1
|
Singh R, Chandi SK, Sran S, Aulakh SK, Nijjar GS, Singh K, Singh S, Tanvir F, Kaur Y, Sandhu APS. Emerging Therapeutic Strategies in Cardiovascular Diseases. Cureus 2024; 16:e64388. [PMID: 39131016 PMCID: PMC11317025 DOI: 10.7759/cureus.64388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 08/13/2024] Open
Abstract
Cardiovascular diseases (CVDs), including ischemic heart disease and stroke, are the leading cause of mortality worldwide, causing nearly 20 million deaths annually. Traditional therapies, while effective, have not curbed the rising prevalence of CVDs driven by aging populations and lifestyle factors. This review highlights innovative therapeutic strategies that show promise in improving patient outcomes and transforming cardiovascular care. Emerging pharmacological treatments, such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and sodium-glucose co-transporter 2 (SGLT2) inhibitors, introduce novel mechanisms to complement existing therapies, significantly reducing cardiovascular events and mortality. These advancements emphasize the necessity of ongoing clinical trials and research to discover new therapeutic targets. Advanced biological therapies, including gene therapy, stem cell therapy, and RNA-based treatments, offer groundbreaking potential for repairing and regenerating damaged cardiovascular tissues. Despite being in various stages of clinical validation, early results are promising, suggesting these therapies could fundamentally change the CVD treatment landscape. Innovative medical devices and technologies, such as implantable devices, minimally invasive procedures, and wearable technology, are revolutionizing CVD management. These advancements facilitate early diagnosis, continuous monitoring, and effective treatment, driving care out of hospitals and into homes, improving patient outcomes and reducing healthcare costs. Personalized medicine, driven by genetic profiling and biomarker identification, allows for tailored therapies that enhance treatment efficacy and minimize adverse effects. However, the adoption of these emerging therapies faces significant challenges, including regulatory hurdles, cost and accessibility issues, and ethical considerations. Addressing these barriers and fostering interdisciplinary collaboration are crucial for accelerating the development and implementation of innovative treatments. Integrating emerging therapeutic strategies in cardiovascular care holds immense potential to transform CVD management. By prioritizing future research and overcoming existing challenges, a new era of personalized, effective, and accessible cardiovascular care can be achieved.
Collapse
Affiliation(s)
- Rajinderpal Singh
- Internal Medicine, Government Medical College Amritsar, Amritsar, IND
| | | | - Seerat Sran
- Internal Medicine, Sri Guru Ram Das University of Health Sciences and Research, Amritsar, IND
| | - Smriti K Aulakh
- Internal Medicine, Sri Guru Ram Das University of Health Sciences and Research, Amritsar, IND
| | | | | | - Sumerjit Singh
- Medicine, Government Medical College Amritsar, Amritsar, IND
| | - Fnu Tanvir
- Medicine, Government Medical College Amritsar, Amritsar, IND
| | - Yasmeen Kaur
- Medicine, Government Medical College Amritsar, Amritsar, IND
| | - Ajay Pal Singh Sandhu
- Medicine, Sri Guru Ram Das University of Health Sciences and Research, Amritsar, IND
| |
Collapse
|
2
|
Ismail H, Gabriels JK, Chang D, Donnelly J, Kim BS, Epstein LM, Hentz R, Fishbein J, Huang X, Kowalski M, Dasrat P, Rahyab AS, Goldner B. Site-specific effects of dobutamine on cardiac conduction and refractoriness. J Interv Card Electrophysiol 2024; 67:71-82. [PMID: 37227538 DOI: 10.1007/s10840-023-01573-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Isoproterenol, a non-specific beta agonist, is commonly used during electrophysiology studies (EPS). However, with the significant increase in the price of isoproterenol in 2015 and the increasing number of catheter ablations performed, the cost implications cannot be ignored. Dobutamine is a less expensive synthetic compound developed from isoproterenol with a similar mechanism to enhance cardiac conduction and shorten refractoriness, thus making it a feasible substitute with a lower cost. However, the use of dobutamine for EPS has not been well-reported in the literature. OBJECTIVE To determine the site-specific effects of various doses of dobutamine on cardiac conduction and refractoriness and assess its safety during EPS. METHODS From February 2020 to October 2020, 40 non-consecutive patients scheduled for elective EPS, supraventricular tachycardia, atrial fibrillation, and premature ventricular contraction ablations at a single center were consented and prospectively enrolled to assess the effect of dobutamine on the cardiac conduction system. At the end of each ablation procedure, measures of cardiac conduction and refractoriness were recorded at baseline and with incremental