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1.
ABC., imagem cardiovasc ; 34(3)2021. ilus, tab
Article in Portuguese | LILACS | ID: biblio-1292264

ABSTRACT

A cardiomiopatia arritmogênica do ventrículo direito é uma desordem hereditária caracterizada pela substituição fibrogordurosa do músculo cardíaco. O manejo clínico busca reduzir os riscos de morte súbita e melhorar a qualidade de vida, aliviando os sintomas arrítmicos e de insuficiência cardíaca. O ecocardiograma é o exame inicial para a investigação da cardiomiopatia arritmogênica do ventrículo direito, podendo apresentar dilatação das câmaras direitas e disfunção sistólica do ventrículo direito. Este relato chama atenção por envolver o diagnóstico de cardiomiopatia arritmogênica do ventrículo direito em paciente atleta. Mulher, 47 anos, maratonista, sem história familiar de morte súbita cardíaca, deu entrada na emergência com palpitação associada à pré-síncope. O eletrocardiograma da admissão mostrava taquicardia ventricular. O ecocardiograma revelou aumento de câmaras cardíacas direitas e disfunção sistólica do ventrículo direito. O cateterismo cardíaco não evidenciou doença coronária obstrutiva. A paciente foi orientada acerca da necessidade de suspensão de atividades físicas, porém, 3 meses depois, foi readmitida com instabilidade hemodinâmica por nova taquicardia ventricular, tendo sido cardiovertida. Realizou ressonância cardíaca, que evidenciou áreas de discinesia e formação de microaneurismas em ventrículo direito. Foi diagnosticada com cardiomiopatia arritmogênica do ventrículo direito, tendo sido com cardioversor desfibrilador implantável, amiodarona e betabloqueador. A diferenciação entre a cardiomiopatia arritmogênica do ventrículo direito e o coração do atleta representa um desafio, devido à sobreposição de alterações estruturais que coexistem nessas entidades, daí a importância da análise integrada de fatores clínicos, eletrocardiográficos e morfofuncionais.(AU)


Subject(s)
Humans , Female , Middle Aged , Death, Sudden, Cardiac , Tachycardia, Ventricular/diagnosis , Arrhythmogenic Right Ventricular Dysplasia/genetics , Arrhythmogenic Right Ventricular Dysplasia/mortality , Heart Failure , Genetic Diseases, Inborn , Electric Countershock/methods , Echocardiography/methods , Magnetic Resonance Spectroscopy/methods , Electrocardiography, Ambulatory/methods , Heart Transplantation/methods , Defibrillators, Implantable , Catheter Ablation/methods , Electrocardiography/methods , Amiodarone/administration & dosage , Anti-Arrhythmia Agents/therapeutic use
3.
Article in Chinese | WPRIM | ID: wpr-880447

ABSTRACT

The methods of monitoring the thermal ablation of tumor are compared and analyzed in recent years. The principle method results and insufficient of ultrasound elastography and quantitative ultrasound imaging are discussed. The results show that ultrasonic tissue signature has great development space in the field of real-time monitoring of thermal ablation, but there are still some problems such as insufficient monitoring accuracy difficulty in whole-course monitoring and insufficient


Subject(s)
Catheter Ablation , Elasticity Imaging Techniques , Humans , Hyperthermia, Induced , Liver/surgery , Neoplasms/surgery , Ultrasonography
4.
Rev. bras. cir. cardiovasc ; 35(6): 999-1002, Nov.-Dec. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1143991

ABSTRACT

Abstract Minimally invasive surgical ablation is generally contraindicated in patients with atrial fibrillation and thrombosis of the left atrial appendage. We have treated three of these patients using an innovative technique based on a bilateral video-thoracoscopic approach, performing a continuous encircling lesion at the pulmonary veins outflow with radio-frequency ablation, simultaneously excluding the left atrial appendage. The postoperative course was uneventful, without neurologic events and all patients maintained a stable sinus rhythm at 1-year follow-up. This procedure represents a new mini-invasive method to treat persistent atrial fibrillation when partial thrombosis of the left atrial appendage contraindicates other ablation techniques.


