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Objective To investigate the effect of radiofrequency catheter ablation (RFCA) on the function and structure of left ventricle during treatment for frequent premature ventricular beats (PVBs). Methods Totally 56 patients with PVBs, who had been successfully treated with RFCA from Jan. 2006 to Dec. 2010, were included in the present study (ablation group). The other 42 patients with frequent PVBs, who received no RFCA treatment, served as controlsCnon-ablation group). The changes of total number of PVBs, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), interventricular septal diameter (IVSd), left ventricular posterior wall diameter (LVPWd) were observed before and after different treatments. Results (1) Compared with the non-ablation group, the ablation group had significantly reduced total number of PVBs ([125 ± 113]/24 h vs [17 813 ± 1 542]/24 h, P< 0.01), increased LVEF ([0.72 ± 0.06] vs [0.64 ± 0.08], P<0.05), and significantly decreased LVEDD ([44. 1 ±4. 0] mm vs [48.9 ± 3.8] mm), LVESD ([27. 0 ±3. 7] mm vs [30. 1 ± 4. 2] mm), IVSd ([7. 5 ±0. 8] mm vs [8.5 ± 0.8] mm), and LVPWd ([7. 5 ± 0. 8] mm vs [8. 5 ± 0. 9] mm) (P<0. 05). (2)Compared with the baseline levels, the total number of PVBs in the ablation group decreased from (23 662 ± 12 559)/24 h before RFCA to (125±113)/24 h(P<0. 01) after RFCA, and patients had relieved chest tightness and heart palpitations. Meanwhile, the LVEF was significantly increased after RFCA ([0. 72 ± 0. 06] vs [0. 64 ± 0. 09], P<0. 05), LVEDD ([44. 1 ± 4. 0] mm vs [50. 6 ± 5. 4] mm), LVESD ([27. 0 ± 3. 7] mm vs [32.1 ± 5.3] mm), IVSd ([7. 5 ± 0. 8] mm vs [8 8 ± 1. 1] mm), and LVPWd ([7. 5 ± 0. 8] mm vs [8.7 ± 1. 1] mm) were significantly decreased after RCFA (P<0. 05). Conclusion RFCA can effectively improve the structural remodeling and cardiac dysfunction induced by PVBs, relieving the patient symptoms.
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Objective To evaluate the histologic changes in the dermis and the changes of the rate of type Ⅲ and type Ⅰ collagen by the radiofrequency device. Methods The effects of radiofrequency current on the dermis were observed. Ten rabbits were treated by radiofrequency, and the histologic change in the dermis were observed by H-E staining and Sirius red staining. Results After RF treatment, the fibers in the dermis appeared more compact and the quantity of the type Ⅲ (red) and type Ⅰ (green) collagen were both increased. The fibers in the dermis appeared more compact and the rate of type Ⅲ and type Ⅰ collagen was increased. It was also found that a significant proliferation of dermal collagen was observed in 8 days after treatment. As time went by, the proliferation of dermal collagen was more pronounced, and the rate of type Ⅲ was increased. Conclusion The radiofrequency current can increase the quantity of collagen in the dermis and increase the rate of type Ⅲ and type Ⅰ collagen, which may be one of the key mechanisms of facial rejuvenation by RF.
