著者らは、記事の重要なレビューのために氏マギーウォルナー（Atritech株式会社/ボストン·サイエンティフィック）に感謝。著者は、彼の行政支援や組織の著作権のため氏マヘシュDeshpanade（ボストン·サイエンティフィック）に感謝したいと思います。 ビデオは、ボストン·サイエンティフィック社の無制限の助成金によって支えられている。

<ol>
	<li>Miyasaka, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Time+trends+of+ischemic+stroke+incidence+and+mortality+in+patients+diagnosed+with+first+atrial+fibrillation+in+1980+to+2000:+report+of+a+community-based+study.">Time trends of ischemic stroke incidence and mortality in patients diagnosed with first atrial fibrillation in 1980 to 2000: report of a community-based study.</a> Stroke. 36, 2362-2366 (2005).</li><li>Holmes, D. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+closure+of+the+left+atrial+appendage+versus+warfarin+therapy+for+prevention+of+stroke+in+patients+with+atrial+fibrillation:+a+randomised+non-inferiority+trial.">Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial.</a> Lancet. 374, 534-542 (2009).</li><li>Schweizer, P. A., Becker, R., Katus, H. A., Thomas, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dronedarone:+current+evidence+for+its+safety+and+efficacy+in+the+management+of+atrial+fibrillation.">Dronedarone: current evidence for its safety and efficacy in the management of atrial fibrillation.</a> Drug. 5, 27-39 (2011).</li><li>Wyse, D. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comparison+of+rate+control+and+rhythm+control+in+patients+with+atrial+fibrillation.">A comparison of rate control and rhythm control in patients with atrial fibrillation.</a> N. Engl. J. Med. 347, 1825-1833 (2002).</li><li>Carlsson, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Randomized+trial+of+rate-control+versus+rhythm-control+in+persistent+atrial+fibrillation:+the+Strategies+of+Treatment+of+Atrial+Fibrillation+(STAF)+study.">Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study.</a> J. Am. Coll. Cardiol. 41, 1690-1696 (2003).</li><li>Van Gelder, I. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comparison+of+rate+control+and+rhythm+control+in+patients+with+recurrent+persistent+atrial+fibrillation.">A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation.</a> N. Engl. J. Med. 347, 1834-1840 (2002).</li><li>Echt, D. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mortality+and+morbidity+in+patients+receiving+encainide,+flecainide,+or+placebo.+The+Cardiac+Arrhythmia+Suppression+Trial.">Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial.</a> N. Engl. J. Med. 324, 781-788 (1991).</li><li>Ames, A., Stevenson, W. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cardiology+patient+page.+Catheter+ablation+of+atrial+fibrillation.">Cardiology patient page. Catheter ablation of atrial fibrillation.</a> Circulation. 113, e666-e668 (2006).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stroke+Prevention+in+Atrial+Fibrillation+Study.+Final+results.">Stroke Prevention in Atrial Fibrillation Study. Final results.</a> Circulation. 84, 527-539 (1991).</li><li>Singer, D. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Antithrombotic+therapy+in+atrial+fibrillation:+American+College+of+Chest+Physicians+Evidence-Based+Clinical+Practice+Guidelines+(8th+Edition).">Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition).</a> Chest. 133, 546S-592S (2008).</li><li>Connolly, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dabigatran+versus+warfarin+in+patients+with+atrial+fibrillation.">Dabigatran versus warfarin in patients with atrial fibrillation.</a> N. Engl. J. Med. 361, 1139-1151 (2009).</li><li>Patel, M. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rivaroxaban+versus+warfarin+in+nonvalvular+atrial+fibrillation.">Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.</a> N. Engl. J. Med. 365, 883-891 (2011).</li><li>Albers, G. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ximelagatran+vs+warfarin+for+stroke+prevention+in+patients+with+nonvalvular+atrial+fibrillation:+a+randomized+trial.">Ximelagatran vs warfarin for stroke prevention in patients with nonvalvular atrial fibrillation: a randomized trial.</a> JAMA. 293, 690-698 (2005).</li><li>Fiessinger, J. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ximelagatran+vs+low-molecular-weight+heparin+and+warfarin+for+the+treatment+of+deep+vein+thrombosis:+a+randomized+trial.">Ximelagatran vs low-molecular-weight heparin and warfarin for the treatment of deep vein thrombosis: a randomized trial.</a> JAMA. 293, 681-689 (2005).</li><li>Schulman, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dabigatran+versus+warfarin+in+the+treatment+of+acute+venous+thromboembolism.">Dabigatran versus warfarin in the treatment of acute venous thromboembolism.</a> N. Engl. J. Med. 361, 2342-2352 (2009).</li><li>Sick, P. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Initial+worldwide+experience+with+the+WATCHMAN+left+atrial+appendage+system+for+stroke+prevention+in+atrial+fibrillation.">Initial worldwide experience with the WATCHMAN left atrial appendage system for stroke prevention in atrial fibrillation.</a> J. Am. Coll. Cardiol. 49, 1490-1495 (2007).</li><li>Reddy, V. Y., Holmes, D., Doshi, S. K., Neuzil, P., Kar, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+of+percutaneous+left+atrial+appendage+closure:+results+from+the+Watchman+Left+Atrial+Appendage+System+for+Embolic+Protection+in+Patients+with+AF+(PROTECT+AF)+clinical+trial+and+the+Continued+Access+Registry.">Safety of percutaneous left atrial appendage closure: results from the Watchman Left Atrial Appendage System for Embolic Protection in Patients with AF (PROTECT AF) clinical trial and the Continued Access Registry.</a> Circulation. 123, 417-424 (2011).</li></ol>