doses of dobutamine at 5, 10, 15, and 20 mcg/kg/min. For the primary analysis, the change per dose of dobutamine from baseline to each dosing level of dobutamine received by the patients, comparing atrioventricular node block cycle length (AVNBCL), ventricular atrial block cycle length (VABCL) and sinus cycle length (SCL), was tested using mixed-effect regression. For the secondary analysis, dobutamine dose level was tested for association with relative changes from baseline of each electrophysiologic parameter (SCL, AVNBCL, VABCL, atrioventricular node effective refractory period (AVNERP), AH, QRS, QT, QTc, atrial effective refractory period (AERP), ventricular effective refractory period (VERP), using mixed-effect regression. Changes in systolic and diastolic blood pressures were also assessed. The Holm-Bonferroni method was used to adjust for multiple testing. RESULTS For the primary analysis there was no statistically significant change of AVNBCL and VABCL relative to SCL from baseline to each dose level of dobutamine. The SCL, AVNBCL, VABCL, AVNERP, AERP, VERP and the AH, and QT intervals all demonstrated a statistically significant decrease from baseline to at least one dose level with incremental dobutamine dosing. Two patients (5%) developed hypotension during the study and one patient (2.5%) received a vasopressor. Two patients (5%) had induced arrhythmias but otherwise no major adverse events were noted. CONCLUSION In this study, there was no statistically significant change of AVNBCL and VABCL relative to SCL from baseline to any dose level of dobutamine. As expected, the AH and QT intervals, and the VABCL, VERP, AERP and AVNERP all significantly decreased from baseline to at least one dose level with an escalation in dobutamine dose. Dobutamine was well-tolerated and safe to use during EPS.
Collapse
Affiliation(s)
- Haisam Ismail
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - James K Gabriels
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - David Chang
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Joseph Donnelly
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Beom Soo Kim
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Laurence M Epstein
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Roland Hentz
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, NY, USA
| | - Joanna Fishbein
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, NY, USA
| | - Xueqi Huang
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New York, NY, USA
| | - Marcin Kowalski
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Parmanand Dasrat
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Ali Seyar Rahyab
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA
| | - Bruce Goldner
- Department of Cardiac Electrophysiology, Northwell Health, New York, NY, USA.
| |
Collapse
|
3
|
Krist D, Linz D, Schotten U, Zeemering S, Leenen D. A Novel Laser Energy Ablation Catheter for Endocardial Cavo-Tricuspid Isthmus Ablation and Epicardial Ventricular Lesion Formation: An in vivo Proof-of-Concept Study. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:834856. [PMID: 35387364 PMCID: PMC8979165 DOI: 10.3389/fmedt.2022.834856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Aim This proof-of-concept study aimed to investigate atrial and ventricular lesion formation by a 20-mm linear laser ablation catheter, regarding lesion depth and tissue damage. Methods In total, 6 female swines underwent standard femoral vein access to introduce a novel 20-mm linear laser ablation catheter in the right atrium to perform endocardial cavotricuspid isthmus (CTI) ablations. The navigation took place under fluoroscopy with additional visualization by intracardiac echocardiograph. Via a sternotomy, epicardial ablations were performed on the surface of the left ventricle (LV), right ventricle (RV), and right atrial appendage (RAA). Procedural safety was assessed by registration of intraprocedural adverse events and by macroscopic examination of the excised hearts for the presence of charring or tissue disruption at the lesion site. Results Altogether 39 lesions were created, including 8 endocardial CTI (mean lesion length 20.6 ± 1.65 mm), 26 epicardial ventricle (mean lesion length LV: 25.3 ± 1.35 mm, RV: 24.9 ± 2.40 mm), and 5 epicardial appendage ablations (mean lesion length RAA: 26.0 ± 3.16 mm). Transmurality was achieved in all CTI and atrial appendage ablations, in 62% of the RV ablations and in none of the LV ablations. No perforation or steam pop occurred, and no animal died during the procedure. Conclusion In this porcine study, the 20-mm linear laser ablation catheter has shown excellent results for endocardial cavotricuspid isthmus ablation, and it resulted in acceptable lesion depth during atrial and ventricular epicardial ablation. The absence of tissue charring, steam pops, or microbubbles under the experimental conditions suggests a high degree of procedural safety.