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0.05). Accessory pathway antegrade and retrograde effective refractory period values were shorter in patients with PAF attacks (P
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Objective To investigate whether taking diastolic potential(DP)and earliest Purkinje potential(PP)as ablation targets together is superior to taking earliest PP alone in patients with left posterior fascicular ventricular tachycardia(VT).MethodsTotally 18 patients who were admitted in our department from May 2006 to May 2009 were enrolled,and the results of their electrophysiological examination were analyzed.According to radiofrequency(RF)ablation targets,patients were classified into 2 groups:DP+PP group(DP and PP as ablation targets together)and PP group(PP as the target alone).Successful RF ablation was established when the ventricular tachycardia was no longer inducible.The acute success rate,recurrent rate,number of ablation application,procedure time,X-ray exposure and complications were compared between DP+PP and PP groups.ResultsThere was 1 case receiving no ablation because of not being induced to clinical VT.Seventeen cases were induced to clinical VT and displayed right bundle branch block(RBBB)and left axis morphology(DP+PP group 7 cases,and PP group 10 cases).All cases were successfully ablated,their DP-Q interval and PP-Q interval were 60.17?8.16 and 30.64?7.19 ms,respectively.There was no significant difference between the 2 groups in the age,ventricular tachycardial cycle,procedure time and recurrent rate.Compared to the PP group,the number of RF application in DP+PP group was fewer(4.55?2.07 vs 7.50?1.64,P=0.04),and X-ray exposure time was a little longer(18.33?1.51 min vs 15.37?2.77 min,P=0.03).There was neither left posterior fascicular block nor other complications seen in the 2 groups.The follow-up period was 14.29?10.05 months,and during this there was 1 case recurrence in DP group(2 months after procedure)and 1 case in PP group(1 month after procedure)respectively.ConclusionThe 2 methods are effective and safe for successful ablation of left posterior fascicular VT.Compared to ablation of earliest PP site alone,ablation of DP+PP might need fewer times of RF application but longer X-ray exposure time.
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Objective The aim of this study is to evaluate the effects of drug,electric cardiovertion,radiofrepuency ablation and implantable anti-atrial-fibrillation pacemaker on patients with persistent idiopathic atrial fibrillation.Methods 58 patients with persistent idiopathic atrial fibrillation were treated with drug or electric cardjovertion,radiofrequence ablation and anti-atrial-fibrillation pacemaker.Results There were 30 patients successfully converted to sinus rhythm by drug.The mean conversion time of drug was 8?5 days.22 patients were converted by electric cardioversion.10% of cases(6 of 58)failed to convert by both methods.In follow-up period,12 cases of patients were healed,19 cases got significant improvement,14 cases got moderate improvement,8 cases had no improvement.The total efficiency rate was 76%.18 cases in successful cardioversion patients were healed,5 cases got significant improvement,5 cases got moderate improvement,4 cases had no improvement.The total efficiency rate was 75%(14 of 18).2 cases got improvement by anti-atrial-fibrillation pacemaker.Conclusion Combined treatment of drug,electric cardioversion,radiofreqency ablation and anti-atrial-fibrillation pacemaker can imrove cure rate of persistent idiopathic atrial fibrillation.
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The present study investigated the effect of radiofrequency (RF) current energy energy on the release pattern of myocardial marker proteins in 44 patients undergoing RF catheter ablation of supraventricular and ventricular tachycardia serial measurements of the activity of enzyme creatine kinase (enzymatic method), CK-MB isoneration TnT Enzymum ELISA, Boehringer Mannheim). The results showed that nearly all (91 percent) of the patients studied demonstrated a significant elevation in cTnT concentration following transcatheter applications of RF energy, whereas only 12 (27 percent) and 13 (29 percent) patients exhibited a postprocedural increase in CK and CK-MB activity, respectively. In contrast to the variable time for peak activity of CK and CK-MB, 40 of the 44 patients displayed an early peak cTnT concentration at eight hours after the procedure with a subsequent decline thereafter. Levels of cTnT and, to a lesser extent, CK but not CK-MB activity corressory pathways or atrioventricular nodal reentrant tachycardia. In conclusion, cardiac troponin T is a more sensitive indicator of RF energy-induced myocardial injury and has a more uniform pattern of myocardial release than the conventional CK and CK-MB. Determinations of cTnT serum concentration may thus provide a reliable method for assessing the extent of myocardial damage and for monitoring complications developed after radiofrequency or other froms of treascatheter ablation procedures.