Subject(s)
Humans , Atrial Fibrillation/surgery , Thrombosis/etiology , Catheter Ablation , Atrial Appendage/surgery , Atrial Appendage/diagnostic imaging , Thoracoscopy , Treatment Outcome
5.
Arq. bras. cardiol ; 115(5 supl.1): 11-11, nov. 2020. ilus
Article in Portuguese | LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-1128956

ABSTRACT

INTRODUÇÃO: A ablação por cateter para FV surgiu como uma estratégia nos pacientes nos quais um batimento ectópico é identificado como gatilho. Descrevemos um caso de ablação de FV com sucesso, desencadeada por EV's com origem na cúspide coronariana esquerda (CCE). Relato de caso: Uma mulher de 73 anos com MCP dilatada não isquêmica (FEVE de 20%) e CDI implantado há 9 anos devido a FV induzida em EEF, foi admitida em nosso serviço por choque apropriado. ECG demonstrou EV's frequentes com morfologia de BRE e eixo inferior. Holter 24h revelou EV's monomórficas frequentes (19%) e 68 episódios de TVNS. A interrogação do dispositivo mostrou um episódio de EV desencadeando TV rápida que logo degenerou em FV. Realizada telemetria do CDI concomitante à gravação de ECG, confirmando que as ectopias espontâneas e as que desencadeavam os episódios de TV/FV eram exatamente da mesma morfologia. A paciente foi encaminhada para ablação por cateter. O mapeamento do VE foi realizado por via de acesso retroaórtica. A ativação mais precoce foi registrada na CCE com potenciais precedendo o QRS da extrassístole em 50ms. A energia de RF (potência 50W, temperatura 60°C) foi aplicada no VE em posição subcúspide (Fig.1), com eliminação imediata dos batimentos ectópicos. O Holter 24h foi repetido 2 meses após o procedimento e não mostrou arritmias ventriculares. A paciente evoluiu bem, com resolução dos sintomas e melhora da classe funcional. Discussão: O ECG desempenha um papel importante na identificação da origem das EV's. No presente caso, foram observadas EV's com morfologia de BRE e achados sugestivos de local de origem em VSVE / cúspide coronariana. As cúspides coronarianas esquerdas representam 5-8% do total de sítios focais de extrassístoles ventriculares. Este é o primeiro caso relatado de FV desencadeada por extrassístoles decorrentes da cúspide coronariana esquerda e com resolução completa dos sintomas e densidade da arritmia durante o acompanhamento. Conclusões: Descrevemos um caso de FV desencadeada por EV tratada com sucesso com ablação por RF. A raridade da FV relacionada à cúspide coronariana esquerda é o principal destaque deste caso.


Subject(s)
Ventricular Fibrillation , Catheter Ablation , Ventricular Premature Complexes
7.
Rev. bras. cir. cardiovasc ; 35(5): 841-843, Sept.-Oct. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1137322

ABSTRACT

Abstract Cardiac rhythm disorders are common in many patients with cancer. The management of synchronous long-standing persistent atrial fibrillation and pulmonary lesions remains a serious surgical dilemma due to the lack of clinical data and surgical guidelines. To the best of our knowledge, this is the first described case of simultaneous thoracoscopic pulmonary segmentectomy and left atrial posterior wall and pulmonary vein isolation combined with left atrial appendage resection in a patient with early-stage primary lung cancer and long-standing persistent atrial fibrillation.