博士はメビウス·ウィンクラー、博士Dähnert教授シューラーは、保護AFトライアルに参加しました。 博士はメビウス·ウィンクラーはAtritech社とボストン·サイエンティフィック社の見張り注入のために監督として働いています。

夜警の経皮注入するための手順は、ここで説明心耳閉鎖装置を残して、ワルファリン療法2、安全な17〜非劣性、16可能であることが臨床試験で示されている。すべての試験で安全性を評価したインプラント2,16,17を受けた群で合併症の率が高く、PROTECT AF試験とCAPのレジストリ研究からのデータは、夜警の移植に伴う合併症ができることが示唆されたものの、主としてオペレータの未熟に起因する。安全性イベント発生率の周波数は、当初高かったが、時間が17以上減少した。 ここで紹介する方法は、手続きの合併症を防ぐためのいくつかの重要なステップを強調表示します。パイロットスタディ時には、3つの安全のイベントは、デバイスの障害の結果として発生しました。 2名の被験者において塞栓装置、および1名の被験者において、ワイヤは、プランタ中に骨折る手順。これらのイベントは第一世代のデバイスで発生し、第二世代のデバイスで発生していないにもかかわらず、夜警システムは常に完全に使用する16の前に検討する必要があります。 プロシージャに関連付けられた最も一般的な合併症は、介入と空気塞栓症を必要とする心嚢液胸水があります。画像データの解析は、PROTECT AF試験における重篤な心胸水がtransseptal穿刺時には、夜警デバイスの操作によって、または、最適な移植手順に到達するためのシースとLAA内操作によりオペレータの誤操作によって引き起こされたことを示唆している。ピグテールカテーテルを用いてシースの先端からLAAの穿孔のリスクは著しく減少することができます。一つ心嚢液貯留は、ほとんどのLAAのデバイスの安定性を確認するために行わ積極的な &quot;綱引きテスト&quot;に起因する。このような理由から、それは私を監視する手順を通してTEEとX線透視を使用することが重要です。mplantationプロセス。安定性をチェックするときに、チャンバーを可視化するためにコントラストがLAAに注入されるべき、またはプロセスが継続的にTEEを使用して監視する必要があります。観測と、それ以上の綱引き関連の胸水は観察されていない。手続きに関連したストロークが大きい12F transseptalアクセスシースからの空気塞栓症の結果として3例が発生しました。したがって、適切にシースが空気がシース17内にトラップされていないことを確認フラッシングで勤勉であることが重要です。また、手続きの前に絶食すると、空気塞栓症を引き起こす可能性があります移植手順、中の低左房圧、その結果脱水症につながることができます。したがって、従来のデバイスを導入するまで、生理食塩水は約10 mmHgに患者の左房圧を高めるために注入されるべきである。 ワルファリンの治療に比べLAA閉塞安全イベントの率が高いにもかかわらず、LAA閉塞の罹患率/死亡率に関しては全体的な結果は、IMであった17を証明した 。左心耳の閉鎖は、したがって、非弁膜症性心房細動患者の継続的なワルファリン療法に有望な効果的な代替手段です。

