablation method to be CONV (mean disposable catheter cost = CONV US$2340; CRYO US$3515; RMN US$5190). Despite comparable clinical outcomes, the incremental cost of RMN over CONV averaged US$3094 per procedure. Conclusion AVNRT ablation using either CONV or RMN techniques is equally effective and associated with lower AVNRT recurrence rates than CRYO. CONV ablation carries significant disposable cost savings as compared to RMN, despite similar efficacy. PMID:29138585

  3. A comparative analysis of clinical outcomes and disposable costs of different catheter ablation methods for the treatment of atrioventricular nodal reentrant tachycardia.

    PubMed

    Berman, Adam E; Rivner, Harold; Chalkley, Robin; Heboyan, Vahé

    2017-01-01

    Catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) is a commonly performed electrophysiology (EP) procedure. Few data exist comparing conventional (CONV) versus novel ablation strategies from both clinical and direct cost perspectives. We sought to investigate the disposable costs and clinical outcomes associated with three different ablation methodologies used in the ablation of AVNRT. We performed a retrospective review of AVNRT ablations performed at Augusta University Medical Center from 2006 to 2014. A total of 183 patients were identified. Three different ablation techniques were compared: CONV manual radiofrequency (RF) (n=60), remote magnetic navigation (RMN)-guided RF (n=67), and cryoablation (CRYO) (n=56). Baseline demographics did not differ between the three groups except for a higher prevalence of cardiomyopathy in the RMN group ( p <0.01). The clinical end point of interest was recurrent AVNRT following the index ablation procedure. A significantly higher number of recurrent AVNRT cases occurred in the CRYO group as compared to CONV and RMN ( p =0.003; OR =7.75) groups. Cost-benefit analysis showed both CONV and RMN to be dominant compared to CRYO. Cost-minimization analysis demonstrated the least expensive ablation method to be CONV (mean disposable catheter cost = CONV US$2340; CRYO US$3515; RMN US$5190). Despite comparable clinical outcomes, the incremental cost of RMN over CONV averaged US$3094 per procedure. AVNRT ablation using either CONV or RMN techniques is equally effective and associated with lower AVNRT recurrence rates than CRYO. CONV ablation carries significant disposable cost savings as compared to RMN, despite similar efficacy.

  4. Thermoplastic microchannel fabrication using carbon dioxide laser ablation.

    PubMed

    Wang, Shau-Chun; Lee, Chia-Yu; Chen, Hsiao-Ping

    2006-04-14

    We report the procedures of machining microchannels on Vivak co-polyester thermoplastic substrates using a simple industrial CO(2) laser marker. To avoid overheating the substrates, we develop low-power marking techniques in nearly anaerobic environment. These procedures are able to machine microchannels at various aspect ratios. Either straight or serpent channel can be easily marked. Like the wire-embossed channel walls, the ablated channel surfaces become charged after alkaline hydrolysis treatment. Stable electroosmotic flow in the charged conduit is observed to be of the same order of magnitude as that in fused silica capillary. Typical dynamic coating protocols to alter the conduit surface properties are transferable to the ablated channels. The effects of buffer acidity on electroosmotic mobility in both bare and coated channels are similar to those in fused silica capillaries. Using video microscopy we also demonstrate that this device is useful in distinguishing the electrophoretic mobility of bare and latex particles from that of functionalized ones.

  5. Unaltered radial maze performance and brain acetylcholine of the endothelial nitric oxide synthase knockout mouse.

    PubMed

    Dere, E; Frisch, C; De Souza Silva, M A; Gödecke, A; Schrader, J; Huston, J P

    2001-01-01

    Proceeding from previous findings of a beneficial effect of endothelial nitric oxide synthase (eNOS) gene inactivation on negatively reinforced water maze performance, we asked whether this improvement in place learning capacities also holds for a positively reinforced radial maze task. Unlike its beneficial effects on the water maze task, eNOS gene inactivation did not facilitate radial maze performance. The acquisition performance over the days of place learning did not differ between eNOS knockout (eNOS-/-) and wild-type mice (eNOS+/+). eNOS-/- mice displayed a slight and eNOS+/+ mice a more severe working memory deficit in the place learning version of the radial maze compared to the genetic background C57BL/6 strain. Possible differential effects of eNOS inactivation, related to differences in reinforcement contingencies between the Morris water maze and radial maze tasks, behavioral strategy requirements, or to different emotional and physiological concomitants inherent in the two tasks are discussed. These task-unique characteristics might be differentially affected by the reported anxiogenic and hypertensional effects of eNOS gene inactivation. Post-mortem determination of acetylcholine concentrations in diverse brain structures revealed that acetylcholine and choline contents were not different between eNOS-/- and eNOS+/+ mice, but were increased in eNOS+/+ mice compared to C57BL/6 mice in the frontal cortex. Our findings demonstrate that phenotyping of learning and memory capacities should not rely on one learning task only, but should include tasks employing both negative and positive reinforcement contingencies in order to allow valid statements regarding differences in learning capacities between rodent strains.

  6. Regional pericarditis status post cardiac ablation: a case report.

    PubMed

    Orme, Joseph; Eddin, Moneer; Loli, Akil

    2014-09-01

    Regional pericarditis is elusive and difficult to diagnosis. Healthcare providers should be familiar with post-cardiac ablation complications as this procedure is now widespread and frequently performed. The management of regional pericarditis differs greatly from that of acute myocardial infarction. A 52 year-old male underwent atrial fibrillation ablation and developed severe mid-sternal chest pain the following day with electrocardiographic findings suggestive of acute myocardial infarction, and underwent coronary angiography, a left ventriculogram, and 2D transthoracic echocardiogram, all of which were unremarkable without evidence of obstructive coronary disease, wall motion abnormalities, or pericardial effusions. Ultimately, the patient was diagnosed with regional pericarditis. After diagnosis, the patient's presenting symptoms resolved with treatment including nonsteroidal anti-inflammatory agents and colchicine. This is the first reported case study of regional pericarditis status post cardiac ablation. Electrocardiographic findings were classic for an acute myocardial infarction; however, coronary angiography and left ventriculogram demonstrated no acute coronary occlusion or ventricular wall motion abnormalities. Healthcare professionals must remember that the electrocardiographic findings in pericarditis are not always classic and that pericarditis can occur status post cardiac ablation.

  7. Remote magnetic navigation for catheter ablation of atrioventricular nodal reentrant tachycardia: a systematic review and meta-analysis.

    PubMed

    Shurrab, Mohammed; Danon, Asaf; Crystal, Alexander; Arouny, Banafsheh; Tiong, Irving; Lashevsky, Ilan; Newman, David; Crystal, Eugene

    2013-07-01

    Catheter ablation has become a well-established, first-line therapy for atrioventricular nodal reentrant tachycardia (AVNRT), the most common reentry supraventricular tachycardia in humans. Robotic systems are becoming increasingly common in both complex and simple ablation procedures with presumed potential improvements in procedural efficacy and safety. The authors of this article conducted a systematic review and meta-analysis on the effectiveness and safety of the magnetic navigation system (MNS) in comparison with conventional catheter navigation for AVNRT ablation. An electronic search was performed using Cochrane Central database, Medline, Embase and Web of Knowledge between 2002 and 2012. References were searched manually. Outcomes of interest were: acute and long-term success, complications, total procedure, ablation and fluoroscopic times. Continuous variables were reported as standardized difference in means (SDM); odds ratios (OR) were reported for dichotomous variables. Thirteen studies (seven of which were nonrandomized controlled, four were case series and two were randomized controlled studies) involving 679 adult patients were identified. Twelve studies were based on a single center and one study was multicentral. MNS was deployed in 339 patients. The follow-up period ranged between 75 and 180 days. Acute success and long-term freedom from arrhythmia were not significantly different between MNS and control groups (98 vs 98%, OR: 0.94 [95% CI: 0.21-4.1] and 97 vs 96%, OR: 1.18 [95% CI: 0.35-4.0], respectively). A shorter fluoroscopic time was achieved with MNS; however, this did not reach statistical significance (15 vs 19 min, SDM: -0.26 [95% CI: -0.64-0.12]). Longer total procedure but similar ablation times were noted with MNS (160 vs 148 min, SDM: 3.48 [95% CI: 0.75-6.21] and 4 vs 6 min, SDM: -0.83 [95% CI: -2.19-0.53], respectively). The overall complication rate was similar between both groups (2.7 vs 1.0%, OR: 1.28 [95%

  8. [Electrophysiological findings and ablation strategies in patients with atrial tachyarrhythmias after left atrial circumferential ablation in the treatment of atrial fibrillation].

    PubMed

    Chen, Ming-long; Yang, Bing; Xu, Dong-jie; Zou, Jian-gang; Shan, Qi-jun; Chen, Chun; Chen, Hong-wu; Li, Wen-qi; Cao, Ke-jiang

    2007-02-01

    To report the electrophysiological findings and the ablation strategies in patients with atrial tachyarrhythmias (ATAs) or atrial fibrillation (AF) recurrence after left atrial circumferential ablation (LACA) in the treatment of AF. 91 patients with AF had LACA procedure from April 2004 to May 2006, 19 of which accepted the second ablation procedure due to ATAs or AF recurrence. In all the 19 patients [17 male, 2 female, age 25 - 65 (53 +/- 12) years], 11 presented with paroxysmal AF before the first ablation procedure, 2 with persistent AF and 6 with permanent AF. Pulmonary vein potentials (PVP) were investigated in both sides in all the patients. Delayed PVP was identified inside the left circular line in 5 patients, in the right in 1 and both in 2 during sinus rhythm. "Gap" conduction was found and successfully closed guided by circular mapping catheter. In 3 cases, irregular left atrial tachycardia was caused by fibrillation rhythm inside the left ring via decremental "gap" conduction. Reisolation was done successfully again guided by 3-D mapping and made the left atrium in sinus rhythm but the fibrillation rhythm was still inside the left ring. Pulmonary vein tachycardia with 1:1 conduction to the left atrium presented in one case and reisolation stopped the tachycardia. No PVP was discovered in both sides in 4 patients but other tachycardias could be induced, including two right atrial scar related tachycardias, two supraventricular tachycardias mediated by concealed accessory pathway, one cavo-tricuspid isthmus dependent atrial flutter and one focal atrial tachycardia near the coronary sinus ostium. All the tachycardias in these 4 patients were successfully ablated with the help of routine and 3-D mapping techniques. In the rest 3, which were in AF rhythm, LACA was successfully done again. After a mean follow-up of 4 - 26 (11.5 +/- 8.5) months, 16 patients were symptom free without anti-arrhythmic drug therapy; 1 of them had frequent palpitation attack with

  9. Comparative Effectiveness Review of Cooled Versus Pulsed Radiofrequency Ablation for the Treatment of Knee Osteoarthritis: A Systematic Review.

    PubMed

    Gupta, Anita; Huettner, Daniel P; Dukewich, Matthew

    2017-03-01

    Patients suffering from osteoarthritis of the knee and patients post total knee arthroplasty often develop refractory, disabling chronic knee pain. Radiofrequency ablation, including conventional, pulsed, and cooled, has recently become more accepted as an interventional technique to manage chronic knee pain in patients who have failed conservative treatment or who are not suitable candidates for surgical treatment. This systematic review aimed to analyze published studies on radiofrequency ablation to provide an overview of the current knowledge regarding variations in procedures, nerve targets, adverse events, and temporal extent of clinical benefit. A systematic review of published studies investigating conventional, pulsed, or cooled radiofrequency ablation in the setting of chronic knee pain. Medline, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were reviewed for studies on radiofrequency ablation for patients with chronic knee pain through July 29, 2016. From the studies, the procedural details, outcomes after treatment, follow-up points, and complications were compiled and analyzed in this literature review. Included studies were analyzed for clinical relevance and strength of evidence was graded using either the NHLBI Quality assessment of controlled intervention studies or the NHLBI quality assessment for before-after (pre-post) studies with no control group. Seventeen total publications were identified in the search, including articles investigating conventional, pulsed, or cooled radiofrequency ablation. These studies primarily targeted either the genicular nerves or used an intraarticular approach. Of the studies, 5 were small-sized randomized controlled trials, although one involved diathermy radiofrequency ablation. There were 8 retrospective or prospective case series and 4 case reports. Utilizing the strength of evidence grading, there is a low level of certainty to suggest a superior benefit between

  10. Contrast-enhanced cardiac C-arm CT evaluation of radiofrequency ablation lesions in the left ventricle

    PubMed Central

    Girard, Erin E; Al-Ahmad, Amin A; Rosenberg, Jarrett; Luong, Richard; Moore, Teri; Lauritsch, Günter; Boese, Jan; Fahrig, Rebecca

    2011-01-01

    Objectives The purpose of this study was to evaluate use of cardiac C-arm computed tomography (CT) in the assessment of the dimensions and temporal characteristics of radiofrequency ablation (RFA) lesions. This imaging modality uses a standard C-arm fluoroscopy system rotating around the patient, providing CT-like images during the RFA procedure. Background Both magnetic resonance imaging (MRI) and CT can be used to assess myocardial necrotic tissue. Several studies have reported visualizing cardiac RF ablation lesions with MRI, however obtaining MR images during interventional procedures is not common practice. Direct visualization of RFA lesions using C-arm CT during the procedure may improve outcomes and circumvent complications associated with cardiac ablation procedures. Methods RFA lesions were created on the endocardial surface of the left ventricle of 9 swine using a 7-F RF ablation catheter. An ECG-gated C-arm CT imaging protocol was used to acquire projection images during iodine contrast injection and following the injection every 5 min for up to 30 min, with no additional contrast. Reconstructed images were analyzed offline. The mean and standard deviation of the signal intensity of the lesion and normal myocardium were measured in all images in each time series. Lesion dimensions and area were measured and compared in pathologic specimens and C-arm CT images. Results All ablation lesions (n=29) were visualized and lesion dimensions, as measured on C-arm CT, correlated well with postmortem tissue measurements (1D dimensions : concordance correlation = 0.87; area : concordance correlation = 0.90). Lesions were visualized as a perfusion defect on first-pass C-arm CT images with a signal intensity 95 HU lower than normal myocardium (95% confidence interval: -111 to -79 HU). Images acquired at 1 and 5 minutes exhibited an enhancing ring surrounding the perfusion defect in 24 (83%) lesions. Conclusions RFA lesion size, including transmurality, can be

  11. Echo Decorrelation Imaging of Rabbit Liver and VX2 Tumor during In Vivo Ultrasound Ablation.

    PubMed

    Fosnight, Tyler R; Hooi, Fong Ming; Keil, Ryan D; Ross, Alexander P; Subramanian, Swetha; Akinyi, Teckla G; Killin, Jakob K; Barthe, Peter G; Rudich, Steven M; Ahmad, Syed A; Rao, Marepalli B; Mast, T Douglas

    2017-01-01

    In open surgical procedures, image-ablate ultrasound arrays performed thermal ablation and imaging on rabbit liver lobes with implanted VX2 tumor. Treatments included unfocused (bulk ultrasound ablation, N = 10) and focused (high-intensity focused ultrasound ablation, N = 13) exposure conditions. Echo decorrelation and integrated backscatter images were formed from pulse-echo data recorded during rest periods after each therapy pulse. Echo decorrelation images were corrected for artifacts using decorrelation measured prior to ablation. Ablation prediction performance was assessed using receiver operating characteristic curves. Results revealed significantly increased echo decorrelation and integrated backscatter in both ablated liver and ablated tumor relative to unablated tissue, with larger differences observed in liver than in tumor. For receiver operating characteristic curves computed from all ablation exposures, both echo decorrelation and integrated backscatter predicted liver and tumor ablation with statistically significant success, and echo decorrelation was significantly better as a predictor of liver ablation. These results indicate echo decorrelation imaging is a successful predictor of local thermal ablation in both normal liver and tumor tissue, with potential for real-time therapy monitoring. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  12. Critical phase transitions during ablation of atrial fibrillation

    NASA Astrophysics Data System (ADS)

    Iravanian, Shahriar; Langberg, Jonathan J.

    2017-09-01

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia with significant morbidity and mortality. Pharmacological agents are not very effective in the management of AF. Therefore, ablation procedures have become the mainstay of AF management. The irregular and seemingly chaotic atrial activity in AF is caused by one or more meandering spiral waves. Previously, we have shown the presence of sudden rhythm organization during ablation of persistent AF. We hypothesize that the observed transitions from a disorganized to an organized rhythm is a critical phase transition. Here, we explore this hypothesis by simulating ablation in an anatomically-correct 3D AF model. In 722 out of 2160 simulated ablation, at least one sudden transition from AF to an organized rhythm (flutter) was noted (33%). They were marked by a sudden decrease in the cycle length entropy and increase in the mean cycle length. At the same time, the number of reentrant wavelets decreased from 2.99 ± 0.06 in AF to 1.76 ± 0.05 during flutter, and the correlation length scale increased from 13.3 ± 1.0 mm to 196.5 ± 86.6 mm (both P < 0.0001). These findings are consistent with the hypothesis that transitions from AF to an anatomical flutter behave as phase transitions in complex non-equilibrium dynamical systems with flutter acting as an absorbing state. Clinically, the facilitation of phase transition should be considered a novel mechanism of ablation and may help to design effective ablation strategies.

  13. Microwave ablation of pancreatic head cancer: safety and efficacy.

    PubMed

    Carrafiello, Gianpaolo; Ierardi, Anna Maria; Fontana, Federico; Petrillo, Mario; Floridi, Chiara; Lucchina, Natalie; Cuffari, Salvatore; Dionigi, Gianlorenzo; Rotondo, Antonio; Fugazzola, Carlo

    2013-10-01

    To evaluate the safety and efficacy of percutaneous microwave (MW) ablation treatment in locally advanced, nonresectable, nonmetastatic pancreatic head cancer. Ten patients with pancreatic head cancer treated with percutaneous (n = 5) or laparotomic (n = 5) MW ablation were retrospectively reviewed. The MW generator used (45 W at 915 MHz) was connected by coaxial cable to 14-gauge straight MW antennas with a 3.7- or 2-cm radiating section. One or two antennae were used, with an ablation time of 10 minutes. Ultrasonographic (US) and combined US/cone-beam computed tomographic (CT) guidance were used in five patients each. Follow-up was performed by CT after 1, 3, 6, and, when possible, 12 months. Tumor response was assessed per Response Evaluation Criteria In Solid Tumors (version 1.1) and Choi criteria. The feasibility, safety, and major and minor complications associated with quality of life (QOL) were recorded prospectively. The procedure was feasible in all patients (100%). One late major complication was observed in one patient, and no visceral injury was detected. No patient had further surgery, and all minor complications resolved during the hospital stay. An improvement in QOL was observed in all patients despite a tendency to return to preoperative levels in the months following the procedure, without the influence of minor complications. No repeat treatment was performed. Despite the small number of patients, the present results can be considered encouraging, showing that MW ablation is a feasible approach in the palliative treatment of pancreatic tumors. © SIR, 2013.

  14. Using endometrial ablation as a treatment for abnormal bleeding: energy source comparisons and clinical results

    NASA Astrophysics Data System (ADS)

    Ryan, Thomas P.

    2000-01-01

    A great number of women suffer from abnormal uterine bleeding. Most do not want to undergo a hysterectomy and have searched for an alternative treatment. Ablation of the endometrium has become a viable alternative. Initially, surgical applications utilized thermal ablation by passing a rolling electrode, energized by monopolar radiofrequency (RF) energy, to ablate the inner uterine lining. This procedure was done under visual guidance and required practiced surgical skills to perform the ablation. It was not possible to assess subsurface damage. More recently, various energy systems have been applied to the endometrium such as lasers, microwaves, monopolar and bipolar RF, hot fluid balloons, and cryotherapy. They are being used in computer controlled treatments that obviate the user's skill, and utilize a self-positioning device paired with a temperature monitored, thermal treatment. Finite element models have also been created to predict heating profiles with devices that either rely on conductive heating or that deposit power in tissue. This is a very active field in terms of innovation with creative solutions using contemporary technology to reduce or halt the bleeding. Devices and minimally invasive treatments will offer choices to women and will be able to replace a surgical procedure with an office-based procedure. They are very promising and are discussed at length herein.

  15. The adenosine A2A antagonist MSX-3 reverses the effects of the dopamine antagonist haloperidol on effort-related decision making in a T-maze cost/benefit procedure

    PubMed Central

    Mott, Allison M.; Nunes, Eric J.; Collins, Lyndsey E.; Port, Russell G.; Sink, Kelly S.; Hockemeyer, Jörg; Müller, Christa E.

    2010-01-01

    Rationale Mesolimbic dopamine (DA) is a critical component of the brain circuitry regulating behavioral activation and effort-related processes. Research involving choice tasks has shown that rats with impaired DA transmission reallocate their instrumental behavior away from food-reinforced tasks with high response requirements and instead select less effortful food-seeking behaviors. Objective Previous work showed that adenosine A2A antagonism can reverse the effects of the DA antagonist haloperidol in an operant task that assesses effort-related choice. The present work used a T-maze choice procedure to assess the effects of adenosine A2A and A1 antagonism. Materials and methods With this task, the two arms of the maze have different reinforcement densities (four vs. two food pellets), and a vertical 44 cm barrier is positioned in the arm with the higher density, presenting the animal with an effort-related challenge. Untreated rats strongly prefer the arm with the high density of food reward and climb the barrier in order to obtain the food. Results Haloperidol produced a dose-related (0.05–0.15 mg/kg i.p.) reduction in the number of trials in which the rats chose the high-barrier arm. Co-administration of the adenosine A2A receptor antagonist MSX-3 (0.75, 1.5, and 3.0 mg/kg i.p.), but not the A1 antagonist 8-cyclopentyl-1,3-dipropylxanthine (0.75, 1.5, and 3.0 mg/kg i.p.), reversed the effects of haloperidol on effort-related choice and latency. Conclusions Adenosine A2A and D2 receptors interact to regulate effort-related decision making, which may have implications for the treatment of psychiatric symptoms such as psychomotor slowing or anergia that can be observed in depression, parkinsonism, and other disorders. PMID:19132351

  16. The adenosine A2A antagonist MSX-3 reverses the effects of the dopamine antagonist haloperidol on effort-related decision making in a T-maze cost/benefit procedure.

    PubMed

    Mott, Allison M; Nunes, Eric J; Collins, Lyndsey E; Port, Russell G; Sink, Kelly S; Hockemeyer, Jörg; Müller, Christa E; Salamone, John D

    2009-05-01

    Mesolimbic dopamine (DA) is a critical component of the brain circuitry regulating behavioral activation and effort-related processes. Research involving choice tasks has shown that rats with impaired DA transmission reallocate their instrumental behavior away from food-reinforced tasks with high response requirements and instead select less effortful food-seeking behaviors. Previous work showed that adenosine A(2A) antagonism can reverse the effects of the DA antagonist haloperidol in an operant task that assesses effort-related choice. The present work used a T-maze choice procedure to assess the effects of adenosine A(2A) and A(1) antagonism. With this task, the two arms of the maze have different reinforcement densities (four vs. two food pellets), and a vertical 44 cm barrier is positioned in the arm with the higher density, presenting the animal with an effort-related challenge. Untreated rats strongly prefer the arm with the high density of food reward and climb the barrier in order to obtain the food. Haloperidol produced a dose-related (0.05-0.15 mg/kg i.p.) reduction in the number of trials in which the rats chose the high-barrier arm. Co-administration of the adenosine A(2A) receptor antagonist MSX-3 (0.75, 1.5, and 3.0 mg/kg i.p.), but not the A(1) antagonist 8-cyclopentyl-1,3-dipropylxanthine (0.75, 1.5, and 3.0 mg/kg i.p.), reversed the effects of haloperidol on effort-related choice and latency. Adenosine A(2A) and D2 receptors interact to regulate effort-related decision making, which may have implications for the treatment of psychiatric symptoms such as psychomotor slowing or anergia that can be observed in depression, parkinsonism, and other disorders.

  17. A Miniaturized, Programmable Deep-Brain Stimulator for Group-Housing and Water Maze Use

    PubMed Central

    Pinnell, Richard C.; Pereira de Vasconcelos, Anne; Cassel, Jean C.; Hofmann, Ulrich G.

    2018-01-01

    Pre-clinical deep-brain stimulation (DBS) research has observed a growing interest in the use of portable stimulation devices that can be carried by animals. Not only can such devices overcome many issues inherent with a cable tether, such as twisting or snagging, they can also be utilized in a greater variety of arenas, including enclosed or large mazes. However, these devices are not inherently designed for water-maze environments, and their use has been restricted to individually-housed rats in order to avoid damage from various social activities such as grooming, playing, or fighting. By taking advantage of 3D-printing techniques, this study demonstrates an ultra-small portable stimulator with an environmentally-protective device housing, that is suitable for both social-housing and water-maze environments. The miniature device offers 2 channels of charge-balanced biphasic pulses with a high compliance voltage (12 V), a magnetic switch, and a diverse range of programmable stimulus parameters and pulse modes. The device's capabilities have been verified in both chronic pair-housing and water-maze experiments that asses the effects of nucleus reuniens DBS. Theta-burst stimulation delivered during a reference-memory water-maze task (but not before) had induced performance deficits during both the acquisition and probe trials of a reference memory task. The results highlight a successful application of 3D-printing for expanding on the range of measurement modalities capable in DBS research. PMID:29706862

  18. Radiofrequency Ablation of Uterine Fibroids: a Review.

    PubMed

    Lee, Bruce B; Yu, Steve P

    2016-01-01

    Laparoscopic, ultrasound-guided radiofrequency ablation (RFA) is a new, FDA-cleared uterine sparing, outpatient procedure for uterine fibroids. The procedure utilizes recent technological advancements in instrumentation and imaging, allowing surgeons to treat numerous fibroids of varying size and location in a minimally invasive fashion. Early and mid-term data from multi-center clinical trials have demonstrated safety and efficacy, with resolution or improvement of symptoms and significant volume reduction. Re-intervention rates for fibroid symptoms have been low. The procedure is well tolerated with a typically uneventful and rapid recovery requiring NSAIDs only for postoperative pain. While post RFA pregnancy data are limited, the results are promising.

  19. Treatment of Recurrent Nonparoxysmal Atrial Fibrillation Using Focal Impulse and Rotor Mapping (FIRM)-Guided Rotor Ablation: Early Recurrence and Long-Term Outcomes.

    PubMed

    Spitzer, Stefan Georg; Károlyi, László; Rämmler, Carola; Scharfe, Frank; Weinmann, Thomas; Zieschank, Mirko; Langbein, Anke

    2017-01-01

    A patient-tailored ablation approach focused on the elimination of both pulmonary vein triggers as well as substrate drivers may result in favorable outcomes in recurrent persistent AF patients. We evaluated the long-term outcomes of rotor ablation combined with conventional pulmonary vein isolation (PVI) in patients with recurrent nonparoxysmal AF. Fifty-eight consecutive patients underwent FIRM-guided rotor ablation followed by conventional PVI for the treatment of recurrent nonparoxysmal AF. A software algorithm was used to display rotational activity at rotor sites by creating propagation maps from unipolar electrograms recorded using a 64-electrode basket catheter. These rotor sites were targeted for ablation, followed by conventional PVI. All patients had nonparoxysmal AF (83% longstanding persistent) and a previously failed conventional ablation procedure. Stable rotors were identified in all patients (mean of 3.0 ± 1.6 per patient), with 55.2% having right atrial rotors and 96.6% left atrial rotors, respectively. Complications occurred in 5.2% of patients, none related to the FIRM procedure. The median follow-up was 12 months. At 6 and 12 months of follow-up, 73.2% and 76.9% of patients remained free from AF/AT, respectively. Excluding 2 patients who underwent a successful redo ablation procedure/electrical cardioversion, at 12 months of follow-up, 69.2% were free from any AF/AT and 73.1% were free from AF after a single FIRM-guided ablation procedure. A high degree of success was observed in this cohort of primarily longstanding persistent AF patients treated for recurrent AF with FIRM-guided rotor ablation. Prospective randomized controlled trials are needed. © 2016 Wiley Periodicals, Inc.

  20. Prediction and prognosis of ventricular tachycardia recurrence after catheter ablation with remote magnetic navigation for electrical storm in patients with ischemic cardiomyopathy.

    PubMed

    Jin, Qi; Jacobsen, Peter Karl; Pehrson, Steen; Chen, Xu

    2017-11-01

    Ventricular tachycardia (VT) recurrence after catheter ablation for electrical storm is commonly seen in patients with ischemic cardiomyopathy (ICM). We hypothesized that VT recurrence can be predicted and be related to the all-cause death after VT storm ablation guided by remote magnetic navigation (RMN) in patients with ICM. A total of 54 ICM patients (87% male; mean age, 65 ± 7.1 years) presenting with VT storm undergoing acute ablation using RMN were enrolled. Acute complete ablation success was defined as noninducibility of any sustained monomorphic VT at the end of the procedure. Early VT recurrence was defined as the occurrence of sustained VT within 1 month after the first ablation. After a mean follow-up of 17.1 months, 27 patients (50%) had freedom from VT recurrence. Sustained VT recurred in 12 patients (22%) within 1 month following the first ablation. In univariate analysis, VT recurrence was associated with incomplete procedural success (hazard ratio [HR]: 6.25, 95% confidence interval [CI]: 1.20-32.47, P = 0.029), lack of amiodarone usage before ablation (HR: 4.71, 95% CI: 1.12-19.7, P = 0.034), and a longer procedural time (HR: 1.023, 95% CI: 1.00-1.05, P = 0.05). The mortality of patients with early VT recurrence was higher than that of patients without recurrence (P < 0.01). Inducibility of any VT at the end of procedure for VT storm guided by RMN is the strongest predictor of VT recurrence. ICM patients who have early recurrences after VT storm ablation are at high risk of all-cause death. © 2017 Wiley Periodicals, Inc.

  1. Ultrasound-guided trans-rectal high-intensity focused ultrasound (HIFU) for advanced cervical cancer ablation is feasible: a case report.

    PubMed

    Abel, M; Ahmed, H; Leen, E; Park, E; Chen, M; Wasan, H; Price, P; Monzon, L; Gedroyc, W; Abel, P

    2015-01-01

    High-intensity focused ultrasound (HIFU) is an ablative treatment undergoing assessment for the treatment of benign and malignant disease. We describe the first reported intracavitary HIFU ablation for recurrent, unresectable and symptomatic cervical cancer. A 38 year old woman receiving palliative chemotherapy for metastatic cervical adenocarcinoma was offered ablative treatment from an intracavitary trans-rectal HIFU device (Sonablate® 500). Pre-treatment symptoms included vaginal bleeding and discharge that were sufficient to impede her quality of life. No peri-procedural adverse events occurred. Symptoms resolved completely immediately post-procedure, reappeared at 7 days, increasing to pre-procedural levels by day 30. This first time experience of intracavitary cervical HIFU suggests that it is feasible for palliation of advanced cervical cancer, with no early evidence of unexpected toxicity. Ethical approval had also been granted for the use of per-vaginal access if appropriate. This route, alone or in combination with the rectal route, may provide increased accessibility in future patients with a redesigned device more suited to trans-vaginal ablations. Intracavitary HIFU is a potentially safe procedure for the treatment of cervical cancer and able to provide symptomatic improvement in the palliative setting.

  2. Safety and Long-Term Outcomes of Catheter Ablation of Atrial Fibrillation Using Magnetic Navigation versus Manual Conventional Ablation: A Propensity-Score Analysis.

    PubMed

    Adragão, Pedro Pulido; Cavaco, Diogo; Ferreira, António Miguel; Costa, Francisco Moscoso; Parreira, Leonor; Carmo, Pedro; Morgado, Francisco Bello; Santos, Katya Reis; Santos, Pedro Galvão; Carvalho, Maria Salomé; Durazzo, Anai; Marques, Hugo; Gonçalves, Pedro Araújo; Raposo, Luís; Mendes, Miguel

    2016-03-01

    Whether or not the potential advantages of using a magnetic navigation system (MNS) translate into improved outcomes in patients undergoing atrial fibrillation (AF) ablation is a question that remains unanswered. In this observational registry study, we used propensity-score matching to compare the outcomes of patients with symptomatic drug-refractory AF who underwent catheter ablation using MNS with the outcomes of those who underwent catheter ablation using conventional manual navigation. Among 1,035 eligible patients, 287 patients in each group had similar propensity scores and were included in the analysis. The primary efficacy outcome was the rate of AF relapse after a 3-month blanking period. At a mean follow-up of 2.6 ± 1.5 years, AF ablation with MNS was associated with a similar risk of AF relapse as compared with manual navigation (18.4% per year and 22.3% per year, respectively; hazard ratio 0.81, 95% CI 0.63-1.05; P = 0.108). Major complications occurred in two patients (0.7%) using MNS, and in six patients (2.1%) undergoing manually navigated ablation (P = 0.286). Fluoroscopy times were 21 ± 10 minutes in the manual navigation group, and 12 ± 9 minutes in the MNS group (P < 0.001), whereas total procedure times were 152 ± 52 minutes and 213 ± 58 minutes, respectively (P < 0.001). In this propensity-score matched comparison, magnetic navigation and conventional manual AF ablations seem to have similar relapse rates and a similar risk of complications. AF ablations with magnetic navigation take longer to perform but expose patients to significantly shorter fluoroscopy times. © 2015 Wiley Periodicals, Inc.

  3. Initial experience of a novel mapping system combined with remote magnetic navigation in the catheter ablation of atrial fibrillation.

    PubMed

    Lin, Changjian; Pehrson, Steen; Jacobsen, Peter Karl; Chen, Xu

    2017-12-01

    There have been advancements of sophisticated mapping systems used for ablation procedures over the last decade. Utilization of these novel mapping systems in combination with remote magnetic navigation (RMN) needs to be established. We investigated the new EnSite Precision mapping system (St. Jude Medical, Inc., St. Paul, MN, USA), which collects magnetic data for checking navigation field stability and is built on an open platform, allowing physicians to choose diagnostic and ablation catheters. We address its compatibility with RMN. To assess the clinical utility of a novel 3D mapping system (EnSite Precision mapping system) combined with RMN (Niobe ES, Stereotaxis, Inc., St. Louis, MO, USA) for atrial fibrillation (AF) ablation. In this prospective nonrandomized study, two groups of patients were treated in our center for drug refractory AF. Patients were consecutively enrolled in each group. Group A (n = 35, 14 persistent AF [PsAF]) was treated using the novel 3D mapping system combined with RMN. Group B (n = 38, 16 PsAF) was treated using Carto ® 3 (Biosense Webster, Inc., Diamond Bar, CA, USA) combined with RMN. In Group A, the left atrium (LA) was mapped with a circular magnetic catheter manually and was then replaced by a RMN ablation catheter. At the end of the procedures in Group A, the circular catheter was used for confirming field stability. In Group B, an ablation catheter was controlled by RMN to perform both LA mapping and ablation. All patients underwent pulmonary vein antrum isolation. Additional complex fractionated atrial electrograms (CFAEs) ablation was performed for PsAF. Procedural, ablation, and fluoroscopy times were recorded and complications were assessed. Electrophysiological end points were achieved in all patients. Using the novel mapping system, LA mapping time was fast (308 ± 60 seconds) with detailed anatomy points (178,831 ± 70,897) collected and magnetic points throughout LA. At the end of the procedures in Group A, the

  4. Remote magnetic versus manual catheter navigation for circumferential pulmonary vein ablation in patients with atrial fibrillation.