Subject(s)
Humans , Female , Aged , Atrial Fibrillation/surgery , Atrial Fibrillation/complications , Catheter Ablation/methods , Adenocarcinoma, Mucinous/surgery , Adenocarcinoma, Mucinous/complications , Adenocarcinoma, Mucinous/diagnostic imaging , Pneumonectomy/methods , Pulmonary Veins/surgery , Thoracoscopy , Tomography, X-Ray Computed , Treatment Outcome , Atrial Appendage/surgery , Heart Atria/surgery , Lung Neoplasms/surgery , Lung Neoplasms/complications , Lung Neoplasms/diagnostic imaging
8.
Rev. bras. cir. cardiovasc ; 35(4): 577-579, July-Aug. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1137308

ABSTRACT

Abstract Early recognition and rapid and appropriate treatment of cardiac tamponade are mandatory to prevent the irreversible deterioration of cerebral perfusion and other important organs. In this study, cardiac tamponade was induced by inadvertent transseptal puncture, which was managed with pericardial drainage and surgical repair in a patient with symptomatic paroxysmal atrial fibrillation. Epicardial atrial fibrillation ablation and left atrial appendage amputation were also performed at the same time.


Subject(s)
Humans , Atrial Fibrillation/surgery , Atrial Fibrillation/etiology , Cardiac Tamponade/etiology , Cardiac Tamponade/diagnostic imaging , Atrial Appendage/surgery , Atrial Appendage/diagnostic imaging , Cardiac Tamponade/surgery , Treatment Outcome , Catheter Ablation , Catheters , Amputation
9.
Rev. bras. cir. cardiovasc ; 35(3): 375-386, May-June 2020. tab
Article in English | LILACS, SES-SP | ID: biblio-1137267

ABSTRACT

Abstract Medical management of atrial fibrillation can be complex, challenging and requiring time to prove its effectiveness; furthermore, the response can be refractory and inconsistent if the underlying pathology is not permanently addressed. Surgical ablation has become a key intervention, and since its first intervention in 1987 (the Cox-maze procedure), the technique has evolved from a conventional open method to a minimally invasive technique whilst retaining excellent outcomes. Furthermore, recent advances in the use of a hybrid approach have been established as satisfactory approach in managing atrial fibrillation with satisfactory outcomes. This literature review focuses on the evidence behind the surgical success in managing atrial fibrillation throughout the past, present and the future of these surgical interventions.


Subject(s)
Humans , Atrial Fibrillation/surgery , Catheter Ablation , Treatment Outcome , Minimally Invasive Surgical Procedures
10.
Arq. bras. cardiol ; 114(5): 775-782, maio 2020. tab, graf
Article in Portuguese | LILACS, SES-SP | ID: biblio-1131230