Collapse
Affiliation(s)
- Dennis Krist
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- *Correspondence: Dennis Krist
| | - Dominik Linz
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- Department of Cardiology, Maastricht University Medical Centre +, Maastricht, Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Ulrich Schotten
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Stef Zeemering
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Dwayne Leenen
- Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Aachen, Germany
| |
Collapse
|
4
|
Li Z, Tang Q, Dickfeld T, Chen Y. Depth-resolved mapping of muscular bundles in myocardium pulmonary junction using optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-5. [PMID: 29981228 PMCID: PMC8357322 DOI: 10.1117/1.jbo.23.7.076004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/21/2018] [Indexed: 05/31/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and has high patient morbidity. One of the root causes of AF is initiating triggers from atrial myocardium extending into the pulmonary veins. Visualizing the muscular bundles of myocardial extension is essential to guide the catheter radio-frequency ablation and confirm the curative tissue necrosis thereafter. We applied optical coherence tomography (OCT) for direct visualization of cardial muscle extension in myocardium pulmonary junction. Two perspectives (cross-sectional and en face images) are presented for imaging myocardial extensions. The results demonstrated that cross-sectional images can quickly locate the myocardium pulmonary junction. And en face images provide depth-resolved arrangement information of muscular bundles in the myocardium pulmonary junction. The results indicated that OCT could potentially be used to guide catheter radio-frequency ablation for treatment of AF.
Collapse
Affiliation(s)
- Zhifang Li
- Ministry of Education, Fujian Normal University, College of Photonic and Electronic Engineering, Fujian Provincial Engineering Technology Research Center of Photoelectric Sensing Application, Key Laboratory of Optoelectronic Science and Technology for Medicine, Fujian Provincial Key Laboratory of Photonics Technology, Fuzhou, China
| | - Qinggong Tang
- University of Maryland, Fischell Department of Bioengineering, College Park, Maryland, United States
| | - Timm Dickfeld
- University of Maryland, School of Medicine, Baltimore, Maryland, United States
| | - Yu Chen
- Ministry of Education, Fujian Normal University, College of Photonic and Electronic Engineering, Fujian Provincial Engineering Technology Research Center of Photoelectric Sensing Application, Key Laboratory of Optoelectronic Science and Technology for Medicine, Fujian Provincial Key Laboratory of Photonics Technology, Fuzhou, China
- University of Maryland, Fischell Department of Bioengineering, College Park, Maryland, United States
| |
Collapse
|
5
|
Schuring CA, Mountjoy LJ, Priaulx AB, Schneider RJ, Smith HL, Wall GC, Kadaria D, Sodhi A. Atrio-Esophageal Fistula: A Case Series and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:847-854. [PMID: 28761039 PMCID: PMC5551930 DOI: 10.12659/ajcr.903966] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Case series Patient: Male, 72 • Male, 29 • Male, 75 Final Diagnosis: Atrio-esophageal fistula Symptoms: Altered mental state • chest pain • fever • melena Medication: — Clinical Procedure: — Specialty: Critical Care Medicine
Collapse
Affiliation(s)
- Craig A Schuring
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Luke J Mountjoy
- Department of Internal Medicine, Iowa Methodist Medical Center, Des Moines, IA, USA
| | - Ashley B Priaulx
- Department of Internal Medicine, Iowa Methodist Medical Center, Des Moines, IA, USA
| | - Robert J Schneider
