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Paul Nordin A, Drca N, Insulander P, Bastani H, Bourke T, Braunschweig F, Kenneback G, Von Olshausen G, Sadigh B, Saluveer O, Tapanainen J, Schwieler J, Akerstrom F, Jensen-Urstad M. Low incidence of major complications after the first six hours post-atrial fibrillation ablation – same-day discharge safe and feasible in most patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Catheter ablation of atrial fibrillation (AF) is associated with a complication risk. It is common practice to monitor patients overnight post-procedurally which is resource craving.
Purpose
To evaluate the incidence of procedural complications related to catheter ablation of AF to assess the potential feasibility and safety of same day discharge in a large cohort.
Methods
We performed an analysis of prospectively collected data of complications of all patients staying overnight after undergoing AF ablation between 2001 and 2020 at a tertiary centre. By studying medical records, we analysed complications occurring intraprocedurally until six hours post-ablation, and between six hours post-ablation until discharge the day after ablation procedure (up to 24 hours post-procedure).
Results
In 5414 AF ablations we identified a total of 108 (2.0%) major complications occurring intraprocedural or until discharge the day after procedure. Most major complications occurred early and were detected intraprocedurally or within six hours after completed procedure (n=96, 1.8%). Twelve (0.2%) major complications occurred between six hours post-ablation and until discharge the day after procedure. The most common of these were congestive heart failure (n=6) and transient ischemic attack (TIA, n=4). In addition, there were 61 (1.1%) minor complications which occurred in this time span. Factors independently associated with major complications intraprocedurally or within 24 hours were age (p=0.046), body mass index (BMI) ≥30 kg/m2 (p=0.009), significant valvular disease (p=0.001), cardiomyopathy (p<0.001), prior stroke or TIA (p=0.014), first time procedure vs. repeat procedure (p=0.013), cryoablation vs. radiofrequency (p<0.001) and procedure duration (p<0.001).
Conclusion
Very few complications occurred between six hours and until discharge after ablation of atrial fibrillation. Therefore, same-day discharge may be a safe option for a large proportion of patients.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Region Stockholm funding
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Affiliation(s)
| | - N Drca
- Karolinska University Hospital, Stockholm, Sweden
| | - P Insulander
- Karolinska University Hospital, Stockholm, Sweden
| | - H Bastani
- Karolinska University Hospital, Stockholm, Sweden
| | - T Bourke
- Karolinska University Hospital, Stockholm, Sweden
| | | | - G Kenneback
- Karolinska University Hospital, Stockholm, Sweden
| | | | - B Sadigh
- Karolinska University Hospital, Stockholm, Sweden
| | - O Saluveer
- Karolinska University Hospital, Stockholm, Sweden
| | - J Tapanainen
- Karolinska University Hospital, Stockholm, Sweden
| | - J Schwieler
- Karolinska University Hospital, Stockholm, Sweden
| | - F Akerstrom
- Karolinska University Hospital, Stockholm, Sweden
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Bastani H, Bourke T, Braunschweig F, Drca N, Gudmundsson K, Insulander P, Jemtren A, Kennebäck G, Ljungström E, Sadigh B, Saluveer O, Scheel S, Schwieler J, Tapanainen J, Jensen-Urstad M. Cryoablation as standard treatment of atrial flutter: a prospective, 2-center study (CASTAF). Acta Cardiol 2021; 76:267-271. [PMID: 32208915 DOI: 10.1080/00015385.2020.1721717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cryoablation (CRYO) of cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) has been shown to be non-inferior to radiofrequency ablation (RF) in terms of ablation success and is associated with less pain. However, procedural time has been significantly longer with CRYO compared to RF. A possible explanation for this could be that operators had less experience with CRYO than with RF. The purpose of this study was to test the hypothesis that in the hands of experienced operators, cryoablation of CTI-dependent AFL is effective with procedure-time similar to what is reported for RF. METHODS This prospective 2-center study included 184 patients with CTI-dependent AFL - median age 66 years (range 28-83), 159 men (86%). Cryoablation was performed using a 9 F, 8 mm tip catheter (Freezor MAX, Medtronic, Inc, MN, USA). Ablation endpoint was bidirectional CTI-block. Pain was evaluated with a visual analogue scale (VAS 0-10). All operators had experience of at least 25 previous CTI-ablations with CRYO. RESULTS The acute success rate was 89%. Procedural time including an observation period of 30 min, was 115 ± 36 min which is similar to procedural times for RF in previous studies. Fluoroscopy time was 11 ± 9 min. Cryoablation was perceived as almost pain- free by the patients, VAS (mean) 1.8 ± 1.2. Success rate at 12-month follow-up (FU) was 88% in patients with primary success. No major adverse events occurred. CONCLUSIONS Cryoablation of CTI-dependent AFL is effective, with a low level of procedure-related pain. In experienced hands, the procedure time in this prospective non-randomised trial seems to be in the level of reported procedure times for RF. The long-term relapse rate appears to be higher than for RF.