    PubMed

    Lüthje, Lars; Vollmann, Dirk; Seegers, Joachim; Dorenkamp, Marc; Sohns, Christian; Hasenfuss, Gerd; Zabel, Markus

    2011-11-01

    Only limited data exist on the clinical utility of remote magnetic navigation (RMN) for pulmonary vein (PV) ablation. Aim of this prospective study was to evaluate the safety and efficacy of RMN for PV isolation as compared to the manual (CON) approach. A total of 161 consecutive patients undergoing circumferential PV isolation were included. Open-irrigated 3.5 mm ablation catheters under the guidance of a mapping system were used. The catheter was navigated with the Stereotaxis Niobe II system in the RMN group (n = 107) and guided manually in the CON group (n = 54). Electrical isolation of all PVs was achieved in 90% of the patients in the RMN group and in 87% in the CON group (p = 0.6). All subjects were followed every 3 months by 7d Holter-ECG. At 12 months of follow-up, 53.5% (RMN) and 55.5% (CON) of the patients were free of any left atrial tachycardia/atrial fibrillation (AF) episode (p = 0.57). Free of symptomatic AF recurrence were 66.3% (RMN) and 62.1% (CON) of the subjects (p = 0.80). Use of RMN was associated with longer procedure duration (p < 0.0001), ablation times (p < 0.0001), and RF current application duration (p < 0.05). In contrast, fluoroscopy time was lower in the RMN group (p < 0.0001). Major complications occurred in 6 of 161 procedures (3.7%), with no significant difference between groups (p = 0.75). RMN-guided PV ablation provides comparable acute and long-term success rates as compared to manual navigation. Procedural complication rates are similar. The use of RMN is associated with markedly reduced fluoroscopy time, but prolonged ablation and procedure duration.

  5. Catheter Ablation of Atrial Fibrillation in Patients with Hardware in the Heart - Septal Closure Devices, Mechanical Valves and More.

    PubMed

    Bartoletti, Stefano; Santangeli, Pasquale; DI Biase, Luigi; Natale, Andrea

    2013-01-01

    Patients with mechanical "hardware" in the heart, such as those with mechanical cardiac valves or atrial septal closure devices, represent a population at high risk of developing AF. Catheter ablation of AF in these subjects might represent a challenge, due to the perceived higher risk of complications associated with the presence of intracardiac mechanical devices. Accordingly, such patients were excluded or poorly represented in major trials proving the benefit of catheter ablation for the rhythm-control of AF. However, recent evidence supports the concept that catheter ablation procedures might be equally effective in these patients, without a significant increase in the risk of procedural complications. This review will summarize the current state-of-the-art on catheter ablation of AF in patients with mechanical "hardware" in the heart.

  6. Laparoscopic microwave thermosphere ablation of malignant liver tumors: an initial clinical evaluation.

    PubMed

    Berber, Eren

    2016-02-01

    Microwave ablation (MWA) has been recently recognized as a technology to overcome the limitations of radiofrequency ablation. The aim of the current study was to evaluate the safety and efficacy of a new 2.45-GHz thermosphere MWA system in the treatment of malignant liver tumors. This was a prospective IRB-approved study of 18 patients with malignant liver tumors treated with MWA within a 3-month time period. Tumor sizes and response to MWA were obtained from triphasic liver CT scans done before and after MWA. The ablation zones were assessed for complete tumor response and spherical geometry. There were a total of 18 patients with an average of three tumors measuring 1.4 cm (range 0.2-4). Ablations were performed laparoscopically in all, but three patients who underwent combined liver resection. A single ablation was created in 72% and overlapping ablations in 28% of lesions. Total ablation time per patient was 15.6 ± 1.9 min. There was no morbidity or mortality. At 2-week CT scans, there was 100% tumor destruction, with no residual lesions. Roundness indices A, B and transverse were 1.1, 0.9 and 0.9, respectively, confirming the spherical nature of ablation zones. To the best of our knowledge, this is the first report of a new thermosphere MWA technology in the laparoscopic treatment of malignant liver tumors. The results demonstrate the safety of the technology, with satisfactory spherical ablation zones seen on post-procedural CT scans.

  7. Acute and long term outcomes of catheter ablation using remote magnetic navigation for the treatment of electrical storm in patients with severe ischemic heart failure.

    PubMed

    Jin, Qi; Jacobsen, Peter Karl; Pehrson, Steen; Chen, Xu

    2015-03-15

    Catheter ablation with remote magnetic navigation (RMN) can offer some advantages compared to manual techniques. However, the relevant clinical evidence for how RMN-guided ablation affects electrical storm (ES) due to ventricular tachycardia (VT) in patients with severe ischemic heart failure (SIHF) is still limited. Forty consecutive SIHF patients (left ventricular ejection fraction, 21 ± 6.9%) presenting with ES underwent ablation using RMN. All the patients received implantable cardioverter-defibrillators (ICDs) either before or after ablation. Acute ablation success was defined as noninducibility of any sustained monophasic VT at the end of the procedure. Long-term analysis addressed VT recurrence, ICD therapies and all-cause death. ES was acutely suppressed by ablation in all patients. Acute ablation success was obtained in 32 of 40 (80%) patients. The procedure time and fluoroscopy time were 105 ± 27 min and 7.5 ± 4.8 min respectively. No major complications occurred during procedures. During a mean follow-up of 17.4 months, 19 patients (47.5%) remained free of VT recurrence. The percentage of patients receiving ICD shocks after ablation was lower than before ablation (30% vs 69%, P<0.01). The mean number of ICD shocks per individual per year was reduced from 4.3 before ablation to 1.9 after ablation (P<0.05). Ten patients died during follow-up. Acute catheter ablation with RMN is safe and effective to suppress ES in SIHF patients. RMN-guided catheter ablation can prevent VT recurrence and significantly reduce ICD shocks, suggesting that this strategy can be used as an alternative therapy for VT storm in SIHF patients with ICDs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. Prospective study of atrial fibrillation termination during ablation guided by automated detection of fractionated electrograms.

    PubMed

    Porter, Michael; Spear, William; Akar, Joseph G; Helms, Ray; Brysiewicz, Neil; Santucci, Peter; Wilber, David J

    2008-06-01

    Complex fractionated atrial electrograms (CFAE) may identify critical sites for perpetuation of atrial fibrillation (AF) and provide useful targets for ablation. Current assessment of CFAE is subjective; automated detection algorithms may improve reproducibility, but their utility in guiding ablation has not been tested. In 67 patients presenting for initial AF ablation (42 paroxysmal, 25 persistent), LA and CS mapping were performed during induced or spontaneous AF. CFAE were identified by an online automated computer algorithm and displayed on electroanatomical maps. A mean of 28 +/- 18 sites/patient were identified (20 +/- 13% of mapped sites), and were more frequent during persistent AF. CFAE occurred most commonly within the CS, on the atrial septum, and around the pulmonary veins. Ablation initially targeting CFAE terminated AF in 88% of paroxysmal AF, but only 20% of persistent AF (P < 0.001). Subsequently, additional ablation was performed in all patients (PV isolation for paroxysmal AF, PV isolation + mitral and roof lines for persistent AF). Minimum follow-up was 1 year. One-year freedom from recurrent atrial arrhythmias without antiarrhythmic drug therapy after a single procedure was 90% for paroxysmal AF, and 68% for persistent AF. Ablation guided by automated detection of CFAE proved feasible, and was associated with a high AF termination rate in paroxysmal, but not persistent AF. As an adjunct to conventional techniques, it was associated with excellent long-term single procedure outcomes in both groups. Criteria for identifying optimal CFAE sites for ablation, and selection of patients most likely to benefit, require additional study.

  9. High power microwave ablation of normal swine lung: impact of duration of energy delivery on adverse event and heat sink effects.

    PubMed

    Kodama, Hiroshi; Ueshima, Eisuke; Gao, Song; Monette, Sebastien; Paluch, Lee-Ronn; Howk, Kreg; Erinjeri, Joseph P; Solomon, Stephen B; Srimathveeravalli, Govindarajan

    2018-04-18

    The purpose of this study is to assess the impact of duration of energy delivery on adverse events (AEs) and heat sink effects during high power microwave ablation (MWA) of normal swine lung. High power (100 W) MWA was performed with short (2 min, 18 ablations) or long (10 min, nine ablations) duration of energy delivery in unilateral lung of swine (n = 10). CT imaging was done prior to sacrifice at 2 or 28 d post-treatment, with additional imaging at 7 and 14 d for the latter cohort. Ablation zones were assessed with CT imaging and histopathology analysis. Differences in AEs and ablation characteristics between groups were compared with Fisher's exact test and Student's t-test, respectively. There were no significant differences in formation of air-filled needle tract, cavitation, and pneumonia (p > 0.5) between the treatment groups. Intra-procedural pneumothorax requiring chest tube placement occurred in three animals. Substantial (>20%, p = 0.01) intra-procedural ablation zone distortion was observed in both groups. The presence of large airways or blood vessels did not result in heat sink effect within the ablation zones and was not indicative of reduced ablation size. Increased energy delivery yielded larger (8.9 ± 3.1 cm 3 vs. 3.4 ± 1.7 cm 3 , p < 0.001) spherical ablations (sphericity: 0.70 ± 0.10 vs. 0.56 ± 0.13, p = 0.01). High power MWA of normal lung with longer duration of energy delivery can create larger spherical ablations, without significant differences in post-procedure AEs when compared with shorter energy delivery time.

  10. Ablation mass features in multi-pulses femtosecond laser ablate molybdenum target

    NASA Astrophysics Data System (ADS)

    Zhao, Dongye; Gierse, Niels; Wegner, Julian; Pretzler, Georg; Oelmann, Jannis; Brezinsek, Sebastijan; Liang, Yunfeng; Neubauer, Olaf; Rasinski, Marcin; Linsmeier, Christian; Ding, Hongbin

    2018-03-01

    In this study, the ablation mass features related to reflectivity of bulk Molybdenum (Mo) were investigated by a Ti: Sa 6 fs laser pulse at central wavelength 790 nm. The ablated mass removal was determined using Confocal Microscopy (CM) technique. The surface reflectivity was calibrated and measured by a Lambda 950 spectrophotometer as well as a CCD camera during laser ablation. The ablation mass loss per pulse increase with the increasing of laser shots, meanwhile the surface reflectivity decrease. The multi-pulses (100 shots) ablation threshold of Mo was determined to be 0.15 J/cm2. The incubation coefficient was estimated as 0.835. The reflectivity change of the Mo target surface following multi-pulses laser ablation were studied as a function of laser ablation shots at various laser fluences from 1.07 J/cm2 to 36.23 J/cm2. The results of measured reflectivity indicate that surface reflectivity of Mo target has a significant decline in the first 3-laser pulses at the various fluences. These results are important for developing a quantitative analysis model for laser induced ablation and laser induced breakdown spectroscopy for the first wall diagnosis of EAST tokamak.

  11. Bipolar radiofrequency ablation of liver metastases during laparotomy. First clinical experiences with a new multipolar ablation concept.

    PubMed

    Ritz, Joerg-Peter; Lehmann, Kai S; Reissfelder, Christoph; Albrecht, Thomas; Frericks, Bernd; Zurbuchen, Urte; Buhr, Heinz J

    2006-01-01

    Radiofrequency ablation (RFA) is a promising method for local treatment of liver malignancies. Currently available systems for radiofrequency ablation use monopolar current, which carries the risk of uncontrolled electrical current paths, collateral damages and limited effectiveness. To overcome this problem, we used a newly developed internally cooled bipolar application system in patients with irresectable liver metastases undergoing laparotomy. The aim of this study was to clinically evaluate the safety, feasibility and effectiveness of this new system with a novel multipolar application concept. Patients with a maximum of five liver metastases having a maximum diameter of 5 cm underwent laparotomy and abdominal exploration to control resectability. In cases of irresectability, RFA with the newly developed bipolar application system was performed. Treatment was carried out under ultrasound guidance. Depending on tumour size, shape and location, up to three applicators were simultaneously inserted in or closely around the tumour, never exceeding a maximum probe distance of 3 cm. In the multipolar ablation concept, the current runs alternating between all possible pairs of consecutively activated electrodes with up to 15 possible electrode combinations. Post-operative follow-up was evaluated by CT or MRI controls 24-48 h after RFA and every 3 months. In a total of six patients (four male, two female; 61-68 years), ten metastases (1.0-5.5 cm) were treated with a total of 14 RF applications. In four metastases three probes were used, and in another four and two metastases, two and one probes were used, respectively. During a mean ablation time of 18.8 min (10-31), a mean energy of 48.8 kJ (12-116) for each metastases was applied. No procedure-related complications occurred. The patients were released from the hospital between 7 and 12 days post-intervention (median 9 days). The post-interventional control showed complete tumour ablation in all cases. Bipolar

  12. Reasons for failed ablation for idiopathic right ventricular outflow tract-like ventricular arrhythmias.

    PubMed

    Yokokawa, Miki; Good, Eric; Crawford, Thomas; Chugh, Aman; Pelosi, Frank; Latchamsetty, Rakesh; Jongnarangsin, Krit; Ghanbari, Hamid; Oral, Hakan; Morady, Fred; Bogun, Frank

    2013-08-01

    The right ventricular outflow tract (RVOT) is the most common site of origin of ventricular arrhythmias (VAs) in patients with idiopathic VAs. A left bundle branch block, inferior axis morphology arrhythmia is the hallmark of RVOT arrhythmias. VAs from other sites of origin can mimic RVOT VAs, and ablation in the RVOT typically fails for these VAs. To analyze reasons for failed ablations of RVOT-like VAs. Among a consecutive series of 197 patients with an RVOT-like electrocardiographic (ECG) morphology who were referred for ablation, 38 patients (13 men; age 46 ± 14 years; left ventricular ejection fraction 47% ± 14%) in whom a prior procedure failed within the RVOT underwent a second ablation procedure. ECG characteristics of the VA were compared to a consecutive series of 50 patients with RVOT VAs. The origin of the VA was identified in 95% of the patients. In 28 of 38 (74%) patients, the arrhythmia origin was not in the RVOT. The VA originated from intramural sites (n = 8, 21%), the pulmonary arteries (n = 7, 18%), the aortic cusps (n = 6, 16%), and the epicardium (n = 5, 13%). The origin was within the RVOT in 10 (26%) patients. In 2 (5%) patients, the origin could not be identified despite biventricular, aortic, and epicardial mapping. The VA was eliminated in 34 of 38 (89%) patients with repeat procedures. The ECG features of patients with failed RVOT-like arrhythmias were different from the characteristics of RVOT arrhythmias. In patients in whom ablation of a VA with an RVOT-like appearance fails, mapping of the pulmonary artery, the aortic cusps, the epicardium, the left ventricular outflow tract, and the aortic cusps will help identify the correct site of origin. The 12-lead ECG is helpful in differentiating these VAs from RVOT VAs. Copyright © 2013 Heart Rhythm Society. All rights reserved.

  13. Protection of skin with subcutaneous administration of 5% dextrose in water during superficial radiofrequency ablation in a rabbit model.

    PubMed

    Guo, Hui; Liu, Xia-Lei; Wang, Yu-Ling; Li, Jing-Yi; Lu, Wu-Zhu; Xian, Jian-Zhong; Zhang, Bai-Meng; Li, Jian

    2014-06-01

    This study was to evaluate the efficacy of subcutaneous administration of 5% dextrose in water (D5W), to prevent skin injury during radiofrequency (RF) ablation. Twenty-four rabbits were divided into three groups: a pre-injection group, a perfusion group, and a control group. Ablative zones were created in the superficial part of the thigh muscle for 6 min. A needle was placed subcutaneously for injection of D5W, and a thermal sensor was positioned nearby for real-time temperature monitoring. The sizes of the ablative zones were measured by contrast-enhanced ultrasonography, and severity of the observed skin injury were scored semi-quantitatively and compared. The highest temperature, the duration of the temperature above 50 °C, and the rise time of the post-procedure temperature were all highest in the control group (p < 0.001), while these values were lower in the perfusion group than those in the pre-injection group (p < 0.001). Post-procedure skin injury was most severe in the control group (p < 0.001). On post-procedure day 1, no significant difference was found between the skin injury of the pre-injection group and the perfusion group (p = 0.091), while the skin injury of the perfusion group was less severe than that of the pre-injection group on post-procedure day 14 (p = 0.004). No significant difference was found in the sizes of the ablative zones among the groups (p = 0.720). Subcutaneous perfusion with D5W is effective in protecting the skin against burns during RF ablation without compromising the effect of ablation.

  14. Initial clinical experience of remote magnetic navigation system for catheter mapping and ablation of supraventricular tachycardias.

    PubMed

    Xu, Dongjie; Yang, Bin; Shan, Qijun; Zou, Jiangang; Chen, Minglong; Chen, Chun; Hou, Xiaofeng; Zhang, Fengxiang; Li, Wen-Qi; Cao, Kejiang; Tse, Hung-Fat

    2009-09-01

    A remote magnetic navigation system (MNS) has been developed for mapping and catheter ablation of cardiac arrhythmias. The present study evaluates the safety and feasibility of this system to perform radiofrequency (RF) ablation in patients with supraventricular tachycardias (SVT). A total of 32 patients (22 female; mean age 44 +/- 16 years) with documented SVT underwent mapping and ablation using Helios II (a 4-mm-tip magnetic catheter), under the guidance of the MNS (Niobe II, Stereotaxis, Inc.). Catheter ablation procedure with MNS was successful in 30/32 (94%) patients including all patients (27/27, 100%) with atrioventricular nodal reentrant tachycardia (AVNRT) and three of five patients (60%) with atrioventricular reentrant tachycardia (AVRT) without any complication. The procedural successful rate in patients with AVNRT was significantly higher than those in patients with AVRT (P < 0.001). Overall, the medium number of RF application using the MNS was 2 (mean 2.7 +/- 1.6, range 1 to 7), and the medium numbers of RF for AVNRT and AVRT were 2 and 3, respectively. There was no significant difference in the mean procedural time between patients with AVNRT and AVRT (126.3 +/- 38.6 vs. 138.0 +/- 40.3 min, P = 0.54). However, the mean fluoroscopy time was significantly shorter in patients with AVNRT than those with AVRT (5.7 +/- 3.0 vs. 16.5 +/- 2.5 min, P < 0.001). Among those patients with AVNRT, the mean procedural time (139.3 +/- 45.0 vs. 112.3 +/- 24.9 min, P = 0.07) and fluoroscopic time (3.2 +/- 1.0 vs. 8.0 +/- 2.2 min, P < 0.001) were shorter for the later 13 patients than the first 14 patients, suggesting a learning curve in using the MNS for RF ablation. The Niobe MNS is a new technique that can allow safe and effective remote-controlled navigation and minimize the need for fluoroscopic guidance for ablation catheter of AVNRT. However, further improvement is required to achieve a higher successful rate for treatment of AVRT.

  15. Efficacy comparison between cryoablation and radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter: a meta-analysis

    NASA Astrophysics Data System (ADS)

    Chen, Yi-He; Lin, Hui; Xie, Cheng-Long; Zhang, Xiao-Ting; Li, Yi-Gang

    2015-06-01

    We perform this meta-analysis to compare the efficacy and safety of cryoablation versus radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter. By searching EMBASE, MEDLINE, PubMed and Cochrane electronic databases from March 1986 to September 2014, 7 randomized clinical trials were included. Acute (risk ratio[RR]: 0.93; P = 0.14) and long-term (RR: 0.94; P = 0.08) success rate were slightly lower in cryoablation group than in radiofrequency ablation group, but the difference was not statistically significant. Additionally, the fluoroscopy time was nonsignificantly reduced (weighted mean difference[WMD]: -2.83 P = 0.29), whereas procedure time was significantly longer (WMD: 25.95; P = 0.01) in cryoablation group compared with radiofrequency ablation group. Furthermore, Pain perception during the catheter ablation was substantially less in cryoabaltion group than in radiofrequency ablation group (standardized mean difference[SMD]: -2.36 P < 0.00001). Thus, our meta-analysis demonstrated that cryoablation and radiofrequency ablation produce comparable acute and long-term success rate for patients with cavotricuspid valve isthmus dependent atrial flutter. Meanwhile, cryoablation ablation tends to reduce the fluoroscopy time and significantly reduce pain perception in cost of significantly prolonged procedure time.

  16. Efficacy comparison between cryoablation and radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter: a meta-analysis

    PubMed Central

    Chen, Yi-He; Lin, Hui; Xie, Cheng-Long; Zhang, Xiao-Ting; Li, Yi-Gang

    2015-01-01

    We perform this meta-analysis to compare the efficacy and safety of cryoablation versus radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter. By searching EMBASE, MEDLINE, PubMed and Cochrane electronic databases from March 1986 to September 2014, 7 randomized clinical trials were included. Acute (risk ratio[RR]: 0.93; P = 0.14) and long-term (RR: 0.94; P = 0.08) success rate were slightly lower in cryoablation group than in radiofrequency ablation group, but the difference was not statistically significant. Additionally, the fluoroscopy time was nonsignificantly reduced (weighted mean difference[WMD]: −2.83; P = 0.29), whereas procedure time was significantly longer (WMD: 25.95; P = 0.01) in cryoablation group compared with radiofrequency ablation group. Furthermore, Pain perception during the catheter ablation was substantially less in cryoabaltion group than in radiofrequency ablation group (standardized mean difference[SMD]: −2.36; P < 0.00001). Thus, our meta-analysis demonstrated that cryoablation and radiofrequency ablation produce comparable acute and long-term success rate for patients with cavotricuspid valve isthmus dependent atrial flutter. Meanwhile, cryoablation ablation tends to reduce the fluoroscopy time and significantly reduce pain perception in cost of significantly prolonged procedure time. PMID:26039980

  17. Chemical nonequilibrium Navier-Stokes solutions for hypersonic flow over an ablating graphite nosetip

    NASA Technical Reports Server (NTRS)

    Chen, Y. K.; Henline, W. D.

    1993-01-01

    The general boundary conditions including mass and energy balances of chemically equilibrated or nonequilibrated gas adjacent to ablating surfaces have been derived. A computer procedure based on these conditions was developed and interfaced with the Navier-Stokes solver for predictions of the flow field, surface temperature, and surface ablation rates over re-entry space vehicles with ablating Thermal Protection Systems (TPS). The Navier-Stokes solver with general surface thermochemistry boundary conditions can predict more realistic solutions and provide useful information for the design of TPS. A test case with a proposed hypersonic test vehicle configuration and associated free stream conditions was developed. Solutions with various surface boundary conditions were obtained, and the effect of nonequilibrium gas as well as surface chemistry on surface heating and ablation rate were examined. The solutions of the GASP code with complete ablating surface conditions were compared with those of the ASC code. The direction of future work is also discussed.

  18. CBM Maze-Scores as Indicators of Reading Level and Growth for Seventh-Grade Students

    ERIC Educational Resources Information Center

    Chung, Siuman; Espin, Christine A.; Stevenson, Claire E.

    2018-01-01

    The technical adequacy of CBM maze-scores as indicators of reading level and growth for seventh-grade secondary-school students was examined. Participants were 452 Dutch students who completed weekly maze measures over a period of 23 weeks. Criterion measures were school level, dyslexia status, scores and growth on a standardized reading test.…

  19. MR imaging guidance for minimally invasive procedures

    NASA Astrophysics Data System (ADS)

    Wong, Terence Z.; Kettenbach, Joachim; Silverman, Stuart G.; Schwartz, Richard B.; Morrison, Paul R.; Kacher, Daniel F.; Jolesz, Ferenc A.

    1998-04-01

    Image guidance is one of the major challenges common to all minimally invasive procedures including biopsy, thermal ablation, endoscopy, and laparoscopy. This is essential for (1) identifying the target lesion, (2) planning the minimally invasive approach, and (3) monitoring the therapy as it progresses. MRI is an ideal imaging modality for this purpose, providing high soft tissue contrast and multiplanar imaging, capability with no ionizing radiation. An interventional/surgical MRI suite has been developed at Brigham and Women's Hospital which provides multiplanar imaging guidance during surgery, biopsy, and thermal ablation procedures. The 0.5T MRI system (General Electric Signa SP) features open vertical access, allowing intraoperative imaging to be performed. An integrated navigational system permits near real-time control of imaging planes, and provides interactive guidance for positioning various diagnostic and therapeutic probes. MR imaging can also be used to monitor cryotherapy as well as high temperature thermal ablation procedures sing RF, laser, microwave, or focused ultrasound. Design features of the interventional MRI system will be discussed, and techniques will be described for interactive image acquisition and tracking of interventional instruments. Applications for interactive and near-real-time imaging will be presented as well as examples of specific procedures performed using MRI guidance.

  20. Microwave Ablation: Comparison of Simultaneous and Sequential Activation of Multiple Antennas in Liver Model Systems

    PubMed Central

    Harari, Colin M.; Magagna, Michelle; Bedoya, Mariajose; Lee, Fred T.; Lubner, Meghan G.; Hinshaw, J. Louis; Ziemlewicz, Timothy

    2016-01-01

    Purpose To compare microwave ablation zones created by using sequential or simultaneous power delivery in ex vivo and in vivo liver tissue. Materials and Methods All procedures were approved by the institutional animal care and use committee. Microwave ablations were performed in both ex vivo and in vivo liver models with a 2.45-GHz system capable of powering up to three antennas simultaneously. Two- and three-antenna arrays were evaluated in each model. Sequential and simultaneous ablations were created by delivering power (50 W ex vivo, 65 W in vivo) for 5 minutes per antenna (10 and 15 minutes total ablation time for sequential ablations, 5 minutes for simultaneous ablations). Thirty-two ablations were performed in ex vivo bovine livers (eight per group) and 28 in the livers of eight swine in vivo (seven per group). Ablation zone size and circularity metrics were determined from ablations excised postmortem. Mixed effects modeling was used to evaluate the influence of power delivery, number of antennas, and tissue type. Results On average, ablations created by using the simultaneous power delivery technique were larger than those with the sequential technique (P < .05). Simultaneous ablations were also more circular than sequential ablations (P = .0001). Larger and more circular ablations were achieved with three antennas compared with two antennas (P < .05). Ablations were generally smaller in vivo compared with ex vivo. Conclusion The use of multiple antennas and simultaneous power delivery creates larger, more confluent ablations with greater temperatures than those created with sequential power delivery. © RSNA, 2015 PMID:26133361

  1. Microwave Ablation: Comparison of Simultaneous and Sequential Activation of Multiple Antennas in Liver Model Systems.

    PubMed

    Harari, Colin M; Magagna, Michelle; Bedoya, Mariajose; Lee, Fred T; Lubner, Meghan G; Hinshaw, J Louis; Ziemlewicz, Timothy; Brace, Christopher L

    2016-01-01

    To compare microwave ablation zones created by using sequential or simultaneous power delivery in ex vivo and in vivo liver tissue. All procedures were approved by the institutional animal care and use committee. Microwave ablations were performed in both ex vivo and in vivo liver models with a 2.45-GHz system capable of powering up to three antennas simultaneously. Two- and three-antenna arrays were evaluated in each model. Sequential and simultaneous ablations were created by delivering power (50 W ex vivo, 65 W in vivo) for 5 minutes per antenna (10 and 15 minutes total ablation time for sequential ablations, 5 minutes for simultaneous ablations). Thirty-two ablations were performed in ex vivo bovine livers (eight per group) and 28 in the livers of eight swine in vivo (seven per group). Ablation zone size and circularity metrics were determined from ablations excised postmortem. Mixed effects modeling was used to evaluate the influence of power delivery, number of antennas, and tissue type. On average, ablations created by using the simultaneous power delivery technique were larger than those with the sequential technique (P < .05). Simultaneous ablations were also more circular than sequential ablations (P = .0001). Larger and more circular ablations were achieved with three antennas compared with two antennas (P < .05). Ablations were generally smaller in vivo compared with ex vivo. The use of multiple antennas and simultaneous power delivery creates larger, more confluent ablations with greater temperatures than those created with sequential power delivery. © RSNA, 2015.

  2. Visual servoing of a laser ablation based cochleostomy

    NASA Astrophysics Data System (ADS)

    Kahrs, Lüder A.; Raczkowsky, Jörg; Werner, Martin; Knapp, Felix B.; Mehrwald, Markus; Hering, Peter; Schipper, Jörg; Klenzner, Thomas; Wörn, Heinz

    2008-03-01

    The aim of this study is a defined, visually based and camera controlled bone removal by a navigated CO II laser on the promontory of the inner ear. A precise and minimally traumatic opening procedure of the cochlea for the implantation of a cochlear implant electrode (so-called cochleostomy) is intended. Harming the membrane linings of the inner ear can result in damage of remaining organ functions (e.g. complete deafness or vertigo). A precise tissue removal by a laser-based bone ablation system is investigated. Inside the borehole the pulsed laser beam is guided automatically over the bone by using a two mirror galvanometric scanner. The ablation process is controlled by visual servoing. For the detection of the boundary layers of the inner ear the ablation area is monitored by a color camera. The acquired pictures are analyzed by image processing. The results of this analysis are used to control the process of laser ablation. This publication describes the complete system including image processing algorithms and the concept for the resulting distribution of single laser pulses. The system has been tested on human cochleae in ex-vivo studies. Further developments could lead to safe intraoperative openings of the cochlea by a robot based surgical laser instrument.

  3. Cigarette smoking causes a worse long-term outcome in persistent atrial fibrillation following catheter ablation.

    PubMed

    Cheng, Wen-Han; Lo, Li-Wei; Lin, Yenn-Jiang; Chang, Shih-Lin; Hu, Yu-Feng; Hung, Yuan; Chung, Fa-Po; Chang, Ting-Yung; Huang, Ting-Chung; Yamada, Shinya; Salim, Simon; Te, Abigail Louise D; Liao, Jo-Nan; Tuan, Ta-Chuan; Chao, Tze-Fan; Tsai, Tseng-Ying; Liu, Shin-Huei; Chen, Shih-Ann

    2018-02-09

    Cigarette smoking contributes to the development of atrial fibrosis via nicotine. The impact of smoking on ablation results in persistent atrial fibrillation (AF) is unknown. We aimed to investigate the triggers and long-term outcome between smokers and nonsmokers in the patients with persistent AF after catheter ablation. This study included 201 (177 males, 53 ± 10 years old) patients who received index catheter ablation, including pulmonary vein isolation (PVI) and complex fractionated atrial electrograms (CFAEs) ablation for persistent AF, retrospectively. Electrophysiological characteristics at the index procedure and long-term outcome were investigated to determine the differences between smokers and nonsmokers. Baseline characteristics were similar between two groups. Pulmonary vein (PV) triggers were found in all patients in the two groups. There was a higher incidence of nonpulmonary vein (NPV) triggers in smokers than in nonsmokers (61% vs. 31%, P < 0.05). There were no differences of the long-term ablation outcomes between smokers and nonsmokers in Kaplan-Meier analysis. Smokers with PV plus right atrial NPV (RA-NPV) triggers had a higher incidence of recurrence (log-rank P < 0.05) than those without RA-NPV triggers, but not in nonsmokers, after a mean follow-up of 31 ± 25 months. Smoking increases the incidence of NPV triggers in patients with persistent AF. Smokers who have RA-NPV triggers during index procedure do have a worse outcome after catheter ablation, indicating the harmful effects of nicotine to right atrium. © 2018 Wiley Periodicals, Inc.

  4. Ultrasound-ultrasound image overlay fusion improves real-time control of radiofrequency ablation margin in the treatment of hepatocellular carcinoma.

    PubMed

    Minami, Yasunori; Minami, Tomohiro; Hagiwara, Satoru; Ida, Hiroshi; Ueshima, Kazuomi; Nishida, Naoshi; Murakami, Takamichi; Kudo, Masatoshi

    2018-05-01

    To assess the clinical feasibility of US-US image overlay fusion with evaluation of the ablative margin in radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). Fifty-three patients with 68 HCCs measuring 0.9-4.0 cm who underwent RFA guided by US-US overlay image fusion were included in this retrospective study. By an overlay of pre-/postoperative US, the tumor image could be projected onto the ablative hyperechoic zone. Therefore, the ablative margin three-dimensionally could be shown during the RFA procedure. US-US image overlay was compared to dynamic CT a few days after RFA for assessment of early treatment response. Accuracy of graded response was calculated, and the performance of US-US image overlay fusion was compared with that of CT using a Kappa agreement test. Technically effective ablation was achieved in a single session, and 59 HCCs (86.8 %) succeeded in obtaining a 5-mm margin on CT. The response with US-US image overlay correctly predicted early CT evaluation with an accuracy of 92.6 % (63/68) (k = 0.67; 95 % CI: 0.39-0.95). US-US image overlay fusion can be proposed as a feasible guidance in RFA with a safety margin and predicts early response of treatment assessment with high accuracy. • US-US image overlay fusion visualizes the ablative margin during RFA procedure. • Visualizing the margin during the procedure can prompt immediate complementary treatment. • US image fusion correlates with the results of early evaluation CT.

  5. Design and Laboratory Validation of a Capacitive Sensor for Measuring the Recession of Thin-Layered Ablator

    NASA Technical Reports Server (NTRS)

    Noffz, Gregory K.; Bowman, Michael P.

    1996-01-01

    Flight vehicles are typically instrumented with subsurface thermocouples to estimate heat transfer at the surface using inverse analysis procedures. If the vehicle has an ablating heat shield, however, temperature time histories from subsurface thermocouples no longer provide enough information to estimate heat flux at the surface. In this situation, the geometry changes and thermal energy leaves the surface in the form of ablation products. The ablation rate is required to estimate heat transfer to the surface. A new concept for a capacitive sensor has been developed to measure ablator depth using the ablator's dielectric effect on a capacitor's fringe region. Relying on the capacitor's fringe region enables the gage to be flush mounted in the vehicle's permanent structure and not intrude into the ablative heat shield applied over the gage. This sensor's design allows nonintrusive measurement of the thickness of dielectric materials, in particular, the recession rates of low-temperature ablators applied in thin (0.020 to 0.060 in. (0.05 to 0.15 mm)) layers. Twenty capacitive gages with 13 different sensing element geometries were designed, fabricated, and tested. A two-dimensional finite-element analysis was performed on several candidate geometries. Calibration procedures using ablator-simulating shims are described. A one-to-one correspondence between system output and dielectric material thickness was observed out to a thickness of 0.055 in. (1.4 mm) for a material with a permittivity about three times that of air or vacuum. A novel method of monitoring the change in sensor capacitance was developed. This technical memorandum suggests further improvements in gage design and fabrication techniques.

  6. Pulmonary vein region ablation in experimental vagal atrial fibrillation: role of pulmonary veins versus autonomic ganglia.

