저자는 문서의 비판적 검토를 위해 양 매기 Wallner을 (Atritech 주식 회사 / 보스턴 과학) 감사합니다. 저자는 그의 행정 지원과 조직 저작권 권한 씨 마헤시 Deshpanade을 (보스턴 과학) 감사드립니다. 비디오는 보스턴 과학의 무제한 교부금에 의해 지원되었다.

<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>

박사 Möbius-Winkler 박사 Dähnert과 교수 슐러는 보호 AF 시험에 참가했습니다. 박사 Möbius-Winkler는 Atritech 주식과 보스턴 과학을위한 경비원 주입을위한 조교로 작동합니다.

경비원의 percutaneous 주입에 대한 절차는 심방 부위요 폐쇄 장치가 여기에 설명된 남아, 17 warfarin 치료 2 ~ 비 열등하고, 안전하고, 가능한 16으로 임상 실험에 표시되었습니다. 모든 연구에서 임플란트 2,16,17를받은 그룹에서 합병증의 높은 비율있었습니다지만, 안전을 부과 보호 AF 시범 및 CAP 레지스트리 연구, 데이터는 경비원의 주입과 관련된 합병증이 될 수 있다고 제안합니다 주로 운영자 무경험에 기인. 안전 이벤트 요금의 빈도는 우선 높은했지만 시간이 17 이상 감소했다. 여기에 제시된 방법은 절차적 합병증을 예방 몇 가지 중요한 단계를 보여줍니다. 파일럿 연구 기간 동안, 세 안전 이벤트는 장치 실패의 결과로 발생했습니다. 두 과목에서 embolized 장치는 하나의 주제에 와이어가 implanta 동안 골절기 절차. 이러한 이벤트가 먼저 발생 장치에서 발생하고, 2 세대 장치에서 발생되지는 않았지만, 경비원이 시스템은 항상 철저하게 사용하기 16 전에 검사해야합니다. 절차와 관련된 가장 흔한 합병증은 개입과 공기 색전증을 필요로 pericardial effusions 있습니다. 영상 데이터의 분석 보호 AF 재판에 심각한 pericardial effusions가 경비원이 장치의 조작에 의해 transseptal 펑크 중 운영자 오류 또는 최적의 주입 절차에 도달하는 칼집과 LAA 내에서 조작에 의한 원인이 제안합니다. 변발 카테터를 사용하면 칼집 끝에 의한 LAA의 천공의 위험을 강력하게 줄일 수 있습니다. 한 pericardial 유출 가능성이 높습 LAA에서 장치의 안정성을 확인하는 수행 활발한 &quot;예인선 시험&quot;에서 결과. 이러한 이유로, 그것은 i를 모니터링하는 절차 전반에 걸쳐 티와 fluoroscopy를 사용하는 중요mplantation 과정. 안정성을 확인할 때, 대비는 챔버를 시각화하는 LAA로 주입해야하거나 프로세스는 지속적으로 티로 모니터링해야합니다. 관찰을 통해 더 이상의 예인선 관련 effusions은 관찰되지 않았다. 절차 관련 스트로크가 크고 12F transseptal 액세스 드레스에서 공기 색전증의 결과로 삼가지 경우에 발생했습니다. 따라서 제대로 칼집은 공기가 칼집 17 안에 갇혀되지 않도록 홍조에 부지런 것이 중요합니다. 또한, 이전 절차 금식하는 것은 공기 색전증을 일으킬 수 임플랜테이션 절차 동안 낮은 왼쪽 심방 압력, 그 결과 탈수로 이어질 수 있습니다. 따라서 사전에 장치를 배포까지, 염분 10 mmHg에 대해 환자의 왼쪽 심방 압력을 증가 풍의해야합니다. warfarin 치료에 비해 LAA 폐색과 안전 이벤트의 높은 속도에도 불구하고, 병적 상태 / LAA 폐색과 사망률에 관한 전반적인 결과는 메신저였다17이었다. 왼쪽 심방 부위요의 폐쇄 따라서 비 밸브 모양의 심방 세동 환자에서 지속적인 warfarin 치료에 유망한 효과적인 대안입니다.