- Department of Internal Medicine, Iowa Methodist Medical Center, Des Moines, IA, USA
| | - Hayden L Smith
- Department of Internal Medicine, Iowa Methodist Medical Center, Des Moines, IA, USA
| | - Geoffrey C Wall
- Department of Internal Medicine, Iowa Methodist Medical Center, Des Moines, IA, USA
| | - Dipen Kadaria
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Amik Sodhi
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
6
|
Donal E, Lip GYH, Galderisi M, Goette A, Shah D, Marwan M, Lederlin M, Mondillo S, Edvardsen T, Sitges M, Grapsa J, Garbi M, Senior R, Gimelli A, Potpara TS, Van Gelder IC, Gorenek B, Mabo P, Lancellotti P, Kuck KH, Popescu BA, Hindricks G, Habib G, Cosyns B, Delgado V, Haugaa KH, Muraru D, Nieman K, Cohen A. EACVI/EHRA Expert Consensus Document on the role of multi-modality imaging for the evaluation of patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging 2016; 17:355-83. [DOI: 10.1093/ehjci/jev354] [Citation(s) in RCA: 187] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
|
7
|
Ipsen S, Blanck O, Oborn B, Bode F, Liney G, Hunold P, Rades D, Schweikard A, Keall PJ. Radiotherapy beyond cancer: target localization in real-time MRI and treatment planning for cardiac radiosurgery. Med Phys 2015; 41:120702. [PMID: 25471947 DOI: 10.1118/1.4901414] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Atrial fibrillation (AFib) is the most common cardiac arrhythmia that affects millions of patients world-wide. AFib is usually treated with minimally invasive, time consuming catheter ablation techniques. While recently noninvasive radiosurgery to the pulmonary vein antrum (PVA) in the left atrium has been proposed for AFib treatment, precise target location during treatment is challenging due to complex respiratory and cardiac motion. A MRI linear accelerator (MRI-Linac) could solve the problems of motion tracking and compensation using real-time image guidance. In this study, the authors quantified target motion ranges on cardiac magnetic resonance imaging (MRI) and analyzed the dosimetric benefits of margin reduction assuming real-time motion compensation was applied. METHODS For the imaging study, six human subjects underwent real-time cardiac MRI under free breathing. The target motion was analyzed retrospectively using a template matching algorithm. The planning study was conducted on a CT of an AFib patient with a centrally located esophagus undergoing catheter ablation, representing an ideal case for cardiac radiosurgery. The target definition was similar to the ablation lesions at the PVA created during catheter treatment. Safety margins of 0 mm (perfect tracking) to 8 mm (untracked respiratory motion) were added to the target, defining the planning target volume (PTV). For each margin, a 30 Gy single fraction IMRT plan was generated. Additionally, the influence of 1 and 3 T magnetic fields on the treatment beam delivery was simulated using Monte Carlo calculations to determine the dosimetric impact of MRI guidance for two different Linac positions. RESULTS Real-time cardiac MRI showed mean respiratory target motion of 10.2 mm (superior-inferior), 2.4 mm (anterior-posterior), and 2 mm (left-right). The planning study showed that increasing safety margins to encompass untracked respiratory motion leads to overlapping structures even in the ideal scenario, compromising either normal tissue dose constraints or PTV coverage. The magnetic field caused a slight increase in the PTV dose with the in-line MRI-Linac configuration. CONCLUSIONS The authors' results indicate that real-time tracking and motion compensation are mandatory for cardiac radiosurgery and MRI-guidance is feasible, opening the possibility of treating cardiac arrhythmia patients completely noninvasively.