    PubMed

    Lemola, Kristina; Chartier, Denis; Yeh, Yung-Hsin; Dubuc, Marc; Cartier, Raymond; Armour, Andrew; Ting, Michael; Sakabe, Masao; Shiroshita-Takeshita, Akiko; Comtois, Philippe; Nattel, Stanley

    2008-01-29

    Pulmonary vein (PV) -encircling radiofrequency ablation frequently is effective in vagal atrial fibrillation (AF), and there is evidence that PVs may be particularly prone to cholinergically induced arrhythmia mechanisms. However, PV ablation procedures also can affect intracardiac autonomic ganglia. The present study examined the relative role of PVs versus peri-PV autonomic ganglia in an experimental vagal AF model. Cholinergic AF was studied under carbachol infusion in coronary perfused canine left atrial PV preparations in vitro and with cervical vagal stimulation in vivo. Carbachol caused dose-dependent AF promotion in vitro, which was not affected by excision of all PVs. Sustained AF could be induced easily in all dogs during vagal nerve stimulation in vivo both before and after isolation of all PVs with encircling lesions created by a bipolar radiofrequency ablation clamp device. PV elimination had no effect on atrial effective refractory period or its responses to cholinergic stimulation. Autonomic ganglia were identified by bradycardic and/or tachycardic responses to high-frequency subthreshold local stimulation. Ablation of the autonomic ganglia overlying all PV ostia suppressed the effective refractory period-abbreviating and AF-promoting effects of cervical vagal stimulation, whereas ablation of only left- or right-sided PV ostial ganglia failed to suppress AF. Dominant-frequency analysis suggested that the success of ablation in suppressing vagal AF depended on the elimination of high-frequency driver regions. Intact PVs are not needed for maintenance of experimental cholinergic AF. Ablation of the autonomic ganglia at the base of the PVs suppresses vagal responses and may contribute to the effectiveness of PV-directed ablation procedures in vagal AF.

  7. Contact force monitoring during catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease.

    PubMed

    Krause, Ulrich; Backhoff, David; Klehs, Sophia; Schneider, Heike E; Paul, Thomas

    2016-08-01

    Monitoring of catheter contact force during catheter ablation of atrial fibrillation has been shown to increase efficacy and safety. However, almost no data exists on the use of this technology in catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease. The aim of the present study was to evaluate the impact of contact force monitoring during catheter ablation of intraatrial reentrant tachycardia in those patients. Catheter ablation of intraatrial reentrant tachycardia using monitoring of catheter contact force was performed in 28 patients with congenital heart disease (CHD). Thirty-two patients matched according to gender, age, and body weight with congenital heart disease undergoing catheter ablation without contact force monitoring served as control group. Parameters reflecting acute procedural success, long-term efficacy, and safety were compared. Acute procedural success was statistically not different in both groups (contact force 93 % vs. control 84 %, p = 0.3). Likewise the recurrence rate 1 year after ablation as shown by Kaplan-Meier analysis did not differ (contact force 28 % vs. control 37 %, p = 0.63). Major complications were restricted to groin vessel injuries and occurred in 3 out of 60 patients (contact force n = 1; control n = 2). Complications related to excessive catheter contact force were not observed. The present study did not show superiority of catheter contact force monitoring during ablation of intraatrial reentrant tachycardia in patients with CHD in terms of efficacy and safety. Higher contact force compared to pulmonary vein isolation might therefore be required to increase the efficacy of catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease.

  8. Regional Pericarditis Status Post Cardiac Ablation: A Case Report

    PubMed Central

    Orme, Joseph; Eddin, Moneer; Loli, Akil

    2014-01-01

    Context: Regional pericarditis is elusive and difficult to diagnosis. Healthcare providers should be familiar with post-cardiac ablation complications as this procedure is now widespread and frequently performed. The management of regional pericarditis differs greatly from that of acute myocardial infarction. Case report: A 52 year-old male underwent atrial fibrillation ablation and developed severe mid-sternal chest pain the following day with electrocardiographic findings suggestive of acute myocardial infarction, and underwent coronary angiography, a left ventriculogram, and 2D transthoracic echocardiogram, all of which were unremarkable without evidence of obstructive coronary disease, wall motion abnormalities, or pericardial effusions. Ultimately, the patient was diagnosed with regional pericarditis. After diagnosis, the patient's presenting symptoms resolved with treatment including nonsteroidal anti-inflammatory agents and colchicine. Conclusion: This is the first reported case study of regional pericarditis status post cardiac ablation. Electrocardiographic findings were classic for an acute myocardial infarction; however, coronary angiography and left ventriculogram demonstrated no acute coronary occlusion or ventricular wall motion abnormalities. Healthcare professionals must remember that the electrocardiographic findings in pericarditis are not always classic and that pericarditis can occur status post cardiac ablation. PMID:25317395

  9. The effect of a paraffin screen on the neutron dose at the maze door of a 15 MV linear accelerator

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Krmar, M.; Kuzmanović, A.; Nikolić, D.

    2013-08-15

    Purpose: The purpose of this study was to explore the effects of a paraffin screen located at various positions in the maze on the neutron dose equivalent at the maze door.Methods: The neutron dose equivalent was measured at the maze door of a room containing a 15 MV linear accelerator for x-ray therapy. Measurements were performed for several positions of the paraffin screen covering only 27.5% of the cross-sectional area of the maze. The neutron dose equivalent was also measured at all screen positions. Two simple models of the neutron source were considered in which the first assumed that themore » source was the cross-sectional area at the inner entrance of the maze, radiating neutrons in an isotropic manner. In the second model the reduction in the neutron dose equivalent at the maze door due to the paraffin screen was considered to be a function of the mean values of the neutron fluence and energy at the screen.Results: The results of this study indicate that the equivalent dose at the maze door was reduced by a factor of 3 through the use of a paraffin screen that was placed inside the maze. It was also determined that the contributions to the dosage from areas that were not covered by the paraffin screen as viewed from the dosimeter, were 2.5 times higher than the contributions from the covered areas. This study also concluded that the contributions of the maze walls, ceiling, and floor to the total neutron dose equivalent were an order of magnitude lower than those from the surface at the far end of the maze.Conclusions: This study demonstrated that a paraffin screen could be used to reduce the neutron dose equivalent at the maze door by a factor of 3. This paper also found that the reduction of the neutron dose equivalent was a linear function of the area covered by the maze screen and that the decrease in the dose at the maze door could be modeled as an exponential function of the product φ·E at the screen.« less

  10. A meta-analysis of manual versus remote magnetic navigation for ventricular tachycardia ablation.

    PubMed

    Turagam, Mohit K; Atkins, Donita; Tung, Roderick; Mansour, Moussa; Ruskin, Jeremy; Cheng, Jie; Di Biase, Luigi; Natale, Andrea; Lakkireddy, Dhanunjaya

    2017-09-01

    There are limited studies on the safety and efficacy of remote magnetic navigation (RMN) versus manual navigation (MAN) in ventricular tachycardia (VT) ablation. A comprehensive literature search was performed using the keywords VT ablation, stereotaxis, RMN and MAN in Pubmed, Ebsco, Web of Science, Cochrane, and Google scholar databases. The analysis included seven studies (one randomized, three prospective observational, and three retrospective) including 779 patients [both structural heart disease (SHD) and idiopathic VT] comparing RMN (N = 433) and MAN (N = 339) in VT ablation. The primary end point of long-term VT recurrence was significantly lower with RMN (OR 0.61, 95% CI 0.44-0.85, p = 0.003) compared with MAN. Other end points of acute procedural success (OR 2.13, 95% CI 1.40-3.23, p = 0.0004) was significantly higher with RMN compared with MAN. Fluoroscopy [mean difference -10.42, 95% CI -12.7 to -8.1, p < 0.0001], procedural time [mean difference -9.79, 95% CI -19.27 to -0.3, p = 0.04] and complications (OR 0.35, 95% CI 0.17-0.74, p = 0.0006) were also significantly lower in RMN when compared with MAN. In a subgroup analysis SHD, there was no significant difference in VT recurrence or acute procedural success with RMN vs. MAN. In idiopathic VT, RMN significantly increased acute procedural success with no difference in VT recurrence. The results demonstrate that RMN is safe and effective when compared with MAN in patients with both SHD and idiopathic VT undergoing catheter ablation. Further prospective studies are needed to further verify the safety and efficacy of RMN.

  11. Software-assisted post-interventional assessment of radiofrequency ablation

    NASA Astrophysics Data System (ADS)

    Rieder, Christian; Geisler, Benjamin; Bruners, Philipp; Isfort, Peter; Na, Hong-Sik; Mahnken, Andreas H.; Hahn, Horst K.

    2014-03-01

    Radiofrequency ablation (RFA) is becoming a standard procedure for minimally invasive tumor treatment in clinical practice. Due to its common technical procedure, low complication rate, and low cost, RFA has become an alternative to surgical resection in the liver. To evaluate the therapy success of RFA, thorough follow-up imaging is essential. Conventionally, shape, size, and position of tumor and coagulation are visually compared in a side-by-side manner using pre- and post-interventional images. To objectify the verification of the treatment success, a novel software assistant allowing for fast and accurate comparison of tumor and coagulation is proposed. In this work, the clinical value of the proposed assessment software is evaluated. In a retrospective clinical study, 39 cases of hepatic tumor ablation are evaluated using the prototype software and conventional image comparison by four radiologists with different levels of experience. The cases are randomized and evaluated in two sessions to avoid any recall-bias. Self-confidence of correct diagnosis (local recurrence vs. no local recurrence) on a six-point scale is given for each case by the radiologists. Sensitivity, specificity, positive and negative predictive values as well as receiver operating curves are calculated for both methods. It is shown that the software-assisted method allows physicians to correctly identify local tumor recurrence with a higher percentage than the conventional method (sensitivity: 0.6 vs. 0.35), whereas the percentage of correctly identified successful ablations is slightly reduced (specificity: 0.83 vs. 0.89).

  12. Improvements of deep vein reflux following radiofrequency ablation for saphenous vein incompetence.

    PubMed

    Kim, Suh Min; Jung, In Mok; Chung, Jung Kee

    2017-02-01

    Objectives The aim of this study was to describe the changes of deep vein reflux after radiofrequency ablation for great saphenous vein incompetence. Method The data on 139 limbs which were treated with radiofrequency ablation for great saphenous vein incompetence were prospectively collected and reviewed. Results Deep vein reflux was present in 43 of 139 limbs (30.9%). There were no significant differences in the rate of successful closure, the incidence of procedure-related complications, and the improvements of symptoms and quality of life between the limbs with or without deep vein reflux. With a mean follow-up of 5.9 months, the peak reflux velocity and duration of reflux were improved in all limbs with deep vein reflux and it was completely corrected in 13 limbs (30.2%) after radiofrequency ablation. Conclusions The presence of deep vein reflux does not affect the treatment outcomes of radiofrequency ablation for great saphenous vein incompetence and is improved in all patients. Deep vein reflux is not a barrier to performing radiofrequency ablation.

  13. Robotically assisted ablation produces more rapid and greater signal attenuation than manual ablation.

    PubMed

    Koa-Wing, Michael; Kojodjojo, Pipin; Malcolme-Lawes, Louisa C; Salukhe, Tushar V; Linton, Nick W F; Grogan, Aaron P; Bergman, Dale; Lim, Phang Boon; Whinnett, Zachary I; McCarthy, Karen; Ho, Siew Yen; O'Neill, Mark D; Peters, Nicholas S; Davies, D Wyn; Kanagaratnam, Prapa

    2009-12-01

    Robotic remote catheter ablation potentially provides improved catheter-tip stability, which should improve the efficiency of radiofrequency energy delivery. Percentage reduction in electrogram peak-to-peak voltage has been used as a measure of effectiveness of ablation. We tested the hypothesis that improved catheter-tip stability of robotic ablation can diminish signals to a greater degree than manual ablation. In vivo NavX maps of 7 pig atria were constructed. Separate lines of ablation were performed robotically and manually, recording pre- and postablation peak-to-peak voltages at 10, 20, 30, and 60 seconds and calculating signal amplitude reduction. Catheter ablation settings were constant (25W, 50 degrees , 17 mL/min, 20-30 g catheter tip pressure). The pigs were sacrificed and ablation lesions correlated with NavX maps. Robotic ablation reduced signal amplitude to a greater degree than manual ablation (49 +/- 2.6% vs 29 +/- 4.5% signal reduction after 1 minute [P = 0.0002]). The mean energy delivered (223 +/- 184 J vs 231 +/- 190 J, P = 0.42), power (19 +/- 3.5 W vs 19 +/- 4 W, P = 0.84), and duration of ablation (15 +/- 9 seconds vs 15 +/- 9 seconds, P = 0.89) was the same for manual and robotic. The mean peak catheter-tip temperature was higher for robotic (45 +/- 5 degrees C vs 42 +/- 3 degrees C [P < 0.0001]). The incidence of >50% signal reduction was greater for robotic (37%) than manual (21%) ablation (P = 0.0001). Robotically assisted ablation appears to be more effective than manual ablation at signal amplitude reduction, therefore may be expected to produce improved clinical outcomes.

  14. Microjet-assisted dye-enhanced diode laser ablation of cartilaginous tissue

    NASA Astrophysics Data System (ADS)

    Pohl, John; Bell, Brent A.; Motamedi, Massoud; Frederickson, Chris J.; Wallace, David B.; Hayes, Donald J.; Cowan, Daniel

    1994-08-01

    Recent studies have established clinical application of laser ablation of cartilaginous tissue. The goal of this study was to investigate removal of cartilaginous tissue using diode laser. To enhance the interaction of laser light with tissue, improve the ablation efficiency and localize the extent of laser-induced thermal damage in surrounding tissue, we studied the use of a novel delivery system developed by MicroFab Technologies to dispense a known amount of Indocyanine Green (ICG) with a high spatial resolution to alter the optical properties of the tissue in a controlled fashion. Canine intervertebral disks were harvested and used within eight hours after collection. One hundred forty nL of ICG was topically applied to both annulus and nucleus at the desired location with the MicroJet prior to each irradiation. Fiber catheters (600 micrometers ) were used and positioned to irradiate the tissue with a 0.8 mm spot size. Laser powers of 3 - 10 W (Diomed, 810 nm) were used to irradiate the tissue with ten pulses (200 - 500 msec). Discs not stained with ICG were irradiated as control samples. Efficient tissue ablation (80 - 300 micrometers /pulse) was observed using ICG to enhance light absorption and confine thermal damage while there was no observable ablation in control studied. The extent of tissue damage observed microscopically was limited to 50 - 100 micrometers . The diode laser/Microjet combination showed promise for applications involving removal of cartilaginous tissue. This procedure can be performed using a low power compact diode laser, is efficient, and potentially more economical compared to procedures using conventional lasers.

  15. Increased preference of surface ablation over laser in situ keratomileusis between 2008–2011 is correlated to risk of ecatasia

    PubMed Central

    Moisseiev, Elad; Sela, Tzahi; Minkev, Liza; Varssano, David

    2013-01-01

    Purpose To evaluate the trends in corneal refractive procedure selection for the correction of myopia, focusing on the relative proportions of laser in situ keratomileusis (LASIK) and surface ablation procedures. Methods Only eyes that underwent LASIK or surface ablation for the correction of myopia between 2008–2011 were included in this retrospective study. Additional recorded parameters included patient age, preoperative manifest refraction, corneal thickness, and calculated residual corneal bed thickness. A risk score was given to each eye, based on these parameters, according to the Ectasia Risk Factor Score System (ERFSS), without the preoperative corneal topography. Results This study included 16,163 eyes, of which 38.4% underwent LASIK and 61.6% underwent surface ablation. The risk score correlated with procedure selection, with LASIK being preferred in eyes with a score of 0 and surface ablation in eyes with a score of 2 or higher. When controlling for age, preoperative manifest refraction, corneal thickness, and all parameters, the relative proportion of surface ablation compared with LASIK was found to have grown significantly during the study period. Conclusions Our results indicate that with time, surface ablation tended to be performed more often than LASIK for the correction of myopia in our cohort. Increased awareness of risk factors and preoperative risk assessment tools, such as the ERFSS, have shifted the current practice of refractive surgery from LASIK towards surface ablation despite the former’s advantages, especially in cases in which the risk for ectasia is more than minimal (risk score 2 and higher). PMID:23345963

  16. Ablation of post-surgical intra-atrial reentrant tachycardia. Predilection target sites and mapping approach.

    PubMed

    Anné, W; van Rensburg, H; Adams, J; Ector, H; Van de Werf, F; Heidbüchel, H

    2002-10-01

    Atrial arrhythmias are a frequent complication of atrial surgery. The location of these tachycardias is very diverse due to the individual difference in the original anatomy, surgical corrections, and effects of atrial fibrosis. Nevertheless some recurrent patterns are emerging. Forty-five patients underwent 51 ablation procedures between September 1995 and March 2001 using conventional mapping and temperature-controlled ablation. A duadecapolar catheter was swept from anterior to posterior in the right (and/or left) atrium, allowing for rapid mapping followed by entrainment confirmation. Twenty-eight patients had corrected congenital heart disease, 17 surgery for acquired heart disease. One hundred and sixteen arrhythmias were found, 86 circuits were targeted, 81 with success (94%). Despite the heterogeneous anatomy, the same targets were often encountered: the posterior isthmus between the inferior vena cava and the tricuspid ring (62%), the gap between the inferior vena cava and the atriotomy scar (49%), and the region around the atriopulmonary connection in Fontans (two out of four patients). After a mean follow-up of 24 months, 13 patients had a recurrent arrhythmia (29%) after their last procedure. There was a significant association between the number of circuits found during the initial procedure and the likelihood of recurrent arrhythmias. Knowledge of anatomical predilection sites and mapping the right (and/or left) atrium with a 'sweeping Halo technique' allow for effective ablation of most post-surgical atrial tachycardias. Severely damaged atria with multiple arrhythmias may require 'preventive' ablation of all recognizable channels.

  17. Endometrial ablation in the management of abnormal uterine bleeding.

    PubMed

    Laberge, Philippe; Leyland, Nicholas; Murji, Ally; Fortin, Claude; Martyn, Paul; Vilos, George; Leyland, Nicholas; Wolfman, Wendy; Allaire, Catherine; Awadalla, Alaa; Dunn, Sheila; Heywood, Mark; Lemyre, Madeleine; Marcoux, Violaine; Potestio, Frank; Rittenberg, David; Singh, Sukhbir; Yeung, Grace

    2015-04-01

    , preoperative and postoperative care, operative set-up, anaesthesia, and practical considerations for practice. Implementation of the guideline recommendations will improve the provision of EA as an effective treatment of AUB. Following these recommendations would allow the surgical procedure to be performed safely and maximize success for patients. EA is a safe and effective minimally invasive option for the treatment of AUB of benign etiology. Summary Statements 1. Endometrial ablation is a safe and effective minimally invasive surgical procedure that has become a well-established alternative to medical treatment or hysterectomy to treat abnormal uterine bleeding in select cases. (I) 2. Endometrial preparation can be used to facilitate resectoscopic endometrial ablation (EA) and can be considered for some non-resectoscopic techniques. For resectoscopic EA, preoperative endometrial thinning results in higher short-term amenorrhea rates, decreased irrigant fluid absorption, and shorter operative time than no treatment. (I) 3. Non-resectoscopic techniques are technically easier to perform than resectoscopic techniques, have shorter operative times, and allow the use of local rather than general anaesthesia. However, both techniques have comparable patient satisfaction and reduction of heavy menstrual bleeding. (I) 4. Both resectoscopic and non-resectoscopic endometrial ablation (EA) have low complication rates. Uterine perforation, fluid overload, hematometra, and cervical lacerations are more common with resectoscopic EA; perioperative nausea/vomiting, uterine cramping, and pain are more common with non-resectoscopic EA. (I) 5. All non-resectoscopic endometrial ablation devices available in Canada have demonstrated effectiveness in decreasing menstrual flow and result in high patient satisfaction. The choice of which device to use depends primarily on surgical judgement and the availability of resources. (I) 6. The use of local anaesthetic and blocks, oral analgesia, and

  18. Long-wave plasma radiofrequency ablation for treatment of xanthelasma palpebrarum.

    PubMed

    Baroni, Adone

    2018-03-01

    Xanthelasma palpebrarum is the most common type of xanthoma affecting the eyelids. It is characterized by asymptomatic soft yellowish macules, papules, or plaques over the upper and lower eyelids. Many treatments are available for management of xanthelasma palpebrarum, the most commonly used include surgical excision, ablative CO 2 or erbium lasers, nonablative Q-switched Nd:YAG laser, trichloroacetic acid peeling, and radiofrequency ablation. This study aims to evaluate the effectiveness of RF ablation in the treatment of xanthelasma palpebrarum, with D.A.S. Medical portable device (Technolux, Italia), a radiofrequency tool working with long-wave plasma energy and without anesthesia. Twenty patients, 15 female and 5 male, affected by xanthelasma palpebrarum, were enrolled for long-wave plasma radiofrequency ablation treatment. The treatment consisted of 3/4 sessions that were carried out at intervals of 30 days. Treatments were well tolerated by all patients with no adverse effects and optimal aesthetic results. The procedure is very fast and can be performed without anesthesia because of the low and tolerable pain stimulation. Long-wave plasma radiofrequency ablation is an effective option for treatment of xanthelasma palpebrarum and adds an additional tool to the increasing list of medical devices for aesthetic treatments. © 2018 Wiley Periodicals, Inc.

  19. [Catheter ablation in patients with refractory cardiac arrhythmias with radiofrequency techniques].

    PubMed

    de Paola, A A; Balbão, C E; Silva Netto, O; Mendonça, A; Villacorta, H; Vattimo, A C; Souza, I A; Guiguer Júnior, N; Portugal, O P; Martinez Filho, E E

    1993-02-01

    evaluate the efficacy of radiofrequency catheter ablation in patients with refractory cardiac arrhythmias. twenty patients with refractory cardiac arrhythmias were undertaken to electrophysiologic studies for diagnosis and radiofrequency catheter ablation of their reentrant arrhythmias. Ten patients were men and 10 women with ages varying from 13 to 76 years (mean = 42.4 years). Nineteen patients had supraventricular tachyarrhythmias: One patient had atrial tachycardia and 1 atrial fibrillation with rapid ventricular rate, 5 patients had reentrant nodal tachycardia, 12 patients had reentrant atrioventricular tachycardia and 1 patient had right ventricular outflow tract tachycardia. the mean time of the procedure was 4.1 hours. The radiofrequency current energy applied was 40-50 V for 30-40 seconds. Ablation was successful in 18/20 (90%) patients; in 15/18 (83%) of successfully treated patients the same study was done for diagnosis and radiofrequency ablation. One patient had femoral arterial occlusion and was treated with no significant sequelae. During a mean follow-up of 4 months no preexcitation or reentrant tachycardia occurred. the results of our experience with radiofrequency catheter ablation of cardiac arrhythmias suggest that this technique can benefit an important number of patients with cardiac arrhythmias.

  20. Accessory atrioventricular pathways refractory to catheter ablation: role of percutaneous epicardial approach.

    PubMed

    Scanavacca, Maurício Ibrahim; Sternick, Eduardo Back; Pisani, Cristiano; Lara, Sissy; Hardy, Carina; d'Ávila, André; Correa, Frederico Soares; Darrieux, Francisco; Hachul, Denise; Marcial, Miguel Barbero; Sosa, Eduardo A

    2015-02-01

    Epicardial mapping and ablation of accessory pathways through a subxiphoid approach can be an alternative when endocardial or epicardial transvenous mapping has failed. We reviewed acute and long-term follow-up of 21 patients (14 males) referred for percutaneous epicardial accessory pathway ablation. There was a median of 2 previous failed procedures. All patients were highly symptomatic, 8 had atrial fibrillation (3 with cardiac arrest) and 13 had frequent symptomatic episodes of atrioventricular reentrant tachycardia. Six patients (28.5%) had a successful epicardial ablation. Five patients (23.8%) underwent a successful repeated endocardial mapping, and ablation after epicardial mapping yielded no early activation site. Epicardial mapping was helpful in guiding endocardial ablation in 2 patients (9.5%), showing that the earliest activation was simultaneous at the epicardium and endocardium. Four patients (19%) underwent successful open-chest surgery after failing epicardial/endocardial ablation. Two patients (9.5%) remained controlled under antiarrhythmic drugs after unsuccessful endocardial/epicardial ablation. Two patients had a coronary sinus diverticulum and one a right atrium to right ventricle diverticulum. Three patients acquired postablation coronary sinus stenosis. There was no major complication related to pericardial access. Percutaneous epicardial approach is an alternative when conventional endocardial or transvenous epicardial ablation fails in the elimination of the accessory pathway. A new attempt by endocardial approach was successful in a significant number of patients. Open-chest surgery may be required in symptomatic cases refractory to endocardial-epicardial approach. © 2014 American Heart Association, Inc.

  1. Ablation enhancement of silicon by ultrashort double-pulse laser ablation

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Zhao, Xin; Shin, Yung C.

    In this study, the ultrashort double-pulse ablation of silicon is investigated. An atomistic simulation model is developed to analyze the underlying physics. It is revealed that the double-pulse ablation could significantly increase the ablation rate of silicon, compared with the single pulse ablation with the same total pulse energy, which is totally different from the case of metals. In the long pulse delay range (over 1 ps), the enhancement is caused by the metallic transition of melted silicon with the corresponding absorption efficiency. At ultrashort pulse delay (below 1 ps), the enhancement is due to the electron excitation by the first pulse.more » The enhancement only occurs at low and moderate laser fluence. The ablation is suppressed at high fluence due to the strong plasma shielding effect.« less

  2. Endovascular Radiofrequency Ablation for Varicose Veins

    PubMed Central

    2011-01-01

    treatment plan. The RFA procedure involves the introduction of a guide wire into the target vein under ultrasound guidance followed by the insertion of an introducer sheath through which the RFA catheter is advanced. Once satisfactory positioning has been confirmed with ultrasound, a tumescent anaesthetic solution is injected into the soft tissue surrounding the target vein along its entire length. This serves to anaesthetize the vein, insulate the heat from damaging adjacent structures, including nerves and skin and compresses the vein increasing optimal contact of the vessel wall with the electrodes or expanded prongs of the RF device. The RF generator is then activated and the catheter is slowly pulled along the length of the vein. At the end of the procedure, hemostasis is then achieved by applying pressure to the vein entry point. Adequate and proper compression stockings and bandages are applied after the procedure to reduce the risk of venous thromboembolism and to reduce postoperative bruising and tenderness. Patients are encouraged to walk immediately after the procedure. Follow-up protocols vary, with most patients returning 1 to 3 weeks later for an initial follow-up visit. At this point, the initial clinical result is assessed and occlusion of the treated vessels is confirmed with ultrasound. Patients often have a second follow-up visit 1 to 3 months following RFA at which time clinical evaluation and ultrasound are repeated. If required, additional procedures such as phlebectomy or sclerotherapy may be performed during the RFA procedure or at any follow-up visits. Regulatory Status The Closure System® radiofrequency generator for endovascular thermal ablation of varicose veins was approved by Health Canada as a class 3 device in March 2005, registered under medical device license 67865. The RFA intravascular catheter was approved by Health Canada in November 2007 for the ClosureFast catheter, registered under medical device license 16574. The Closure System

  3. Recovery of atrial transport function after a maze procedure for atrial fibrillation in conversion of a failing Fontan circulation

    PubMed Central

    Bogers, A.J.J.C.; Kik, Ch.; de Jong, P.L.; Meijboom, F.J.

    2008-01-01

    Surgical ablation for atrial arrhythmias at conversion of atriopulmonary or ventriculopulmonary Fontan to a total cavopulmonary connection is feasible with recovery of both sinus rhythm and atrial transport function. Recovery of the patient’s physical condition may take up to a year. (Neth Heart J 2008;16:170-2.18566699) PMID:18566699

  4. A novel technique for orchiectomy and scrotal ablation in the sugar glider (Petaurus breviceps).

    PubMed

    Morges, Michelle A; Grant, Krystan R; MacPhail, Catriona M; Johnston, Matthew S

    2009-03-01

    In this report, we describe a simple, safe, and efficacious technique for orchiectomy and scrotal ablation with the use of a carbon dioxide light amplification by stimulated emission of radiation (laser) in sugar gliders (Petaurus breviceps). The study population included nine sugar gliders, ages 2-24 mo, presented for orchiectomy. After induction of general anesthesia, orchiectomy and scrotal ablation were performed by severing the scrotal stalk with the laser. All sugar gliders were discharged the same day. Mean anesthesia time was 6.09 +/- 0.94 min. Mean surgery time was 15.11 +/- 8.39 sec, and mean recovery time was 4.11 +/- 3.60 min. With an outlier removed, mean recovery time was 2.95 +/- 1.03 min. No serious postoperative surgical complications were observed. The technique described is a simple procedure with rapid surgical and recovery times that has the potential to become the standard procedure for orchiectomy and scrotal ablation in sugar gliders.

  5. Noninvasive microwave ablation zone radii estimation using x-ray CT image analysis.

    PubMed

    Weiss, Noam; Goldberg, S Nahum; Nissenbaum, Yitzhak; Sosna, Jacob; Azhari, Haim

    2016-08-01

    The aims of this study were to noninvasively and automatically estimate both the radius of the ablated liver tissue and the radius encircling the treated zone, which also defines where the tissue is definitely untreated during a microwave (MW) thermal ablation procedure. Fourteen ex vivo bovine fresh liver specimens were ablated at 40 W using a 14 G microwave antenna, for durations of 3, 6, 8, and 10 min. The tissues were scanned every 5 s during the ablation using an x-ray CT scanner. In order to estimate the radius of the ablation zone, the acquired images were transformed into a polar presentation by displaying the Hounsfield units (HU) as a function of angle and radius. From this polar presentation, the average HU radial profile was analyzed at each time point and the ablation zone radius was estimated. In addition, textural analysis was applied to the original CT images. The proposed algorithm identified high entropy regions and estimated the treated zone radius per time. The estimated ablated zone radii as a function of treatment durations were compared, by means of correlation coefficient and root mean square error (RMSE) to gross pathology measurements taken immediately post-treatment from similarly ablated tissue. Both the estimated ablation radii and the treated zone radii demonstrated strong correlation with the measured gross pathology values (R(2) ≥ 0.89 and R(2) ≥ 0.86, respectively). The automated ablation radii estimation had an average discrepancy of less than 1 mm (RMSE = 0.65 mm) from the gross pathology measured values, while the treated zone radii showed a slight overestimation of approximately 1.5 mm (RMSE = 1.6 mm). Noninvasive monitoring of MW ablation using x-ray CT and image analysis is feasible. Automatic estimations of the ablation zone radius and the radius encompassing the treated zone that highly correlate with actual ablation measured values can be obtained. This technique can therefore potentially be used to obtain real time

  6. Local ablative treatments for hepatocellular carcinoma: An updated review

    PubMed Central

    Facciorusso, Antonio; Serviddio, Gaetano; Muscatiello, Nicola

    2016-01-01

    Ablative treatments currently represent the first-line option for the treatment of early stage unresectable hepatocellular carcinoma (HCC). Furthermore, they are effective as bridging/downstaging therapies before orthotopic liver transplantation. Contraindications based on size, number, and location of nodules are quite variable in literature and strictly dependent on local expertise. Among ablative therapies, radiofrequency ablation (RFA) has gained a pivotal role due to its efficacy, with a reported 5-year survival rate of 40%-70%, and safety. Although survival outcomes are similar to percutaneous ethanol injection, the lower local recurrence rate stands for a wider application of RFA in hepato-oncology. Moreover, RFA seems to be even more cost-effective than liver resection for very early HCC (single nodule ≤ 2 cm) and in the presence of two or three nodules ≤ 3 cm. There is increasing evidence that combining RFA to transarterial chemoembolization may increase the therapeutic benefit in larger HCCs without increasing the major complication rate, but more robust prospective data is still needed to validate these pivotal findings. Among other thermal treatments, microwave ablation (MWA) uses high frequency electromagnetic energy to induce tissue death via coagulation necrosis. In comparison to RFA, MWA has several theoretical advantages such as a broader zone of active heating, higher temperatures within the targeted area in a shorter treatment time and the lack of heat-sink effect. The safety concerns raised on the risks of this procedure, due to the broader and less predictable necrosis areas, have been recently overcome. However, whether MWA ability to generate a larger ablation zone will translate into a survival gain remains unknown. Other treatments, such as high-intensity focused ultrasound ablation, laser ablation, and cryoablation, are less investigated but showed promising results in early HCC patients and could be a valuable therapeutic option in

  7. Endometrial Ablation

    MedlinePlus

    ... or lighter levels. If ablation does not control heavy bleeding, further treatment or surgery may be needed. ... ablation is used to treat many causes of heavy bleeding. In most cases, women with heavy bleeding ...

  8. Local ablation therapy with contrast-enhanced ultrasonography for hepatocellular carcinoma: a practical review

    PubMed Central

    Kim, Tae Kyoung; Khalili, Korosh; Jang, Hyun-Jung

    2015-01-01

    A successful program for local ablation therapy for hepatocellular carcinoma (HCC) requires extensive imaging support for diagnosis and localization of HCC, imaging guidance for the ablation procedures, and post-treatment monitoring. Contrast-enhanced ultrasonography (CEUS) has several advantages over computed tomography/magnetic resonance imaging (CT/MRI), including real-time imaging capability, sensitive detection of arterial-phase hypervascularity and washout, no renal excretion, no ionizing radiation, repeatability, excellent patient compliance, and relatively low cost. CEUS is useful for image guidance for isoechoic lesions. While contrast-enhanced CT/MRI is the standard method for the diagnosis of HCC and post-ablation monitoring, CEUS is useful when CT/MRI findings are indeterminate or CT/MRI is contraindicated. This article provides a practical review of the role of CEUS in imaging algorithms for pre- and post-ablation therapy for HCC. PMID:26169081

  9. A multimodality imaging-compatible insertion robot with a respiratory motion calibration module designed for ablation of liver tumors: a preclinical study.

    PubMed

    Li, Dongrui; Cheng, Zhigang; Chen, Gang; Liu, Fangyi; Wu, Wenbo; Yu, Jie; Gu, Ying; Liu, Fengyong; Ren, Chao; Liang, Ping

    2018-04-03

    To test the accuracy and efficacy of the multimodality imaging-compatible insertion robot with a respiratory motion calibration module designed for ablation of liver tumors in phantom and animal models. To evaluate and compare the influences of intervention experience on robot-assisted and ultrasound-controlled ablation procedures. Accuracy tests on rigid body/phantom model with a respiratory movement simulation device and microwave ablation tests on porcine liver tumor/rabbit liver cancer were performed with the robot we designed or with the traditional ultrasound-guidance by physicians with or without intervention experience. In the accuracy tests performed by the physicians without intervention experience, the insertion accuracy and efficiency of robot-assisted group was higher than those of ultrasound-guided group with statistically significant differences. In the microwave ablation tests performed by the physicians without intervention experience, better complete ablation rate was achieved when applying the robot. In the microwave ablation tests performed by the physicians with intervention experience, there was no statistically significant difference of the insertion number and total ablation time between the robot-assisted group and the ultrasound-controlled group. The evaluation by the NASA-TLX suggested that the robot-assisted insertion and microwave ablation process performed by physicians with or without experience were more comfortable. The multimodality imaging-compatible insertion robot with a respiratory motion calibration module designed for ablation of liver tumors could increase the insertion accuracy and ablation efficacy, and minimize the influence of the physicians' experience. The ablation procedure could be more comfortable with less stress with the application of the robot.