the watchman left atrial appendage closure device for atrial fibrillation

심방 세동 (AF)는 미국 1 추산 6백만명에 영향을 미치는 가장 일반적인 심장 부정맥이다. AF는 주로 노인에 영향을 미치는 이후의 유행은 나이가 병렬로 증가합니다. 따라서, 그것은 15,900,000 미국인 년 2,050 2로 영향을받을 것으로 예상된다. 허혈성 뇌졸중은 매년 비 anticoagulated AF 환자의 5 %에​​서 발생합니다. AF에 대한 현재 치료 속도 제어, 리듬 제어 및 뇌졸중 3 방지가 포함됩니다. 심장의 미국 대학, 미국 심장 협회, 그리고 심장의 유럽 사회 AF 3에 대한 치료의 첫 번째 과정으로 현재 권장 속도 제어. 그것이 덜 증상 주 3 도달할 때까지 속도 제어 등의 β-차단제, 그 낮은 심장 박동과 같은 pharmacological 요원의 관리에 의해 이루어진다. 리듬 조절은 정상 부비동 리듬에 마음을 반환하는 것을 목표로하고 일반적으로이러한 amiodarone, 전기 심장 율동이나 절제 요법 등 antiarrhythmic 약물의 관리를 통해 달성했습니다. 리듬 제어 방법은, 그러나, 속도 제어 방법 4-6으로 우수한 것으로 입증되지 않았습니다. 사실, 특정 antiarrhythmic 약물은 높은 입원 율, 심각한 악영향 3, 또는 구조적 심장 결함 7 환자의 사망률 증가와 관련된 것으로 표시되었습니다. 속도 제어 약물이 효과하거나 금기 때 따라서, antiarrhythmics 치료가 더 자주 사용됩니다. 속도 제어 및 antiarrhythmic 에이전트는 palpitations, 호흡 곤란과 피로 8 포함한 AF의 증상을 완화하지만, 안정적으로 thromboembolic 이벤트 6을 방지하지 않습니다. 항응고제 약물 warfarin과 치료는 크게 뇌졸중이나 색전증 9,10의 속도를 줄여줍니다. 그러나, 문제를 적게 50 % 이상은 그 사용과 관련된의 환자는 그것으로 취급됩니다. 치료 선량은 약물,식이, 그리고 신진 대사 상호 작용에 의해 영향을, 따라서 세부적인 모니터링이 필요합니다. 또한, warfarin 2를 받긴했지만, 심각한, 때때로 치명적인 일으킬 수있는 잠재력을 가지고 있습니다. 대안으로 아스피린은 흔히 처방된다. 아스피린은 일반적으로 잘 용납되고 있지만, 뇌졸중 10 예방에 훨씬 효과적입니다. 같은 dabigatran 11 rivaroxaban 12 등 warfarin에 대한 다른 대안은 thromboembolic 이벤트 (사실, dabigatran는 하루 우위를 보여주었다 회 150 밀리그램의 높은 복용으로 주어진)과 관련하여 warfarin에 비 열등감을 보여줍니다. 이러한 약물은 warfarin과보다 다소 덜하므로식이 우려를 제거하고 동시에 정기적인 혈액 모니터링, 주요 출혈과 관련된 합병증에 대한 필요성을 제거하는 장점을 가지고 있지만, 문제는 13-15 남아 있습니다. emboli에서 AF-연결된 스트로크의 90 %가 결과 이​​후 그 아리SE는 왼쪽 심방 부위요에서 (LAA) 2, warfarin 치료에 한 대안 접근 방식은 그들이 종료하기 전에 혈전 잡으 이식 장치를 사용 LAA를 제외하도록하고있다. 여기서는 심방세동 부위요 폐쇄 장치를 왼쪽 경비원을 이온 주입을위한 절차를 보여줍니다. transseptal 정맥은 대퇴 정맥을 통해 삽입되며, fluoroscopic지도하에, 남북 심방 심장들이 꼬여있다. 일단 좌심방에 접속하면 guidewire가 위쪽 폐의 혈관에에 배치되고 경비원 액세스 드레스와 팽창시키는가 와이어를 통해 좌심방으로 진출하고, 달성되었습니다. guidewire이 제거되고, 액세스 드레스는 신중 변발의 카테터 이상 LAA의 말초 부분으로 발달한다. 경비원이 전달 시스템은 준비 액세스 드레스에 삽입하고, 서서히 고도합니다. 경비원이 장치는 다음 LAA로 배포됩니다. 장치 릴리스 조건은 fluoroscopy와 transesophageal echocardiography (티)와 디바이스를 통해 확인하고 난S를 공개했다.

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

첨부된 동영상은 심방세동 부위요 (LAA) 장치를 왼쪽 경비원의 percutaneous 배치를위한 절차를 설명합니다. 경비원이 영구적으로 이식, 또는 그들이 thromboembolic 뇌졸중을 예방, LAA를 종료하기 전에 혈전를 잡는 왼쪽 심방 부위요 (LAA)의 개통에 약간 말초하도록 설계 nitinol 장치입니다.

경비원이 심방세동 세동에 대한 심방세동 부위요 폐쇄 장치를 왼쪽

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

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83.3K 조회수.  University of Leipzig Heart Center. 첨부된 동영상은 심방세동 부위요 (LAA) 장치를 왼쪽 경비원의 percutaneous 배치를위한 절차를 설명합니다. 경비원이 영구적으로 이식, 또는 그들이 thromboembolic 뇌졸중을 예방, LAA를 종료하기 전에 혈전를 잡는 왼쪽 심방 부위요 (LAA)의 개통에 약간 말초하도록 설계 nitinol 장치입니다.

비디오: 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.

새로운 싱글 회의소 Implantable 심방세동 감지와 심장 박동기 : 감지의 실용 데모와 주입의 용이성

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

연구

의학

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.

심방 세동에 대한 왼쪽 심방 부위 요 폐쇄와 함께 카테 테르 박리

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.

심방 세동의 로봇 절제

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.

중재 전기 생리학에서 투시 감소를위한 카테터 추적 비 투시

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;

트랜스카테터 폐쇄 전 심방 통신의 심초음파 평가

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.

경피 심실 보조 장치 /심장 유발 쇼크를위한 대퇴 동맥 우회 시스템에 왼쪽 아트리움의 사용

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.

Cox-Maze IV 절차 판막 수술과 병행 제자리 내대 덱스트로 심장 : 중국에서의 단일 센터 경험

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.

난소 개공(PFO) 폐쇄: 개입 순서

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.

심장 재 동기화 치료 왼쪽된 번들 지점 제거 및 빠른 속도 의해 유도 된 비동기 심장 마비 모델에서의 장점

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

생물학

<meta charset="utf8"></head><body>Efficient Repair of donor left atrial Defect with posterior flap rotation (후방 피판 회전을 이용한 기증자 좌심방 결손의 효율적인 수리)

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>폐 이식에서 좌심방 커프 재건을 위한 기증자 후방 심방 피판 회전(Donor Posterior Atrial Flap Rotation for Left Atrial Cuff Reconstruction in Lung Transplantation)

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.

폐 이식에서 좌심방 커프 재건을 위한 기증자 후방 심방 피판 회전(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 ...