1
|
Sakamoto Y, Osanai H, Tanaka Y, Hiramatsu S, Matsumoto H, Tagahara K, Hosono H, Miyamoto S, Kondo S, Kanbara T, Nakashima Y, Asano H, Ajioka M. Contrast-enhanced computed tomography for optimizing the outcomes of pulmonary vein isolation with cryoablation -the role of isolation of PVs including carina. J Interv Card Electrophysiol 2021; 64:455-461. [PMID: 34435295 PMCID: PMC9399060 DOI: 10.1007/s10840-021-01052-5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022]
Abstract
Purpose Compared with conventional pulmonary vein isolation (PVI) with radiofrequency ablation, PVI with cryoballoon is an easier and shorter procedure without reconnection, particularly in the superior pulmonary vein. However, the durability of the cryoballoon may be reduced due to anatomical factors and the position of the pulmonary vein (PV). Further, inadequate isolation of the carina leads to recurrence of atrial fibrillation (AF). We aimed to determine whether using contrast-enhanced computed tomography (CT) for patient selection improves the early success rate and prevents the recurrence of AF in PVI with cryoballoon. Methods We evaluated patients who underwent ablation for paroxysmal atrial fibrillation in our hospital between July 2019 and November 2020. After excluding patients with contraindications for cryoablation, 50 patients were selected through visual inspection of the results of preoperative contrast-enhanced CT. A treatment plan was established, and the clinical course and outcomes were followed up. Results Of the 200 PVs of the 50 patients, only 8 PVs (4%) were incompletely isolated with a single cryoablation. Six of the eight PVs were successfully isolated with additional cryoablation. Only 2 patients (4%) underwent additional PVI with radiofrequency ablation. Four patients had AF recurrence within a mean follow-up period of 14.3 ± 5.1 months. The rate of sinus rhythm maintenance was 92%. PV reconnection was observed in 2 patients. None of the patients had postoperative atrial flutter. Conclusions Selecting patients for cryoablation according to contrast-enhanced CT findings made the procedure easier to perform, leading to improved early success rates and clinical course.
Collapse
Affiliation(s)
- Yusuke Sakamoto
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan.
| | - Hiroyuki Osanai
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Yuki Tanaka
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Shotaro Hiramatsu
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Hikari Matsumoto
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Kensuke Tagahara
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Hirotaka Hosono
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Shun Miyamoto
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Shun Kondo
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Takahiro Kanbara
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Yoshihito Nakashima
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Hiroshi Asano
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Masayoshi Ajioka
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| |
Collapse
|
2
|
Real F. Isolation of intact Leishmania amazonensis large parasitophorous vacuoles from infected macrophages by density gradient fractionation. Exp Parasitol 2020; 218:107989. [PMID: 32941888 DOI: 10.1016/j.exppara.2020.107989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/31/2020] [Accepted: 09/05/2020] [Indexed: 11/23/2022]
Abstract
As the causative agent of hard-to-treat diffuse cutaneous leishmaniasis, Leishmania (L.) amazonensis persists in the host organism sheltered within large Parasitophorous Vacuoles (PVs) formed mainly in macrophages. In the present study, I present a simple and efficient method for L. amazonensis PV isolation. Isolated PVs are intact as demonstrated by the conservation of lysosomal probes loaded into PVs before the procedure. The method is useful for studies aiming at a complete and accurate molecular profile of these structures, to better understand the biogenesis of this pathogen-containing vacuole and its implication in parasite persistence and in leishmaniasis pathogenesis.
Collapse
|
3
|
Verma N, Gillespie CT, Argento AC, Tomson T, Dandamudi S, Piña P, Ringwala S, Lin AC, Chicos AB, Kim S, Arora R, Passman RS, Knight BP. Bronchial effects of cryoballoon ablation for atrial fibrillation. Heart Rhythm 2018; 14:12-16. [PMID: 28007093 DOI: 10.1016/j.hrthm.2016.10.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Damage to extracardiac structures, including the esophagus and phrenic nerve, is a known complication of cryoballoon ablation (CBA) during pulmonary vein (PV) isolation for atrial fibrillation (AF). Other adjacent structures, including the pulmonary bronchi and lung parenchyma, may be affected during CBA at the PV ostia. OBJECTIVE The purpose of this study was to prospectively study the bronchial effects of CBA in humans undergoing CBA for PV isolation. METHODS Ten patients undergoing CBA for AF under general anesthesia were enrolled in an institutional review board-approved prospective observational study. Real-time bronchoscopy was performed during cryoablation of PVs adjacent to pulmonary bronchi to monitor for thermal injury. Patients were followed for the development of respiratory complaints postprocedure. RESULTS In 7 of 10 patients (70%) and in 13 of 22 freezes (59%), ice formation was visualized in the left mainstem bronchus during CBA in the left upper PV. Ice formation was not seen in the right mainstem bronchus during right upper PV CBA. The average time to ice formation was 89 seconds. There was no significant difference (P = -.45) in average minimum balloon temperature during freezes with ice formation (-48.5°C) and freezes without ice formation (-46.3°C). No patients went on to develop respiratory complications. CONCLUSION Unrecognized ice formation occurs frequently in the left mainstem bronchus during CBA for AF. This information helps explain the source of cough and hemoptysis in some patients who undergo CBA. The long-term consequences of this novel finding and the implications for procedural safety are unknown.
Collapse
Affiliation(s)
- Nishant Verma
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois.
| | - Colin T Gillespie
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - A Christine Argento
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Todd Tomson
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Sanjay Dandamudi
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Paloma Piña
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Sukit Ringwala
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Albert C Lin
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Alexandru B Chicos
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Susan Kim
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Rishi Arora
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Rod S Passman
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Bradley P Knight
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
4
|
Scholten MF, Thornton AS, Mekel J, Rivero-Ayerza MJ, Marrouche NF, Jordaens LJ. Pulmonary vein antrum isolation guided by phased-array intracardiac echocardiography: A third way to do PV ablation. Neth Heart J 2005; 13:439-443. [PMID: 25696440 PMCID: PMC2497373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Pulmonary vein isolation (PVI) has emerged as an important strategy in the treatment of patients with atrial fibrillation (AF). The two most frequently used techniques are segmental PVI and left atrial circumferential ablation. AIM To describe and discuss pulmonary vein antrum isolation guided by phased-array intracardiac echocardiography (ICE) as an alternative approach, and to present initial results. METHODS Patients with symptomatic AF were included. The antra (the larger circumferential area around the PVs) were isolated guided by ICE. ICE was also used to titrate the ablation energy. RESULTS 38 patients (3 with persistent AF) were included. Of the 35 patients with paroxysmal AF, 24 are without recurrences, and in six the incidence of paroxysms was significantly reduced after one procedure and a mean follow-up of 201 days. No major complications occurred. CONCLUSION Pulmonary vein antrum isolation guided by ICE is a promising technique in AF ablation and has the potential to avoid severe complications.
Collapse
|