  10. Microwave thermal ablation of spinal metastatic bone tumors.

    PubMed

    Kastler, Adrian; Alnassan, Hussein; Aubry, Sébastien; Kastler, Bruno

    2014-09-01

    To assess feasibility, safety, and efficacy of microwave ablation of spinal metastatic bone tumors. Retrospective study of 17 patients with 20 spinal metastatic tumors treated with microwave ablation under computed tomographic guidance between March 2011 and August 2013 was performed. Ablations were performed under local anesthesia and nitrous oxide ventilation. Lesions were lumbar (n = 10), sacral (n = 7), and thoracic (n = 3) in location. Primary neoplastic sites were lung (n = 9), prostate (n = 4), kidney (n = 6), and uterus (n = 1). Adjunct cementoplasty was performed in nine cases, and a temperature-monitoring device was used in four cases. Procedure effectiveness was evaluated by visual analog scale (VAS) during a 6-month follow-up. Patient medical records were reviewed, and demographic and clinical data, tumor characteristics, and information on pain were assessed. Mean ablation time was 4.4 minutes ± 2.7 (range, 1-8 min), with an average of 3.8 cycles per ablation at 60 W (range, 30-70 W). The preprocedure mean VAS score was 7.4 ± 1.2 (range, 6-9). Pain relief was achieved in all but one patient. Follow-up VAS scores were as follows: day 0, 1.3 ± 1.8 (P < .001); day 7, 1.6 ± 1.7 (P < .001); month 1, 1.9 ± 1.6 (P < .001); month 3, 2.2 ± 1.5 (P < .001); and month 6, 2.3 ± 1.4 (P < .01). No complications were noted. Microwave ablation appears to be feasible, safe, and an effective treatment of painful refractory spinal metastases and may be considered as a potential alternative percutaneous technique in the management of spinal metastases. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

  11. Development of locomotor activity of rat pups in figure-eight mazes.

    PubMed

    Ruppert, P H; Dean, K F; Reiter, L W

    1985-05-01

    In a series of four experiments, social and experiential factors that influence the development of motor activity in rat pups were examined. Motor activity was monitored from postnatal Days 13 to 21 as photocell interruptions in figure-eight mazes and comparisons were made between pups maintained in a nest box containing a dam and siblings and allowed access to the maze for 23 hr/day, pups tested daily for 1 hr/day vs pups tested only on postnatal Days 15, 18, or 21, pups tested daily for either 5 min, 30 min, or 1 hr/day, and pups tested daily for 30 min/day either singly in a maze, paired with a littermate, or paired with an anesthetized pup of the same age. A monotonic increase in activity was seen for nest-box testing, minimal developmental change was seen for pups tested on only a single day or for pups tested with an anesthetized pup, whereas all other groups showed an inverted U-shaped profile of activity which was influenced by the duration of testing and/or the presence of a littermate. These data emphasize the relevance of environmental factors as determinants of preweaning behavior.

  12. High-frequency microwave ablation method for enhanced cancer treatment with minimized collateral damage.

    PubMed

    Yoon, Jeonghoon; Cho, Jeiwon; Kim, Namgon; Kim, Dae-Duk; Lee, Eunsook; Cheon, Changyul; Kwon, Youngwoo

    2011-10-15

    To overcome the limits of conventional microwave ablation, a new frequency spectrum above 6 GHz has been explored for low-power and low collateral damage ablation procedure. A planar coaxial probe-based applicator, suitable for easy insertion into the human body, was developed for our study to cover a wideband frequency up to 30 GHz. Thermal ablations with small input power (1-3 W) at various microwave frequencies were performed on nude mice xenografted with human breast cancer. Comparative study of ablation efficiencies revealed that 18-GHz microwave results in the largest difference in the temperature rise between cancer and normal tissues as well as the highest ablation efficiency, reaching 20 times that of 2 GHz. Thermal profile study on the composite region of cancer and fat also showed significantly reduced collateral damage using 18 GHz. Application of low-power (1 W) 18-GHz microwave on the nude mice xenografted with human breast cancer cells resulted in recurrence-free treatment. The proposed microwave ablation method can be a very effective process to treat small-sized tumor with minimized invasiveness and collateral damages. Copyright © 2010 UICC.

  13. Impact of Tricuspid Regurgitation on the Success of Atrioventricular Node Ablation for Rate Control in Patients With Atrial Fibrillation: The Node Blast Study.

    PubMed

    Reddy, Yeruva Madhu; Gunda, Sampath; Vallakati, Ajay; Kanmanthareddy, Arun; Pillarisetti, Jayasree; Atkins, Donita; Bommana, Sudharani; Emert, Martin P; Pimentel, Rhea; Dendi, Raghuveer; Berenbom, Loren D; Lakkireddy, Dhanunjaya

    2015-09-15

    Atrioventricular node (AVN) ablation is an effective treatment for symptomatic patients with atrial arrhythmias who are refractory to rhythm and rate control strategies where optimal ventricular rate control is desired. There are limited data on the predictors of failure of AVN ablation. Our objective was to identify the predictors of failure of AVN ablation. This is an observational single-center study of consecutive patients who underwent AVN ablation in a large academic center. Baseline characteristics, procedural variables, and outcomes of AVN ablation were collected. AVN "ablation failure" was defined as resumption of AVN conduction resulting in recurrence of either rapid ventricular response or suboptimal biventricular pacing. A total of 247 patients drug refractory AF who underwent AVN ablation at our center with a mean age of 71 ± 12 years with 46% being males were included. Ablation failure was seen in 11 (4.5%) patients. There were no statistical differences between patients with "ablation failure" versus "ablation success" in any of the baseline clinical variables. Patients with moderate-to-severe tricuspid regurgitation (TR) were much more likely to have ablation failure than those with ablation success (8 [73%] vs 65 [27%]; p = 0.003). All 11 patients with ablation failure had a successful redo procedure, 9 with right and 2 with the left sided approach. On multivariate analysis, presence of moderate-to-severe TR was found to be the only predictor of failure of AVN ablation (odds ratio 9.1, confidence interval 1.99 to 42.22, p = 0.004). In conclusion, moderate-to-severe TR is a strong and independent predictor of failure of AVN ablation. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Remote magnetic navigation for mapping and ablating right ventricular outflow tract tachycardia.

    PubMed

    Thornton, Andrew S; Jordaens, Luc J

    2006-06-01

    Navigation, mapping, and ablation in the right ventricular outflow tract (RVOT) can be difficult. Catheter navigation using external magnetic fields may allow more accurate mapping and ablation. The purpose of this study was to assess the feasibility of RVOT tachycardia ablation using remote magnetic navigation. Mapping and ablation were performed in eight patients with outflow tract ventricular arrhythmias. Tachycardia mapping was undertaken with a 64-polar basket catheter, followed by remote activation and pace-mapping using a magnetically enabled catheter. The area of interest was localized on the basket catheter in seven patients in whom an RVOT arrhythmia was identified. Remote navigation of the magnetic catheter to this area was followed by pace-mapping. Ablation was performed at the site of perfect pace-mapping, with earliest activation if possible. Acute success was achieved in all patients (median four applications). Median procedural time was 144 minutes, with 13.4 minutes of patient fluoroscopy time and 3.8 minutes of physician fluoroscopy time. No complications occurred. One recurrence occurred during follow-up (mean 366 days). RVOT tachycardias can be mapped and ablated using remote magnetic navigation, initially guided by a basket catheter. Precise activation and pace-mapping are possible. Remote magnetic navigation permitted low fluoroscopy exposure for the physician. Long-term results are promising.

  15. Limitations of dormant conduction as a predictor of atrial fibrillation recurrence and pulmonary vein reconnection after catheter ablation.

    PubMed

    Lin, Frank S; Ip, James E; Markowitz, Steven M; Liu, Christopher F; Thomas, George; Lerman, Bruce B; Cheung, Jim W

    2015-05-01

    Adenosine (ADO) can uncover dormant conduction following pulmonary vein (PV) isolation. We sought to identify the value of dormant conduction for predicting atrial fibrillation (AF) recurrence and chronic PV reconnection. One hundred fifty-two patients (80 male; age 60 ± 11 years) undergoing PV isolation for AF were studied. After PV isolation, sites of ADO-induced PV reconnection were recorded and targeted with additional ablation. In patients undergoing repeat ablation for recurrent AF, chronic PV reconnection was assessed. Forty-five (30%) patients had ADO-induced PV reconnection following PV isolation. Dormant conduction was successfully eliminated with additional ablation in 41 (91%) of these patients. After follow-up of 598 ± 270 days, 60 (39%) patients had recurrent AF. Dormant PV conduction was not a significant predictor of AF recurrence (hazard ratio 1.51; 95% confidence interval: 0.89-2.56; P = 0.12) although three of four (75%) patients with residual dormant conduction following initial ablation developed recurrent AF. Twenty-six patients with recurrent AF underwent repeat ablation with 52 of 99 (53%) PVs found to have chronic reconnection. Nine of 11 (82%) PVs with dormant conduction and 43 of 88 (49%) PVs without dormant conduction at initial procedure had chronic reconnection at repeat ablation. When additional ablation is performed to eliminate ADO-induced PV reconnection after PV isolation, dormant conduction is not a significant predictor of recurrent AF. Although PVs with dormant conduction at initial procedure may develop chronic reconnection, the majority of PVs that show conduction recovery at repeat ablation occur in nondormant PVs. © 2015 Wiley Periodicals, Inc.

  16. Conventional versus 3-D Echocardiography to Predict Arrhythmia Recurrence After Atrial Fibrillation Ablation.

    PubMed

    Bossard, Matthias; Knecht, Sven; Aeschbacher, Stefanie; Buechel, Ronny R; Hochgruber, Thomas; Zimmermann, Andreas J; Kessel-Schaefer, Arnheid; Stephan, Frank-Peter; Völlmin, Gian; Pradella, Maurice; Sticherling, Christian; Osswald, Stefan; Kaufmann, Beat A; Conen, David; Kühne, Michael

    2017-06-01

    Arrhythmia recurrence after atrial fibrillation (AF) ablation remains high and requires repeat interventions in a substantial number of patients. We assessed the value of conventional and 3-D echocardiography to predict AF recurrence. Consecutive patients undergoing AF ablation by means of pulmonary vein isolation were included in a prospective registry. Echocardiograms were obtained prior to the ablation procedure, and analyzed offline in a standardized manner, including 3-D left atrial (LA) volumetry and determination of LA function and sphericity. The primary endpoint, AF recurrence (>30 seconds) between 3 to 12 months after AF ablation, was independently adjudicated. We included 276 patients (73% male, mean age 59.9 ± 9.9 years). Paroxysmal and persistent AF were present in 178 (64%) and 98 (36%) patients, respectively. Mean left ventricular ejection fraction and indexed LA volume in 3-D (LAVI) were 52 ± 12% and 42 ± 13 mL/m 2 , respectively. AF recurrence was observed in 110 (40%) patients after a single procedure. Median (interquartile range) time to AF recurrence was 123 (92; 236) days. In multivariable Cox regression models, the only predictors for AF recurrence were the minimal, maximal, and indexed 3-D LA volumes, P = 0.024, P = 0.016, and P = 0.014, respectively. Quartile specific analysis of 3-D LAVI showed an HR of 1.885 (95%CI 1.066-3.334; P for trend = 0.015) for the highest compared to the lowest quartile. Our results show the important role of LA volume for the long-term freedom from arrhythmia after AF ablation. These data also highlight the potential of 3-D echocardiography in this context and may facilitate patient selection for AF ablation. © 2017 Wiley Periodicals, Inc.

  17. Bipolar versus balloon endometrial ablation in the office: a randomized controlled trial.

    PubMed

    Penninx, Josien P M; Herman, Malou C; Kruitwagen, Roy F P M; Ter Haar, Annette J F; Mol, Ben W; Bongers, Marlies Y

    2016-01-01

    To compare the effectiveness of bipolar radiofrequency (Novasure®) ablation and balloon endometrial ablation (Thermablate®). We performed a multi-center double blind, randomized controlled trial in three hospitals in The Netherlands. Women with heavy menstrual bleeding were randomly allocated to bipolar or balloon endometrial ablation, performed in the office, using a paracervical block. The primary outcome was amenorrhea. Secondary outcome measures were pain, satisfaction, quality of life and reintervention. 104 women were randomized into the bipolar (52) and balloon (52) groups. After 12 months amenorrhea rates were 56% (29/52) in the bipolar group and 23% (12/52) in the balloon group (relative risk (RR) 0.6, 95% confidence interval (CI) 0.4-0.8). The mean visual analog pain score of the total procedure was 7.1 in the bipolar group and 7.4 in the balloon group (P<.577). 87% (45/52) of the patients in the bipolar group were satisfied with the result of the treatment versus 69% (36/52) in the balloon group (RR 0.44, 95% CI 0.2-0.97). The reintervention rates were 5/52 (10%) in the bipolar group and 6/52 (12%) in the balloon group (RR 1.02, 95% CI 0.9-1.2). Quality of life (Shaw score) improved over time (P<.001) and was significantly higher in the bipolar group at 12 months follow-up (P=.025). In the treatment of heavy menstrual bleeding, bipolar radiofrequency endometrial ablation is superior to balloon endometrial ablation as an office procedure in amenorrhea rate, patient satisfaction and quality of life. Copyright © 2015. Published by Elsevier Ireland Ltd.

  18. Outcomes after cryoballoon or radiofrequency ablation for persistent atrial fibrillation: a multicentric propensity-score matched study.

    PubMed

    Boveda, Serge; Providência, Rui; Defaye, Pascal; Pavin, Dominique; Cebron, Jean-Pierre; Anselme, Frederic; Halimi, Franck; Khoueiry, Ziad; Combes, Nicolas; Combes, Stephane; Jacob, Sophie; Albenque, Jean-Paul; Sousa, Pedro

    2016-11-01

    Recent data show no benefit of additional ablation beyond pulmonary vein isolation (PVI) in persistent atrial fibrillation (AF). Evidence suggests that radiofrequency energy (RF) and cryoballoon (CRYO) have comparable efficacy for PVI. We aimed to assess the outcomes after a single catheter ablation procedure, comparing PVI using CRYO vs. RF ablation for PVI plus additional ablation in a cohort of patients with persistent AF. In this prospective multicenter propensity score-matched comparison, 59 consecutive patients undergoing CRYO ablation of persistent AF were matched to 59 patients treated with RF from November 2010 to June 2012. During a mean follow-up of 15.6 ± 11.5 months, 43.2 % of patients presented atrial arrhythmia relapse after a blanking period of 3 months, which was comparable between the two groups (40.7 % in CRYO vs. 45.8 % in RF, Log rank P = 0.14; HR = 0.67, 95 %CI 0.38-1.16, P = 0.15), despite the fact that 52.5 % of RF patients add additional complex fractionated atrial electrogram ablation, as well as left atrial linear ablation in over two-thirds (roof line in 67.8 % and mitral isthmus in 32.2 %). On multivariate Cox regression, only AF duration in years (HR = 1.10, 95 %CI 1.01-1.10, P = 0.04) was a predictor of relapse. Patients undergoing RF ablation presented a numerically, but non-significantly, lower complication rate (6.8 vs 10.2 %, P = 0.51). In our multicenter experience, freedom from atrial arrhythmias was comparable among matched patients treated with CRYO and RF, despite non-significant trends in favor of RF in terms of complications, at the cost of longer procedure times.

  19. Atrial fibrillation ablation: "perpetual motion" of open irrigated tip catheters at 50 W is safe and improves outcomes.

    PubMed

    Winkle, Roger A; Mead, R Hardwin; Engel, Gregory; Patrawala, Rob A

    2011-05-01

    Point-by-point use of open irrigated tip catheters (OITCs) at 50 W increases atrial fibrillation (AF) ablation cure rates but also increases complications. We determined if constantly moving the OITC (perpetual motion) when using 50 W increases ablation cure rates without increasing complications. We evaluated procedural data, complications, and individual procedure cure rates (IPCRs) for AF ablation using closed tip catheters (CTC) versus OITC at 40, 45, and 50 W in 1,122 ablations. We used "perpetual motion" to move the OITC at 50 W every 3-10 seconds. The OITC showed higher IPCR than CTC at 45 W (P = 0.012) and 50 W (P < 0.0005). For the OITC, IPCR increased from 44.6% to 60.7% as power increased from 40 to 50 W (P = 0.008). The OITC appeared superior to the CTC for all types of AF. For paroxysmal AF, increasing OITC power from 40 to 50 W provided no increase in IPCR (70.6% vs 71.2%, P = 0.827). For persistent AF, increasing power from 40 to 50 W increased IPCR from 34.5% to 59.5% (P = 0.001). Complications were similar for the CTC and the OITC at any power. The OITC at 50 W had shorter procedure, left atrial, and fluoroscopy times (P < 0.0005). Increasing OITC power from 40 to 50 W increases IPCR with no increase in complications as long as the 50 W setting is done using "perpetual motion." The OITC 50 W power setting results in shorter procedure and fluoroscopy times and should be considered for AF ablations. ©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.

  20. Neural correlates of olfactory and visual memory performance in 3D-simulated mazes after intranasal insulin application.

    PubMed

    Brünner, Yvonne F; Rodriguez-Raecke, Rea; Mutic, Smiljana; Benedict, Christian; Freiherr, Jessica

    2016-10-01

    This fMRI study intended to establish 3D-simulated mazes with olfactory and visual cues and examine the effect of intranasally applied insulin on memory performance in healthy subjects. The effect of insulin on hippocampus-dependent brain activation was explored using a double-blind and placebo-controlled design. Following intranasal administration of either insulin (40IU) or placebo, 16 male subjects participated in two experimental MRI sessions with olfactory and visual mazes. Each maze included two separate runs. The first was an encoding maze during which subjects learned eight olfactory or eight visual cues at different target locations. The second was a recall maze during which subjects were asked to remember the target cues at spatial locations. For eleven included subjects in the fMRI analysis we were able to validate brain activation for odor perception and visuospatial tasks. However, we did not observe an enhancement of declarative memory performance in our behavioral data or hippocampal activity in response to insulin application in the fMRI analysis. It is therefore possible that intranasal insulin application is sensitive to the methodological variations e.g. timing of task execution and dose of application. Findings from this study suggest that our method of 3D-simulated mazes is feasible for studying neural correlates of olfactory and visual memory performance. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. A prospective development study of software-guided radio-frequency ablation of primary and secondary liver tumors: Clinical intervention modelling, planning and proof for ablation cancer treatment (ClinicIMPPACT).

    PubMed

    Reinhardt, Martin; Brandmaier, Philipp; Seider, Daniel; Kolesnik, Marina; Jenniskens, Sjoerd; Sequeiros, Roberto Blanco; Eibisberger, Martin; Voglreiter, Philip; Flanagan, Ronan; Mariappan, Panchatcharam; Busse, Harald; Moche, Michael

    2017-12-01

    Radio-frequency ablation (RFA) is a promising minimal-invasive treatment option for early liver cancer, however monitoring or predicting the size of the resulting tissue necrosis during the RFA-procedure is a challenging task, potentially resulting in a significant rate of under- or over treatments. Currently there is no reliable lesion size prediction method commercially available. ClinicIMPPACT is designed as multicenter-, prospective-, non-randomized clinical trial to evaluate the accuracy and efficiency of innovative planning and simulation software. 60 patients with early liver cancer will be included at four European clinical institutions and treated with the same RFA system. The preinterventional imaging datasets will be used for computational planning of the RFA treatment. All ablations will be simulated simultaneously to the actual RFA procedure, using the software environment developed in this project. The primary outcome measure is the comparison of the simulated ablation zones with the true lesions shown in follow-up imaging after one month, to assess accuracy of the lesion prediction. This unique multicenter clinical trial aims at the clinical integration of a dedicated software solution to accurately predict lesion size and shape after radiofrequency ablation of liver tumors. Accelerated and optimized workflow integration, and real-time intraoperative image processing, as well as inclusion of patient specific information, e.g. organ perfusion and registration of the real RFA needle position might make the introduced software a powerful tool for interventional radiologists to optimize patient outcomes.

  2. Water maze performance of aged Sprague-Dawley rats in relation to retinal morphologic measures.

    PubMed

    Spencer, R L; O'Steen, W K; McEwen, B S

    1995-06-01

    The spatial learning ability of aged male and female Sprague-Dawley rats was assessed using the Morris water maze. To determine the influence of age-related visual deficits on performance levels, retinal morphologic measures were correlated with water maze performance for each rat. Rats were first trained on the water maze task at 21 months of age and were retrained 3 or 4 times at 6-week intervals. After the last training session the rats were killed and their eyes were removed for histopathologic and morphometric evaluation of the retinas. There was a large degree of retinal degeneration in all of the aged Sprague-Dawley rats with an average decrease in the thickness of the retinal outer nuclear layer (photoreceptor nuclei containing layer) of 85% in old males and 95% in old females. Some rats, however, had less degeneration of the retinas than others, and the degree of retinal degeneration was strongly related to performance levels on the water maze task. Among the aged rats in this study with the least retinal degeneration, there was little evidence for a subset of rats that were unable, with extensive training, to learn a platform position. Of the 41 rats with the least retinal degeneration (out of a total of 81), only one was a clear non-learner on the water maze task, whereas, of the 27 rats with the most retinal degeneration, 20 were non-learners. These results illustrate the potentially serious confounding effects of deteriorating visual ability on attempts to assess cognitive functioning of aged albino rats on tasks requiring utilization of visual cues.

  3. Towards multispectral endoscopic imaging of cardiac lesion assessment and classification for cardiac ablation therapy

    NASA Astrophysics Data System (ADS)

    Park, Soo Young; Singh-Moon, Rajinder P.; Hendon, Christine P.

    2018-02-01

    Pulmonary vein (PV) isolation is a critical procedure for the treatment and termination of atrial fibrillation (AF). The success of such treatment depends on the extent of tissue damage, where partial lesions can allow abnormal electrical conduction and risk relapse of AF. Proper evaluation of lesion delivery and ablation line continuity remains challenging with current techniques and in part limit procedural efficacy. A tool for direct visualization of endo-myocardial lesions in vivo could potentially reduce ambiguity in treatment location and extent and improve the overall fidelity of lesion sets. In this work, we introduce a method for wide-field visualization of myocardial tissue including the discernment of ablated and non-ablated regions using an endoscopic multispectral imaging system (EMIS). The system was designed to fit the working channel of most commercial sheathes (<4 Fr) and supported quadruple-wavelength reflectance imaging through a flexible fiber-bundle. A total of 50 endocardial lesions were created and imaged on nine swine hearts, ex vivo in addition to 15 lesions on human LA samples near PV regions. A pixel-wise linear discriminant analysis algorithm was developed to classify regions of ablation treatment based on calibrated EMI maps. Results show good agreement of treatment severity and spatial extent compared to post-hoc tissue vital staining.

  4. Safety and Efficacy of Cryoballoon Ablation for Paroxysmal Atrial Fibrillation in Japan - Results From the Japanese Prospective Post-Market Surveillance Study.

    PubMed

    Okumura, Ken; Matsumoto, Kazuo; Kobayashi, Yoshinori; Nogami, Akihiko; Hokanson, Robert B; Kueffer, Fred

    2016-07-25

    Outcomes of cryoballoon ablation for paroxysmal atrial fibrillation (PAF) have been reported in the Western countries but not in Japan. The CRYO-Japan PMS study was a single-arm, observational, multicenter, prospective study of the 2nd-generation cryoballoon Arctic Front Advance(TM). We evaluated device- and procedure-related complications and clinical outcomes at 6 months. The 616 patients (male, 72%; mean age, 63±11 years) were enrolled from 33 Japanese hospitals. Of all patients, 610 had PAF, and procedural data were analyzed in 607. A subset of 328 patients was followed for 6 months for the primary efficacy analysis. AF recurrence outside the 3-month blanking period or repeat ablation was considered treatment failure. Pulmonary vein isolation was achieved in 606/607 patients (99.8%); 1 patient (0.3%) had a repeat ablation during the blanking period. Freedom from AF at 6 months was 88.4% (95% CI: 84.1-91.6%). Device- and/or procedure-related adverse events included phrenic nerve injury unresolved at hospital discharge in 9/616 patients (1.5%), which resolved within 6 months in 7, pericardial effusion in 5/616 (0.8%), and tamponade in 4/616 (0.6%). One non-device-related death from pneumonia was reported 6 days post-procedure. Cryoballoon ablation is safe and effective for Japanese PAF patients, with 88.4% AF freedom at 6 months post-ablation. (Circ J 2016; 80: 1744-1749).

  5. Percutaneous Irreversible Electroporation Lung Ablation: Preliminary Results in a Porcine Model

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Deodhar, Ajita; Monette, Sebastien; Single, Gordon W.

    2011-12-15

    Objective: Irreversible electroporation (IRE) uses direct electrical pulses to create permanent 'pores' in cell membranes to cause cell death. In contrast to conventional modalities, IRE has a nonthermal mechanism of action. Our objective was to study the histopathological and imaging features of IRE in normal swine lung. Materials and Methods: Eleven female swine were studied for hyperacute (8 h), acute (24 h), subacute (96 h), and chronic (3 week) effects of IRE ablation in lung. Paired unipolar IRE applicators were placed under computed tomography (CT) guidance. Some applicators were deliberately positioned near bronchovascular structures. IRE pulse delivery was synchronized withmore » the cardiac rhythm only when ablation was performed within 2 cm of the heart. Contrast-enhanced CT scan was performed immediately before and after IRE and at 1 and 3 weeks after IRE ablation. Representative tissue was stained with hematoxylin and eosin for histopathology. Results: Twenty-five ablations were created: ten hyperacute, four acute, and three subacute ablations showed alveolar edema and necrosis with necrosis of bronchial, bronchiolar, and vascular epithelium. Bronchovascular architecture was maintained. Chronic ablations showed bronchiolitis obliterans and alveolar interstitial fibrosis. Immediate post-procedure CT images showed linear or patchy density along the applicator tract. At 1 week, there was consolidation that resolved partially or completely by 3 weeks. Pneumothorax requiring chest tube developed in two animals; no significant cardiac arrhythmias were noted. Conclusion: Our preliminary porcine study demonstrates the nonthermal and extracellular matrix sparing mechanism of action of IRE. IRE is a potential alternative to thermal ablative modalities.« less

  6. Use of spatial information and search strategies in a water maze analog in Drosophila melanogaster.

    PubMed

    Foucaud, Julien; Burns, James G; Mery, Frederic

    2010-12-03

    Learning the spatial organization of the environment is crucial to fitness in most animal species. Understanding proximate and ultimate factors underpinning spatial memory is thus a major goal in the study of animal behavior. Despite considerable interest in various aspects of its behavior and biology, the model species Drosophila melanogaster lacks a standardized apparatus to investigate spatial learning and memory. We propose here a novel apparatus, the heat maze, conceptually based on the Morris water maze used in rodents. Using the heat maze, we demonstrate that D. melanogaster flies are able to use either proximal or distal visual cues to increase their performance in navigating to a safe zone. We also show that flies are actively using the orientation of distal visual cues when relevant in targeting the safe zone, i.e., Drosophila display spatial learning. Parameter-based classification of search strategies demonstrated the progressive use of spatially precise search strategies during learning. We discuss the opportunity to unravel the mechanistic and evolutionary bases of spatial learning in Drosophila using the heat maze.

  7. Hippocampal and prefrontal cortex contributions to learning and memory: analysis of lesion and aging effects on maze learning in rats.

    PubMed

    Winocur, G; Moscovitch, M

    1990-08-01

    Young adult rats with bilateral lesions to the hippocampus or prefrontal cortex, young operated controls, and normal old rats were tested on two complex mazes in the Hebb-Williams series. Approximately half the animals were previously trained on one of the mazes; the remainder received no previous training. The trained hippocampal rats showed sparing of memory for the general skill of maze learning but poor recall of the specific maze on which they had been previously trained. The opposite pattern was observed in trained prefrontal rats. In contrast, the aged rats' memory for maze-specific and maze-general information was impaired. The results confirmed the importance of the hippocampus for recalling highly specific information and pointed to a possible role for the frontal lobes in learning and remembering nonspecific skill-related information. The generalized deficit of the aged rats indicates that both types of memory were compromised and offers further evidence of frontal lobe and hippocampal dysfunction in normal aging.

  8. Impact of esophageal temperature monitoring guided atrial fibrillation ablation on preventing asymptomatic excessive transmural injury

    PubMed Central

    Kiuchi, Kunihiko; Okajima, Katsunori; Shimane, Akira; Kanda, Gaku; Yokoi, Kiminobu; Teranishi, Jin; Aoki, Kousuke; Chimura, Misato; Toba, Takayoshi; Oishi, Shogo; Sawada, Takahiro; Tsukishiro, Yasue; Onishi, Tetsuari; Kobayashi, Seiichi; Taniguchi, Yasuyo; Yamada, Shinichiro; Yasaka, Yoshinori; Kawai, Hiroya; Yoshida, Akihiro; Fukuzawa, Koji; Itoh, Mitsuaki; Imamura, Kimitake; Fujiwara, Ryudo; Suzuki, Atsushi; Nakanishi, Tomoyuki; Yamashita, Soichiro; Hirata, Ken-ichi; Tada, Hiroshi; Yamasaki, Hiro; Naruse, Yoshihisa; Igarashi, Miyako; Aonuma, Kazutaka

    2015-01-01

    Background Even with the use of a reduced energy setting (20–25 W), excessive transmural injury (ETI) following catheter ablation of atrial fibrillation (AF) is reported to develop in 10% of patients. However, the incidence of ETI depends on the pulmonary vein isolation (PVI) method and its esophageal temperature monitor setting. Data comparing the incidence of ETI following AF ablation with and without esophageal temperature monitoring (ETM) are still lacking. Methods This study was comprised of 160 patients with AF (54% paroxysmal, mean: 24.0±2.9 kg/m2). Eighty patients underwent ablation accompanied by ETM. The primary endpoint was defined as the occurrence of ETI assessed by endoscopy within 5 d after the AF ablation. The secondary endpoint was defined as AF recurrence after a single procedure. If the esophageal temperature probe registered >39 °C, the radiofrequency (RF) application was stopped immediately. RF applications could be performed in a point-by-point manner for a maximum of 20 s and 20 W. ETI was defined as any injury that resulted from AF ablation, including esophageal injury or periesophageal nerve injury (peri-ENI). Results The incidence of esophageal injury was significantly lower in patients whose AF ablation included ETM compared with patients without ETM (0 [0%] vs. 6 [7.5%], p=0.028), but not the incidence of peri-ENI (2 [2.5%] vs. 3 [3.8%], p=1.0). AF recurrence 12 months after the procedure was similar between the groups (20 [25%] in the ETM group vs. 19 [24%] in the non-ETM group, p=1.00). Conclusions Catheter ablation using ETM may reduce the incidence of esophageal injury without increasing the incidence of AF recurrence but not the incidence of peri-ENI. PMID:26949429

  9. First In Vivo Use of a Capacitive Micromachined Ultrasound Transducer Array–Based Imaging and Ablation Catheter

    PubMed Central

    Stephens, Douglas N.; Truong, Uyen T.; Nikoozadeh, Amin; Oralkan, Ömer; Seo, Chi Hyung; Cannata, Jonathan; Dentinger, Aaron; Thomenius, Kai; de la Rama, Alan; Nguyen, Tho; Lin, Feng; Khuri-Yakub, Pierre; Mahajan, Aman; Shivkumar, Kalyanam; O’Donnell, Matt; Sahn, David J.

    2012-01-01

    Objectives The primary objective was to test in vivo for the first time the general operation of a new multifunctional intracardiac echocardiography (ICE) catheter constructed with a microlinear capacitive micromachined ultrasound transducer (ML-CMUT) imaging array. Secondarily, we examined the compatibility of this catheter with electroanatomic mapping (EAM) guidance and also as a radiofrequency ablation (RFA) catheter. Preliminary thermal strain imaging (TSI)-derived temperature data were obtained from within the endocardium simultaneously during RFA to show the feasibility of direct ablation guidance procedures. Methods The new 9F forward-looking ICE catheter was constructed with 3 complementary technologies: a CMUT imaging array with a custom electronic array buffer, catheter surface electrodes for EAM guidance, and a special ablation tip, that permits simultaneous TSI and RFA. In vivo imaging studies of 5 anesthetized porcine models with 5 CMUT catheters were performed. Results The ML-CMUT ICE catheter provided high-resolution real-time wideband 2-dimensional (2D) images at greater than 8 MHz and is capable of both RFA and EAM guidance. Although the 24-element array aperture dimension is only 1.5 mm, the imaging depth of penetration is greater than 30 mm. The specially designed ultrasound-compatible metalized plastic tip allowed simultaneous imaging during ablation and direct acquisition of TSI data for tissue ablation temperatures. Postprocessing analysis showed a first-order correlation between TSI and temperature, permitting early development temperature-time relationships at specific myocardial ablation sites. Conclusions Multifunctional forward-looking ML-CMUT ICE catheters, with simultaneous intracardiac guidance, ultrasound imaging, and RFA, may offer a new means to improve interventional ablation procedures. PMID:22298868

  10. Microwave Ablation Compared with Radiofrequency Ablation for Breast Tissue in an Ex Vivo Bovine Udder Model

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Tanaka, Toshihiro, E-mail: toshihir@bf6.so-net.ne.jp; Westphal, Saskia, E-mail: swestphal@ukaachen.de; Isfort, Peter, E-mail: isfort@hia.rwth-aachen.de

    2012-08-15

    Purpose: To compare the effectiveness of microwave (MW) ablation with radiofrequency (RF) ablation for treating breast tissue in a nonperfused ex vivo model of healthy bovine udder tissue. Materials and Methods: MW ablations were performed at power outputs of 25W, 35W, and 45W using a 915-MHz frequency generator and a 2-cm active tip antenna. RF ablations were performed with a bipolar RF system with 2- and 3-cm active tip electrodes. Tissue temperatures were continuously monitored during ablation. Results: The mean short-axis diameters of the coagulation zones were 1.34 {+-} 0.14, 1.45 {+-} 0.13, and 1.74 {+-} 0.11 cm for MWmore » ablation at outputs of 25W, 35W, and 45W. For RF ablation, the corresponding values were 1.16 {+-} 0.09 and 1.26 {+-} 0.14 cm with electrodes having 2- and 3-cm active tips, respectively. The mean coagulation volumes were 2.27 {+-} 0.65, 2.85 {+-} 0.72, and 4.45 {+-} 0.47 cm{sup 3} for MW ablation at outputs of 25W, 35W, and 45W and 1.18 {+-} 0.30 and 2.29 {+-} 0.55 cm{sup 3} got RF ablation with 2- and 3-cm electrodes, respectively. MW ablations at 35W and 45W achieved significantly longer short-axis diameters than RF ablations (P < 0.05). The highest tissue temperature was achieved with MW ablation at 45W (P < 0.05). On histological examination, the extent of the ablation zone in MW ablations was less affected by tissue heterogeneity than that in RF ablations. Conclusion: MW ablation appears to be advantageous with respect to the volume of ablation and the shape of the margin of necrosis compared with RF ablation in an ex vivo bovine udder.« less

  11. Conformal needle-based ultrasound ablation using EM-tracked conebeam CT image guidance

    NASA Astrophysics Data System (ADS)

    Burdette, E. Clif; Banovac, Filip; Diederich, Chris J.; Cheng, Patrick; Wilson, Emmanuel; Cleary, Kevin R.