the watchman left atrial appendage closure device for atrial fibrillation

心房細動（AF）は、米国1で推定600万人に影響を与える、最も一般的な不整脈である。 AFは、主に高齢者に影響を与えるので、その有病率は年齢とともに平行に増加します。このように、それは1590万アメリカ人は2050年2によって影響されることが期待されている。虚血性脳卒中は、毎年、非凝固のAF患者の5％で発生します。 AFの現在の治療は、脳卒中の3レート制御、リズムコントロールと予防が含まれています。 米国心臓病学会、米国心臓協会、欧州心臓病学会AF 3の治療の最初のコースとして現在推奨されているレート制御。それは以下の症候状態3に達するまで、速度制御は、例えば、β-ブロッカー、その下の心拍数などの薬剤の投与により達成される。リズムコントロールは、正常洞調律に心を戻すことを目的とし、通常はそのようなアミオダロン、電気的除細動または焼灼療法として抗不整脈薬の投与により達成しました。リズムの制御方法は、しかし、レート制御方式4月6日より優れていることが実証されていません。実際には、特定の抗不整脈薬は、より高い入院率、重篤な副作用3、あるいは構造的な心臓の欠陥7と患者の死亡率の増加に関連付けられていることが示されている。レートコントロール薬が無効または禁忌とされているとき、したがって、抗不整脈薬による治療は、より頻繁に使用されています。レートコントロールと抗不整脈薬動悸、息切れ、疲労8を含むAFの症状を和らげるが、確実に血栓塞栓症6を防ぐことはできません。 抗凝固薬のワルファリンによる治療が大幅に脳卒中や塞栓症9,10の割合を減らすことができます。しかし、50％よりも少ない、その使用に関連する問題のため患者のそれと扱われます。治療用量は、薬、栄養、代謝の相互作用によって影響を受けるため、詳細なモニタリングを必要とします。さらに、ワルファリンは、2出血、重度の、時には致命的な原因となる可能性を秘めています。代替手段として、アスピリンは、一般的に規定されています。アスピリンは一般的に忍容性は良好ですが、それはストローク10の予防にはるかに効果的です。そのようなダビガトラン11またはリバロキサバン12などワルファリンに他の選択肢は、血栓塞栓症（実際には、ダビガトラン1日2回は、優位性を示している150mgの高用量として与えられた）に対してワルファリン非劣性を示しています。これらの薬はワルファリンよりもやや少ないので、食事の心配を排除しながら、定期的な血液モニタリング、大出血とそれに関連する合併症の必要性を排除するという利点がある一方で、問題13から15のままです。 塞栓からAF関連のストロークの90％は結果からそのアリ左心耳（LAA）2からSE、ワルファリン療法の1つの代替アプローチは、それらが終了する前に、血栓をトラップするイオン注入装置を使用してLAAを除外してきました。ここでは、心耳を閉鎖デバイスを左夜警を注入するための手順を示しています。 transseptalカニューレを大腿静脈から挿入し、透視下で、間心房中隔が交差しています。一度左心房へのアクセスが達成されている、ガイドワイヤは、上側肺静脈と夜警のアクセスシースとダイレータに配置され左心房にワイヤを介して進められている。ガイドワイヤーが削除され、アクセスシースは、慎重にピグテールカテーテル上のLAAの遠位部に進出されています。夜警·デリバリー·システムは、整形処理のアクセスシースに挿入し、ゆっくりと進んでいます。夜警·デバイスは、LAAにデプロイされます。デバイスのリリース基準は、透視や食道心エコー（TEE）とデバイスを介して確認された私sがリリースしました。