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PURPOSE: Catheter ablation using radiofrequency currents have been proven to be an effective and safe tool for the treatment of adult patients with accessory atrioventricular pathways. This study was designed to analyze the efficacy of this method in childern and adolescents. METHODS: Using radiofrequency currents, cathether ablation of an accessory pathway was performed in 54 patients (mean age 11.8 years) with drug-refractory supraventricular tachycardia (51 patients in Georg-August University and 3 patients in Choong Ang Gil General Hospital). Criterias for RF current ablation were as following: precise recording of AP potentials, early ventricle activation relative to the onset of delta wave and stable local electrocardiogram. RESULTS: In 33 of 36 (91.6%) patients with left-side accessory pathways and in 15 of 18 (83.3%) patients with right-side accessory connections, conduction over these pathways was interrupted. CONCLUSION: Cathter ablation using radiofrequency current is a highly effective method for the definitive treatment of supraventricular tachycardia in children and adolescents. Even though cathter ablation by using radiofrequency current is safer in comparison to using direct currents, this procedure should be done only by a specialist. Drug therapy does not cure or offers temporary treatment, but the major benefit of radiofrequency catheter ablation is its potential as a cure. Recently, catheter ablation using radiofrequency currents has been used as the primary treatment for supraventricular tachycardia, because the opportunity to eliminate a chronic disease is especially appealing to children and then family.
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Adolescent , Adult , Child , Humans , Accessory Atrioventricular Bundle , Catheter Ablation , Catheters , Chronic Disease , Drug Therapy , Electrocardiography , Specialization , Tachycardia, SupraventricularABSTRACT
Objective To describe the new cognition of mapping, ablation and mechanism of typical atrial flutter using non-contact mapping system. Methods In 9 patients with typital AFL, the bi-directional conduction properties of isthmus, atrial activation sequence and reentrant circuit of AFL were mapped using the non-contact mapping system. Linear isthmus radiofrequency ablation was guided by navigation system without fluoroscopy, and isthmus bi-directional block was verified. Results A clockwise moving reentrant activation wavefront in 1 of the 9 patients was observed and a counter-clockwise rotating wavefront in 7 of the 9 patients, respectively. AFL was not inducible in one patient. The mean cycle length of AFL was (215?36) ms. The whole reentrant way and its relation with anatomical structure of right atrium (RA) were displayed by non-contact mapping. In each mapped AFL, the wavefront conducted through the crista terminalis (CT) and propagated slowly, which that indicated the smooth part of RA was involved in the reentrant circuit. In patients with recurrences, the gap in the line of block in the isthmus was identified and ablated, which was navigated by the system. Complete isthmus bi-directional conduction block was achieved at the end of the procedure except in two patients. No recurrences of AFL occurred during the follow-up of 12-36 months. Conclusion The whole activation circuit and its relation with RA anatomical structure of typical AFL can be directly visualized and its reentry mechanism was verified by non-contact mapping system. In recurred cases ,the gap of isthmus block was identified and ablated accurately. CT, which was previously supposed to be a complete posterior conduction barrier, was now proved to be of transverse slow conduction by non-contact mapping.
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Objective To investigate the efficacy and safety of the segmental electrical isolation of pulmonary veins (PVs) in patients with paroxysmal atrial fibrillation (PAF). Methods Thirty-nine patients (28 males, 11 females) with recurrent documented symptomatic PAF were included. In order to avoid the risk of cardiac tamponand, we adopted one transseptal procedure and obtained unselective angiography of all PVs and left atrial appendage using pigtail catheter. Lasso mapping catheter and ablation catheter were put into target pulmonary vein ostium through the same site of atrial septum. We routinely mapped the right inferior PV lest any pulmonary vein potential (PVP) that triggered PAF should be omitted. RF ablation was applied at the PVP breakthrough and slightly right and left by moving the RF catheter. Results Eighty-five PVs were targeted for segmental RF ablation. Eight-one were isolated completely. Immediate successful rate was 95%. There was not any complication associated with the procedure. Conclusion It is suggested that the method of segmental PV isolation has a higher cure rate and a shorter procedure time compared with other traditional methods. It can minimize the lesion of pulmonary veins and avoid PV stenosis.