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Affiliation(s)
- H. Bastani
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - T. Bourke
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - F. Braunschweig
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - N. Drca
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - K. Gudmundsson
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - P. Insulander
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A. Jemtren
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - G. Kennebäck
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - E. Ljungström
- Department of Cardiology, Blekinge County Hospital, Karlskrona, Sweden
| | - B. Sadigh
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - O. Saluveer
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - S. Scheel
- Department of Cardiology, Blekinge County Hospital, Karlskrona, Sweden
| | - J. Schwieler
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J. Tapanainen
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - M. Jensen-Urstad
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Zepeda-Ruiz LA, Sadigh B, Chernov AA, Haxhimali T, Samanta A, Oppelstrup T, Hamel S, Benedict LX, Belof JL. Extraction of effective solid-liquid interfacial free energies for full 3D solid crystallites from equilibrium MD simulations. J Chem Phys 2018; 147:194704. [PMID: 29166088 DOI: 10.1063/1.4997595] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Molecular dynamics simulations of an embedded atom copper system in the isobaric-isenthalpic ensemble are used to study the effective solid-liquid interfacial free energy of quasi-spherical solid crystals within a liquid. This is within the larger context of molecular dynamics simulations of this system undergoing solidification, where single individually prepared crystallites of different sizes grow until they reach a thermodynamically stable final state. The resulting equilibrium shapes possess the full structural details expected for solids with weakly anisotropic surface free energies (in these cases, ∼5% radial flattening and rounded [111] octahedral faces). The simplifying assumption of sphericity and perfect isotropy leads to an effective interfacial free energy as appearing in the Gibbs-Thomson equation, which we determine to be ∼177 erg/cm2, roughly independent of crystal size for radii in the 50-250 Å range. This quantity may be used in atomistically informed models of solidification kinetics for this system.
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Affiliation(s)
- L A Zepeda-Ruiz
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - B Sadigh
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - A A Chernov
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - T Haxhimali
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - A Samanta
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - T Oppelstrup
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - S Hamel
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - L X Benedict
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - J L Belof
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
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Zepeda-Ruiz LA, Sadigh B, Shin SJ, Kozioziemski BJ, Chernov AA. Effect of wetting on nucleation and growth of D 2 in confinement. J Chem Phys 2018; 148:134708. [PMID: 29626858 DOI: 10.1063/1.5020068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We have performed a computational study to determine how the wetting of liquid deuterium to the walls of the material influences nucleation. We present the development of a pair-wise interatomic potential that includes zero-point motion of molecular deuterium. Deuterium is used in this study because of its importance to inertial confinement fusion and the potential to generate a superfluid state if the solidification can be suppressed. Our simulations show that wetting dominates undercooling compared to the pore geometries. We observe a transition from heterogeneous nucleation at the confining wall to homogeneous nucleation at the bulk of the liquid (and intermediate cases) as the interaction with the confining wall changes from perfect wetting to non-wetting. When nucleation is heterogeneous, the temperature needed for solidification changes by 4 K with decreasing deuterium-wall interaction, but it remains independent (and equal to the one from bulk samples) when homogeneous nucleation dominates. We find that growth and quality of the resulting microstructure also depends on the magnitude of liquid deuterium-wall interaction strength.