Watch this Scientific Journal Video about The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation at JoVE.com

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

付属のビデオは心耳（LAA）デバイスを左夜警の経皮的配置の手順について説明します。警備員は、彼らが血栓塞栓性脳卒中を防ぐために、LAAを終了する前に血栓をトラップするニチノール永久に移植するように設計され、デバイス、またはわずかに遠位、左心耳（LAA）の開口である。

警備員は、心房細動のために心耳の閉鎖デバイスの左

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting an estimated 6 million people in the United States 1. Since AF affects primarily ...

the-watchman-left-atrial-appendage-closure-device-for-atrial

Universidad de Cartagena UDEC

Research

JoVE Journal

Medicine

83.3K ビュー.  University of Leipzig Heart Center. 付属のビデオは心耳（LAA）デバイスを左夜警の経皮的配置の手順について説明します。警備員は、彼らが血栓塞栓性脳卒中を防ぐために、LAAを終了する前に血栓をトラップするニチノール永久に移植するように設計され、デバイス、またはわずかに遠位、左心耳（LAA）の開口である。

ビデオ: The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and  Ease of Implantation

Implantable cardioverter-defibrillators (ICDs) terminate ventricular tachycardia (VT) and ventricular fibrillation (VF) with high efficacy and can protect patients from sudden cardiac death (SCD). However, inappropriate shocks may occur if tachycardias are misdiagnosed. Inappropriate shocks are harmful and impair patient quality of life. The risk of inappropriate therapy increases with lower detection rates programmed in the ICD. Single-chamber detection poses greater risks for misdiagnosis when compared with dual-chamber devices that have the benefit of additional atrial information. However, using a dual-chamber device merely for the sake of detection is generally not accepted, since the risks associated with the second electrode may outweigh the benefits of detection. Therefore, BIOTRONIK developed a ventricular lead called the LinoxSMART S DX, which allows for the detection of atrial signals from two electrodes positioned at the atrial part of the ventricular electrode. This device contains two ring electrodes; one that contacts the atrial wall at the junction of the superior vena cava (SVC) and one positioned at the free floating part of the electrode in the atrium. The excellent signal quality can only be achieved by a special filter setting in the ICD (Lumax 540 and 740 VR-T DX, BIOTRONIK). Here, the ease of implantation of the system will be demonstrated.

Dual-chamber implantable cardioverter-defibrillators (ICDs) may improve detection of atrial fibrillation as well as differentiation of tachycardias. However, this advantage is undermined by complications associated with the second electrode, which is required in conventional dual chamber devices. Therefore, BIOTRONIK has developed a new electrode called the LinoxSMART S DX that, when used in conjunction with the Lumax DX ICD, offers dual-chamber detection without the risks associated with the second electrode.

心房センシングによる新しいシングルチャンバー植込み型除細動器：センシングと注入の容易さの実用的なデモンストレーション

Implantable cardioverter-defibrillators (ICDs) terminate ventricular tachycardia (VT) and ventricular fibrillation (VF) with high efficacy and can protect ...