ABSTRACT

Resumo Fundamento A ablação da fibrilação atrial (FA) e do flutter atrial dependente de istmo cavo-tricuspídeo (FLA-ICT) pode ser realizada simultaneamente quando as duas arritmias tenham sido registradas antes do procedimento. Entretanto, a melhor abordagem não é clara quando pacientes com FLA-ICT são encaminhados para ablação sem o registro prévio de FA. Objetivos Avaliar a prevalência e identificar os preditores de ocorrência do primeiro episódio de FA após ablação de FLA-ICT em pacientes sem o registro prévio de FA. Métodos Coorte retrospectiva de pacientes submetidos exclusivamente a ablação por cateter para FLA-ICT, sem registro prévio de FA. As características clínicas foram comparadas entre os grupos em que houve ocorrência de FA pós-ablação de FLA-ICT vs. sem ocorrência de FA. O nível de significância estatística adotado foi de 5%. Na análise de preditores, o desfecho primário avaliado foi ocorrência de FA após ablação de FLA-ICT. Resultados De um total de 227 pacientes submetidos a ablação de FLA-ICT (110 com registro de FA e 33 sem seguimento adequado), 84 pacientes foram incluídos, dos quais 45 (53,6%) apresentaram FA pós-ablação. Não houve variáveis preditoras de ocorrência de FA. Os escores HATCH e CHA2DS2-VASC foram semelhantes nos dois grupos. As taxas de recorrência de FLA-ICT e complicações após a ablação foram de 11,5% e 1,2%, respectivamente. Conclusões A ablação de FLA-ICT é eficaz e segura, mas 50% dos pacientes desenvolvem FA após ablação. Entretanto, ainda é incerto o papel da ablação combinada (FLA-ICT e FA) visando prevenção da ocorrência de FA. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Abstract Background Simultaneous ablation of atrial fibrillation (AF) and cavotricuspid isthmus (CTI)-dependent atrial flutter can be performed when both arrythmias had been recorded before the procedure. However, the best approach has not been defined in case of patients referred for ablation with CTI-dependent atrial flutter, without history of AF. Objectives To assess the prevalence and to identify predictors of the first episode of AF after ablation of CTI-dependent atrial flutter in patients without history of AF. Methods Retrospective cohort of patients with CTI-dependent atrial flutter without history of AF undergoing catheter ablation. Clinical characteristics were compared between patients who developed AF and those who did not have AF after the procedure. Significance level was set at 5%. In the analysis of predicting factors, the primary outcome was occurrence of AF after CTI-dependent atrial flutter ablation. Results Of a total of 227 patients undergoing ablation of CTI-dependent atrial flutter (110 with history of AF and 33 without adequate follow-up), 84 were included, and 45 (53.6%) developed post-ablation AF. The HATCH and CHA2DS2-VASC scores were not different between the groups. Recurrence rate of CTI-dependent atrial flutter and complication rate were 11.5% and 1.2%, respectively, after ablation. Conclusions Although ablation of CTI-dependent atrial flutter is a safe and effective procedure, 50% of the patients developed AF after the procedure. However, the role of combined ablation (CTI-dependent atrial flutter plus AF) aiming at preventing AF is still uncertain. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Subject(s)
Humans , Atrial Fibrillation/epidemiology , Atrial Flutter/surgery , Catheter Ablation/adverse effects , Recurrence , Atrial Fibrillation/etiology , Atrial Fibrillation/prevention & control , Atrial Flutter/diagnosis , Atrial Flutter/epidemiology , Prevalence , Retrospective Studies , Treatment Outcome , Catheter Ablation/methods
13.
Arq. bras. cardiol ; 114(3): 435-442, mar. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088893

ABSTRACT

Abstract Background: Atrial fibrillation (AF) ablation under uninterrupted warfarin use is safe and recommended by experts. However, there is some controversy regarding direct-acting oral anticoagulants for the same purpose. Objective: To evaluate the safety of AF ablation under uninterrupted anticoagulation with rivaroxaban. Methods: A series of 130 patients underwent AF radiofrequency ablation under uninterrupted rivaroxaban use (RIV group) and was compared to a control group of 110 patients under uninterrupted warfarin use (WFR group) and therapeutic International Normalized Ratio (INR). We analyzed death, rates of thromboembolic events, major and minor bleedings, activated clotting time (ACT) levels, and heparin dose in the procedure. The ablation protocol basically consisted of circumferential isolation of the pulmonary veins guided by electroanatomic mapping. It was adopted a statistical significance of 5%. Results: The clinical characteristics of the groups were similar, and the paroxysmal AF was the most frequent type (63% and 59%, RIV and WFR groups). A thromboembolic event occurred in the RIV group. There were 3 patients with major bleeding (RIV = 1 and WFR = 2; p = 0.5); no deaths. Basal INR was higher in the WFR group (2.5 vs. 1.2 ± 0.02; p < 0.0001), with similar basal ACT levels (123.7 ± 3 vs. 118 ± 4; p= 0, 34). A higher dose of venous heparin was used in the RIV group (9,414 ± 199 vs. 6,019 ± 185 IU; p < 0.0001) to maintain similar mean ACT levels during the procedure (350 ± 3 vs. 348.9 ± 4; p = 0.79). Conclusion: In the study population, AF ablation under uninterrupted rivaroxaban showed a safety profile that was equivalent to uninterrupted warfarin use with therapeutic INR.