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Affiliation(s)
- L A Zepeda-Ruiz
- Physical and Life Sciences Directorate, Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - B Sadigh
- Physical and Life Sciences Directorate, Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - S J Shin
- Physical and Life Sciences Directorate, Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - B J Kozioziemski
- Physical and Life Sciences Directorate, Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - A A Chernov
- Physical and Life Sciences Directorate, Lawrence Livermore National Laboratory, Livermore, California 94551, USA
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Bastani H, Bourke T, Braunschweig F, Drca N, Gudmundsson K, Insulander P, Jemtren A, Kenneback G, Ljungstrom E, Sadigh B, Saluveer O, Scheel S, Schwieler J, Tapanainen J, Jensen-Urstad M. P888Cryoablation as standard treatment of atrial flutter (CASTAF). Europace 2017. [DOI: 10.1093/ehjci/eux151.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gilbert MR, Schuck P, Sadigh B, Marian J. Free energy generalization of the Peierls potential in iron. Phys Rev Lett 2013; 111:095502. [PMID: 24033045 DOI: 10.1103/physrevlett.111.095502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Indexed: 06/02/2023]
Abstract
In body-centered-cubic (bcc) crystals, 1/2<111> screw dislocations exhibit high intrinsic lattice friction as a consequence of their nonplanar core structure, which results in a periodic energy landscape known as the Peierls potential U(P). The main features determining plastic flow, including its stress and temperature dependences, can be derived directly from this potential, hence its importance. In this Letter, we use thermodynamic integration to provide a full thermodynamic extension of U(P) for bcc Fe. We compute the Peierls free energy path as a function of stress and temperature and show that the critical stress vanishes at 700 K, supplying the qualitative elements that explain plastic behavior in the athermal limit.
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Affiliation(s)
- M R Gilbert
- EURATOM/CCFE Fusion Association, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
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Sadigh B, Erhart P, Åberg D, Trave A, Schwegler E, Bude J. First-principles calculations of the Urbach tail in the optical absorption spectra of silica glass. Phys Rev Lett 2011; 106:027401. [PMID: 21405249 DOI: 10.1103/physrevlett.106.027401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Indexed: 05/27/2023]
Abstract
We present density-functional theory calculations of the optical absorption spectra of silica glass for temperatures up to 2400 K. The calculated spectra exhibit exponential tails near the fundamental absorption edge that follow the Urbach rule in good agreement with experiments. We discuss the accuracy of our results by comparing to hybrid exchange correlation functionals. We show that the Urbach rule holds in a frequency interval where optical absorption is Poisson distributed with very large statistical fluctuations. In this regime, a direct relation between the optical absorption coefficient and electronic density of states is derived, which provides a link between photoemission and absorption spectra and is used to determine the lower bound to the Urbach frequency regime.
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Affiliation(s)
- B Sadigh
- Lawrence Livermore National Laboratory, Chemistry, Materials and Life Sciences Directorate, Livermore, California 94550, USA
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Bastani H, Schwieler J, Insulander P, Tabrizi F, Braunschweig F, Kenneback G, Drca N, Sadigh B, Jensen-Urstad M. Acute and long-term outcome of cryoablation therapy of typical atrioventricular nodal reentrant tachycardia. Europace 2009; 11:1077-82. [DOI: 10.1093/europace/eup177] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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9
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Bastani H, Insulander P, Schwieler J, Tabrizi F, Braunschweig F, Kenneback G, Drca N, Sadigh B, Jensen-Urstad M. Safety and efficacy of cryoablation of atrial tachycardia with high risk of ablation-related injuries. Europace 2009; 11:625-9. [DOI: 10.1093/europace/eup004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Söderlind P, Sadigh B, Moore KT. Comment on "new pseudophase structure for alpha-Pu". Phys Rev Lett 2004; 93:199601-199602. [PMID: 15600897 DOI: 10.1103/physrevlett.93.199601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2004] [Indexed: 05/24/2023]
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Hoyt JJ, Asta M, Sadigh B. Test of the universal scaling law for the diffusion coefficient in liquid metals. Phys Rev Lett 2000; 85:594-597. [PMID: 10991348 DOI: 10.1103/physrevlett.85.594] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/1999] [Indexed: 05/23/2023]
Abstract
The recently proposed scaling law relating the diffusion coefficient and the excess entropy of a liquid [M. Dzugutov, Nature (London) 381, 137 (1996)] is tested for several metals using molecular dynamics simulations. Interatomic potentials derived from the embedded atom method are used to study Ag, Au, Cu, Ni, Pd, Pt, Ni(3)Al, and AuPt and the angular dependent Stillinger-Weber form is used to investigate Si.