医学

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting millions of individuals worldwide 1-3. The rapid, irregular, and disordered electrical activity in the atria gives rise to palpitations, fatigue, dyspnea, chest pain and dizziness with or without syncope 4, 5. Patients with AF have a five-fold higher risk of stroke 6.
Oral anticoagulation (OAC) with warfarin is commonly used for stroke prevention in patients with AF and has been shown to reduce the risk of stroke by 64% 7. Warfarin therapy has several major disadvantages, however, including bleeding, non-tolerance, interactions with other medications and foods, non-compliance and a narrow therapeutic range 8-11. These issues, together with poor appreciation of the risk-benefit ratio, unawareness of guidelines, or absence of an OAC monitoring outpatient clinic may explain why only 30-60% of patients with AF are prescribed this drug 8.
The problems associated with warfarin, combined with the limited efficacy and/or serious side effects associated with other medications used for AF 12,13, highlight the need for effective non-pharmacological approaches to treatment. One such approach is catheter ablation (CA), a procedure in which a radiofrequency electrical current is applied to regions of the heart to create small ablation lesions that electrically isolate potential AF triggers 4. CA is a well-established treatment for AF symptoms 14, 15, that may also decrease the risk of stroke. Recent data showed a significant decrease in the relative risk of stroke and transient ischemic attack events among patients who underwent ablation compared with those undergoing antiarrhythmic drug therapy 16.
Since the left atrial appendage (LAA) is the source of thrombi in more than 90% of patients with non-valvular atrial fibrillation 17, another approach to stroke prevention is to physically block clots from exiting the LAA. One method for occluding the LAA is via percutaneous placement of the WATCHMAN LAA closure device. The WATCHMAN device resembles a small parachute. It consists of a nitinol frame covered by fabric polyethyl terephthalate that prevents emboli, but not blood, from exiting during the healing process. Fixation anchors around the perimeter secure the device in the LAA (Figure 1). To date, the WATCHMAN is the only implanted percutaneous device for which a randomized clinical trial has been reported. In this study, implantation of the WATCHMAN was found to be at least as effective as warfarin in preventing stroke (all-causes) and death (all-causes) 18. This device received the Conformit&eacute; Europ&eacute;enne (CE) mark for use in the European Union for warfarin eligible patients and in those who have a contraindication to anticoagulation therapy 19.
Given the proven effectiveness of CA to alleviate AF symptoms and the promising data with regard to reduction of thromboembolic events with both CA and WATCHMAN implantation, combining the two procedures is hoped to further reduce the incidence of stroke in high-risk patients while simultaneously relieving symptoms. The combined procedure may eventually enable patients to undergo implantation of the WATCHMAN device without subsequent warfarin treatment, since the CA procedure itself reduces thromboembolic events. This would present an avenue of treatment previously unavailable to patients ineligible for warfarin treatment because of recurrent bleeding 20 or other warfarin-associated problems.
The combined procedure is performed under general anesthesia with biplane fluoroscopy and TEE guidance. Catheter ablation is followed by implantation of the WATCHMAN LAA closure device. Data from a non-randomized trial with 10 patients demonstrates that this procedure can be safely performed in patients with a CHADS2 score of greater than 1 21. Further studies to examine the effectiveness of the combined procedure in reducing symptoms from AF and associated stroke are therefore warranted.

Catheter ablation is combined with placement of the WATCHMAN Left Atrial Appendage Closure Device to prevent ischemic stroke in a patient with non-valvular atrial fibrillation.

心房細動に対する左心耳閉鎖との組み合わせでカテーテルアブレーション

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting millions of individuals worldwide 1-3. The rapid, irregular, and ...

Robotic Ablation of Atrial Fibrillation

Background: Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). During PVI an electrical conduction block between pulmonary vein (PV) and left atrium (LA) is created. This conduction block prevents AF, which is triggered by irregular electric activity originating from the PV. However, transmural atrial lesions are required which can be challenging. Re-conduction and AF recurrence occur in 20 - 40% of the cases. Robotic catheter systems aim to improve catheter steerability. Here, a procedure with a new remote catheter system (RCS), is presented. Objective of this article is to show feasibility of robotic AF ablation with a novel system. Materials and Methods: After interatrial trans-septal puncture is performed using a long sheath and needle under fluoroscopic guidance. The needle is removed and a guide wire is placed in the left superior PV. Then an ablation catheter is positioned in the LA, using the sheath and wire as guide to the LA. LA angiography is performed over the sheath. A circular mapping catheter is positioned via the long sheath into the LA and a three-dimensional (3-D) anatomical reconstruction of the LA is performed. The handle of the ablation catheter is positioned in the robotic arm of the Amigo system and the ablation procedure begins. During the ablation procedure, the operator manipulates the ablation catheter via the robotic arm with the use of a remote control. The ablation is performed by creating point-by-point lesions around the left and right PV ostia. Contact force is measured at the catheter tip to provide feedback of catheter-tissue contact. Conduction block is confirmed by recording the PV potentials on the circular mapping catheter and by pacing maneuvers. The operator stays out of the radiationfield during ablation. Conclusion: The novel catheter system allows ablation with high stability on low operator fluoroscopy exposure.