Resumo Fundamento: A ablação de fibrilação atrial (FA) sob uso ininterrupto de varfarina é segura e recomendada por especialistas. Entretanto, há controvérsia quanto aos anticoagulantes orais de ação direta para o mesmo fim. Objetivo: Avaliar a segurança em realizar ablação de FA sob anticoagulação ininterrupta com rivaroxabana. Métodos: Uma série de 130 pacientes foi submetida à ablação com radiofrequência da FA sob uso ininterrupto de rivaroxabana (grupo RIV) e comparada a um grupo-controle de 110 pacientes que a fizeram sob uso ininterrupto de varfarina (grupo VRF) e relação normatizada internacional (RNI) terapêutica. Analisamos morte, taxas de eventos tromboembólicos, de sangramentos maiores e menores, níveis do tempo de coagulação ativado (TCA) e dose de heparina no procedimento. O protocolo da ablação consistiu basicamente em isolamento circunferencial das veias pulmonares guiado por mapeamento eletroanatômico. Significância estatística de 5% foi adotada. Resultados: As características clínicas dos grupos foram semelhantes e a FA paroxística mais frequente (63% e 59%, grupos RIV e VRF). Um evento tromboembólico ocorreu no grupo RIV. Foram três pacientes com sangramentos maiores (RIV = 1 e VRF = 2; p = 0,5); nenhum óbito. A RNI basal foi maior no grupo VRF (2,5 vs. 1,2 ± 0,02; p < 0,0001), com níveis de TCA basal semelhantes (123,7 ± 3 vs. 118 ± 4; p = 0,34). Maior dose de heparina venosa foi utilizada no grupo RIV (9.414 ± 199 vs. 6.019 ± 185 UI; p < 0,0001) para manter níveis médios de TCA semelhantes durante o procedimento (350 ± 3 vs. 348,9 ± 4; p = 0,79). Conclusão: Na população estudada, a ablação de FA sob rivaroxabana ininterrupta teve segurança equivalente à varfarina ininterrupta, com RNI terapêutica.


Subject(s)
Humans , Atrial Fibrillation , Catheter Ablation , Warfarin , Treatment Outcome , Rivaroxaban , Anticoagulants
14.
Rev. bras. cir. cardiovasc ; 35(1): 22-27, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1092460

ABSTRACT

Abstract Objective: To evaluate the efficacy and safety of a modified technique for totally thoracoscopic left atrial posterior wall and pulmonary vein isolation in patients with long-standing persistent atrial fibrillation. Methods: From April 2017 to December 2018, we included in this study 28 consecutive patients who underwent thoracoscopic left atrial posterior wall and pulmonary vein radiofrequency isolation combined with left atrial appendage resection. We used a device with irrigated electrodes (Medtronic Cardioblate Gemini-s). The original surgical technique "GALAXY" proposed by Doty in 2012 was modified. The number of ablations was significantly increased, and frequent position changing of the ablation device and change of device angulation were added. Results: Sinus rhythm was restored in all patients. There was no operative mortality, no myocardial infarction, and no stroke or transient ischemic attack. One patient required sternotomy and another survived left anterolateral thoracotomy due to bleeding. A 180-day follow-up (24-hour Holter monitoring) revealed no sign of recurrence of atrial fibrillation or other supraventricular arrhythmia in any patient. Mean follow-up was nine months (range: 6-16 months). At the last follow-up, 26 patients (92,9%) were in sinus rhythm (24-hour Holter monitoring). Conclusion: A frequent ablation device position changing during the surgery makes it possible to achieve complete left atrial posterior wall and pulmonary veins isolation. An increased number of applications allows to avoid a false positive transmural damage assessment showed by impedance drop. Also, frequent position changing of the ablation device and increased number of applications do not affect the number of postoperative complications.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pulmonary Veins , Atrial Fibrillation , Catheter Ablation , Atrial Appendage , Stroke Volume , Ventricular Function, Left , Treatment Outcome , Heart Atria
15.
Clinics ; 75: e1672, 2020. tab, graf
Article in English | LILACS | ID: biblio-1133481