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Affiliation(s)
- J J Hoyt
- Sandia National Laboratories, MS 9161, P. O. Box 969, Livermore, California 94551-0969, USA
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Eriksson BE, Sadigh B, Svedenhag J, Sylvén C. Analgesic effects of adenosine in syndrome X are counteracted by theophylline: a double-blind placebo-controlled study. Clin Sci (Lond) 2000; 98:15-20. [PMID: 10600654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
It has been proposed that adenosine mediates ischaemic pain in humans. Patients with cardiac Syndrome X are hypersensitive to potential pain stimuli, including adenosine. On the other hand, recent findings suggest that low-dose adenosine infusion may have analgesic effects. Our aim was to test two hypotheses: (1) that the analgesic effect of adenosine is peripheral in origin, and (2) that part of the hypersensitivity to pain of patients with cardiac Syndrome X results from a disturbed mechanism of adenosine analgesia. A total of 12 female Syndrome X patients and eight healthy age-matched female controls were studied in a randomized, double-blind and placebo-controlled study. Adenosine (70 microg/min) or placebo was infused into the forearm via an intra-arterial catheter. After 15 min of infusion, a tourniquet on the upper arm was inflated to 225 mmHg to ensure arterial occlusion. The patient then carried out dynamic handgrip work at 60 Hz. Pain or discomfort in the forearm was estimated continuously according to the Borg CR-10 scale. After the first test, theophylline was infused for 10 min intravenously at a dose of 5 mg/kg body weight. The ischaemic forearm test was then repeated. On a second occasion, the procedure was repeated with the opposite treatment (adenosine/placebo). Only six of 12 Syndrome X patients completed the protocol because of pain during the catheterization procedure or an inability to establish an intra-arterial line. The time to onset of pain in the working, ischaemic forearm was greater for subjects treated with adenosine than for those treated with placebo, both in those Syndrome X patients who tolerated catheterization (49+/-27 s compared with 32+/-18 s; P<0.03) and in healthy controls (40+/-19 s compared with 16+/-8 s; P<0.02). The time to maximum pain, limiting ischaemic work, was also greater with adenosine pretreatment both in Syndrome X patients (137+/-28 s compared with 106+/-28 s; P<0.03) and in healthy controls (109+/-31 compared with 82+/-18 s; P<0.01). After infusion of theophylline there was no difference between adenosine and placebo in either group. Intra-arterially infused adenosine had similar peripheral analgesic effects on experimentally induced muscular ischaemia in those female Syndrome X patients who tolerated intra-arterial catheterization and in healthy controls. Thus adenosine analgesia is counteracted by theophylline, suggesting that the effect is mediated by membrane-bound peripheral adenosine receptors.
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Affiliation(s)
- B E Eriksson
- Karolinska Institute, Department of Cardiology and Department of Clinical Physiology, Huddinge University Hospital, SE-141 86 Huddinge, Sweden.
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Sadigh B, Grimvall G. Molecular-dynamics study of thermodynamical properties of liquid copper. Phys Rev B Condens Matter 1996; 54:15742-15746. [PMID: 9985641 DOI: 10.1103/physrevb.54.15742] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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