Pulmonary vein isolation (PVI) with an ablation catheter is a curative treatment for atrial fibrillation (AF). Robotic catheter systems aim to improve catheter steerability. Here, a procedure with a new robotic catheter system is presented. The goal of the procedure is electrical block between pulmonary vein and left atrium.

心房細動のロボットアブレーション

Background: Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). During PVI an electrical conduction block between ...

Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology

A technological platform (MediGuide) has been recently introduced for non-fluoroscopic catheter tracking. In several studies, we have demonstrated that the application of this non-fluoroscopic catheter visualization system (NFCV) reduces fluoroscopy time and dose by 90-95% in a variety of electrophysiology (EP) procedures. This can be of relevance not only to the patients, but also to the nurses and physicians working in the EP lab. Furthermore, in a subset of indications such as supraventricular tachycardias, NFCV enables a fully non-fluoroscopic procedure and allows the lab staff to work without wearing lead aprons. With this protocol, we demonstrate that even complex procedures such as ablations of atrial fibrillation, that are typically associated with fluoroscopy times of &#62;30 min in conventional settings, can safely be performed with a reduction of &#62;90% in fluoroscopy exposure by the additional use of NFCV.

Radiation exposure is an underestimated risk in complex ablation procedures. Here, we describe a protocol to significantly decrease fluoroscopy time and dosage for both the patient and the lab staff by using a novel non-fluoroscopic catheter visualization system.

インターベンション電気生理学における透視削減のための非透視カテーテルトラッキング

A technological platform (MediGuide) has been recently introduced for non-fluoroscopic catheter tracking. In several studies, we have demonstrated that ...

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure

Transthoracic (TTE) and transesophageal echocardiography (TEE) is the standard imaging method for atrial septal defect (ASD) and patent foramen ovale (PFO) detection, for patient selection for transcatheter ASD/PFO closure,&#160;for intraoperative guidance and for long-term follow-up. The size, shape, location and the number of the atrial communications schould be determined. The accuracy of PFO detection can be improved by using agitated saline together with maneuvers to transiently increase the right atrial (RA) pressure. The appearance of microbubbles in the left atrium (LA) within 3 cardiac cycles after opacification of the RA is considered positive for the presence of an intracardiac shunt. Three dimensional TEE identifies further septal fenestrations and describes the dynamic morphology of ASD/PFO and atrial septal aneurysm. Follow-up evaluations with TTE is recommended at 1, 6, and 12 months after the procedure, with a subsequent evaluation every year. Previous studies showed an increased incidence of atrial arrhythmias early after device closure. Speckle tracking analysis may help to understand functional left atrial remodeling following percutaneous closure and its impact on atrial arrhythmias.

Transthoracic (TTE) and transesophageal (TEE) echocardiography represent the basic imaging tools for interatrial septum examination. Three dimensional (3D) TEE provides incremental information in the assessment of the interatrial septum. Further advanced echocardiography techniques using speckle tracking echocardiography are applied for sensitive volumetric and functional assessment of the heart chambers.&#160;

経カテーテル閉鎖前の心房通信の心エコー検査

Transthoracic (TTE) and transesophageal echocardiography (TEE) is the standard imaging method for atrial septal defect (ASD) and patent foramen ovale ...

Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock

The left atrial to femoral artery bypass (LAFAB) system is a mechanical circulatory support (MCS) device used in cardiogenic shock (CS) that bypasses the left ventricle by draining blood from the left atrium (LA) and returning it to the systemic arterial circulation via the femoral artery. It can provide flows ranging from 2.5-5 L/min depending on the size of the cannula. Here, we discuss the mechanism of action of LAFAB, available clinical data, indications for its use in cardiogenic shock, steps of implantation, post-procedural care, and complications associated with the use of this device and their management.
We also provide a brief video of the procedural component of device therapy, including the pre-placement preparation, percutaneous placement of the device via transseptal puncture under echocardiographic guidance and the post-operative management of device parameters.