ABSTRACT

OBJECTIVE: To evaluate whether thawing rate could be a novel predictor of acute pulmonary vein isolation (PVI) and explore the predictive value of thawing rate as a factor ensuring long-term PVI (vagus reflex). METHODS: A total of 151 patients who underwent cryoballoon ablation for atrial fibrillation (AF) were enrolled in this retrospective study between January 2017 and June 2018. The thawing rate was calculated using the thawing phase of the cryoablation curve. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of the thawing rate for acute PVI and vagus reflex. RESULTS: ROC curve analyses revealed that the interval thawing rate at 15°C (ITR15) was the most valuable predictor of PVI, with the highest area under curve (AUC) value of the ROC curve. The best cut-off value of ITR15 for PVI was ≤2.14°C/S and its sensitivity and specificity were 88.62% and 67.18%, respectively. In addition, the ITR15 of the successful PVI group after cryoballoon ablation was significantly slower than the failed PVI group. ITR15 was a predictor of vagus reflex and the occurrence of vagus reflex group had a slower ITR15 compared to the non-occurrence group. CONCLUSIONS: Thawing rate was a novel predictor of acute PVI and the ITR15 was the most valuable predictor of acute PVI. In addition, ITR15 was a predictive factor ensuring long-term PVI (vagus reflex). Our study showed that thawing rate may serve in the early identification of useless cryoballoon ablation.


Subject(s)
Humans , Male , Female , Pulmonary Veins/surgery , Recurrence , Atrial Fibrillation , Stroke Volume , Retrospective Studies , Ventricular Function, Left , Treatment Outcome , Catheter Ablation
16.
Article in English | WPRIM | ID: wpr-787233

ABSTRACT

Endobiliary radiofrequency ablation (RFA) is a procedure performed widely to induce locoregional tumor control by the transfer of thermal energy to the lesion and subsequent tumor necrosis. A 72-year-old male with a prior history of acute calculous cholangitis and perforated cholecystitis was admitted to the Kyungpook National University Hospital complaining of fever and nausea. He had an indwelling percutaneous transhepatic gallbladder drainage (PTGBD) catheter from the previous episode of perforated cholecystitis. An abdominal CT scan showed marked dilation of both the intrahepatic and extrahepatic bile ducts. Common bile duct cancer was confirmed histologically after an endobiliary biopsy. A surgical resection was considered to be the initial treatment option. During open surgery, multiple metastatic nodules were present in the small bowel mesentery and anterior abdominal wall. Resection of the tumor was not feasible, so endobiliary RFA was performed prior to biliary stenting. Cholecystectomy was required for the removal of the PTGBD catheter, but the surgical procedure could not be performed due to a cystic ductal invasion of the tumor. Instead, chemical ablation of the gallbladder (GB) with pure ethanol was performed to breakdown the GB mucosa. Palliative treatment for a biliary obstruction was achieved successfully using these procedures. In addition, a PTGBD catheter was removed successfully without significant side effects. As a result, an improvement in the patient's quality of life was accomplished.


Subject(s)
Abdominal Wall , Aged , Bile Ducts, Extrahepatic , Biopsy , Catheter Ablation , Catheters , Cholangiocarcinoma , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis , Cholecystectomy , Cholecystitis , Common Bile Duct , Cystic Duct , Drainage , Ethanol , Fever , Gallbladder , Humans , Male , Mesentery , Mucous Membrane , Nausea , Necrosis , Palliative Care , Quality of Life , Stents , Tomography, X-Ray Computed
18.
Article in Chinese | WPRIM | ID: wpr-826360