Collapse
Affiliation(s)
- S Ipsen
- Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006, Australia and Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck 23562, Germany
| | - O Blanck
- Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck 23562, Germany
| | - B Oborn
- Illawarra Cancer Care Centre (ICCC), Wollongong, New South Wales 2500, Australia and Centre for Medical Radiation Physics (CMRP), University of Wollongong, Wollongong, New South Wales 2500, Australia
| | - F Bode
- Medical Department II, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck 23562, Germany
| | - G Liney
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, New South Wales 2170, Australia
| | - P Hunold
- Department of Radiology and Nuclear Medicine, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck 23562, Germany
| | - D Rades
- Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck 23562, Germany
| | - A Schweikard
- Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck 23562, Germany
| | - P J Keall
- Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006, Australia
| |
Collapse
|
8
|
Herranz D, Lloret J, Jiménez-Valero S, Rubio-Guivernau JL, Margallo-Balbás E. Novel catheter enabling simultaneous radiofrequency ablation and optical coherence reflectometry. BIOMEDICAL OPTICS EXPRESS 2015; 6:3268-75. [PMID: 26417499 PMCID: PMC4574655 DOI: 10.1364/boe.6.003268] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 07/02/2015] [Accepted: 07/21/2015] [Indexed: 05/22/2023]
Abstract
A novel radiofrequency ablation catheter has been developed with integrated custom designed optics, enabling real-time monitoring of radiofrequency ablation procedures through polarization-sensitive optical coherence reflectometry. The optics allow for proper tissue illumination through a view-port machined in the catheter tip, thus providing lesion depth control over the RF ablation treatment. The system was verified in an in-vitro model of swine myocardium. Optical performance and thermal stability was confirmed after more than 25 procedures, without any damage to the optical assembly induced by thermal stress or material degradation. The use of this catheter in RF ablation treatments may make possible to assess lesion depth during therapy, thus translating into a reduction of potential complications on the procedure.
Collapse
Affiliation(s)
- D. Herranz
- Medlumics S.L, Ronda de Poniente 6, 2A-B, 28760 Tres Cantos,
Spain
| | - Juan Lloret
- Medlumics S.L, Ronda de Poniente 6, 2A-B, 28760 Tres Cantos,
Spain
| | - Santiago Jiménez-Valero
- Medlumics S.L, Ronda de Poniente 6, 2A-B, 28760 Tres Cantos,
Spain
- Servicio de Cardiología Intervencionista, Hospital Universitario La Paz, Madrid,
Spain
| | | | | |
Collapse
|
9
|
Abstract
We propose a method to perform automatic detection and tracking of electrophysiology (EP) catheters in C-arm fluoroscopy sequences. Our approach does not require any initialization, is completely automatic, and can concurrently track an arbitrary number of overlapping catheters. After a pre-processing step, we employ sparse coding to first detect candidate catheter tips, and subsequently detect and track the catheters. The proposed technique is validated on 2835 C-arm images, which include 39,690 manually selected ground-truth catheter electrodes. Results demonstrated sub-millimeter detection accuracy and real-time tracking performances.
Collapse
|
10
|
Moss CE, Fernandez-Caballero S, Walker D. Atrio-oesophageal fistula after transcatheter radiofrequency ablation. BMJ Case Rep 2015; 2015:bcr-2014-204998. [PMID: 25564583 DOI: 10.1136/bcr-2014-204998] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 68-year-old woman presented 3 weeks following unsuccessful transcatheter radiofrequency ablation (TcRFA) for treatment of her chronic atrial fibrillation. Neurological signs manifested on day 2 of admission with generalised tonic-clonic seizures and reduced Glasgow Coma Score. She was treated for presumed central nervous system (CNS) infection, intubated and transferred to the intensive care unit. CT of the head showed bilateral oedema secondary to acute embolic stroke. Blood cultures grew Streptococcus viridans, and lumbar puncture findings were consistent with CNS infection. Echocardiography showed only a septostomy puncture from the atrial fibrillation ablation procedure. Thoracic CT demonstrated air in the left atrium, consistent with the diagnosis of atrio-oesophageal fistula, a rarely reported iatrogenic complication of TcRFA. MRI of the head showed significant neurological injury with innumerable embolic infarcts. After discussion with her family regarding the significant neurological insult, and with no signs of any clinical improvement, the patient died on day 8 of admission.