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0. 05), the mean effective discharge time was 3. 4+ 3. 2 (P0. 05), the mean effective discharge time was 2. 6+1. 7 (P
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Objective To investigate the efficacy and safety of segmental electrical isolation of pulmonary veins (PVs) during atrial fibrillation (AF) Methods Nine patients were included, of whom 4 had recently persistent AF (3～4 months) and 5 suffored from paroxysmal AF occurred AF frequently We adopted one transseptal procedure Lasso mapping catheter and ablation catheter were positioned into target pulmonary vein ostium through the same site of atrial septum RF ablation was applied at the pulmonary vein potential (PVP) breakthrough using thermo control RF catheter during AF Results Twenty nine PVs were targeted for segmental RF ablation and isolated completely PVPs in target PVs were in higher spike and more frequent than left atrial potentials There were no complications associated with the procedure Seven patients were converted to sinus rhythm during the procedure Two patients restored sinus rhythm by cardioversion Conclusion It is suggested that the method of segmental PV isolation during AF is safe and has higher success rate It is not necessary to stop antiarrhymic drugs before RF ablation This study provides a reliable method for segmental electrical isolation of pulmonary veins in patients with persistent AF
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Objective To evaluate the effect of radiofrequency catheter ablation treament of supraventricular tachyarrhythmias on spontaneous attack of atrial fibrillation (AF) and to further discuss the electrophysiological mechanisms of AF. Methods Thirty-one patients (20 men, 11 women; mean age 54?12 years, age range 24-69 years) with supraventricular tachyarrhythmias coexisting with AF were included in the study. The mean history of the study group was 9?5 (range 1-19) years and the mean number of AF attack was 6?5 times (range 2-18). Of the 31 cases, 5 supraventricular tachyarrhythmias were electrophysiologically proven to be typical atrial flutter (AFL), 17 atrioventricular reentrant tachycardia (AVRT), 9 atrioventricular nodal reentrant tachycardia (AVNRT). Linear lesions to make bi-directional block were done in cavo-tricuspid isthmus in AFL patients, slow pathway modification in AVNRT and accessory pathway ablation in AVRT. Results After mean follow-up of 39?19 months (range 12-72), of the 31 patients, 23 had no occurrence of AF. In 3 of the 5 AFL patients, no AF occurred after ablation, but 2 still had AF occurrence, of whom one had frequent atrial premature contractions (APCs) and short runs of AF. In 26 patients with supraventricular tachycardia, 20 had no occurrence of AF after ablation. In the remaining 6, 2 had less frequent occurrence, and 4 remained the same, of whom one had hypertention with enlarged left atrium, and another had frequent APCs and short runs of atrial tachycardia. Conclusion AFL may share the same substrate with AF or may be the trigger factor of AF, and AVNRT and AVRT are only trigger factors of AF. So after successful ablation treatment of these tachycardias, no AF occurs. But in some cases, AF substrate still exists, and AF can be triggered by other trigger factors besides tachycardias mentioned above.
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Fourteen patients with Wolff-Parkinson-White syndrome (W-P-W) and 2 pa-tients with atrioventricular node dual pathway (AVNDP) underwent radiofrequency current abla-tion. There were 14 accessory pathways located on the left side of the heart (11 left-free wall. 1 left postseptal, 1 left postlateral and 1 left midseptal), 2 on the right side (1 right anteroseptal, 1 right free-wall). In patients with left side pathways, ablation was attempted via a catheter posi-tioned in the left ventricule directly below the mitral annulus. In patients with right side accessory pathways , the ablation catheter was positioned in the atrial aspect of tricuspid annulus. Accessory pathway conduction was permanently abolished in all the patients (100% ). 2 patients with AVNDP were also successfully ablated by blocking the slow pathways. Plasma CK-MB , SGOT and LDH in-creased moderately in 9 patients (52. 9%) and decreased to normal level after 3～4 days. No severe complications were noted. Conclusion: catheter radiofrequncy current ablation may be an effective and safe therapeutic modality for patients with refractory tachycardias mediated by these path-ways.