    2011-03-01

    Numerous studies have demonstrated the efficacy of interstitial ablative approaches for the treatment of renal and hepatic tumors. Despite these promising results, current systems remain highly dependent on operator skill, and cannot treat many tumors because there is little control of the size and shape of the zone of necrosis, and no control over ablator trajectory within tissue once insertion has taken place. Additionally, tissue deformation and target motion make it extremely difficult to accurately place the ablator device into the target. Irregularly shaped target volumes typically require multiple insertions and several sequential thermal ablation procedures. This study demonstrated feasibility of spatially tracked image-guided conformal ultrasound (US) ablation for percutaneous directional ablation of diseased tissue. Tissue was prepared by suturing the liver within a pig belly and 1mm BBs placed to serve as needle targets. The image guided system used integrated electromagnetic tracking and cone-beam CT (CBCT) with conformable needlebased high-intensity US ablation in the interventional suite. Tomographic images from cone beam CT were transferred electronically to the image-guided tracking system (IGSTK). Paired-point registration was used to register the target specimen to CT images and enable navigation. Path planning is done by selecting the target BB on the GUI of the realtime tracking system and determining skin entry location until an optimal path is selected. Power was applied to create the desired ablation extent within 7-10 minutes at a thermal dose (>300eqm43). The system was successfully used to place the US ablator in planned target locations within ex-vivo kidney and liver through percutaneous access. Targeting accuracy was 3-4 mm. Sectioned specimens demonstrated uniform ablation within the planned target zone. Subsequent experiments were conducted for multiple ablator positions based upon treatment planning simulations. Ablation zones in

  12. Artificial pneumothorax: a safe and simple method to relieve pain during microwave ablation of subpleural lung malignancy.

    PubMed

    Hou, Xiaowei; Zhuang, Xingjun; Zhang, Haiwen; Wang, Kai; Zhang, Yuanxin

    2017-08-01

    Microwave ablation has been extensively used for eliminating pulmonary tumors; however, it is usually associated with severe pain under local anesthesia. Decreasing the power and shortening the ablation time can help to relieve the pain; however, this leads to incomplete ablation and an increasing recurrence rate. This research aims to employ an artificial pneumothorax to increase both the curative effect and pain relief during the ablation procedure. From July 2013 to January 2015, nine patients presenting with 10 subpleural lung tumors (age: 44-78 years) with a high possibility of severe pain underwent the artificial pneumothorax during microwave ablation. The pain assessment scores and complications induced by the artificial pneumothorax were recorded and analyzed by a CT scan follow-up. The tumors of the nine patients were eliminated successfully using microwave ablation with artificial pneumothorax under local anesthesia. The pain caused by the ablation was relieved to a great extent with an average rate of 94.66% (range: 63.3%-100%) and all tumors were ablated completely. No severe complications occurred after the operation. The artificial pneumothorax is a reliable therapy to improve the curative effect of microwave ablation under local anesthesia by relieving the pain of the patients.

  13. Effects of material composition on the ablation performance of low density elastomeric ablators

    NASA Technical Reports Server (NTRS)

    Tompkins, S. S.; Kabana, W. P.

    1973-01-01

    The ablation performance of materials composed of various concentrations of nylon, hollow silica spheres, hollow phenolic spheres, and four elastomeric resins was determined. Both blunt-body and flat-panel specimens were used, the cold-wall heating-rate ranges being 0.11 to 0.8 MW/sq m, respectively. The corresponding surface pressure ranges for these tests were 0.017 to 0.037 atmosphere and 0.004 to 0.005 atmosphere. Some of the results show that (1) the addition of nylon significantly improved the ablation performance, but the nylon was not compatible with one resin system; (2) panel and blunt-body specimen data do not show the same effect of phenolic sphere content on ablation effectiveness; and (3) there appears to be an optimum concentration of hollow silica spheres for good ablation performance. The composition of an efficient, nonproprietary ablator for lifting body application is identified and the ablation performance of this ablator is compared with the performance of three commercially available materials.

  14. Pediatric Catheter Ablation: Characteristics and Results of a Series in a Tertiary Referral Hospital.

    PubMed

    Alonso-García, Andrés; Atienza, Felipe; Ávila, Pablo; Ugueto, Clara; Centeno, Miriam; Álvarez, Reyes; Datino, Tomás; González-Torrecilla, Esteban; Castellanos, Evaristo; Loughlin, Gerard; Medrano, Constancio; Arenal, Ángel; Fernández-Avilés, Francisco

    2018-02-23

    Catheter ablation has become the treatment of choice in an increasing number of arrhythmias in children and adolescents. There is still limited evidence of its use at a national level in Spain. The aim was to describe the characteristics and results of a modern monocentric series form a referral tertiary care centre. Retrospective register of invasive procedures between 2004 and 2016 performed in patients under 17 years and recorded clinical characteristic, ablation methodology and acute and chronic results of the procedure. A total of 291 procedures in 224 patients were included. Median age was 12.2 years, 60% male. Overall, 46% patients were referred from other autonomous communities. The most frequent substrates were accessory pathways (AP) (70.2%,>50% septal AP localization) and atrioventricular nodal reentrant tachycardia (AVNRT) (15.8%). Congenital and acquired heart disease was frequent (16.8%). Cryoablation was used in 35.5% of the cases. Overall acute success of the primary procedure was 93.5% (AP 93.8%; AVNRT 100%). Redo procedures after recurrence were performed in 18.9% of all substrates, with a long-term cumulative efficacy of 98.4% (AP 99.3%; AVNRT 100%). One (0.37%) serious complication occurred, a case of complete atrioventricular block. Our study replicated previous international reports of high success rates with scarce complications in a high complexity series, confirming the safety and efficacy of pediatric catheter ablation in our environment performed at highly experienced referral centers. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  15. Impact of obesity on atrial fibrillation ablation: Patient characteristics, long-term outcomes, and complications.

    PubMed

    Winkle, Roger A; Mead, R Hardwin; Engel, Gregory; Kong, Melissa H; Fleming, William; Salcedo, Jonathan; Patrawala, Rob A

    2017-06-01

    There is an association between obesity and atrial fibrillation (AF). The impact of obesity on AF ablation procedures is unclear. The purpose of this study was to evaluate the influence of body mass index (BMI) on patient characteristics, long-term ablation outcomes, and procedural complications. We evaluated 2715 patients undergoing 3742 AF ablation procedures. BMI was ≥30 kg/m 2 in 1058 (39%) and ≥40 kg/m 2 in 129 (4.8%). Patients were grouped by BMI ranges (<25, 25-<30, 30-<35, 35-<40, and ≥40 kg/m 2 ). As BMI increased from <25 to ≥40 kg/m 2 , age decreased from 65.3 ± 11.2 to 61.2 ± 9.2 years (P < .001), left atrial size increased from 3.91 ± 0.68 to 4.72 ± 0.62 cm (P < .005), and CHADS 2 scores increased from 1.24 ± 1.10 to 1.62 ± 1.09 (P < .001). As BMI increased, paroxysmal AF decreased from 48.0% to 16.3% (P < .0001) and there was an increase in dilated cardiomyopathy (from 7.6% to 12.4%; P < .0001), hypertension (from 41.0% to 72.9%; P < .0001), diabetes (from 4.3% to 23.3%; P < .0001), and sleep apnea (from 7.0% to 46.9%; P < .0001). For the entire cohort, for BMI ≥35 kg/m 2 the 5-year ablation freedom from AF decreased from 67%-72% to 57% (P = .036). For paroxysmal AF, when BMI was ≥40 kg/m 2 ablation success decreased from 79%-82% to 60% (P = .064), and for persistent AF, when BMI was ≥35 kg/m 2 ablation success decreased from 64%-70% to 52%-57% (P = .021). For long-standing AF, there was no impact of BMI on outcomes (P = .624). In multivariate analysis, BMI ≥35 kg/m 2 predicted worse outcomes (P = .036). Higher BMI did not impact major complication rates (P = .336). However, when BMI was ≥40 kg/m 2 , minor (from 2.1% to 4.4%; P = .035) and total (from 3.5% to 6.7%; P = .023) complications increased. In patients undergoing AF ablation, increasing BMI is associated with more patient comorbidities and more persistent and long-standing AF. BMI ≥35 kg/m 2 adversely impacts ablation outcomes, and BMI ≥40 kg/m 2 increases minor

  16. The effect of elastic modulus on ablation catheter contact area.

    PubMed

    Camp, Jon J; Linte, Cristian A; Rettmann, Maryam E; Sun, Deyu; Packer, Douglas L; Robb, Richard A; Holmes, David R

    2015-02-21

    Cardiac ablation consists of navigating a catheter into the heart and delivering RF energy to electrically isolate tissue regions that generate or propagate arrhythmia. Besides the challenges of accurate and precise targeting of the arrhythmic sites within the beating heart, limited information is currently available to the cardiologist regarding intricate electrode-tissue contact, which directly impacts the quality of produced lesions. Recent advances in ablation catheter design provide intra-procedural estimates of tissue-catheter contact force, but the most direct indicator of lesion quality for any particular energy level and duration is the tissue-catheter contact area, and that is a function of not only force, but catheter pose and material elasticity as well. In this experiment, we have employed real-time ultrasound (US) imaging to determine the complete interaction between the ablation electrode and tissue to accurately estimate contact, which will help to better understand the effect of catheter pose and position relative to the tissue. By simultaneously recording tracked position, force reading and US image of the ablation catheter, the differing material properties of polyvinyl alcohol cryogel [1] phantoms are shown to produce varying amounts of tissue depression and contact area (implying varying lesion quality) for equivalent force readings. We have shown that the elastic modulus significantly affects the surface-contact area between the catheter and tissue at any level of contact force. Thus we provide evidence that a prescribed level of catheter force may not always provide sufficient contact area to produce an effective ablation lesion in the prescribed ablation time.

  17. Use of New Imaging CARTO® Segmentation Module Software to Facilitate Ablation of Ventricular Arrhythmias.

    PubMed

    Tovia-Brodie, Oholi; Belhassen, Bernard; Glick, Aharon; Shmilovich, Haim; Aviram, Galit; Rosso, Raphael; Michowitz, Yoav

    2017-02-01

    A new imaging software (CARTO® Segmentation Module, Biosense Webster) allows preprocedural 3-D reconstruction of all heart chambers based on cardiac CT. We describe our initial experience with the new module during ablation of ventricular arrhythmias. Eighteen consecutive patients with idiopathic ventricular arrhythmias or ischemic ventricular tachycardia (VT) were studied. In the latter group, a combined endocardial and epicardial ablation was performed. Of the 14 patients with idiopathic arrhythmias, 12 were ablated in the outflow tract (OT), 1 in the midseptal left ventricle, and 1 at the left posterior fascicular area; acute successful ablation was achieved in 11 (78.6%) patients. The procedure was discontinued due to close proximity of the arrhythmia origin to the coronary arteries (CA) in 2 patients. Acute successful uncomplicated ablation was achieved in all 4 patients with ischemic VT. During ablation in the coronary cusps commissures, the CARTO® Segmentation Module accurately defined the cusps anatomy. The precise anatomic location provided by the module assisted in successfully ablating when information from activation mapping was not optimal, by ablating at the opposite side of the cusps. In addition, by demonstrating the precise location of the CA, it allowed safe ablation of arrhythmias that originated in close proximity to the CA both in the OT area and the epicardium, eliminating the need for repeat angiography. The CARTO® Segmentation Module is useful for accurate definition of the exact anatomic location of ventricular arrhythmias and for safely ablating them especially in close proximity to the CA. © 2016 Wiley Periodicals, Inc.

  18. Thermal fixation of swine liver tissue after magnetic resonance-guided high-intensity focused ultrasound ablation.

    PubMed

    Courivaud, Frédéric; Kazaryan, Airazat M; Lund, Alice; Orszagh, Vivian C; Svindland, Aud; Marangos, Irina Pavlik; Halvorsen, Per Steinar; Jebsen, Peter; Fosse, Erik; Hol, Per Kristian; Edwin, Bjørn

    2014-07-01

    The aim of this study was to investigate experimental conditions for efficient and controlled in vivo liver tissue ablation by magnetic resonance (MR)-guided high-intensity focused ultrasound (HIFU) in a swine model, with the ultimate goal of improving clinical treatment outcome. Histological changes were examined both acutely (four animals) and 1 wk after treatment (five animals). Effects of acoustic power and multiple sonication cycles were investigated. There was good correlation between target size and observed ablation size by thermal dose calculation, post-procedural MR imaging and histopathology, when temperature at the focal point was kept below 90°C. Structural histopathology investigations revealed tissue thermal fixation in ablated regions. In the presence of cavitation, mechanical tissue destruction occurred, resulting in an ablation larger than the target. Complete extra-corporeal MR-guided HIFU ablation in the liver is feasible using high acoustic power. Nearby large vessels were preserved, which makes MR-guided HIFU promising for the ablation of liver tumors adjacent to large veins. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  19. Factors associated with initial incomplete ablation for benign thyroid nodules after radiofrequency ablation: First results of CEUS evaluation.

    PubMed

    Zhao, Chong-Ke; Xu, Hui-Xiong; Lu, Feng; Sun, Li-Ping; He, Ya-Ping; Guo, Le-Hang; Li, Xiao-Long; Bo, Xiao-Wan; Yue, Wen-Wen

    2017-01-01

    To assess the factors associated with initial incomplete ablation (ICA) after radiofrequency ablation for benign thyroid nodules (BTNs). 69 BTNs (mean volume 6.35±5.66 ml, range 1.00-25.04 ml) confirmed by fine-needle aspiration cytology (FNAC) in fifty-four patients were treated with ultrasound-guided percutaneous radiofrequency ablation (RFA) and the local treatment efficacy was immediately assessed by intra-procedural contrast-enhanced ultrasound (CEUS). The RFA was performed with a bipolar electrode (CelonProSurge 150-T20, output power: 20 W). CEUS was performed with a second generation contrast agent under low acoustic power (i.e. coded phase inversion, CPI). Characteristics of clinical factors, findings on conventional gray-scale ultrasound, color-Doppler ultrasound, and CEUS were evaluated preoperatively. Factors associated with initial ICA and initial ICA patterns on CEUS were assessed. Volume reduction ratios (VRRs) of ICA nodules were compared with those with complete ablation (CA). The RFA procedures were accomplished with a mean ablation time and mean total energy deposition of 11.13±3.39 min (range, 5.38-22.13 min) and 12612±4466 J (range, 6310-26130 J) respectively. CEUS detected initial ICA in 21 of 69 (30.8%) BTNs and 16 (76.2%) of the 21 BTNs with initial ICA achieved CA after additional RFA, leading to a final CA rate of 92.8% (64/69). The factors associated with initial ICA were predominantly solid nodule, nodule close to danger triangle area, nodule close to carotid artery, and peripheral blood flow on color-Doppler ultrasound (all P < 0.05). The mean VRRs of all BTNs were 23.4%, 54.4% and 81.9% at the 1-, 3- and 6-month follow-up, respectively. All BTNs achieved therapeutic success in this series in that all had VRRs of >50% at the 6-month follow-up, among which 7 nodules (10.1%) had VRRs of >90%. There were significant differences in VRRs between ICA nodules and CA nodules at the 3- and 6-month follow-up (all P < 0

  20. Femtosecond laser ablation of dentin and enamel: relationship between laser fluence and ablation efficiency.

    PubMed

    Chen, Hu; Liu, Jing; Li, Hong; Ge, Wenqi; Sun, Yuchun; Wang, Yong; Lü, Peijun

    2015-02-01

    The objective was to study the relationship between laser fluence and ablation efficiency of a femtosecond laser with a Gaussian-shaped pulse used to ablate dentin and enamel for prosthodontic tooth preparation. A diode-pumped thin-disk femtosecond laser with wavelength of 1025 nm and pulse width of 400 fs was used for the ablation of dentin and enamel. The laser spot was guided in a line on the dentin and enamel surfaces to form a groove-shaped ablation zone under a series of laser pulse energies. The width and volume of the ablated line were measured under a three-dimensional confocal microscope to calculate the ablation efficiency. Ablation efficiency for dentin reached a maximum value of 0.020 mm3∕J when the laser fluence was set at 6.51 J∕cm2. For enamel, the maximum ablation efficiency was 0.009 mm3∕J at a fluence of 7.59 J∕cm2.Ablation efficiency of the femtosecond laser on dentin and enamel is closely related to the laser fluence and may reach a maximum when the laser fluence is set to an appropriate value. © 2015 Society of Photo-Optical Instrumentation Engineers (SPIE)

  1. [Hepato-pericardial fistula caused by radiofrequency ablation of colorectal liver metastases].

    PubMed

    Mogensen, Mads Filtenborg; Edling, Poul; Raade, Thomas Bo; Pedersen, Torben Ingemann; Pilegaard, Hans Kristian

    2015-03-30

    Radiofrequency ablation (RFA) of colorectal liver metastases is a well tolerated minimally invasive procedure. Various complications can occur but most of these are self-limiting if diagnosed and treated in time. This case report describes a serious and rare complication following RFA treatment: hepato-pericardial fistula caused by several RFA procedures aiming to cure colorectal liver metastases. Complications to RFA treatment vary and can be difficult to diagnose. We recommend that RFA procedures and management of complications take place in highly specialised multidisciplinary departments.

  2. 5-Year Outcome of Pulmonary Vein Isolation by Loss of Pace Capture on the Ablation Line Versus Electrical Circumferential Pulmonary Vein Isolation.

    PubMed

    Moser, Julia; Sultan, Arian; Lüker, Jakob; Servatius, Helge; Salzbrunn, Tim; Altenburg, Manuel; Schäffer, Benjamin; Schreiber, Doreen; Akbulak, Ruken Ö; Vogler, Julia; Hoffmann, Boris A; Willems, Stephan; Steven, Daniel

    2017-11-01

    This study sought to compare long-term arrhythmia-free survival between electrical circumferential pulmonary vein isolation (PVI) and PVI with the endpoint of unexcitability along the ablation line. PVI is the standard ablation strategy of paroxysmal atrial fibrillation, although arrhythmia recurrence in long-term follow-up (FU) is high. The endpoint of unexcitability along the ablation line results in decreased arrhythmia recurrence compared to electrical PVI in 1-year FU. Seventy-four consecutive patients (age 62.5 ± 10.6 years; 70.3% male) with de novo paroxysmal atrial fibrillation who were initially included in our randomized trial and underwent catheter ablation at our institution were analyzed. Patients who were randomized to either a conventional group (PVI, guided by circumferential catheter signals) or a pace-guided group (PG, anatomical ablation line encircling, ablation until loss of pace capture at 10 V, 2-ms pulse width on the ablation line) underwent long-term FU. The primary endpoint was recurrence of any atrial fibrillation or atrial tachycardia after a blanking period of 3 months. Sixty-nine patients completed a mean FU period of 5.14 ± 0.98 years. Arrhythmia-free survival without antiarrhythmic drug therapy was significantly higher in the PG group (71.05% vs. 25.81%, p = 0.002). Furthermore, multiple procedure success (1.29 ± 0.61 procedures in PG vs. 1.97 ± 1.06 procedures in conventional group, p < 0.001) was higher in the PG group compared to the conventional group (89.47% vs. 58.06%, p = 0.005). The endpoint of unexcitability along the PVI line improves success rates, resulting in a significant reduction of exposure to invasive procedures in 5-year FU. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  3. Optimization of direct current-enhanced radiofrequency ablation: an ex vivo study.

    PubMed

    Tanaka, Toshihiro; Isfort, Peter; Bruners, Philipp; Penzkofer, Tobias; Kichikawa, Kimihiko; Schmitz-Rode, Thomas; Mahnken, Andreas H

    2010-10-01

    The purpose of this study was to investigate the optimal setting for radiofrequency (RF) ablation combined with direct electrical current (DC) ablation in ex vivo bovine liver. An electrical circuit combining a commercially available RF ablation system with DC was developed. The negative electrode of a rectifier that provides DC was connected to a 3-cm multitined expandable RF probe. A 100-mH inductor was used to prevent electrical leakage from the RF generator. DC was applied for 15 min and followed by RF ablation in freshly excised bovine livers. Electric current was measured by an ammeter. Coagulation volume, ablation duration, and mean amperage were assessed for various DC voltages (no DC, 2.2, 4.5, and 9.0 V) and different RF ablation protocols (stepwise increase from 40 to 80 W, 40 W fixed, and 80 W fixed). Results were compared using Kruskal-Wallis and Mann-Whitney U test. Applying DC with 4.5 or 9.0 V, in combination with 40 W fixed or a stepwise increase of RF energy, resulted in significantly increased zone of ablation size compared with 2.2 V or no DC (P = 0.009). At 4.5 V DC, the stepwise increase of RF energy resulted in the same necrosis size as a 40 W fixed protocol (26.6 +/- 3.9 vs. 26.5 +/- 4.0 ml), but ablation duration was significantly decreased (296 +/- 85 s vs. 423 +/- 104 s; P = 0.028). Mean amperage was significantly lower at 4.5 V compared with 9.0 V (P = 0.028). Combining a stepwise increase of RF energy with a DC voltage of 4.5 V is most appropriate to increase coagulation volume and to minimize procedure time.

  4. Optimization of Direct Current-Enhanced Radiofrequency Ablation: An Ex Vivo Study

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Tanaka, Toshihiro, E-mail: toshihir@bf6.so-net.ne.jp; Isfort, Peter; Bruners, Philipp

    2010-10-15

    The purpose of this study was to investigate the optimal setting for radiofrequency (RF) ablation combined with direct electrical current (DC) ablation in ex vivo bovine liver. An electrical circuit combining a commercially available RF ablation system with DC was developed. The negative electrode of a rectifier that provides DC was connected to a 3-cm multitined expandable RF probe. A 100-mH inductor was used to prevent electrical leakage from the RF generator. DC was applied for 15 min and followed by RF ablation in freshly excised bovine livers. Electric current was measured by an ammeter. Coagulation volume, ablation duration, andmore » mean amperage were assessed for various DC voltages (no DC, 2.2, 4.5, and 9.0 V) and different RF ablation protocols (stepwise increase from 40 to 80 W, 40 W fixed, and 80 W fixed). Results were compared using Kruskal-Wallis and Mann-Whitney U test. Applying DC with 4.5 or 9.0 V, in combination with 40 W fixed or a stepwise increase of RF energy, resulted in significantly increased zone of ablation size compared with 2.2 V or no DC (P = 0.009). At 4.5 V DC, the stepwise increase of RF energy resulted in the same necrosis size as a 40 W fixed protocol (26.6 {+-} 3.9 vs. 26.5 {+-} 4.0 ml), but ablation duration was significantly decreased (296 {+-} 85 s vs. 423 {+-} 104 s; P = 0.028). Mean amperage was significantly lower at 4.5 V compared with 9.0 V (P = 0.028). Combining a stepwise increase of RF energy with a DC voltage of 4.5 V is most appropriate to increase coagulation volume and to minimize procedure time.« less

  5. Bronchopleural Fistula After Radiofrequency Ablation of Lung Tumours

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Cannella, Mathieu; Cornelis, Francois; Descat, Edouard

    2011-02-15

    The present article describes two cases of bronchopleural fistula (BPF) occurring after radiofrequency ablation of lung tumors. Both procedures were carried out using expandable multitined electrodes, with no coagulation of the needle track. After both ablations, ground-glass opacities encompassed the nodules and abutted the visceral pleura. The first patient had a delayed pneumothorax, and the second had a recurrent pneumothorax. Both cases of BPF were diagnosed on follow-up computed tomography chest scans (i.e., visibility of a distinct channel between the lung or a peripheral bronchus and the pleura) and were successfully treated with chest tubes alone. Our goal is tomore » highlight the fact that BPF can occur without needle-track coagulation and to suggest that minimally invasive treatment is sufficient to cure BPFs of this specific origin.« less

  6. Wholly Patient-tailored Ablation of Atrial Fibrillation Guided by Spatio-Temporal Dispersion of Electrograms in the Absence of Pulmonary Veins Isolation

    PubMed Central

    Seitz, Julien; Bars, Clément; Théodore, Guillaume; Beurtheret, Sylvain; Lellouche, Nicolas; Bremondy, Michel; Ferracci, Ange; Faure, Jacques; Penaranda, Guillaume; Yamazaki, Masatoshi; Avula, Uma Mahesh R.; Curel, Laurence; Siame, Sabrina; Berenfeld, Omer; Pisapia, André; Kalifa, Jérôme

    2017-01-01

    Background The use of intra-cardiac electrograms to guide atrial fibrillation (AF) ablation has yielded conflicting results. We evaluated an electrogram marker of AF drivers: the clustering of electrograms exhibiting spatio-temporal dispersion — regardless of whether such electrograms were fractionated or not. Objective To evaluate the usefulness of spatio-temporal dispersion, a visually recognizable electric footprint of AF drivers, for the ablation of all forms of AF. Methods We prospectively enrolled 105 patients admitted for AF ablation. AF was sequentially mapped in both atria with a 20-pole PentaRay catheter. We tagged and ablated only regions displaying electrogram dispersion during AF. Results were compared to a validation set in which a conventional ablation approach was used (pulmonary vein isolation/stepwise approach). To establish the mechanism underlying spatio-temporal dispersion of AF electrograms, we conducted realistic numerical simulations of AF drivers in a 2-dimensional model and optical mapping of ovine atrial scar-related AF. Results Ablation at dispersion areas terminated AF in 95%. After ablation of 17±10% of the left atrial surface and 18 months of follow-up, the atrial arrhythmia recurrence rate was 15% after 1.4±0.5 procedure/patient vs 41% in the validation set after 1.5±0.5 procedure/patient (arrhythmia free-survival rates: 85% vs 59%, log rank P<0.001). In comparison with the validation set, radiofrequency times (49 ± 21 minutes vs 85 ± 34.5 minutes, p=0.001) and procedure times (168 ± 42 minutes vs. 230 ± 67 minutes, p<.0001) were shorter. In simulations and optical mapping experiments, virtual PentaRay recordings demonstrated that electrogram dispersion is mostly recorded in the vicinity of a driver. Conclusions The clustering of intra-cardiac electrograms exhibiting spatio-temporal dispersion is indicative of AF drivers. Their ablation allows for a non-extensive and patient-tailored approach to AF ablation. Clinical trial

  7. Phrenic nerve injury after radiofrequency ablation of lung tumors: retrospective evaluation of the incidence and risk factors.

    PubMed

    Matsui, Yusuke; Hiraki, Takao; Gobara, Hideo; Uka, Mayu; Masaoka, Yoshihisa; Tada, Akihiro; Toyooka, Shinichi; Mitsuhashi, Toshiharu; Mimura, Hidefumi; Kanazawa, Susumu

    2012-06-01

    To retrospectively investigate the incidence of and risk factors for phrenic nerve injury after radiofrequency (RF) ablation of lung tumors. The study included 814 RF ablation procedures of lung tumors. To evaluate the development of phrenic nerve injury, chest radiographs obtained before and after the procedure were examined. Phrenic nerve injury was assumed to have developed if the diaphragmatic level was elevated after the procedure. To identify risk factors for phrenic nerve injury, multiple variables were compared between cases of phrenic nerve injury and randomly selected controls by using univariate analyses. Multivariate analysis was then performed to identify independent risk factors. Evaluation of phrenic nerve injury from chest radiographs was possible after 786 procedures. Evidence of phrenic nerve injury developed after 10 cases (1.3%). Univariate analysis revealed that larger tumor size (≥ 20 mm; P = .014), proximity of the phrenic nerve to the tumor (< 10 mm; P < .001), the use of larger electrodes (array diameter or noninsulated tip length ≥ 3 cm; P = .001), and higher maximum power applied during ablation (≥ 100 W; P < .001) were significantly associated with the development of phrenic nerve injury. Multivariate analysis demonstrated that the proximity of the phrenic nerve to the tumor (< 10 mm; P < .001) was a significant independent risk factor. The incidence of phrenic nerve injury after RF ablation was 1.3%. The proximity of the phrenic nerve to the tumor was an independent risk factor for phrenic nerve injury. Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.

  8. First bite syndrome: our experience of laser tympanic plexus ablation.

    PubMed

    Amin, N; Pelser, A; Weighill, J

    2014-02-01

    First bite syndrome is a condition characterised by severe facial pain brought on by the first bite of each meal. This can severely affect the patient's ability to eat. We present a 70-year-old woman for whom we performed a laser ablation of the left ear tympanic plexus, as treatment of first bite syndrome. A permeatal approach was used to raise a tympanomeatal flap. The tympanic plexus was identified on the promontory and a 4 mm2 area of the plexus was ablated using CO2 laser. The flap was repositioned and a dressing was placed with topical antibiotics. At two-month follow up, there was full resolution of the patient's symptoms. First bite syndrome carries a high morbidity; treatment options are variable, and often unsuccessful. We describe the first documented case of laser tympanic plexus ablation, with a very effective initial response. This procedure represents a useful therapeutic option for first bite syndrome.

  9. Concurrent application of charge using a novel circuit prevents heat-related coagulum formation during radiofrequency ablation.

    PubMed

    Lim, Bernard; Venkatachalam, Kalpathi L; Jahangir, Arshad; Johnson, Susan B; Asirvatham, Samuel J

    2008-08-01

    Thromboembolism resulting from coagulum formation on the catheter and electrode surfaces is a serious complication with radiofrequency ablation procedures for heart rhythm disorders. Why coagulum occurs despite therapeutic heparinization is unclear. In this report, we demonstrate a novel approach to minimize coagulum formation based on the electromolecular characteristics of fibrinogen. Atomic force microscopy was used to establish that fibrinogen deposited on surfaces underwent conformational changes that resulted in spontaneous clot formation. We then immersed ablation catheters that were uncharged, negatively, or positively charged in heparinized blood for 30 minutes and noted the extent of clot formation. In separate experiments, ablation catheters were sutured to the ventricle of an excised porcine heart immersed in whole, heparinized blood and radiofrequency ablation performed for 5 minutes with and without charge delivered to the catheter tips. Electron microscopy of the catheter tips showed surface coverage of fibrin clot of the catheter to be 33.8% for negatively charged catheters, compared with 84.7% (P = 0.01) in noncharged catheters. There was no significant difference in surface coverage of fibrin clot between positively charged catheters (93.8%) and noncharged catheters (84.7%, P = ns). In contrast, the thickness of surface clot coverage for positively charged catheters was 87.5%, compared with 28.45% (P= 0.03) for noncharged catheters and 11.25% (P = 0.03) for negatively charged catheters, compared with noncharged catheters. We describe a novel method of placing negative charge on electrodes during ablation that reduced coagulum formation. This may decrease thromboembolism-related complications with radiofrequency ablation procedures.

  10. Initial experience of EUS-guided radiofrequency ablation of unresectable pancreatic cancer.

    PubMed

    Song, Tae Jun; Seo, Dong Wan; Lakhtakia, Sundeep; Reddy, Nageshwar; Oh, Dong Wook; Park, Do Hyun; Lee, Sang Soo; Lee, Sung Koo; Kim, Myung-Hwan

    2016-02-01

    Radiofrequency ablation (RFA) has been used as a valuable treatment modality for various unresectable malignancies. EUS-guided radiofrequency ablation (EUS-RFA) of the porcine pancreas was reported to be feasible and safe in our previous study, suggesting that EUS-RFA may be applicable as an adjunct and effective alternative treatment method for unresectable pancreatic cancer. This study aimed to assess the technical feasibility and safety of EUS-RFA for unresectable pancreatic cancer. An 18-gauge endoscopic RFA electrode and a radiofrequency generator were used for the procedure. The length of the exposed tip of the RFA electrode was 10 mm. After insertion of the RFA electrode into the mass, the radiofrequency generator was activated to deliver 20 to 50 W ablation power for 10 seconds. Depending on tumor size, the procedure was repeated to sufficiently cover the tumor. EUS-RFA was performed successfully in all 6 patients (median age 62 years, range 43-73 years). Pancreatic cancer was located in the head (n = 4) or body (n = 2) of the pancreas. The median diameter of masses was 3.8 cm (range 3cm-9cm). Four patients had stage 3 disease, and 2 patients had stage 4 disease. After the procedure, 2 patients experienced mild abdominal pain, but there were no other adverse events such as pancreatitis or bleeding. EUS-RFA could be a technically feasible and safe option for patients with unresectable pancreatic cancer. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  11. Laparoscopic microwave thermosphere ablation of malignant liver tumors: An analysis of 53 cases.

    PubMed

    Zaidi, Nisar; Okoh, Alexis; Yigitbas, Hakan; Yazici, Pinar; Ali, Noaman; Berber, Eren

    2016-02-01

    Microwave thermosphere ablation (MTA) is a new technology that is designed to create spherical zones of ablation using a single antenna. The aim of this study is to assess the results of MTA in a large series of patients. This was a prospective study assessing the use of MTA in patients with malignant liver tumors. The procedures were done mostly laparoscopically and ablation zones created were assessed for completeness of tumor response, spherical geometry and recurrence on tri-phasic CT scans done on follow-up. There were a total of 53 patients with an average of 3 tumors measuring 1.5 cm. Ablations were performed laparoscopically in all but eight patients. Morbidity was 11.3% (n = 6), and mortality zero. On postoperative scans, there was 99.3% tumor destruction. Roundness indices A, B, and transverse were 1.1, 1.0, and 0.9, respectively. At a median follow-up of 4.5 months, incomplete ablation was seen in 1 of 149 lesions treated (0.7%) and local tumor recurrence in 1 lesion (0.7%). The results of this series confirm the safety and feasibility of MTA technology. The 99.3% rate of complete tumor ablation and low rate of local recurrence at short-term follow up are promising. © 2015 Wiley Periodicals, Inc.

  12. The contemporary role of ablative treatment approaches in the management of renal cell carcinoma (RCC): focus on radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and cryoablation.

    PubMed

    Klatte, Tobias; Kroeger, Nils; Zimmermann, Uwe; Burchardt, Martin; Belldegrun, Arie S; Pantuck, Allan J

    2014-06-01

    Currently, most of renal tumors are small, low grade, with a slow growth rate, a low metastatic potential, and with up to 30 % of these tumors being benign on the final pathology. Moreover, they are often diagnosed in elderly patients with preexisting medical comorbidities in whom the underlying medical conditions may pose a greater risk of death than the small renal mass. Concerns regarding overdiagnosis and overtreatment of patients with indolent small renal tumors have led to an increasing interest in minimally invasive, ablative as an alternative to extirpative interventions for selected patients. To provide an overview about the state of the art in radiofrequency ablation (RFA), high-intensity focused ultrasound, and cryoablation in the clinical management of renal cell carcinoma. A PubMed wide the literature search of was conducted. International consensus panels recommend ablative techniques in patients who are unfit for surgery, who are not considered candidates for or elect against elective surveillance, and who have small renal masses. The most often used techniques are cryoablation and RFA. These ablative techniques offer potentially curative outcomes while conferring several advantages over extirpative surgery, including improved patient procedural tolerance, faster recovery, preservation of renal function, and reduction in the risk of intraoperative and postsurgical complications. While it is likely that outcomes associated with ablative modalities will improve with further advances in technology, their application will expand to more elective indications as longer-term efficacy data become available. Ablative techniques pose a valid treatment option in selected patients.