Collapse
Affiliation(s)
| | | | - David Walker
- Department of ICM/Anaesthetics, UCLH, London, UK
| |
Collapse
|
11
|
Fu X, Wang Z, Wang H, Wang YT, Jenkins MW, Rollins AM. Fiber-optic catheter-based polarization-sensitive OCT for radio-frequency ablation monitoring. OPTICS LETTERS 2014; 39:5066-9. [PMID: 25166075 PMCID: PMC4424424 DOI: 10.1364/ol.39.005066] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
An all-fiber optic catheter-based polarization-sensitive optical coherence tomography system is demonstrated. A novel multiplexing method was used to illuminate the sample, splitting the light from a 58.5 kHz Fourier-domain mode-locked laser such that two different polarization states, alternated in time, are generated by two semiconductor optical amplifiers. A 2.3 mm forward-view cone-scanning catheter probe was designed, fabricated, and used to acquire sample scattering intensity and phase retardation images. The system was first verified with a quarter-wave plate and then by obtaining intensity and phase retardation images of high-birefringence plastic, human skin in vivo, and untreated and thermally ablated porcine myocardium ex vivo. The system can potentially in vivo image of the cardiac wall to aid radio-frequency ablation therapy for cardiac arrhythmias.
Collapse
|
12
|
John M, Comaniciu D. Multi-part modeling and segmentation of left atrium in C-arm CT for image-guided ablation of atrial fibrillation. IEEE TRANSACTIONS ON MEDICAL IMAGING 2014; 33:318-331. [PMID: 24108749 DOI: 10.1109/tmi.2013.2284382] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
As a minimally invasive surgery to treat atrial fibrillation (AF), catheter based ablation uses high radio-frequency energy to eliminate potential sources of abnormal electrical events, especially around the ostia of pulmonary veins (PV). Fusing a patient-specific left atrium (LA) model (including LA chamber, appendage, and PVs) with electro-anatomical maps or overlaying the model onto 2-D real-time fluoroscopic images provides valuable visual guidance during the intervention. In this work, we present a fully automatic LA segmentation system on nongated C-arm computed tomography (C-arm CT) data, where thin boundaries between the LA and surrounding tissues are often blurred due to the cardiac motion artifacts. To avoid segmentation leakage, the shape prior should be exploited to guide the segmentation. A single holistic shape model is often not accurate enough to represent the whole LA shape population under anatomical variations, e.g., the left common PVs vs. separate left PVs. Instead, a part based LA model is proposed, which includes the chamber, appendage, four major PVs, and right middle PVs. Each part is a much simpler anatomical structure compared to the holistic one and can be segmented using a model-based approach (except the right middle PVs). After segmenting the LA parts, the gaps and overlaps among the parts are resolved and segmentation of the ostia region is further refined. As a common anatomical variation, some patients may contain extra right middle PVs, which are segmented using a graph cuts algorithm under the constraints from the already extracted major right PVs. Our approach is computationally efficient, taking about 2.6 s to process a volume with 256 × 256 × 245 voxels. Experiments on 687 C-arm CT datasets demonstrate its robustness and state-of-the-art segmentation accuracy.
Collapse
|
13
|
Abstract
The ablation of persistent atrial fibrillation (AF) poses many challenges compared with ablation for paroxysmal AF, including greater procedural complexity, longer procedural time, unclear endpoints, increased patient comorbidity with a greater risk of procedural complications, and lower success rate. Nevertheless, using a combination of patient selection, careful procedural planning of both ablation strategy and endpoints, and by setting realistic patient expectations, successful ablation may be achieved. Further improvements will come from continued technical advances as well as from greater mechanistic understanding of persistent AF, including the physiologically-targeted ablation of localized rotors and focal sources that have recently been shown to maintain human AF.
Collapse
Affiliation(s)
- David E Krummen
- University of California San Diego and Veterans' Affairs Medical Center Healthcare System, 3350 La Jolla Village Drive, Cardiology Section 111A, San Diego, CA 92161, USA.
| | | |
Collapse
|