The following article describes the stepwise procedure for placement of a device (e.g., Tandemheart) in cardiogenic shock (CS) that is a percutaneous left ventricular assist device (pLVAD) and a left atrial to femoral artery bypass (LAFAB) system that bypasses and supports the left ventricle (LV) in CS.

心原性ショックに対する経皮心室補助装置/左心房から大腿動脈バイパスシステムへの使用

The left atrial to femoral artery bypass (LAFAB) system is a mechanical circulatory support (MCS) device used in cardiogenic shock (CS) that bypasses the ...

Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China

Atrial fibrillation (AF) is the most common cardiac arrhythmia. The use of ablation technologies made the Cox-Maze IV procedure (CMP-IV) technically easier, faster, becoming the gold standard for the surgical treatment of AF. However, the efficacy and safety of CMP-IV in situs inversus dextrocardia are largely unknown. This paper summarizes the CMP-IV procedure performed concomitantly with valvular surgery in patients with situs inversus dextrocardia at this institution.
From February 2016 to September 2020, three dextrocardia patients with persistent AF and valvular diseases were referred to this institution for valvular and CMP-IV surgery. CMP-IV was performed using either cryoablation with a nitrous oxide (N2O)-based cryoprobe or a bipolar radiofrequency clamp and bipolar radiofrequency pen. Mechanical valve replacement or mitral vavuloplasty was performed in another patient in addition to tricuspid annuloplasty. Transmurality of the ablated atrial tissues was evaluated by electron microscopy. Heart function was assessed by transthoracic echocardiography. Cardiac rhythm was monitored by 24 h Holter at 3, 6, 12, 18, 24, and 48 months follow-up. 
All the AF was successfully eliminated in the ablation procedure without recurrence or other complications during hospitalization. The mean bypass and crossclamp times were similar in all the patients. The postoperative ventilator support time, the duration of stay in the ICU, and postoperative residence time were also not significantly different among the patients. Transmural atrial necrosis was detected in the ablated atrial tissues. Sinus rhythm maintenance was achieved at 3, 6, 12, 18, 24, and 48 months follow-up in all the patients. All valve protheses switched freely; no tricuspid regurgitation was observed. The results of the present study demonstrate that the CMP-IV is safe and effective in eliminating AF in dextrocardia patients concomitant with valvular surgery.

We summarize the Cox-Maze IV procedure concomitant with valvular surgery performed in patients with situs inversus dextrocardia at this institution.

上皮内対右心不全の弁膜手術に伴うCox-MazeIV手順:中国での単一施設の経験

Atrial fibrillation (AF) is the most common cardiac arrhythmia. The use of ablation technologies made the Cox-Maze IV procedure (CMP-IV) technically ...

Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence

A patent foramen ovale (PFO) persists in about one-quarter of people and is the source of up to 25% of all ischemic strokes, especially strokes in young adults. PFO can be easily diagnosed by transthoracic contrast and/or transesophageal echocardiography. Interventional closure of the PFO via the femoral vein is a commonly used cardiological procedure since several trials have demonstrated the superiority of PFO closure over standard medical therapy in patients with PFO and who have experienced post ischemic, cardioembolic, or cryptogenic stroke. The current paper and video show the procedure of PFO closure in a step-by-step manner.

Closure of a Patent Foramen Ovale PFO: An Intervention Sequence

The closure of a patent foramen ovale (PFO) is a catheter-based intervention to prevent PFO-associated stroke. The PFO-occlusion device is advanced through the femoral vein and deployed across the interatrial septum using transesophageal echocardiography (TEE) and fluoroscopic guidance. The following protocol provides a step-by-step guide for the PFO-closure intervention using a double-disc device.