  13. Comparison of microbubble presence in the right heart during mechanochemical and radiofrequency ablation for varicose veins.

    PubMed

    Moon, K H; Dharmarajah, B; Bootun, R; Lim, C S; Lane, Tra; Moore, H M; Sritharan, K; Davies, A H

    2017-07-01

    Objective Mechanochemical ablation is a novel technique for ablation of varicose veins utilising a rotating catheter and liquid sclerosant. Mechanochemical ablation and radiofrequency ablation have no reported neurological side-effect but the rotating mechanism of mechanochemical ablation may produce microbubbles. Air emboli have been implicated as a cause of cerebrovascular events during ultrasound-guided foam sclerotherapy and microbubbles in the heart during ultrasound-guided foam sclerotherapy have been demonstrated. This study investigated the presence of microbubbles in the right heart during varicose vein ablation by mechanochemical abaltion and radiofrequency abaltion. Methods Patients undergoing great saphenous vein ablation by mechanochemical abaltion or radiofrequency ablation were recruited. During the ablative procedure, the presence of microbubbles was assessed using transthoracic echocardiogram. Offline blinded image quantification was performed using International Consensus Criteria grading guidelines. Results From 32 recruited patients, 28 data sets were analysed. Eleven underwent mechanochemical abaltion and 17 underwent radiofrequency abaltion. There were no neurological complications. In total, 39% (11/28) of patients had grade 1 or 2 microbubbles detected. Thirty-six percent (4/11) of mechanochemical abaltion patients and 29% (5/17) of radiofrequency ablation patients had microbubbles with no significant difference between the groups ( p=0.8065). Conclusion A comparable prevalence of microbubbles between mechanochemical abaltion and radiofrequency ablation both of which are lower than that previously reported for ultrasound-guided foam sclerotherapy suggests that mechanochemical abaltion may not confer the same risk of neurological events as ultrasound-guided foam sclerotherapy for treatment of varicose veins.

  14. Left atrial concomitant surgical ablation for treatment of atrial fibrillation in cardiac surgery: A meta-analysis of randomized controlled trials

    PubMed Central

    Wang, Chunguo; Ye, Minhua; Lin, Jiang; Jin, Jiang; Hu, Quanteng; Zhu, Chengchu; Chen, Baofu

    2018-01-01

    Introduction Surgical ablation is a generally established treatment for patients with atrial fibrillation undergoing concomitant cardiac surgery. Left atrial (LA) lesion set for ablation is a simplified procedure suggested to reduce the surgery time and morbidity after procedure. The present meta-analysis aims to explore the outcomes of left atrial lesion set versus no ablative treatment in patients with AF undergoing cardiac surgery. Methods A literature research was performed in six database from their inception to July 2017, identifying all relevant randomized controlled trials (RCTs) comparing left atrial lesion set versus no ablative treatment in AF patient undergoing cardiac surgery. Data were extracted and analyzed according to predefined clinical endpoints. Results Eleven relevant RCTs were included for analysis in the present study. The prevalence of sinus rhythm in ablation group was significantly higher at discharge, 6-month and 1-year follow-up period. The morbidity including 30 day mortality, late all-cause mortality, reoperation for bleeding, permanent pacemaker implantation and neurological events were of no significant difference between two groups. Conclusions The result of our meta-analysis demonstrates that left atrial lesion set is an effective and safe surgical ablation strategy for AF patients undergoing concomitant cardiac surgery. PMID:29360851

  15. Temporal trends in safety and complication rates of catheter ablation for atrial fibrillation.

    PubMed

    Muthalaly, Rahul G; John, Roy M; Schaeffer, Benjamin; Tanigawa, Shinichi; Nakamura, Tomofumi; Kapur, Sunil; Zei, Paul C; Epstein, Laurence M; Tedrow, Usha B; Michaud, Gregory F; Stevenson, William G; Koplan, Bruce A

    2018-06-01

    Atrial fibrillation (AF) ablation is increasingly common, but is associated with potential major complications. Technology, experience, and protocols have evolved significantly in recent times, and may have impacted procedural safety. We sought to compare AF ablation safety profiles, including complication rates and fluoroscopy times in a "modern" versus "historical" cohort. We evaluated consecutive patients undergoing AF ablation from a modern cohort (MC) from 2014 to 2015 and a historic cohort (HC) from 2009 to 2011 for complications. Major complications were categorized according to Heart Rhythm Society guidelines. We included 1,425 patients, 726 in the HC and 699 in the MC. The MC was older, had more OSA and less valvular AF. Fifty-two (3.5%) procedures suffered major complications across the cohorts, with significantly fewer in the MC (5.0% vs. 2.3%, P  =  0.007). The largest reductions were seen in vascular, hemorrhagic, ischemic stroke, and perforation/tamponade related complications. Periprocedural antiplatelets drugs (aHR 2.1 [95 CI 1.1-3.9], P  =  0.02) and force-sensing catheters (aHR 0.4 [95 CI 0.2-0.9], P  =  0.03) were independently related to major complication rates. Direct oral anticoagulants and uninterrupted anticoagulation were not associated with complications. There was a decrease in both fluoroscopy (-17.4 minutes [95 CI 19.2-15.6], P < 0.0001) and radiofrequency ablation times (-561 seconds [95CI -750 to -371], P < 0.0001). The safety profile of AF ablation has improved significantly in less than a decade. © 2018 Wiley Periodicals, Inc.

  16. An experimental model to investigate the targeting accuracy of MR-guided focused ultrasound ablation in liver.

    PubMed

    Petrusca, Lorena; Viallon, Magalie; Breguet, Romain; Terraz, Sylvain; Manasseh, Gibran; Auboiroux, Vincent; Goget, Thomas; Baboi, Loredana; Gross, Patrick; Sekins, K Michael; Becker, Christoph D; Salomir, Rares

    2014-01-16

    Magnetic Resonance-guided High Intensity Focused Ultrasound (MRgHIFU) is a hybrid technology that aims to offer non-invasive thermal ablation of targeted tumors or other pathological tissues. Acoustic aberrations and non-linear wave propagating effects may shift the focal point significantly away from the prescribed (or, theoretical) position. It is therefore mandatory to evaluate the spatial accuracy of ablation for a given HIFU protocol and/or device. We describe here a method for producing a user-defined ballistic target as an absolute reference marker for MRgHIFU ablations. The investigated method is based on trapping a mixture of MR contrast agent and histology stain using radiofrequency (RF) ablation causing cell death and coagulation. A dedicated RF-electrode was used for the marker fixation as follows: a RF coagulation (4 W, 15 seconds) and injection of the mixture followed by a second RF coagulation. As a result, the contrast agent/stain is encapsulated in the intercellular space. Ultrasonography imaging was performed during the procedure, while high resolution T1w 3D VIBE MR acquisition was used right after to identify the position of the ballistic marker and hence the target tissue. For some cases, after the marker fixation procedure, HIFU volumetric ablations were produced by a phased-array HIFU platform. First ex vivo experiments were followed by in vivo investigation on four rabbits in thigh muscle and six pigs in liver, with follow-up at Day 7. At the end of the procedure, no ultrasound indication of the marker's presence could be observed, while it was clearly visible under MR and could be conveniently used to prescribe the HIFU ablation, centered on the so-created target. The marker was identified at Day 7 after treatment, immediately after animal sacrifice, after 3 weeks of post-mortem formalin fixation and during histology analysis. Its size ranged between 2.5 and 4 mm. Experimental validation of this new ballistic marker method was performed for

  17. Six-month follow-up of isthmus-dependent right atrial flutter ablation using a remote magnetic catheter navigation system: a case-control study.

    PubMed

    Huo, Yan; Hindricks, Gerhard; Piorkowski, Christopher; Bollmann, Andreas; Wetzel, Ulrike; Sommer, Phillip; Gaspar, Thomas; Kottkamp, Hans; Arya, Arash

    2010-06-01

    The objective of this study was to compare results between the magnetic navigation system (MNS) and conventional catheter ablation of cavo-tricuspid isthmus (CTI)-dependent right atrial flutter (AFL) in a case control study. A remote MNS has been used for ablation of various arrhythmias including CTI-dependent AFL but comparative results between MNS and conventional ablation are not available. Between May and September 2007, a total of 51 consecutive patients (45 men, mean age 65.4 +/- 9.4 years) had undergone catheter ablation for CTI-dependent AFL. The catheter ablation (70 degrees C, 70 W, 90 s) was performed with either an 8-mm-tip magnetic catheter using MNS (case group, n = 26, 23 men, mean age 64.6 +/- 9.6 y) or a conventional 8-mm catheter (case group, n = 25, 22 men, mean age 65.4 +/- 9.1 y). Acute procedural success was defined as complete bidirectional isthmus block and success at six months was defined as absence of AFL during the six months follow-up. With respect to baseline characteristics there were no differences between the two groups. The procedure time in MNS and conventional group was [median (range)] 53 (30-130) min and 45 (30-100) min, respectively (P = 0.12). Acute success was achieved by MNS and conventional ablation in 25/26 (96.2%) and 25/25 (100%) of patients, respectively (P = 0.53). During the six months of follow-up 4 patients, 2 in each group, experienced recurrence (P = 0.90). No major complication occurred during the procedure. Charring on the catheter tip occurred in 5 patients (19.2%) in MNS and none of the patients in the control group (P <0.05). This case-control study demonstrated the acute and mid-term efficacy and safety of catheter ablation by MNS for CTI-dependent AFL, similar to rates achieved by conventional radiofrequency catheter ablation.

  18. Loss of Pace Capture on the Ablation Line During Pulmonary Vein Isolation versus "Dormant Conduction": Is Adenosine Expendable?

    PubMed

    Schaeffer, Benjamin; Willems, Stephan; Sultan, Arian; Hoffmann, Boris A; Lüker, Jakob; Schreiber, Doreen; Akbulak, Ruken; Moser, Julia; Kuklik, Pawel; Steven, Daniel

    2015-10-01

    Permanent pulmonary vein isolation (PVI) remains an essential goal of ablation therapy in patients with atrial fibrillation. Aim of this study was the intraindividual comparison of unexcitability to pacing along the ablation line versus dormant conduction (DC) as additional procedural endpoints. A total of 58 patients with paroxysmal atrial fibrillation (PAF) underwent PVI by circumferential ablation of ipsilateral pulmonary veins (PVs), followed by testing for DC by adenosine administration. Irrespective of the presence of DC, pacing along the ablation line for left atrium capture was performed and additional radio frequency energy applied if necessary. PVs with initial DC were retested after achieving unexcitability. PVI was achieved in 224 of 224 PVs. In 33 of 224 PVs (15%) DC was revealed. At 92 of 112 ablation lines (82%) sites of excitability were found. Three (9%) of the initial 33 PVs with DC showed further DC after achieving unexcitability at repeated testing. Thirty-two of 33 assumed areas of unmasked PV-LA reconduction as revealed by DC-testing showed a corresponding site of excitability on the ablation line. After a follow-up of 11.6 ± 3.4 months 79% of patients were free of arrhythmia. Pacing for unexcitability can safely identify potential sites of DC and even sites that would have not been detected by testing for DC. Unexcitability, therefore, serves as a suitable and safe procedural endpoint not only for patients with contraindications to adenosine administration. Our data suggest that adenosine may be expendable when achieving unexcitability along the ablation line. © 2015 Wiley Periodicals, Inc.

  19. Acute stress switches spatial navigation strategy from egocentric to allocentric in a virtual Morris water maze.

    PubMed

    van Gerven, Dustin J H; Ferguson, Thomas; Skelton, Ronald W

    2016-07-01

    Stress and stress hormones are known to influence the function of the hippocampus, a brain structure critical for cognitive-map-based, allocentric spatial navigation. The caudate nucleus, a brain structure critical for stimulus-response-based, egocentric navigation, is not as sensitive to stress. Evidence for this comes from rodent studies, which show that acute stress or stress hormones impair allocentric, but not egocentric navigation. However, there have been few studies investigating the effect of acute stress on human spatial navigation, and the results of these have been equivocal. To date, no study has investigated whether acute stress can shift human navigational strategy selection between allocentric and egocentric navigation. The present study investigated this question by exposing participants to an acute psychological stressor (the Paced Auditory Serial Addition Task, PASAT), before testing navigational strategy selection in the Dual-Strategy Maze, a modified virtual Morris water maze. In the Dual-Strategy maze, participants can chose to navigate using a constellation of extra-maze cues (allocentrically) or using a single cue proximal to the goal platform (egocentrically). Surprisingly, PASAT stress biased participants to solve the maze allocentrically significantly more, rather than less, often. These findings have implications for understanding the effects of acute stress on cognitive function in general, and the function of the hippocampus in particular. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Value of microwave ablation in treatment of large lesions of hepatocellular carcinoma.

    PubMed

    Medhat, Eman; Abdel Aziz, Ashraf; Nabeel, Mohammed; Elbaz, Tamer; Zakaria, Zeinab; Shousha, Hend; Amer, Ayman; Fouad Fathalah, Waleed; Maher, Rabab; Musa, Shereif

    2015-08-01

    Thermal ablative therapies continue to be favored as a safe and effective treatment for patients with non-resectable hepatocellular carcinoma (HCC). Percutaneous microwave ablative therapy, which is a relatively new technique, has the advantage in providing faster ablation of large tumors. This study aimed to evaluate microwave ablation in the treatment of large HCC (5-7 cm) and to assess its effect on local tumor progression, prognostic outcome and patients' survival. In all, 26 patients with large HCC lesions (5-7 cm) were managed in the multidisciplinary clinic of Kasr Al Ainy University hospital using microwave ablation. The treatment was performed with the patient under conscious sedation and analgesia and ultrasonography-guided using an HS AMICA microwave machine operating at frequency of 2450 MHz and a power up to 100 W. Multiple needle insertions were made in one or two sessions according to the size of the lesion. The complete ablation rate, local tumor progression and patients' overall survival were analyzed, and the efficacy and safety of MWA was evaluated. Complete ablation was achieved in 19/26 (73.1%). Local tumor progression was recorded in five treated lesions (19.2%). Distant tumor progression within the liver was recorded in six patients (23.1%), with a mean survival of 21.5 months. No procedure-related major complications or deaths were observed. Percutaneous microwave ablation is safe and effective in the treatment of large HCC tumors. Patients' survival and local tumor control were acceptable. © 2015 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  1. First noninvasive thermal ablation of a brain tumor with MR-guided focused ultrasound

    PubMed Central

    2014-01-01

    Magnetic resonance-guided focused ultrasound surgery (MRgFUS) allows for precise thermal ablation of target tissues. While this emerging modality is increasingly used for the treatment of various types of extracranial soft tissue tumors, it has only recently been acknowledged as a modality for noninvasive neurosurgery. MRgFUS has been particularly successful for functional neurosurgery, whereas its clinical application for tumor neurosurgery has been delayed for various technical and procedural reasons. Here, we report the case of a 63-year-old patient presenting with a centrally located recurrent glioblastoma who was included in our ongoing clinical phase I study aimed at evaluating the feasibility and safety of transcranial MRgFUS for brain tumor ablation. Applying 25 high-power sonications under MR imaging guidance, partial tumor ablation could be achieved without provoking neurological deficits or other adverse effects in the patient. This proves, for the first time, the feasibility of using transcranial MR-guided focused ultrasound to safely ablate substantial volumes of brain tumor tissue. PMID:25671132

  2. Surgical perspectives in the management of atrial fibrillation

    PubMed Central

    Kyprianou, Katerina; Pericleous, Agamemnon; Stavrou, Antonio; Dimitrakaki, Inetzi A; Challoumas, Dimitrios; Dimitrakakis, Georgios

    2016-01-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia and a huge public health burden associated with significant morbidity and mortality. For decades an increasing number of patients have undergone surgical treatment of AF, mainly during concomitant cardiac surgery. This has sparked a drive for conducting further studies and researching this field. With the cornerstone Cox-Maze III “cut and sew” procedure being technically challenging, the focus in current literature has turned towards less invasive techniques. The introduction of ablative devices has revolutionised the surgical management of AF, moving away from the traditional surgical lesions. The hybrid procedure, a combination of catheter and surgical ablation is another promising new technique aiming to improve outcomes. Despite the increasing number of studies looking at various aspects of the surgical management of AF, the literature would benefit from more uniformly conducted randomised control trials. PMID:26839656

  3. Analysis of the change in peak corneal temperature during excimer laser ablation in porcine eyes

    NASA Astrophysics Data System (ADS)

    Mosquera, Samuel Arba; Verma, Shwetabh

    2015-07-01

    The objective is to characterize the impact of different ablation parameters on the thermal load during corneal refractive surgery by means of excimer laser ablation on porcine eyes. One hundred eleven ablations were performed in 105 porcine eyes. Each ablation was recorded using infrared thermography and analyzed mainly based on the two tested local frequencies (40 Hz, clinical local frequency; 1000 Hz, no local frequency). The change in peak corneal temperature was analyzed with respect to varying ablation parameters [local frequency, system repetition rate, pulse energy, optical zone (OZ) size, and refractive correction]. Transepithelial ablations were also compared to intrastromal ablations. The average of the baseline temperature across all eyes was 20.5°C±1.1 (17.7°C to 22.2°C). Average of the change in peak corneal temperature for all clinical local frequency ablations was 5.8°C±0.8 (p=3.3E-53 to baseline), whereas the average was 9.0°C±1.5 for all no local frequency ablations (p=1.8E-35 to baseline, 1.6E-16 to clinical local frequency ablations). A logarithmic relationship was observed between the changes in peak corneal temperature with increasing local frequency. For clinical local frequency, change in peak corneal temperature was comparatively flat (r2=0.68 with a range of 1.5°C) with increasing system repetition rate and increased linearly with increasing OZ size (r2=0.95 with a range of 2.4°C). Local frequency controls help maintain safe corneal temperature increase during excimer laser ablations. Transepithelial ablations induce higher thermal load compared to intrastromal ablations, indicating a need for stronger thermal controls in transepithelial refractive procedures.

  4. Use of Oral Steroid and its Effects on Atrial Fibrillation Recurrence and Inflammatory Cytokines Post Ablation - The Steroid AF Study.

    PubMed

    Iskandar, Sandia; Reddy, Madhu; Afzal, Muhammad R; Rajasingh, Johnson; Atoui, Moustapha; Lavu, Madhav; Atkins, Donita; Bommana, Sudha; Umbarger, Linda; Jaeger, Misty; Pimentel, Rhea; Dendi, Raghuveer; Emert, Martin; Turagam, Mohit; Di Biase, Luigi; Natale, Andrea; Lakkireddy, Dhanunjaya

    2017-01-01

    Use of corticosteroids before and after atrial fibrillation (AF) ablation can decrease acute inflammation and reduce AF recurrence. To assess the efficacy of oral prednisone in improving the outcomes of pulmonary vein isolation with radiofrequency ablation and its effect on inflammatory cytokine. A total of 60 patients with paroxysmal AF undergoing radiofrequency ablation were randomized (1:1) to receive either 3 doses of 60 mg daily of oral prednisone or a placebo. Inflammatory cytokine levels (TNF-α, IL-1, IL6, IL-8) were measured at baseline, prior to ablation, immediately after ablation, and 24 hours post ablation. Patients underwent 30 day event monitoring at 3 months, 6 months and 12 months post procedure. Immediate post ablation levels of inflammatory cytokines were lower in the steroid group when compared to the placebo group; IL-6: 9.0 ±7 vs 15.8 ±13 p=0.031; IL-8: 10.5 ±9 vs 15.3 ±8; p=0.047 respectively. Acute PV reconnection rates during the procedure (7/23% vs 10/36%; p = 0.39), and RF ablation time (51±13 vs 56±11 min, p = 0.11) trended to be lower in the placebo group than the steroid group. There was no difference in the incidence of early recurrence of AF during the blanking period and freedom from AF off AAD at 12 months between both groups (5/17% vs 8/27%; p = 0.347 and 21/70% vs 18/60%; p=0.417 in placebo and steroid groups respectively). Although oral corticosteroids have significant effect in lowering certain cytokines, it did not impact the clinical outcomes of AF ablation.

  5. [Interventional radiology procedures for malignancies of the liver treatment: Intraarterial procedures].

    PubMed

    Cristina, V; Pracht, M; Lachenal, Y; Adib, S; Boubaker, A; Prior, J; Senys, A; Wagner, A D; Bize, P

    2014-05-21

    Intraarterial procedures such as chemoembolization and radioembolization aim for the palliative treatment of advanced hepatocellular carcinoma (stage BCLC B and C with tumoral portal thrombosis). The combination of hepatic intraarterial chemotherapy and systemic chemotherapy can increase the probability of curing colorectal cancer with hepatic metastases not immediately accessible to surgical treatment or percutaneous ablation.

  6. Remote magnetic navigation with irrigated tip catheter for ablation of paroxysmal atrial fibrillation.

    PubMed

    Miyazaki, Shinsuke; Shah, Ashok J; Xhaët, Olivier; Derval, Nicolas; Matsuo, Seiichiro; Wright, Matthew; Nault, Isabelle; Forclaz, Andrei; Jadidi, Amir S; Knecht, Sébastien; Rivard, Lena; Liu, Xingpeng; Linton, Nick; Sacher, Frédéric; Hocini, Mélèze; Jaïs, Pierre; Haïssaguerre, Michel

    2010-12-01

    The remote magnetic navigation system (MNS) has been used with a nonirrigated magnetic catheter for atrial fibrillation (AF) ablation. The objective of this study was to evaluate the feasibility and efficiency of the newly available irrigated tip magnetic catheter for index pulmonary vein isolation (PVI) in patients with paroxysmal AF (PAF). Between January 2008 and June 2009, 30 consecutive patients with drug-resistant PAF underwent circular mapping catheter-guided PVI with MNS (MNS group). The outcomes were compared retrospectively with those of a conventional hand-controlled ablation technique during the same period in 44 consecutive patients (manual group). All 4 pulmonary veins were successfully isolated in both groups except in 4 patients in the MNS group. Radiofrequency and procedure duration were higher in the MNS group (60 ± 27 versus 43 ± 16 minutes; P = 0.0019) than in the manual group (246 ± 50 versus 153 ± 51 minutes; P < 0.0001). In the patients who underwent only PVI, total fluoroscopic time also was longer in the MNS group than in the manual group (58 ± 24 versus 40 ± 14 minutes; P = 0.0002). At 12-month follow-up after a single procedure, 69.0% of the patients in MNS group and 61.8% of patients in manual group were free of atrial tachyarrhythmia without antiarrhythmic drugs. There was no significant difference in the atrial tachyarrhythmia-free survival between the 2 groups (P = 0.961). Cardiac tamponade occurred in 1 patient in the manual group. In patients with PAF, MNS-guided PVI with the newly available irrigated tip magnetic catheter backed up with manual ablation whenever required is feasible. However, it requires longer ablation, fluoroscopy, and procedural times than the conventional approach in the early experience stage.

  7. Catheter ablation as a treatment of atrioventricular block.

    PubMed

    Tuohy, Stephen; Saliba, Walid; Pai, Manjunath; Tchou, Patrick

    2018-01-01

    Symptomatic second-degree atrioventricular (AV) block is typically treated by implantation of a pacemaker. An otherwise healthy AV conduction system can nevertheless develop AV block due to interference from junctional extrasystoles. When present with a high burden, these can produce debilitating symptoms from AV block despite an underlying normal AV node and His-Purkinje system properties. The purpose of this study was to describe a catheter ablation approach for alleviating symptomatic AV block due to a ventricular nodal pathway interfering with AV conduction. Common clinical monitoring techniques such as Holter and event recorders were used. Standard electrophysiological study techniques using multipolar recording and ablation catheters were utilized during procedures. A 55-year-old woman presented with highly symptomatic, high-burden second-degree AV block due to concealed and manifest junctional premature beats. Electrophysiological characteristics indicated interference of AV conduction due to a concealed ventricular nodal pathway as the cause of the AV block. The patient's AV nodal and His-Purkinje system conduction characteristics were otherwise normal. Radiofrequency catheter ablation of the pathway was successful in restoring normal AV conduction and eliminating her clinical symptoms. Pathways inserting into the AV junction can interfere with AV conduction. When present at a high burden, this type of AV block can be highly symptomatic. Catheter ablation techniques can be used to alleviate this type of AV block and restore normal AV conduction. Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  8. Reflectance confocal microscopy-guided laser ablation of basal cell carcinomas: initial in vivo results

    NASA Astrophysics Data System (ADS)

    Sierra, Heidy; Cordova, Miguel; Yelamos, Oriol; Chen, Chih-Shan Jason; Rajadhyaksha, Milind

    2017-02-01

    Laser ablation offers a procedure for precise, fast and minimally invasive removal of superficial and early nodular basal cell carcinomas (BCCs). However, the lack of histopathological confirmation has been a limitation toward widespread use in the clinic. A reflectance confocal microscopy (RCM) imaging-guided laser ablation approach offers cellular-level histopathology-like feedback directly on the patient, which may guide and help improve the efficacy of this procedure. We performed an initial study on 44 BCCs on 21 patients in vivo (based in an ex vivo bench-top study reported in our earlier papers), using a pulsed erbium: ytterbium aluminum garnet laser and a contrast agent (aluminum chloride). Initial 10 lesions, the RCM imaging-guided detection of either presence of residual tumor or complete clearance was immediately confirmed with histopathology. Additionally, 34 BCCs on 15 patients were treated with RCM imaging-guided laser ablation, and the clearance of tumor is currently being monitored with follow-up imaging (i. e., no histopathology) at 3, 6 and 18 months. Thus far, the imaging resolution appears to be sufficient and consistent for monitoring efficacy in the wound, both immediately post-ablation and subsequently during recovery. The efficacy appears to be promising. However, further investigation and optimization to image over the entire wound (without missing any areas) need to be investigated.

  9. Comparison of transcatheter laser and direct-current shock ablation of endocardium near tricuspid anulus

    NASA Astrophysics Data System (ADS)

    Zhang, Yu-Zhen; Wang, Shi-Wen; Li, Junheng

    1993-03-01

    Forty to eighty percent of the patients with accessory pathways (APs) manifest themselves by tachyarrhythmias. Many of these patients needed either life-long medical therapy or surgery. In order to avoid the discomfort and expenses in surgical procedures, closed chest percutaneous catheter ablation of APs became a potentially desirable therapeutic approach. Many investigations indicated that ablation of right APs by transcatheter direct current (dc) shock could cause life-threatening arrhythmias, right coronary arterical (RCA) spasm, etc. With the development of transcatheter laser technique, it has been used in drug-incurable arrhythmias. The results show that laser ablation is much safer than surgery and electric shock therapy. The purpose of this study is to explore the effectiveness, advantages, and complications with transcatheter Nd:YAG laser and dc shock in the ablation of right atrioventricular accessory pathways in the atrium near the tricuspid annulus (TA) in 20 dogs.

  10. Atrial fibrillation ablation using a closed irrigation radiofrequency ablation catheter.

    PubMed

    Golden, Keith; Mounsey, John Paul; Chung, Eugene; Roomiani, Pahresah; Morse, Michael Andew; Patel, Ankit; Gehi, Anil

    2012-05-01

    Catheter ablation is an effective therapy for symptomatic, medically refractory atrial fibrillation (AF). Open-irrigated radiofrequency (RF) ablation catheters produce transmural lesions at the cost of increased fluid delivery. In vivo models suggest closed-irrigated RF catheters create equivalent lesions, but clinical outcomes are limited. A cohort of 195 sequential patients with symptomatic AF underwent stepwise AF ablation (AFA) using a closed-irrigation ablation catheter. Recurrence of AF was monitored and outcomes were evaluated using Kaplan-Meier survival analysis and Cox proportional hazards models. Mean age was 59.0 years, 74.9% were male, 56.4% of patients were paroxysmal and mean duration of AF was 5.4 years. Patients had multiple comorbidities including hypertension (76.4%), tobacco abuse (42.1%), diabetes (17.4%), and obesity (mean body mass index 30.8). The median follow-up was 55.8 weeks. Overall event-free survival was 73.6% with one ablation and 77.4% after reablation (reablation rate was 8.7%). Median time to recurrence was 26.9 weeks. AF was more likely to recur in patients being treated with antiarrhythmic therapy at the time of last follow-up (recurrence rate 30.3% with antiarrhythmic drugs, 13.2% without antiarrhythmic drugs; hazard ratio [HR] 2.2, 95% confidence interval [CI] 1.1-4.4, P = 0.024) and in those with a history of AF greater than 2 years duration (HR 2.7, 95% CI 1.1-6.9, P = 0.038). Our study represents the largest cohort of patients receiving AFA with closed-irrigation ablation catheters. We demonstrate comparable outcomes to those previously reported in studies of open-irrigation ablation catheters. Given the theoretical benefits of a closed-irrigation system, a large head-to-head comparison using this catheter is warranted. ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

  11. Possible role for cryoballoon ablation of right atrial appendage tachycardia when conventional ablation fails.

    PubMed

    Amasyali, Basri; Kilic, Ayhan

    2015-06-01

    Focal atrial tachycardia arising from the right atrial appendage usually responds well to radiofrequency ablation; however, successful ablation in this anatomic region can be challenging. Surgical excision of the right atrial appendage has sometimes been necessary to eliminate the tachycardia and prevent or reverse the resultant cardiomyopathy. We report the case of a 48-year-old man who had right atrial appendage tachycardia resistant to multiple attempts at ablation with use of conventional radiofrequency energy guided by means of a 3-dimensional mapping system. The condition led to cardiomyopathy in 3 months. The arrhythmia was successfully ablated with use of a 28-mm cryoballoon catheter that had originally been developed for catheter ablation of paroxysmal atrial fibrillation. To our knowledge, this is the first report of cryoballoon ablation without isolation of the right atrial appendage. It might also be an alternative to epicardial ablation or surgery when refractory atrial tachycardia originates from the right atrial appendage.

  12. Catheter ablation of atrial fibrillation using remote magnetic catheter navigation: a case-control study.

    PubMed

    Arya, Arash; Zaker-Shahrak, Ruzbeh; Sommer, Phillip; Bollmann, Andreas; Wetzel, Ulrike; Gaspar, Thomas; Richter, Sergio; Husser, Daniela; Piorkowski, Christopher; Hindricks, Gerhard

    2011-01-01

    To compare the acute and the 6 month outcome of catheter ablation of atrial fibrillation (AF) using irrigated tip magnetic catheter and remote magnetic cathter navigation (RMN) with manual catheter navigation (MCN) in patients with paroxysmal and persistent AF. In this retrospective analysis 356 patients (235 male, mean age: 57.9 ± 10.9 years) with AF (70.5%, paroxysmal) who underwent catheter ablation between August 2007 and May 2008 using either RMN (n = 70, 46 male, mean age: 57.9 ± 10.1 years, 50% paroxysmal) or MCN (n = 286, 189 male, mean age: 58.0 ± 13.9 years, 75.5% paroxysmal) were included. All patients completed an intensive follow-up strategy. Complete pulmonary vein isolation was achieved in 87.6 and 99.6% of patients in RMN and MCN groups, respectively (P < 0.05). The procedure, fluoroscopy, and radiofrequency application times were 223 ± 44 vs. 166 ± 52 min (P < 0.0001), 13.7 ± 7.8 vs. 34.5 ± 15.1 min (P < 0.0001), and 75.4 ± 20.9 vs. 53.2 ± 21.4 min (P < 0.0001) in RMN and MCN groups, respectively. Seven (10.0%) and 28 (9.8%) patients in RMN and MCN groups received antiarrhythmic medications during the follow-up (P = 0.96). All the patients completed the 6 month follow-up. Freedom from AF at 6 months was achieved in 57.8 and 66.4% of the patients in RMN and MCN groups, respectively (P = 0.196). In patients without previous AF catheter ablation procedure the freedom from AF at 6 months were 68.2 and 60.5% in the MCN and RMN groups, respectively (P = 0.36). Catheter ablation using irrigated tip magnetic catheter and RMN is an effective and safe method for catheter ablation of AF. Compared to manual catheter navigation, the procedure and radiofrequency application times were longer and fluoroscopy time was shorter in the RMN group compared with the MCN group.

  13. Interatrial septum thickness and difficulty with transseptal puncture during redo catheter ablation of atrial fibrillation.

    PubMed

    Tomlinson, David R; Sabharwal, Nikant; Bashir, Yaver; Betts, Timothy R

    2008-12-01

    Patients undergoing catheter ablation for atrial fibrillation (AF) frequently require redo procedures, but there are no data reporting interatrial septum thickness (IAS) and difficulty during repeat transseptal puncture (TSP). Patients undergoing two separate AF ablation procedures had preprocedural fossa ovalis (FO) thickness measured using transesophageal echocardiography (TEE). "Difficult" TSP was defined by two observers as requiring excessive force, or conversion to TEE guidance. The study comprised 42 patients (37 male) with mean+/-SD age 55+/-9 years. Mean FO thickness was significantly greater at the time of redo TSP (2.2+/-1.6 mm vs 2.6+/-1.5 mm at redo, P=0.03); however, this finding was limited to those who underwent initial dual transseptal sheath procedures, FO thickness 2.0+/-1.5 mm and 2.5+/-1.4 mm for TEE 1 and 2, respectively (P=0.048). There was a trend for more frequent difficult redo TSP procedures, 7/42 (17%; 95% confidence interval [CI] 8-31) redo, versus 4/42 (10%; 95% CI 3-23) first TSP. On univariate analysis, FO thickness was not predictive of TSP difficulty; the only predictor of difficult redo TSP was diabetes. IAS thickness at the FO increased following catheter ablation of AF, yet on subgroup analysis this was limited to initial procedures utilizing dual transseptal sheaths. There was a trend toward more frequent difficulty during redo TSP, yet this was not associated with FO thickening. Diabetes may predispose to difficulty during redo TSP; this finding requires confirmation in a larger study population.

