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Shoji M, Inaba K, Itami J, Hamada M, Okamoto H, Iwasa T, Ushigusa T, Yoshida M, Matsuyama TA, Otsuka T, Kumagai K, Hirao K, Maguire P, Qian P, Gardner E, Zei PC. Advantages and challenges for noninvasive atrial fibrillation ablation. J Interv Card Electrophysiol 2020; 62:319-327. [PMID: 33106957 DOI: 10.1007/s10840-020-00904-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/21/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Although catheter ablation is an effective therapy for atrial fibrillation (AF), risks remain and improved efficacy is desired. Stereotactic radiotherapy is a well-established therapy used to noninvasively treat malignancies with precision. We sought to evaluate stereotactic arrhythmia radioablation (STAR) as a therapeutic option for treating AF. METHODS AND RESULTS Three cancer patients with drug refractory AF were enrolled. Planning software using 3-D CT of the left atrium was used to design a desired ablation volume encompassing antral circumferential pulmonary vein isolation, roof and floor lines to create a "box" lesion set. After planning, patients were treated in the radioablation suite. STAR was able to deliver the intended radiation dose to the target in all 3 patients. No complications were observed over a follow-up period of 24 months. One patient with paroxysmal AF died from deterioration of cancer. The autopsy revealed evidence of fibroblasts and fibrogenesis in the region of atrial tissues targeted with radioablation. In one of these patients, left atrial posterior wall electrograms recorded from the esophagus before and 3 months after STAR indicated successful electrical isolation. CONCLUSIONS This is the first report of non-invasive radioablation of the left atrium with demonstration of successful electrical isolation. Although STAR may be safe and effective in delivering ablative energy to the left atrium, further evaluation is warranted regarding effectiveness.
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Affiliation(s)
- Masaaki Shoji
- Department of Cardiovascular Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan.
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Minoru Hamada
- Department of Radiological Technology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Okamoto
- Department of Medical Physics, National Cancer Center Hospital, Tokyo, Japan
| | - Takeshi Iwasa
- Department of Cardiovascular Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan
| | - Takeshi Ushigusa
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Masayuki Yoshida
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Taka-Aki Matsuyama
- Department of Legal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Takayuki Otsuka
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | | | - Kenzo Hirao
- Division of Cardiovascular Medicine, AOI Universal Hospital, Kanagawa, Japan
| | | | - Pierre Qian
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Paul C Zei
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Boston, MA, USA
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Vachev SA, Bogachev-Prokof'ev AV, Zotov AS, Elesin DA, Voronin SV, Troitskiĭ AV, Khabazov RI. Surgical treatment of atrial fibrillation: technique of thoracoscopic radiofrequency fragmentation of the left atrium. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:146-157. [PMID: 31855212 DOI: 10.33529/angio2019416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Presented in the article is a detailed description of a modified technique of minimally invasive surgical treatment of patients with atrial fibrillation - thoracoscopic radiofrequency fragmentation of the left atrium. This modification differs from the prototype GALAXY procedure by a significant increase of the 'quantitative' rather than 'qualitative' parameter of surgical aggression in relation to the left atrium. This technique results in creation of multiple transmural continuous closed lines of lesion to the left atrium and, consequently, a reduced risk of inadequate surgical treatment for atrial fibrillation. Besides the radiofrequency action on the wall of the left atrium, the protocol of the operation included destruction of the ligament of Marshall and resection of the left atrial appendage. An indication for performing this operation is the presence of various forms of atrial fibrillation.
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Affiliation(s)
- S A Vachev
- Federal Scientific and Clinical Centre of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency, Moscow, Russia
| | - A V Bogachev-Prokof'ev
- National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - A S Zotov
- Federal Scientific and Clinical Centre of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency, Moscow, Russia
| | - D A Elesin
- National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - S V Voronin
- Federal Scientific and Clinical Centre of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency, Moscow, Russia
| | - A V Troitskiĭ
- Federal Scientific and Clinical Centre of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency, Moscow, Russia
| | - R I Khabazov
- Federal Scientific and Clinical Centre of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency, Moscow, Russia
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De Ponti R, My I, Vilotta M, Caravati F, Marazzato J, Bagliani G, Leonelli FM. Advanced Cardiac Signal Recording. Card Electrophysiol Clin 2019; 11:203-217. [PMID: 31084847 DOI: 10.1016/j.ccep.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Implantable loop recorders allow prolonged and continuous single-lead electrocardiogram recording, with the pivotal addition of remote monitoring. They have significantly shortened time to electrocardiographic diagnosis and appropriate therapy of many bradyarrhythmias/tachyarrhythmias and proved helpful in arrhythmia burden definition, offering invaluable information in the diagnostic workup for syncope and atrial fibrillation. Advanced cardiac signal recording is also possible by transesophageal catheters. They have been used to orient diagnosis during wide and narrow QRS complex tachycardias and also to perform minimally invasive pacing. Intracardiac electrophysiologic study remains, however, essential for diagnosis of several arrhythmias in the perspective of curative catheter ablation.
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Affiliation(s)
- Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy.
| | - Ilaria My
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy
| | - Manola Vilotta
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy
| | - Fabrizio Caravati
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy
| | - Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo and Macchi Foundation-University of Insubria, Viale Borri, 57, 21100 Varese, Italy
| | - Giuseppe Bagliani
- Arrhythmology Unit, Cardiology Department, Foligno General Hospital, Via Massimo Arcamone, Foligno, 06034 Perugia, Italy; Cardiovascular Disease Department, University of Perugia, Piazza Menghini 1, 06129 Perugia, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA
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