卵円孔(PFO)の閉鎖:介入シーケンス

A patent foramen ovale (PFO) persists in about one-quarter of people and is the source of up to 25% of all ischemic strokes, especially strokes in young ...

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

It is now well recognized that heart failure (HF) patients with left bundle branch block (LBBB) derive substantial clinical benefits from cardiac resynchronization therapy (CRT), and LBBB has become one of the important predictors for CRT response. The conventional tachypacing-induced HF model has several major limitations, including absence of stable LBBB and rapid reversal of left ventricular (LV) dysfunction after cessation of pacing. Hence, it is essential to establish an optimal model of chronic HF with isolated LBBB for studying CRT benefits. In the present study, a canine model of asynchronous HF induced by left bundle branch (LBB) ablation and 4 weeks of rapid right ventricular (RV) pacing is established. The RV and right atrial (RA) pacing electrodes via the jugular vein approach, together with an epicardial LV pacing electrode, were implanted for CRT performance. Presented here are the detailed protocols of radiofrequency (RF) catheter ablation, pacing leads implantation, and rapid pacing strategy. Intracardiac and surface electrograms during operation were also provided for a better understanding of LBB ablation. Two-dimensional speckle tracking imaging and aortic velocity time integral (aVTI) were acquired to validate the chronic stable HF model with LV asynchrony and CRT benefits. By coordinating ventricular activation and contraction, CRT uniformed the LV mechanical work and restored LV pump function, which was followed by reversal of LV dilation. Moreover, the histopathological study revealed a significant restoration of cardiomyocyte diameter and collagen volume fraction (CVF) after CRT performance, indicating a histologic and cellular reverse remodeling elicited by CRT. In this report, we described a feasible and valid method to develop a chronic asynchronous HF model, which was suitable for studying structural and biologic reverse remodeling following CRT.

The establishment of a chronic asynchronous heart failure (HF) model by rapid pacing combined with left bundle branch ablation is presented. Two-dimensional speckle tracking imaging and aortic velocity time integral are applied to validate this stable HF model with left ventricular asynchrony and the benefits of cardiac resynchronization therapy.

左脚枝アブレーションおよび急速なペーシングによる心不全の非同期モデルでの心臓再同期療法の利点

It is now well recognized that heart failure (HF) patients with left bundle branch block (LBBB) derive substantial clinical benefits from cardiac ...

生物学

<meta charset="utf8"></head><body>後方皮弁回転によるドナー左心房欠損の効率的な修復

Donor Posterior Atrial Flap Rotation for Left Atrial Cuff Reconstruction in Lung Transplantation

We describe in detail a novel surgical technique for repairing donor anterior left atrial wall defect in vivo by rotating the posterior atrial flap during lung transplantation. This method can safely and effectively address the most common type of donor left atrial cuff defect: the anterior wall defect, with the intact posterior wall, typically retained when the donor heart is also used. During atrial cuff anastomosis in lung transplantation, the excess donor posterior atrial wall is trimmed into an atrial flap. After the posterior wall anastomosis is completed, the atrial flap is rotated 180&#176; and used as a patch for anterior wall reconstruction anastomosis. 
After restoring blood flow, the flow rate of the pulmonary vein is normal and smooth as confirmed by transesophageal echocardiography. Compared with the traditional patch reconstruction method, the new method effectively reduces the atrial cuff anastomosis time. Our results showed no significant difference in pulmonary vein obstruction after reconstruction. Pulmonary artery systolic blood pressure was significantly lower and pulmonary function improved postoperatively in all groups, with no significant differences among the groups. The new technique provides a feasible strategy for the reconstruction of left atrial cuff defects and can improve the effective utilization rate of donor lungs.

<meta charset="utf8"></head><body>肺移植における左心房カフ再建のためのドナー後心房皮弁回転

This protocol describes a new method for effectively reconstructing donor atrial cuff anterior wall defects during lung transplantation through the rotation of the donor posterior atrial flap.

肺移植における左心房カフ再建のためのドナー後心房皮弁回転

We describe in detail a novel surgical technique for repairing donor anterior left atrial wall defect in vivo by rotating the posterior atrial flap during ...