  14. Remote magnetic navigation vs. manual navigation for ablation of ventricular tachycardia: a meta-analysis.

    PubMed

    Wu, Y; Li, K-L; Zheng, J; Zhang, C-Y; Liu, X-Y; Cui, Z-M; Yu, Z-M; Wang, R-X; Wang, W

    2015-09-01

    The purpose of this study was to prospectively evaluate the efficacy and safety of remote magnetic navigation (RMN) in comparison with manual catheter navigation (MCN) in performing ventricular tachycardia ablation. An electronic search was performed using PubMed (1948-2013) and EMBASE (1974-2013) studies comparing RMN with MCN which were published prior to 31 December 2013. Outcomes of interest were as follows: acute success, recurrence rate, complications, total procedure and fluoroscopic times. Standard mean difference (SMD) and its 95 % confidence interval (CI) were used for continuous outcomes; odds ratios (OR) were reported for dichotomous variables. Four non-randomised studies, including a total of 328 patients, were identified. RMN was deployed in 191 patients. Acute success and long-term freedom from arrhythmias were not significantly different between the RMN and control groups (OR 1.845, 95 % CI 0.731-4.659, p = 0.195 and OR 0.676, 95 % CI 0.383-1.194, p = 0.177, respectively). RMN was associated with less peri-procedural complications (OR 0.279, 95 % CI 0.092-0.843, p = 0.024). Shorter procedural and fluoroscopy times were achieved (95 % CI -0.487 to -0.035, p = 0.024 and 95 % CI -1.467 to -0.984, p<0.001, respectively). The acute and long-term success rates for VT ablation are equal between RMN and MCN, whereas the RMN-guided procedure can be performed with a lower complication rate and less procedural and fluoroscopic times. More prospective randomised trials will be needed to better evaluate the superior role of RMN for catheter ablation of ventricular tachycardia.

  15. TECHNIQUES AND OUTCOMES OF MINIMALLY-INVASIVE TRABECULAR ABLATION AND BYPASS SURGERY

    PubMed Central

    Kaplowitz, Kevin; Schuman, Joel S.; Loewen, Nils A.

    2014-01-01

    Minimally invasive glaucoma surgeries (MIGS) can improve the conventional, pressure dependent outflow by bypassing or ablating the trabecular meshwork or create alternative drainage routes into the suprachoroidal or subconjunctival space. They have a highly favorable risk profile compared to penetrating surgeries and lower intraocular pressure with variable efficacy that may depend on the extent of outflow segments accessed. Since they are highly standardized procedures that use clear corneal incisions, they can elegantly be combined with cataract and refractive procedures to improve vision in the same session. There is a growing need for surgeons to become proficient in MIGS to address the increasing prevalence of glaucoma and cataracts in a well-informed, aging population. Techniques of visualization and instrumentation in an anatomically highly confined space with semi-transparent tissues are fundamentally different from other anterior segment surgeries and present even experienced surgeons with a substantial learning curve. Here, we provide practical tips and review techniques and outcomes of TM bypass and ablation MIGS. PMID:24338085

  16. Loss of pace capture on the ablation line: a new marker for complete radiofrequency lesions to achieve pulmonary vein isolation.

    PubMed

    Steven, Daniel; Reddy, Vivek Y; Inada, Keiichi; Roberts-Thomson, Kurt C; Seiler, Jens; Stevenson, William G; Michaud, Gregory F

    2010-03-01

    Catheter ablation procedures for atrial fibrillation (AF) often involve circumferential antral isolation of pulmonary veins (PV). Inability to reliably identify conduction gaps on the ablation line necessitates placing additional lesions within the intended lesion set. This pilot study investigated the relationship between loss of pace capture directly along the ablation line and electrogram criteria for PV isolation (PVI). Using a 3-dimensional anatomic mapping system and irrigated-tip radiofrequency (RF) ablation catheter, lesions were placed in the PV antra to encircle ipsilateral vein pairs until pace capture at 10 mA/2 ms no longer occurred along the line. During ablation, a circular mapping catheter was placed in an ipsilateral PV, but the electrograms were not revealed until loss-of-pace capture. The procedural end point was PVI (entrance and exit block). Thirty patients (57 +/- 12 years; 15 male [50%]) undergoing PVI in 2 centers (3 primary operators) were included (left atrial diameter 40 +/- 4 mm, left ventricular ejection fraction 60 +/- 7%). All patients reached the end points of complete PVI and loss of pace capture. When PV electrograms were revealed after loss of pace capture along the line, PVI was present in 57 of 60 (95%) vein pairs. In the remaining 3 of 60 (5%) PV pairs, further RF applications achieved PVI. The procedure duration was 237 +/- 46 minutes, with a fluoroscopy time of 23 +/- 9 minutes. Analysis of the blinded PV electrograms revealed that even after PVI was achieved, additional sites of pace capture were present on the ablation line in 30 of 60 (50%) of the PV pairs; 10 +/- 4 additional RF lesions were necessary to fully achieve loss of pace capture. After ablation, the electrogram amplitude was lower at unexcitable sites (0.25 +/- 0.15 mV vs. 0.42 +/- 0.32 mV, P < .001), but there was substantial overlap with pace capture sites, suggesting that electrogram amplitude lacks specificity for identifying pace capture sites. Complete

  17. Recurrence and Survival Outcomes After Percutaneous Thermal Ablation of Oligometastatic Melanoma.

    PubMed

    White, Mariah L; Atwell, Thomas D; Kurup, A Nicholas; Schmit, Grant D; Carter, Rickey E; Geske, Jennifer R; Kottschade, Lisa A; Pulido, Jose S; Block, Matthew S; Jakub, James W; Callstrom, Matthew R; Markovic, Svetomir N

    2016-03-01

    To evaluate focal treatment of melanoma metastases and to explore whether any potential extended survival benefit exists in a select patient population. All patients who underwent image-guided local thermal ablation of metastatic melanoma over an 11-year period (January 1, 2002, to December 31, 2013) were retrospectively identified using an internally maintained clinical registry. Only patients with oligometastatic stage IV disease amenable to complete ablation of all clinical disease at the time of ablation were included in the analysis. Overall survival and median progression-free survival periods were calculated. Thirty-three patients with primary ocular or nonocular melanoma had 66 metastases treated in the lungs, liver, bones, or soft tissues. Eleven (33%) patients were on systemic medical therapy at the time of the procedure. The median survival time was 3.8 years (range, 0.5-10.5 years), with a 4-year estimated survival of 44.1% (95% CI, 28%-68%). Local recurrence at the ablation site developed in 15.1% (5 of 33) of the patients and 13.6% of the tumors (9 of 66). The median progression-free survival time was 4.4 months (95% CI, 1.4 months to 10.5 years), with an estimated 1-year progression-free survival of 30.3% (95% CI, 18%-51%). A subgroup analysis identified 11 patients with primary ocular melanoma and 22 with nonocular melanoma, with a median survival time of 3.9 years (range, 0.9-4.7 years) and 3.8 years (range, 0.5-10.5 years), respectively (P=.58). There were no major complications and no deaths within 30 days of the procedure. Selective use of image-guided thermal ablation of oligometastatic melanoma may provide results similar to surgical resection in terms of technical effectiveness and oncologic outcomes with minimal risk. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  18. Image-guided tumor ablation: standardization of terminology and reporting criteria.

    PubMed

    Goldberg, S Nahum; Grassi, Clement J; Cardella, John F; Charboneau, J William; Dodd, Gerald D; Dupuy, Damian E; Gervais, Debra A; Gillams, Alice R; Kane, Robert A; Lee, Fred T; Livraghi, Tito; McGahan, John; Phillips, David A; Rhim, Hyunchul; Silverman, Stuart G; Solbiati, Luigi; Vogl, Thomas J; Wood, Bradford J; Vedantham, Suresh; Sacks, David

    2009-07-01

    The field of interventional oncology with use of image-guided tumor ablation requires standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison between treatments that use different technologies, such as chemical (ethanol or acetic acid) ablation, and thermal therapies, such as radiofrequency (RF), laser, microwave, ultrasound, and cryoablation. This document provides a framework that will hopefully facilitate the clearest communication between investigators and will provide the greatest flexibility in comparison between the many new, exciting, and emerging technologies. An appropriate vehicle for reporting the various aspects of image-guided ablation therapy, including classification of therapies and procedure terms, appropriate descriptors of imaging guidance, and terminology to define imaging and pathologic findings, are outlined. Methods for standardizing the reporting of follow-up findings and complications and other important aspects that require attention when reporting clinical results are addressed. It is the group's intention that adherence to the recommendations will facilitate achievement of the group's main objective: improved precision and communication in this field that lead to more accurate comparison of technologies and results and, ultimately, to improved patient outcomes. The intent of this standardization of terminology is to provide an appropriate vehicle for reporting the various aspects of image-guided ablation therapy.

  19. Food restriction affects Y-maze spatial recognition memory in developing mice.

    PubMed

    Fu, Yu; Chen, Yanmei; Li, Liane; Wang, Yumei; Kong, Xiangyang; Wang, Jianhong

    2017-08-01

    The ambiguous effects of food restriction (FR) on cognition in rodents have been mostly explored in the aged brain by a variety of paradigms, in which either rewards or punishments are involved. This study aims to examine the effects of chronic and acute FR with varying intensities on spatial recognition memory in developing mice. We have used a Y-maze task that is based on the innate tendency of rodents to explore novel environments. In chronic FR, mice had 70-30% chow of control for seven weeks. In acute FR, mice were food restricted for 12-48h before the tests. We found that chronic FR had no effect on the preference of mice for novelty in the Y-maze, but severe FR (50-30% of control) caused impairment on spatial recognition memory. The impairment significantly correlated with the slow weight growth induced by FR. Acute FR also did not affect the novelty preference of mice, but either improved or impaired the memory retention. These data suggest chronic FR impairs Y-maze spatial recognition memory in developing mice depending on FR intensity and individual tolerability of the FR. Moreover, acute FR exerts diverse effects on the memory, either positive or negative. Our findings have revealed new insights on the effects of FR on spatial recognition memory in developing animals. Copyright © 2017 ISDN. Published by Elsevier Ltd. All rights reserved.

  20. Outcomes of atrioesophageal fistula following catheter ablation of atrial fibrillation treated with surgical repair versus esophageal stenting.

    PubMed

    Mohanty, Sanghamitra; Santangeli, Pasquale; Mohanty, Prasant; Di Biase, Luigi; Trivedi, Chintan; Bai, Rong; Horton, Rodney; Burkhardt, J David; Sanchez, Javier E; Zagrodzky, Jason; Bailey, Shane; Gallinghouse, Joseph G; Hranitzky, Patrick M; Sun, Albert Y; Hongo, Richard; Beheiry, Salwa; Natale, Andrea

    2014-06-01

    Atrioesophageal fistula (AEF) is a rare but devastating complication of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Surgical repair and esophageal stents are available treatment options for AEF. We report outcomes of these 2 management strategies. Nine patients with AEF post-RFCA for AF were included in this study. AEF was diagnosed based on symptoms and chest CT imaging. Of the 9 patients, 5 received stents and 4 underwent surgical repair of fistula. AF ablation was performed under general anesthesia (n = 4) or conscious sedation (n = 5). During ablation, RF power was maintained between 25 and 35 Watts in areas close to the esophagus and energy delivery discontinued when esophageal temperature reached 38 °C. Seven patients underwent ablation with 3.5-mm open-irrigated catheter, 1 with 8-mm nonirrigated catheter, and 1 had surgical epicardial ablation. Seven patients received proton pump inhibitor and sucralfate before and after procedure. AEF symptoms developed within 2–6 weeks from ablation. Esophageal stenting was performed in 5 patients (median age 58 years, median time from RFCA 4 weeks) and 4 underwent surgical repair (median age 54 years, median time from RFCA 4 weeks) within 2–4 hours from diagnosis. All 5 patients receiving stents died within 1 week of the procedure due to cerebral embolism, septic shock, or respiratory failure. On the other hand, the 4 patients that received surgical repair were alive at median follow-up of 2.1 years (P = 0.005). Esophageal stenting should be discouraged and prompt surgical repair is crucial for survival in patients with atrioesophageal fistula.

  1. Mexametric and cutometric assessment of the signs of aging of the skin area around the eyes after the use of non-ablative fractional laser, non-ablative radiofrequency and intense pulsed light.

    PubMed

    Kołodziejczak, Anna Maria; Rotsztejn, Helena

    2017-03-01

    The assessment of the signs of aging within eyes area in cutometric (skin elasticity) and mexametric (discoloration and severity of erythema) examination after the treatment with: non-ablative fractional laser, non-ablative radiofrequency (RF) and intense light source (IPL). This study included 71 patients, aged 33-63 years (the average age was 45.81) with Fitzpatrick skin type II and III. 24 patients received 5 successive treatment sessions with a 1,410-nm non-ablative fractional laser in two-week intervals, 23 patients received 5 successive treatment sessions with a non-ablative RF in one-week intervals and 24 patients received 5 successive treatment sessions with an IPL in two-week intervals. The treatment was performed for the skin in the eye area. The Cutometer and Mexameter (Courage + Khazaka electronic) reference test was used as an objective method for the assessment of skin properties: elasticity, skin pigmentation and erythema. Measurements of skin elasticity were made in three or four sites within eye area. The results of cutometric measurements for R7 showed the improvement in skin elasticity in case of all treatment methods. The largest statistically significant improvement (p < .0001) was observed in case of laser and RF, during treatment sessions, at sites at upper and lower eyelid. The smallest change in skin elasticity for the laser, RF and IPL - p = .017, p = .003 and p = .001, respectively-was observed in a site within the outer corner of the eye. In all sites of measurements and for all methods, the greatest improvement in skin elasticity was demonstrated between the first and second measurement (after 3rd procedures). The majority of the results of mexametric measurements-MEX (melanin level) and ERYT (the severity of erythema) are statistically insignificant. Fractional, non-ablative laser, non-ablation RF and intense light source can be considered as methods significantly affecting elasticity and to a lesser extent erythema

  2. Use of an eight-arm radial water maze to assess working and reference memory following neonatal brain injury.

    PubMed

    Penley, Stephanie C; Gaudet, Cynthia M; Threlkeld, Steven W

    2013-12-04

    Working and reference memory are commonly assessed using the land based radial arm maze. However, this paradigm requires pretraining, food deprivation, and may introduce scent cue confounds. The eight-arm radial water maze is designed to evaluate reference and working memory performance simultaneously by requiring subjects to use extra-maze cues to locate escape platforms and remedies the limitations observed in land based radial arm maze designs. Specifically, subjects are required to avoid the arms previously used for escape during each testing day (working memory) as well as avoid the fixed arms, which never contain escape platforms (reference memory). Re-entries into arms that have already been used for escape during a testing session (and thus the escape platform has been removed) and re-entries into reference memory arms are indicative of working memory deficits. Alternatively, first entries into reference memory arms are indicative of reference memory deficits. We used this maze to compare performance of rats with neonatal brain injury and sham controls following induction of hypoxia-ischemia and show significant deficits in both working and reference memory after eleven days of testing. This protocol could be easily modified to examine many other models of learning impairment.

  3. Insights into energy delivery to myocardial tissue during radiofrequency ablation through application of the first law of thermodynamics.

    PubMed

    Bunch, T Jared; Day, John D; Packer, Douglas L

    2009-04-01

    The approach to catheter-based radiofrequency ablation of atrial fibrillation has evolved, and as a consequence, more energy is delivered in the posterior left atrium, exposing neighboring tissue to untoward thermal injury. Simultaneously, catheter technology has advanced to allow more efficient energy delivery into the myocardium, which compounds the likelihood of collateral injury. This review focuses on the basic principles of thermodynamics as they apply to energy delivery during radiofrequency ablation. These principles can be used to titrate energy delivery and plan ablative approaches in an effort to minimize complications during the procedure.

  4. Development of a 3D ultrasound-guided system for thermal ablation of liver tumors

    NASA Astrophysics Data System (ADS)

    Neshat, Hamid R. S.; Cool, Derek W.; Barker, Kevin; Gardi, Lori; Kakani, Nirmal; Fenster, Aaron

    2013-03-01

    Two-dimensional ultrasound (2D US) imaging is commonly used for diagnostic and intraoperative guidance of interventional abdominal procedures including percutaneous thermal ablation of focal liver tumors with radiofrequency (RF) or microwave (MW) induced energy. However, in many situations 2D US may not provide enough anatomical detail and guidance information. Therefore, intra-procedural CT or MR imaging are used in many centers for guidance purposes. These modalities are costly and are mainly utilized to confirm tool placement rather than guiding the insertion. Three-dimensional ultrasound (3D US) has been introduced to address these issues. In this paper, we present our integrated solution to provide 3D US images using a newly developed mechanical transducer with a large field-ofview and without the need for external tracking devices to combine diagnostic and planning information of different modalities for intraoperative guidance. The system provides tools to segment the target(s), plan the treatment, and detect the ablation applicators during the procedure for guiding purposes. We present experimental results used to ensure that our system generates accurate measurements and our early clinical evaluation results. The results suggest that 3D US used for focal liver ablation can provide a more reliable planning and guidance tool compared to 2D US only, and in many cases offers comparable measurements to other alternatives at significantly lower cost, faster time and with no harmful radiation.

  5. Tracking Perfluorocarbon Nanoemulsion Delivery by 19F MRI for Precise High Intensity Focused Ultrasound Tumor Ablation

    PubMed Central

    Shin, Soo Hyun; Park, Eun-Joo; Min, Changki; Choi, Sun Il; Jeon, Soyeon; Kim, Yun-Hee; Kim, Daehong

    2017-01-01

    Perfluorocarbon nanoemulsions (PFCNEs) have recently been undergoing rigorous study to investigate their ability to improve the therapeutic efficacy of tumor ablation by high intensity focused ultrasound (HIFU). For precise control of PFCNE delivery and thermal ablation, their accumulation and distribution in a tumor should be quantitatively analyzed. Here, we used fluorine-19 (19F) magnetic resonance imaging (MRI) to quantitatively track PFCNE accumulation in a tumor, and analyzed how intra-tumoral PFCNE quantities affect the therapeutic efficacy of HIFU treatment. Ablation outcomes were assessed by intra-voxel incoherent motion analysis and bioluminescent imaging up to 14 days after the procedure. Assessment of PFCNE delivery and treatment outcomes showed that 2-3 mg/mL of PFCNE in a tumor produces the largest ablation volume under the same HIFU insonation conditions. Histology showed varying degrees of necrosis depending on the amount of PFCNE delivered. 19F MRI promises to be a valuable platform for precisely guiding PFCNE-enhanced HIFU ablation of tumors. PMID:28255351

  6. Interventional articular and para-articular knee procedures

    PubMed Central

    Lalam, Radhesh K; Winn, Naomi

    2016-01-01

    The knee is a common area of the body to undergo interventional procedures. This article discusses image-guided interventional issues specific to the knee area. The soft tissues in and around the knee are frequently affected by sport-related injuries and often need image-guided intervention. This article details the specific technical issues related to intervention in these soft tissues, including the iliotibial tract, fat pads, patellar tendon and other tendons, bursae and the meniscus. Most often, simple procedures such as injection and aspiration are performed without image guidance. Rarely image-guided diagnostic arthrography and therapeutic joint injections are necessary. The technique, indications and diagnostic considerations for arthrography are discussed in this article. Primary bone and soft-tissue tumours may involve the knee and adjacent soft tissues. Image-guided biopsies are frequently necessary for these lesions; this article details the technical issues related to image-guided biopsy around the knee. A number of newer ablation treatments are now available, including cryoablation, high-frequency ultrasound and microwave ablation. Radiofrequency ablation, however, still remains the most commonly employed ablation technique. The indications, technical and therapeutic considerations related to the application of this technique around the knee are discussed here. Finally, we briefly discuss some newer, but as of yet, unproven image-guided interventions for osteochondral lesions and Brodie's abscess. PMID:26682669

  7. Thermal Ablation in the Management of Adrenal Metastasis Originating from Non-small Cell Lung Cancer: A 5-year Single-center Experience

    PubMed Central

    Botsa, Evanthia I; Thanou, Ioanna L; Papatheodoropoulou, Aspasia T; Thanos, Loukas I

    2017-01-01

    Background: Treatment of adrenal metastasis from lung carcinoma may prolong survival in the selected patients. However, not all patients can undergo surgery; thus, minimally invasive ablation procedures such as radiofrequency ablation (RFA) and microwave ablation (MWA) have gained acceptance as alternative treatment methods. This study summarized a 5-year single-center experience regarding the evaluation of safety and efficacy of computed tomography (CT)-guided thermal ablation in the management of adrenal metastasis originating from non-small cell lung cancer (NSCLC). Methods: The data of NSCLC patients ablated for adrenal metastasis at the Department of Diagnostic Imaging and Interventional Radiology, General Hospital Sotiria, were retrospectively analyzed. Patients were divided into two groups: RFA group and MWA group according to the therapeutic approaches. Preprocedural blood tests included measurement of international normalized ratio, partial thromboplastin time, and platelet enumeration. A dual-phase contrast-enhanced spiral CT was performed immediately after the procedure to assess the immediate response after ablation and to screen for related complications. Follow-up was performed with CT or magnetic resonance imaging at 1, 3, 6 months and 1 year after ablation and every 6 months thereafter. Results: A total of 99 ablation sessions in 71 patients with adrenal metastasis originating from NSCLC were included in the final analysis. Self-limited, postablation syndrome occurred in 16/99 (16.1%) of ablation sessions. All procedures were technically successful. Immediate postablation imaging showed no contrast enhancement of the ablated tumor in all patients. Follow-up imaging at 3 months revealed local tumor progression in 8 (22.8%) patients of the RFA group and 7 (19.4%) patients of MWA group, all of them underwent a second session successfully. The 1-year assessment revealed local recurrence of the ablated tumor in six patients (17.1%) of RFA group and seven

  8. Ablative skin resurfacing.

    PubMed

    Agrawal, Nidhi; Smith, Greg; Heffelfinger, Ryan

    2014-02-01

    Ablative laser resurfacing has evolved as a safe and effective treatment for skin rejuvenation. Although traditional lasers were associated with significant thermal damage and lengthy recovery, advances in laser technology have improved safety profiles and reduced social downtime. CO2 lasers remain the gold standard of treatment, and fractional ablative devices capable of achieving remarkable clinical improvement with fewer side effects and shorter recovery times have made it a more practical option for patients. Although ablative resurfacing has become safer, careful patient selection and choice of suitable laser parameters are essential to minimize complications and optimize outcomes. This article describes the current modalities used in ablative laser skin resurfacing and examines their efficacy, indications, and possible side effects. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  9. Comparison of catheter ablation for paroxysmal atrial fibrillation between cryoballoon and radiofrequency: a meta-analysis.

    PubMed

    Chen, Chao-Feng; Gao, Xiao-Fei; Duan, Xu; Chen, Bin; Liu, Xiao-Hua; Xu, Yi-Zhou

    2017-04-01

    The present systematic review and meta-analysis aimed to assess and compare the safety and efficacy of radiofrequency (RF) and cryoballoon (CB) ablation for paroxysmal atrial fibrillation (PAF). RF and CB ablation are two frequently used methods for pulmonary vein isolation in PAF, but which is a better choice for PAF remains uncertain. A systematic review was conducted in Medline, PubMed, Embase, and Cochrane Library. All trials comparing RF and CB ablation were screened and included if the inclusion criteria were met. A total of 38 eligible studies, 9 prospective randomized or randomized controlled trials (RCTs), and 29 non- RCTs were identified, adding up to 15,496 patients. Pool analyses indicated that CB ablation was more beneficial in terms of procedural time [standard mean difference = -0.58; 95% confidence interval (CI), -0.85 to -0.30], complications without phrenic nerve injury (PNI) [odds ratio (OR) = 0.79; 95% CI, 0.67-0.93; I 2  = 16%], and recrudescence (OR = 0.83; 95% CI, 0.70-0.97; I 2  = 63%) for PAF; however, the total complications of CB was higher than RF. The subgroup analysis found that, compared with non-contact force radiofrequency (non-CF-RF), both first-generation cryoballoon (CB1) and second-generation cryoballoon (CB2) ablation could reduce complications with PNI, procedural time, and recrudescence. However, the safety and efficacy of CB2 was similar to those of CF-RF. Available overall and subgroup data suggested that both CB1 and CB2 were more beneficial than RF ablation, and the main advantages were reflected in comparing them with non-CF-RF. However, CF-RF and CB2 showed similar clinical benefits.

  10. Atrial fibrillation ablation using remote magnetic navigation and the risk of atrial-esophageal fistula: international multicenter experience.

    PubMed

    Danon, Asaf; Shurrab, Mohammed; Nair, Krishnakumar Mohanan; Latcu, Decebal Gabriel; Arruda, Mauricio S; Chen, Xu; Szili-Torok, Tamas; Rossvol, Ole; Wissner, Eric E; Lashevsky, Ilan; Crystal, Eugene

    2015-08-01

    Remote magnetic navigation (RMN) has been used in various electrophysiological procedures, including atrial fibrillation (AF) ablation. Atrial-esophageal fistula (AEF) is one of most disastrous complications of AF ablation. We aimed to evaluate the incidence of AEF during AF ablation using RMN in comparison to manual ablation. We conducted the first international survey among RMN operators for assessment of the prevalence of AEF and procedural parameters affecting the risk. Data from parallel survey of AEF among Canadian interventional electrophysiologists (CIE) using only manual catheters served as control. Fifteen RMN operators (who performed 3637 procedures) and 25 manual CIE operators (7016 procedures) responded to the survey. RMN operators were more experienced than CIE operators (16.3 ± 8.3 vs. 9.2 ± 5.4 practice years in electrophysiology, p = 0.007). The maximal energy output in the posterior wall was higher in the operator using RMN (33 ± 5 vs. 28.6 ± 4.9 W; p = 0.02). Other parameters including use of preprocedural images, irrigated catheter, pump flow rate, esophageal temperature monitoring, intracardiac echocardiography (ICE), and general anesthesia were similar. CIE operators administered proton-pump inhibitors postoperatively significantly more than RMN operators (76 vs. 35%, p = 0.01). AEF was reported in 5 of the 7016 patients in the control group (0.07%) but in none of the RMN group (p = 0.11). AEF is a rare complication and its evaluation necessitates large-scale studies. Although no AEF case with RMN was reported in this large study or previously on the literature, the rarity of this complication prevents firm conclusion about the risk.

  11. Development of a fine thermocouple-needle system for real-time feedback of thermal tumour ablation margin

    PubMed Central

    Ishizaka, H; Shiraishi, A; Awata, S; Shimizu, A; Hirasawa, S

    2011-01-01

    Thermal tumour ablation techniques such as radiofrequency (RF) ablation are applied for radical removal of local tumours as an easier, less invasive alternative to surgical resection. A serious drawback of thermal ablation, however, is that the ablation area cannot be accurately assessed during the procedure. To achieve real-time feedback and exact and safe ablation, a superfine thermocouple-needle system (TNS) comprising a 0.25-mm diameter thermocouple embedded in a 22-G, 15-cm-long needle was devised and efficacy was tested in vitro using porcine livers (n = 15) and in vivo using rabbit back muscles (n = 2) and livers (n = 3). A 17-gauge RF electrode with a 2 cm active tip was used for ablation. The TNS was inserted 1 cm from the active tip of the RF electrode and liver temperature around the electrode was measured concurrently. The RF current was cut off when the temperature reached 60°C or after 5 min at ≥50°C. Porcine livers and rabbit back muscles were then cut along a plane passing through the axes of the electrode and the TNS. In rabbit livers, contrast-enhanced CT was performed to evaluate ablation areas. Ablation areas in cut surfaces of porcine livers exhibited well-defined discoloured regions and the TNS tip precisely pinpointed the margin of the ablation area. Contrast-enhanced CT of rabbit livers showed the TNS tip accurately located at the margin of areas without contrast enhancement. These results indicate that the TNS can accurately show ablation margins and that placing the TNS tip at the intended ablation margin permits exact thermal ablation. PMID:21937618

  12. Long-term outcomes of remote magnetic navigation for ablation of supraventricular tachycardias.

    PubMed

    Kim, Sung-Hwan; Oh, Yong-Seog; Kim, Dong-Hwi; Choi, Ik Jun; Kim, Tae-Seok; Shin, Woo-Seung; Kim, Ji-Hoon; Jang, Sung-Won; Lee, Man Young; Rho, Tai-Ho

    2015-08-01

    Little is known about the long-term outcomes of catheter ablation of supraventricular tachycardia (SVT) using remote magnetic navigation system (RMN). One hundred twenty patients underwent catheter ablation of SVTs with RMN (Niobe, Stereotaxis, USA): atrioventricular nodal re-entrant tachycardia (AVNRT; n = 59), atrioventricular re-entrant tachycardia (AVRT; n = 45), and focal atrial tachycardia (AT, n = 16). The outcome of AVRT with right free wall accessory pathway was compared with those of a group of 26 consecutive patients undergoing manual ablation. Mean follow-up period was 2.2 ± 1.4 years. Overall arrhythmia-free survival was 86%; AVRT (77%), AVNRT (96%), and focal AT (71%). After the learning period (initial 50 cases), procedural outcomes had improved for AVRT and AVNRT (91% in overall group, 90% in AVRT group, 100% in AVNRT group, and 68% in focal AT group). The recurrence-free rate was higher for the free wall accessory pathways than those of the other sites (92 vs. 73%, log-rank P = 0.06). Furthermore, when it is confined for the right free wall accessory pathway, RMN showed excellent long-term outcome (7/7, 100 %) compared to the results of manual approach (18/26, 69.2%, log-rank P = 0.07). RMN showed favorable long-term outcomes for the ablation of SVT. In our experience, RMN-guided ablation may be associated with a higher success rate as compared to manual ablation when treating right-sided free wall pathways.

  13. The magnetic navigation system allows safety and high efficacy for ablation of arrhythmias

    PubMed Central

    Bauernfeind, Tamas; Akca, Ferdi; Schwagten, Bruno; de Groot, Natasja; Van Belle, Yves; Valk, Suzanne; Ujvari, Barbara; Jordaens, Luc; Szili-Torok, Tamas

    2011-01-01

    Aims We aimed to evaluate the safety and long-term efficacy of the magnetic navigation system (MNS) in a large number of patients. The MNS has the potential for improving safety and efficacy based on atraumatic catheter design and superior navigation capabilities. Methods and results In this study, 610 consecutive patients underwent ablation. Patients were divided into two age- and sex-matched groups. Ablations were performed either using MNS (group MNS, 292) or conventional manual ablation [group manual navigation (MAN), 318]. The following parameters were analysed: acute success rate, fluoroscopy time, procedure time, complications [major: pericardial tamponade, permanent atrioventricular (AV) block, major bleeding, and death; minor: minor bleeding and temporary AV block]. Recurrence rate was assessed during follow-up (15 ± 9.5 months). Subgroup analysis was performed for the following groups: atrial fibrillation, isthmus dependent and atypical atrial flutter, atrial tachycardia, AV nodal re-entrant tachycardia, circus movement tachycardia, and ventricular tachycardia (VT). Magnetic navigation system was associated with less major complications (0.34 vs. 3.2%, P = 0.01). The total numbers of complications were lower in group MNS (4.5 vs. 10%, P = 0.005). Magnetic navigation system was equally effective as MAN in acute success rate for overall groups (92 vs. 94%, P = ns). Magnetic navigation system was more successful for VTs (93 vs. 72%, P < 0.05). Less fluoroscopy was used in group MNS (30 ± 20 vs. 35 ± 25 min, P < 0.01). There were no differences in procedure times and recurrence rates for the overall groups (168 ± 67 vs. 159 ± 75 min, P = ns; 14 vs. 11%, P = ns; respectively). Conclusions Our data suggest that the use of MNS improves safety without compromising efficiency of ablations. Magnetic navigation system is more effective than manual ablation for VTs. PMID:21508006

  14. The magnetic navigation system allows safety and high efficacy for ablation of arrhythmias.

    PubMed

    Bauernfeind, Tamas; Akca, Ferdi; Schwagten, Bruno; de Groot, Natasja; Van Belle, Yves; Valk, Suzanne; Ujvari, Barbara; Jordaens, Luc; Szili-Torok, Tamas

    2011-07-01

    We aimed to evaluate the safety and long-term efficacy of the magnetic navigation system (MNS) in a large number of patients. The MNS has the potential for improving safety and efficacy based on atraumatic catheter design and superior navigation capabilities. In this study, 610 consecutive patients underwent ablation. Patients were divided into two age- and sex-matched groups. Ablations were performed either using MNS (group MNS, 292) or conventional manual ablation [group manual navigation (MAN), 318]. The following parameters were analysed: acute success rate, fluoroscopy time, procedure time, complications [major: pericardial tamponade, permanent atrioventricular (AV) block, major bleeding, and death; minor: minor bleeding and temporary AV block]. Recurrence rate was assessed during follow-up (15±9.5 months). Subgroup analysis was performed for the following groups: atrial fibrillation, isthmus dependent and atypical atrial flutter, atrial tachycardia, AV nodal re-entrant tachycardia, circus movement tachycardia, and ventricular tachycardia (VT). Magnetic navigation system was associated with less major complications (0.34 vs. 3.2%, P=0.01). The total numbers of complications were lower in group MNS (4.5 vs. 10%, P=0.005). Magnetic navigation system was equally effective as MAN in acute success rate for overall groups (92 vs. 94%, P=ns). Magnetic navigation system was more successful for VTs (93 vs. 72%, P<0.05). Less fluoroscopy was used in group MNS (30±20 vs. 35±25 min, P<0.01). There were no differences in procedure times and recurrence rates for the overall groups (168±67 vs. 159±75 min, P=ns; 14 vs. 11%, P=ns; respectively). Our data suggest that the use of MNS improves safety without compromising efficiency of ablations. Magnetic navigation system is more effective than manual ablation for VTs.

  15. Ablation of Persistent Atrial Fibrillation Targeting Low-Voltage Areas With Selective Activation Characteristics.

    PubMed

    Jadidi, Amir S; Lehrmann, Heiko; Keyl, Cornelius; Sorrel, Jérémie; Markstein, Viktor; Minners, Jan; Park, Chan-Il; Denis, Arnaud; Jaïs, Pierre; Hocini, Mélèze; Potocnik, Clemens; Allgeier, Juergen; Hochholzer, Willibald; Herrera-Sidloky, Claudia; Kim, Steve; Omri, Youssef El; Neumann, Franz-Josef; Weber, Reinhold; Haïssaguerre, Michel; Arentz, Thomas

    2016-03-01

    Complex-fractionated atrial electrograms and atrial fibrosis are associated with maintenance of persistent atrial fibrillation (AF). We hypothesized that pulmonary vein isolation (PVI) plus ablation of selective atrial low-voltage sites may be more successful than PVI only. A total of 85 consecutive patients with persistent AF underwent high-density atrial voltage mapping, PVI, and ablation at low-voltage areas (LVA < 0.5 mV in AF) associated with electric activity lasting > 70% of AF cycle length on a single electrode (fractionated activity) or multiple electrodes around the circumferential mapping catheter (rotational activity) or discrete rapid local activity (group I). The procedural end point was AF termination. Arrhythmia freedom was compared with a control group (66 patients) undergoing PVI only (group II). PVI alone was performed in 23 of 85 (27%) patients of group I with low amount (< 10% of left atrial surface area) of atrial low voltage. Selective atrial ablation in addition to PVI was performed in 62 patients with termination of AF in 45 (73%) after 11 ± 9 minutes radiofrequency delivery. AF-termination sites colocalized within LVA in 80% and at border zones in 20%. Single-procedural arrhythmia freedom at 13 months median follow-up was achieved in 59 of 85 (69%) patients in group I, which was significantly higher than the matched control group (31/66 [47%], P < 0.001). There was no significant difference in the success rate of patients in group I with a low amount of low voltage undergoing PVI only and patients requiring PVI+selective low-voltage ablation (P = 0.42). Ablation of sites with distinct activation characteristics within/at borderzones of LVA in addition to PVI is more effective than conventional PVI-only strategy for persistent AF. PVI only seems to be sufficient to treat patients with left atrial low voltage < 10%. © 2016 American Heart Association, Inc.

  16. Electroanatomic Mapping-Guided Catheter Ablation of Supraventricular Tachycardia in Children with Ebstein's Anomaly.

    PubMed

    Ergul, Yakup; Koca, Serhat; Akdeniz, Celal; Tuzcu, Volkan

    2018-06-07

    In Ebstein's anomaly (EA), tachycardia substrates are complex, and accessory pathway (AP) ablations are often challenging. This study demonstrates the utility of the EnSite Velocity system (St. Jude Medical, St Paul, MN) in the catheter ablation of supraventricular tachycardia in children with EA. Twenty patients [Female/Male = 8/12, median age 11.5 years (2.6-18)] with EA who underwent catheter ablation guided by the EnSite Velocity system between December 2011 and December 2016 were retrospectively evaluated. Five patients had severe EA, and two of them were at Fontan palliation pathway. The most common indications for ablations were palpitations/syncope and treatment-resistant arrhythmias. Thirty-one tachycardia substrate foci (21 manifest AP, 2 concealed AP, 4 Mahaim AP, 3 focal atrial tachycardias, and 1 typical atrioventricular nodal reentrant tachycardia) were detected in 20 patients. There were multiple tachycardia substrates in 11 patients (55%). The patient-based acute procedure success rate was 19/20 (95%), and the tachycardia-based success rate was 30/31 (97%). The mean procedure time was 170 ± 43 min (90-265). Fluoroscopy was not used in 15 (75%) patients. The mean fluoroscopy time in the remaining five patients was 3.6 ± 2.9 min (0.7-7.8). During a mean follow-up of 35.1 ± 20.3 months (6-60), tachycardia recurred in four patients (4/19, 21%). No complications were seen. Catheter ablation of arrhythmias can be performed effectively and safely in pediatric EA patients by using a limited fluoroscopic approach with the help of electroanatomical mapping systems. However, the rate of tachycardia recurrence at follow-up remains high.

  17. A two-scale model of radio-frequency electrosurgical tissue ablation

    NASA Astrophysics Data System (ADS)

    Karaki, Wafaa; Rahul; Lopez, Carlos A.; Borca-Tasciuc, Diana-Andra; De, Suvranu

    2017-12-01

    Radio-frequency electrosurgical procedures are widely used to simultaneously dissect and coagulate tissue. Experiments suggest that evaporation of cellular and intra-cellular water plays a significant role in the evolution of the temperature field at the tissue level, which is not adequately captured in a single scale energy balance equation. Here, we propose a two-scale model to study the effects of microscale phase change and heat dissipation in response to radiofrequency heating on the tissue level in electrosurgical ablation procedures. At the microscale, the conservation of mass along with thermodynamic and mechanical equilibrium is applied to obtain an equation-of-state relating vapor mass fraction to temperature and pressure. The evaporation losses are incorporated in the macro-level energy conservation and results are validated with mean experimental temperature distributions measured from electrosurgical ablation testing on ex vivo porcine liver at different power settings of the electrosurgical instrument. Model prediction of water loss and its effect on the temperature along with the effect of the mechanical properties on results are evaluated and discussed.

  18. OCDR guided laser ablation device

    DOEpatents

    Dasilva, Luiz B.; Colston, Jr., Bill W.; James, Dale L.

    2002-01-01

    A guided laser ablation device. The device includes a mulitmode laser ablation fiber that is surrounded by one or more single mode optical fibers that are used to image in the vicinity of the laser ablation area to prevent tissue damage. The laser ablation device is combined with an optical coherence domain reflectometry (OCDR) unit and with a control unit which initializes the OCDR unit and a high power laser of the ablation device. Data from the OCDR unit is analyzed by the control unit and used to control the high power laser. The OCDR images up to about 3 mm ahead of the ablation surface to enable a user to see sensitive tissue such as a nerve or artery before damaging it by the laser.

  19. Feasibility of Intraoperative Nerve Monitoring in Preventing Thermal Damage to the “Nerve at Risk” During Image-Guided Ablation of Tumors

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Marshall, Richard H., E-mail: rmars1@lsuhsc.edu; Avila, Edward K., E-mail: avilae@mskcc.org; Solomon, Stephen B., E-mail: solomons@mskcc.org

    PurposeTo assess feasibility of intraoperative neurophysiologic monitoring (IONM) during image-guided, percutaneous thermal ablation of tumors.Materials and MethodsFrom February 2009 to October 2013, a retrospective review of all image-guided percutaneous thermal ablation interventions using IONM was performed and data was compiled using electronic medical records and imaging studies.ResultsTwelve patients were treated in 13 ablation interventions. In 4 patients, real-time feedback from the monitoring neurologist was used to adjust applicator placement and ablation settings. IONM was technically feasible in all procedures and there were no complications related to monitoring or ablation. All nerves at risk remained intact and of the 11 patientsmore » who could be followed, none developed new nerve deficit up to a minimum of 2 months after ablation.ConclusionIONM is safe and feasible for use during image-guided thermal ablation of tumors in the vicinity of nerves. Outcomes in this study demonstrate its potential utility in image-guided ablation interventions.« less

  20. Real-time circumferential mapping catheter tracking for motion compensation in atrial fibrillation ablation procedures

    NASA Astrophysics Data System (ADS)

    Brost, Alexander; Bourier, Felix; Wimmer, Andreas; Koch, Martin; Kiraly, Atilla; Liao, Rui; Kurzidim, Klaus; Hornegger, Joachim; Strobel, Norbert

    2012-02-01

    Atrial fibrillation (AFib) has been identified as a major cause of stroke. Radiofrequency catheter ablation has become an increasingly important treatment option, especially when drug therapy fails. Navigation under X-ray can be enhanced by using augmented fluoroscopy. It renders overlay images from pre-operative 3-D data sets which are then fused with X-ray images to provide more details about the underlying soft-tissue anatomy. Unfortunately, these fluoroscopic overlay images are compromised by respiratory and cardiac motion. Various methods to deal with motion have been proposed. To meet clinical demands, they have to be fast. Methods providing a processing frame rate of 3 frames-per-second (fps) are considered suitable for interventional electrophysiology catheter procedures if an acquisition frame rate of 2 fps is used. Unfortunately, when working at a processing rate of 3 fps, the delay until the actual motion compensated image can be displayed is about 300 ms. More recent algorithms can achieve frame rates of up to 20 fps, which reduces the lag to 50 ms. By using a novel approach involving a 3-D catheter model, catheter segmentation and a distance transform, we can speed up motion compensation to 25 fps which results in a display delay of only 40 ms on a standard workstation for medical applications. Our method uses a constrained 2-D/3-D registration to perform catheter tracking, and it obtained a 2-D tracking error of 0.61 mm.

  1. Microglial ablation and lipopolysaccharide preconditioning affects pilocarpine-induced seizures in mice

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Mirrione, M.M.; Mirrione, M.M.; Konomosa, D.K.

    2010-04-01

    Activated microglia have been associated with neurodegeneration in patients and in animal models of Temporal Lobe Epilepsy (TLE), however their precise functions as neurotoxic or neuroprotective is a topic of significant investigation. To explore this, we examined the effects of pilocarpine-induced seizures in transgenic mice where microglia/macrophages were conditionally ablated. We found that unilateral ablation of microglia from the dorsal hippocampus did not alter acute seizure sensitivity. However, when this procedure was coupled with lipopolysaccharide (LPS) preconditioning (1 mg/kg given 24 h prior to acute seizure), we observed a significant pro-convulsant phenomenon. This effect was associated with lower metabolic activationmore » in the ipsilateral hippocampus during acute seizures, and could be attributed to activity in the mossy fiber pathway. These findings reveal that preconditioning with LPS 24 h prior to seizure induction may have a protective effect which is abolished by unilateral hippocampal microglia/macrophage ablation.« less

  2. Evaluation of corneal ablation by an optical parametric oscillator (OPO) at 2.94 μm and an Er:YAG laser and comparison to ablation by a 193-nm excimer laser

    NASA Astrophysics Data System (ADS)

    Telfair, William B.; Hoffman, Hanna J.; Nordquist, Robert E.; Eiferman, Richard A.

    1998-06-01

    Purpose: This study first evaluated the corneal ablation characteristics of (1) an Nd:YAG pumped OPO (Optical Parametric Oscillator) at 2.94 microns and (2) a short pulse Er:YAG laser. Secondly, it compared the histopathology and surface quality of these ablations with (3) a 193 nm excimer laser. Finally, the healing characteristics over 4 months of cat eyes treated with the OPO were evaluated. Methods: Custom designed Nd:YAG/OPO and Er:YAG lasers were integrated with a new scanning delivery system to perform PRK myopic correction procedures. After initial ablation studies to determine ablation thresholds and rates, human cadaver eyes and in-vivo cat eyes were treated with (1) a 6.0 mm Dia, 30 micron deep PTK ablation and (2) a 6.0 mm Dia, -5.0 Diopter PRK ablation. Cadaver eyes were also treated with a 5.0 mm Dia, -5.0 Diopter LASIK ablation. Finally, cats were treated with the OPO in a 4 month healing study. Results: Ablation thresholds below 100 mJ/cm2 and ablation rates comparable to the excimer were demonstrated for both infrared systems. Light Microscopy (LM) showed no thermal damage for low fluence treatments, but noticeable thermal damage at higher fluences. SEM and TEM revealed morphologically similar surfaces for low fluence OPO and excimer samples with a smooth base and no evidence of collagen shrinkage. The Er:YAG and higher fluence OPO treated samples revealed more damage along with visible collagen coagulation and shrinkage in some cases. Healing was remarkably unremarkable. All eyes had a mild healing response with no stromal haze and showed topographic flattening. LM demonstrated nothing except a moderate increase in keratocyte activity in the upper third of the stroma. TEM confirmed this along with irregular basement membranes. Conclusions: A non- thermal ablation process called photospallation is demonstrated for the first time using short pulse infrared lasers yielding damage zones comparable to the excimer and healing which is also comparable to

  3. Massive prolapsed haemorrhoids managed by ablation and correction in a poor resourced area

    PubMed Central

    Weledji, Elroy Patrick; Enow Orock, George; Aminde, Leopold

    2013-01-01

    More recently some patients with rectal mucosal prolapse and obstructive defaecation have been treated with the procedure for prolapse and haemorrhoids. We report a case of symptomatic chronic circumferentially prolapsed haemorrhoids that had several failed attempts at surgical repair. This was finally managed by ablation and correction of the associated rectal mucosal prolapse by a modified ‘Delorme's procedure akin to a stapled anopexy. PMID:24968428

  4. Preparation And Analysis Of Specimens Of Ablative Materials

    NASA Technical Reports Server (NTRS)

    Solomon, William C.

    1994-01-01

    Procedure for chemical analysis of specimens of silicone-based ablative thermal-insulation materials SLA-561 and MA25 involves acid digestion of specimens to prepare them for analysis by inductively-coupled-plasma/atomic-emission spectroscopy (ICP/AES). In comparison with atomic-absorption spectroscopy (AAS), ICP/AES is faster and more accurate than AAS. Results of analyses stored in data base, used to trace variations in concentrations of chemical elements in materials during long-term storage, and used in timely manner in investigations of failures. Acid-digestion portion of procedure applied to other thermal-insulation materials containing room-temperature-vulcanizing silicones and enables instrumental analysis of these materials.

  5. Orientation of lizards in a Morris water-maze: roles of the sun compass and the parietal eye.

    PubMed

    Foà, Augusto; Basaglia, Francesca; Beltrami, Giulia; Carnacina, Margherita; Moretto, Elisa; Bertolucci, Cristiano

    2009-09-15

    The present study examined for the first time whether a Morris water-maze can be used to explore compass and other orientation mechanisms in the ruin lizard Podarcis sicula. In the open field, during sunny days, lizards were individually trained to swim from the center of the water maze onto a hidden platform (the goal), positioned at the periphery of the maze in a single compass direction. The goal was invisible because it was placed just beneath the water surface and the water was rendered opaque. The results showed that lizards learn to swim directly towards the hidden goal under the sun in the absence of visual feature cues. We further examined whether the observed orientation response would be due to lizards learning the spatial position of the goal relative to the sun's azimuth, i.e. to the use of a time-compensated sun compass. Lizards reaching learning criteria were subjected to 6 h clock-shift (fast or slow), and tested for goal orientation in the Morris water-maze. Results demonstrated that the learned orientation response is mediated by a time-compensated sun compass. Further investigations provided direct evidence that in ruin lizards an intact parietal eye is required to perform goal orientation under the sun inside a Morris water-maze, and that other brain photoreceptors, like the pineal or deep brain photoreceptors, are not involved in orientation.

  6. Accessing Information: The Internet--A Highway or a Maze?

    ERIC Educational Resources Information Center

    Hoctor, Marge

    2005-01-01

    The Internet is often called "The Information Highway," a metaphor that implies that there is a straight, clearly mapped path to obtaining information. In reality, it is more like a maze with twists and turns and many dead ends. Efficient navigation strategies must be taught; they will not be acquired through osmosis. Schools with a strong…

  7. Mazes and Maps: Can Young Children Find Their Way?

    ERIC Educational Resources Information Center

    Jirout, Jamie J.; Newcombe, Nora S.

    2014-01-01

    Games provide important informal learning activities for young children, and spatial game play (e.g., puzzles and blocks) has been found to relate to the development of spatial skills. This study investigates 4- and 5-year-old children's use of scaled and unscaled maps when solving mazes, asking whether an important aspect of spatial…

  8. Radiofrequency ablation of neuroendocrine liver metastases: the Middlesex experience.

    PubMed

    Gillams, A; Cassoni, A; Conway, G; Lees, W

    2005-01-01

    Current treatment options for neuroendocrine liver metastases are not widely applicable or not that effective. Image-guided thermal ablation offers the possibility of a minimally invasive, albeit palliative, treatment that decreases tumor volume, preserves most of the normal liver, and can be repeated several times. We report our experience with image-guided thermal ablation in 25 patients with unresectable liver metastases. Since 1990 we have treated 189 tumors at 66 treatment sessions in 25 patients (12 female, 13 male; median age, 56 years; age range, 26--78 years). Thirty treatments were performed with a solid-state laser, and 36 treatments were performed with radiofrequency ablation. All but one treatment was performed percutaneously under image guidance. Sixteen patients had metastases from carcinoid primaries, three from gastrinoma, two from insulinoma, and four from miscellaneous causes. Fourteen of 25 had symptoms from hormone secretion. Imaging follow-up was available in 19 patients at a median of 21 months (range, 4--75 months). There was a complete response in six patients, a partial response in seven, and stable disease in one; hence, tumor load was controlled in 14 of 19 patients (74%). Relief of hormone-related symptoms was achieved in nine of 14 patients (69%). The median survival period from the diagnosis of liver metastases was 53 months. One patient with end-stage cardiac disease died after a carcinoid crisis. There were eight (12%) complications: five local and three distant, four major and four minor. As a minimally invasive, readily repeatable procedure that can be used to ablate small tumors, preferably before patients become severely symptomatic, radiofrequency ablation can provide effective control of liver tumor volume in most patients over many years.

  9. Fast and automatic depth control of iterative bone ablation based on optical coherence tomography data

    NASA Astrophysics Data System (ADS)

    Fuchs, Alexander; Pengel, Steffen; Bergmeier, Jan; Kahrs, Lüder A.; Ortmaier, Tobias

    2015-07-01

    Laser surgery is an established clinical procedure in dental applications, soft tissue ablation, and ophthalmology. The presented experimental set-up for closed-loop control of laser bone ablation addresses a feedback system and enables safe ablation towards anatomical structures that usually would have high risk of damage. This study is based on combined working volumes of optical coherence tomography (OCT) and Er:YAG cutting laser. High level of automation in fast image data processing and tissue treatment enables reproducible results and shortens the time in the operating room. For registration of the two coordinate systems a cross-like incision is ablated with the Er:YAG laser and segmented with OCT in three distances. The resulting Er:YAG coordinate system is reconstructed. A parameter list defines multiple sets of laser parameters including discrete and specific ablation rates as ablation model. The control algorithm uses this model to plan corrective laser paths for each set of laser parameters and dynamically adapts the distance of the laser focus. With this iterative control cycle consisting of image processing, path planning, ablation, and moistening of tissue the target geometry and desired depth are approximated until no further corrective laser paths can be set. The achieved depth stays within the tolerances of the parameter set with the smallest ablation rate. Specimen trials with fresh porcine bone have been conducted to prove the functionality of the developed concept. Flat bottom surfaces and sharp edges of the outline without visual signs of thermal damage verify the feasibility of automated, OCT controlled laser bone ablation with minimal process time.

  10. History of hyperthyroidism and long-term outcome of catheter ablation of drug-refractory atrial fibrillation.

    PubMed

    Wongcharoen, Wanwarang; Lin, Yenn-Jiang; Chang, Shih-Lin; Lo, Li-Wei; Hu, Yu-Feng; Chung, Fa-Po; Chong, Eric; Chao, Tze-Fan; Tuan, Ta-Chuan; Chang, Yao-Ting; Lin, Chin-Yu; Liao, Jo-Nan; Lin, Yi-Chun; Chen, Yun-Yu; Chen, Shih-Ann

    2015-09-01

    Hyperthyroidism is a known reversible cause of atrial fibrillation (AF). However, some patients remain in AF despite restoration of euthyroid status. The purpose of this study was to compare the electrophysiologic characteristics and long-term ablation outcome in AF patients with and without history of hyperthyroidism. The study enrolled 717 consecutive patients with AF who underwent first AF ablation, which involved pulmonary vein (PV) isolation in paroxysmal AF and additional substrate modification in nonparoxysmal AF patients. Eighty-four patients (12%) with hyperthyroidism history were compared to those without. Euthyroid status was achieved for ≥3 months before ablation in hyperthyroid patients. Patients with hyperthyroid history were associated with older age, more female gender, lower mean right atrial voltage, higher number of PV ectopic foci (1.3 ± 0.4 vs 1.0 ± 0.2, P < .01), and higher prevalence of non-PV foci (42% vs 23%, P < .01). Ectopic foci from ligament of Marshall were demonstrated more often in hyperthyroid patients (7.1% vs 1.6%, P < .01) in whom alcohol ablations were required. After propensity score matching for potential covariates, history of hyperthyroidism was an independent predictor of AF recurrence after single procedure (hazard ratio 2.07, 95% confidence interval 1.27-3.38). AF recurrence rates after multiple procedures were not different between patients with and those without hyperthyroid history. Patients with hyperthyroid history had a significantly higher number of PV ectopies and higher prevalence of non-PV ectopic foci compared to euthyroid patients, which resulted in a higher AF recurrence rate after a single procedure. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  11. A new catheter design for combined radiofrequency ablation and optoacoustic treatment monitoring using copper-coated light-guides

    NASA Astrophysics Data System (ADS)

    Rebling, Johannes; Oyaga Landa, Francisco Javier; Deán-Ben, Xosé Luis; Razansky, Daniel

    2018-02-01

    Electrosurgery, i.e. the application of radiofrequency current for tissue ablation, is a frequently used treatment for many cardiac arrhythmias. Electrophysiological and anatomic mapping, as well as careful radiofrequency power control typically guide the radiofrequency ablation procedure. Despite its widespread application, accurate monitoring of the lesion formation with sufficient spatio-temporal resolution remains challenging with the existing imaging techniques. We present a novel integrated catheter for simultaneous radiofrequency ablation and optoacoustic monitoring of the lesion formation in real time and 3D. The design combines the delivery of both electric current and optoacoustic excitation beam in a single catheter consisting of copper-coated multimode light-guides and its manufacturing is described in detail. The electrical current causes coagulation and desiccation while the excitation light is locally absorbed, generating OA responses from the entire treated volume. The combined ablation-monitoring capabilities were verified using ex-vivo bovine tissue. The formed ablation lesions showed a homogenous coagulation while the ablation was monitored in realtime with a volumetric frame rate of 10 Hz over 150 seconds.

  12. 1.0 T open-configuration magnetic resonance-guided microwave ablation of pig livers in real time

    PubMed Central

    Dong, Jun; Zhang, Liang; Li, Wang; Mao, Siyue; Wang, Yiqi; Wang, Deling; Shen, Lujun; Dong, Annan; Wu, Peihong

    2015-01-01

    The current fastest frame rate of each single image slice in MR-guided ablation is 1.3 seconds, which means delayed imaging for human at an average reaction time: 0.33 seconds. The delayed imaging greatly limits the accuracy of puncture and ablation, and results in puncture injury or incomplete ablation. To overcome delayed imaging and obtain real-time imaging, the study was performed using a 1.0-T whole-body open configuration MR scanner in the livers of 10 Wuzhishan pigs. A respiratory-triggered liver matrix array was explored to guide and monitor microwave ablation in real-time. We successfully performed the entire ablation procedure under MR real-time guidance at 0.202 s, the fastest frame rate for each single image slice. The puncture time ranged from 23 min to 3 min. For the pigs, the mean puncture time was shorted to 4.75 minutes and the mean ablation time was 11.25 minutes at power 70 W. The mean length and widths were 4.62 ± 0.24 cm and 2.64 ± 0.13 cm, respectively. No complications or ablation related deaths during or after ablation were observed. In the current study, MR is able to guide microwave ablation like ultrasound in real-time guidance showing great potential for the treatment of liver tumors. PMID:26315365

  13. Gd-EOB-DTPA-Enhanced MR Guidance in Thermal Ablation of Liver Malignancies

    PubMed Central

    Rosenberg, Christian; Jahn, Andrea; Pickartz, Tilman; Wahnschaffe, Ulrich; Patrzyk, Maciej; Hosten, Norbert

    2014-01-01

    Objective To evaluate the potency of Gd-EOB-DTPA to support hepatic catheter placement in laser ablation procedures by quantifying time-dependent delineation effects for instrumentation and target tumor within liver parenchyma. Monitoring potential influence on online MR thermometry during the ablation procedure is a secondary aim. Materials and Methods 30 cases of MR-guided laser ablation were performed after i.v. bolus injection of gadoxetic acid (0.025 mmol/Kg Gd-EOB-DTPA; Bayer Healthcare, Berlin, Germany). T1-weighted GRE sequences were used for applicator guidance (FLASH 3D) in the catheter placement phase and for therapy monitoring (FLASH 2D) in the therapy phase. SNR and consecutive CNR values were measured for elements of interest plotted over time both for catheter placement and therapy phase and compared with a non-contrast control group of 19 earlier cases. Statistical analysis was realized using the paired Wilcoxon test. Results Sustainable signal elevation of liver parenchyma in the contrast-enhanced group was sufficient to silhouette both target tumor and applicator against the liver. Differences in time dependent CNR alteration were highly significant between contrast-enhanced and non-contrast interventions for parenchyma and target on the one hand (p = 0.020) and parenchyma and instrument on the other hand (p = 0.002). Effects lasted for the whole procedure (monitoring up to 60 min) and were specific for the contrast-enhanced group. Contrasting maxima were seen after median 30 (applicator) and 38 (tumor) minutes, in the potential core time of a multineedle procedure. Contrast influence on T1 thermometry for real-time monitoring of thermal impact was not significant (p = 0.068–0.715). Conclusion Results strongly support anticipated promotive effects of Gd-EOB-DTPA for MR-guided percutaneous liver interventions by proving and quantifying the delineating effects for therapy-relevant elements in the procedure. Time benefit, cost

  14. Gd-EOB-DTPA-enhanced MR guidance in thermal ablation of liver malignancies.

    PubMed

    Rosenberg, Christian; Jahn, Andrea; Pickartz, Tilman; Wahnschaffe, Ulrich; Patrzyk, Maciej; Hosten, Norbert

    2014-01-01

    To evaluate the potency of Gd-EOB-DTPA to support hepatic catheter placement in laser ablation procedures by quantifying time-dependent delineation effects for instrumentation and target tumor within liver parenchyma. Monitoring potential influence on online MR thermometry during the ablation procedure is a secondary aim. 30 cases of MR-guided laser ablation were performed after i.v. bolus injection of gadoxetic acid (0.025 mmol/Kg Gd-EOB-DTPA; Bayer Healthcare, Berlin, Germany). T1-weighted GRE sequences were used for applicator guidance (FLASH 3D) in the catheter placement phase and for therapy monitoring (FLASH 2D) in the therapy phase. SNR and consecutive CNR values were measured for elements of interest plotted over time both for catheter placement and therapy phase and compared with a non-contrast control group of 19 earlier cases. Statistical analysis was realized using the paired Wilcoxon test. Sustainable signal elevation of liver parenchyma in the contrast-enhanced group was sufficient to silhouette both target tumor and applicator against the liver. Differences in time dependent CNR alteration were highly significant between contrast-enhanced and non-contrast interventions for parenchyma and target on the one hand (p = 0.020) and parenchyma and instrument on the other hand (p = 0.002). Effects lasted for the whole procedure (monitoring up to 60 min) and were specific for the contrast-enhanced group. Contrasting maxima were seen after median 30 (applicator) and 38 (tumor) minutes, in the potential core time of a multineedle procedure. Contrast influence on T1 thermometry for real-time monitoring of thermal impact was not significant (p = 0.068-0.715). Results strongly support anticipated promotive effects of Gd-EOB-DTPA for MR-guided percutaneous liver interventions by proving and quantifying the delineating effects for therapy-relevant elements in the procedure. Time benefit, cost effectiveness and oncologic outcome of the described beneficiary effects

  15. Efficacy and safety of cryoballoon ablation versus radiofrequency catheter ablation in atrial fibrillation: an updated meta-analysis

    PubMed Central

    Ma, Honglan; Sun, Dongdong; Luan, Hui; Feng, Wei; Zhou, Yaqiong; Wu, Jine; He, Caiyun

    2017-01-01

    Introduction Cryoballoon ablation (CBA) and irrigated radiofrequency catheter ablation (RFCA) are the main treatments for drug-refractory symptomatic atrial fibrillation (AF). Aim To compare the efficacy and safety between CBA and RFCA for the treatment of AF. Material and methods We searched the Embase and Medline databases for clinical studies published up to December 2016. Studies that satisfied our predefined inclusion criteria were included. Results After searching through the literature in the two major databases, 20 studies with a total of 9,141 patients were included in our study. The CBA had a significantly shorter procedure time (weighted mean difference (WMD) –30.38 min; 95% CI: –46.43 to –14.33, p = 0.0002) and non-significantly shorter fluoroscopy time (WMD –3.18 min; 95% CI: –6.43 to 0.07, p = 0.06) compared with RFCA. There was no difference in freedom from AF between CBA and RFCA (CBA 78.55% vs. RFCA 83.13%, OR = 1.15, 95% CI: 0.95–1.39, p = 0.14). The CBA was associated with a high risk of procedure-related complications (CBA 9.02% vs. RFCA 6.56%, OR = 1.56, 95% CI: 1.05–2.31, p = 0.03), especially phrenic nerve paralysis (PNP, OR = 10.72, 95% CI: 5.59–20.55, p < 0.00001). The risk of pericardial effusions/cardiac tamponade was low in the CBA group (CBA 1.05% vs. RFCA 1.86%, OR = 0.62, 95% CI: 0.41–0.93, p = 0.02). Conclusions For AF, CBA was as effective as RFCA. However, CBA had a shorter procedure time and a non-significantly shorter fluoroscopy time, a significantly high risk of PNP and a low incidence of pericardial effusions/cardiac tamponade compared with RFCA. PMID:29056997

  16. First experience with zero-fluoroscopic ablation for supraventricular tachycardias using a novel impedance and magnetic-field-based mapping system.

    PubMed

    Walsh, Katie A; Galvin, Joseph; Keaney, John; Keelan, Edward; Szeplaki, Gabor

    2018-02-23

    Zero- and near-zero-fluoroscopic ablation techniques reduce the harmful effects of ionizing radiation during invasive electrophysiology procedures. We aimed to test the feasibility and safety of a zero-fluoroscopic strategy using a novel integrated magnetic and impedance-based electroanatomical mapping system for radiofrequency ablation (RFA) of supraventricular tachycardias (SVTs). We retrospectively studied 92 consecutive patients undergoing electrophysiology studies with/without RFA for supraventricular tachycardia (SVT) performed by a single operator at a single center. The first 42 (Group 1) underwent a conventional fluoroscopic-guided approach and the second 50 (Group 2) underwent a zero-fluoroscopic approach using the Ensite Precision ™ 3-D magnetic and impedance-based mapping system (Abbott Inc). Group 1 comprised 14 AV-nodal re-entrant tachycardia (AVNRT), 12 typical atrial flutter, 4 accessory pathway (AP), 2 atrial tachycardia (AT), and 9 diagnostic EP studies (EPS). Group 2 comprised 16 AVNRT, 17 atrial flutter, 6 AP, 3 AT, 2 AV-nodal ablations, and 7 EPS. A complete zero-fluoroscopic approach was achieved in 94% of Group 2 patients. All procedures were acutely successful, and no complications occurred. There was a significant reduction in fluoroscopy dose, dose area product, and time (p < 0.0001, for all), with no difference in procedure times. Ablation time for typical atrial flutter was shorter in Group 2 (p = 0.006). A zero-fluoroscopic strategy for diagnosis and treatment of SVTs using this novel 3D-electroanatomical mapping system is feasible in majority of patients, is safe, reduces ionizing radiation exposure, and does not compromise procedural times, success rates, or complication rates.

  17. An experimental model to investigate the targeting accuracy of MR-guided focused ultrasound ablation in liver

    PubMed Central

    2014-01-01

    Background Magnetic Resonance-guided High Intensity Focused Ultrasound (MRgHIFU) is a hybrid technology that aims to offer non-invasive thermal ablation of targeted tumors or other pathological tissues. Acoustic aberrations and non-linear wave propagating effects may shift the focal point significantly away from the prescribed (or, theoretical) position. It is therefore mandatory to evaluate the spatial accuracy of ablation for a given HIFU protocol and/or device. We describe here a method for producing a user-defined ballistic target as an absolute reference marker for MRgHIFU ablations. Methods The investigated method is based on trapping a mixture of MR contrast agent and histology stain using radiofrequency (RF) ablation causing cell death and coagulation. A dedicated RF-electrode was used for the marker fixation as follows: a RF coagulation (4 W, 15 seconds) and injection of the mixture followed by a second RF coagulation. As a result, the contrast agent/stain is encapsulated in the intercellular space. Ultrasonography imaging was performed during the procedure, while high resolution T1w 3D VIBE MR acquisition was used right after to identify the position of the ballistic marker and hence the target tissue. For some cases, after the marker fixation procedure, HIFU volumetric ablations were produced by a phased-array HIFU platform. First ex vivo experiments were followed by in vivo investigation on four rabbits in thigh muscle and six pigs in liver, with follow-up at Day 7. Results At the end of the procedure, no ultrasound indication of the marker’s presence could be observed, while it was clearly visible under MR and could be conveniently used to prescribe the HIFU ablation, centered on the so-created target. The marker was identified at Day 7 after treatment, immediately after animal sacrifice, after 3 weeks of post-mortem formalin fixation and during histology analysis. Its size ranged between 2.5 and 4 mm. Conclusions Experimental validation of this

  18. Image-guided Tumor Ablation: Standardization of Terminology and Reporting Criteria—A 10-Year Update

    PubMed Central

    Solbiati, Luigi; Brace, Christopher L.; Breen, David J.; Callstrom, Matthew R.; Charboneau, J. William; Chen, Min-Hua; Choi, Byung Ihn; de Baère, Thierry; Dodd, Gerald D.; Dupuy, Damian E.; Gervais, Debra A.; Gianfelice, David; Gillams, Alice R.; Lee, Fred T.; Leen, Edward; Lencioni, Riccardo; Littrup, Peter J.; Livraghi, Tito; Lu, David S.; McGahan, John P.; Meloni, Maria Franca; Nikolic, Boris; Pereira, Philippe L.; Liang, Ping; Rhim, Hyunchul; Rose, Steven C.; Salem, Riad; Sofocleous, Constantinos T.; Solomon, Stephen B.; Soulen, Michael C.; Tanaka, Masatoshi; Vogl, Thomas J.; Wood, Bradford J.; Goldberg, S. Nahum

    2014-01-01

    Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes. © RSNA, 2014 Online supplemental material is available for this article. PMID:24927329

  19. Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update.

    PubMed

    Ahmed, Muneeb; Solbiati, Luigi; Brace, Christopher L; Breen, David J; Callstrom, Matthew R; Charboneau, J William; Chen, Min-Hua; Choi, Byung Ihn; de Baère, Thierry; Dodd, Gerald D; Dupuy, Damian E; Gervais, Debra A; Gianfelice, David; Gillams, Alice R; Lee, Fred T; Leen, Edward; Lencioni, Riccardo; Littrup, Peter J; Livraghi, Tito; Lu, David S; McGahan, John P; Meloni, Maria Franca; Nikolic, Boris; Pereira, Philippe L; Liang, Ping; Rhim, Hyunchul; Rose, Steven C; Salem, Riad; Sofocleous, Constantinos T; Solomon, Stephen B; Soulen, Michael C; Tanaka, Masatoshi; Vogl, Thomas J; Wood, Bradford J; Goldberg, S Nahum

    2014-10-01

    Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes. Online supplemental material is available for this article . © RSNA, 2014.

  20. Extinction-induced "despair" in the water maze, exploratory behavior and fear: effects of chronic antidepressant treatment.

    PubMed

    Schulz, Daniela; Buddenberg, Tim; Huston, Joseph P

    2007-05-01

    In former studies, we found evidence for the hypothesis that withdrawal of negative reinforcement presents a major source for stress and despair. Specifically, the removal of a hidden platform in the water maze induced extinction of previously reinforced escape behavior and behavioral immobility, indicative of "despair", which also correlated with indices of fear. Here, we tested the effects of antidepressants on extinction in the water maze, and expected that such drugs would attenuate the rate of extinction of a conditioned place preference (CPP) and also any emotionally relevant behavior that is induced by the loss of reinforcement, such as immobility. Adult male Wistar rats were trained to escape onto a hidden platform for 10 days. Daily treatment with desipramine hydrochloride (DMI, 10mg/kg) or fluoxetine (FLX, 10 mg/kg) commenced 1 day before the first of 11 extinction trials without the platform, administered 48 h apart, and continued thereafter, as the rats were tested in an open field and elevated-plus maze. As compared to controls, DMI increased the resistance-to-extinction of CPP, attenuated immobility, and increased wall climbing behavior. In the open field, DMI reduced activity levels, but was without effect on traditional fear parameters in the elevated-plus maze. FLX, by contrast, increased immobility during the extinction trials and fear in the elevated-plus maze. The withdrawal of reinforcement induced "despair" that was alleviated by the noradrenaline reuptake inhibitor DMI. The effects of the selective serotonin reuptake inhibitor FLX on immobility and fear may be explained in terms of its side effect profile.