ABSTRACT

To investigate the value of injecting a small amount of absolute ethanol into the benign solid nodules of the thyroid before radiofrequency ablation(RFA)to improve the efficiency of radiofrequency ablation. A total of 98 eligible patients(98 nodules)with pathologically confirmed benign solid nodules who were treated in our center from December 2016 to February 2018 were included and randomized into ethanol ablation(EA)combined with radiofrequency ablation(RFA)group(EA+RFA group)and RFA group,with 49 patients in each group.Routine ultrasound,contrast-enhanced ultrasound(CEUS),and thyroid function test were performed before treatment and 1,3,6,and 12 months after treatment.The general information,treatment time,ablation energy,ablation power,postoperative nodule volume reduction ratio(VRR),symptom score(SS)and cosmetic score(CS),thyroid function level,and incidence of complications were compared between these two groups. The mean treatment time [(441.30±243.31)s (790.70±349.82)s;= 4.403, =0.000],mean ablation energy [(3.92±2.01)kJ (5.15±2.12)kJ;=2.709, =0.009],and mean ablation power [(6.07±1.44)W (7.30±1.29)W;=3.612, =0.006] were significantly lower in the EA+RFA group than in the RFA group.At 3,6 and 12 months after surgery,the VRR in the EA+RFA group was(57.73±11.07)%(=-3.16, <0.001),(64.40±10.56)%(=-5.45, <0.001),and(77.29±8.48)%(=-10.46, <0.001),respectively;the VRR in the RFA group was(55.44±13.01)%(=-1.76, <0.001),(65.28±11.33)%(=-5.09, <0.001),and(75.17±9.84)%(=-8.93, <0.001),which were significantly smaller than those before surgery.There was no significant difference in VRR between the EA+RFA group and the RFA group at 1(=3.41, =0.33),3(=2.05, =0.21),6(=2.77, =0.49),and 12 months(=5.05, =0.10)after treatment.During the follow-up,no recurrence of nodules was observed on CEUS.In the EA+RFA group,the SS [(1.77±0.86).(5.54±2.15);=9.63, <0.001] and the CS[(1.39±0.77).(3.32±0.61);=10.09, =0.004]at 12 months after surgery were significantly lower than those before surgery.In the RFA group,SS [(1.63±1.04).(5.90±1.79);=12.72, <0.001] and CS [(1.64±0.83).(3.15±0.72);=8.13, =0.012] at 12 months after surgery were also significantly lower than those before surgery.The CSS in the EA+RFA group was significantly lower than that in the RFA group [(0.93±0.55).(2.44±0.53);=-11.70, =0.007].Both groups had no significant change in thyroid function during the follow-up period,and no serious complications were observed. Anhydrous alcohol injection can effectively improve the efficiency of radiofrequency ablation in treating benign solid thyroid nodules and is effective in reducing nodule volume,alleviating compressive symptoms,and decreasing cosmetic discomfort.


Subject(s)
Catheter Ablation , Ethanol , Humans , Neoplasm Recurrence, Local , Prospective Studies , Thyroid Nodule , Treatment Outcome
19.
Korean Circulation Journal ; : 289-301, 2020.
Article in English | WPRIM | ID: wpr-811371

ABSTRACT

Brugada syndrome (BrS) is an arrhythmogenic disease associated with an increased risk of ventricular fibrillation (VF) and sudden cardiac death (SCD). To date, the standard therapy for the prevention of SCD in BrS is the use of an implantable cardioverter-defibrillator (ICD) especially in patients who have experienced a prior cardiac arrest or syncopal events secondary to VF. However, ICDs do not prevent the occurrence of VF but react to defibrillate the VF episode, thereby preventing SCD. Often patients with recurrent VF have to be maintained on antiarrhythmic drugs that are effective but have remarkable adverse effects. An alternative therapy for BrS with recurrent VF is catheter ablation which emerged as an effective therapy in eliminating VF-triggering premature ventricular complexes in limited case series; however, there has been a remarkable progress in effectiveness of catheter ablation since epicardial substrate ablation was first applied in 2011 and such approach is now widely applicable.


Subject(s)
Anti-Arrhythmia Agents , Brugada Syndrome , Catheter Ablation , Catheters , Death, Sudden, Cardiac , Defibrillators, Implantable , Heart Arrest , Humans , Ventricular Fibrillation , Ventricular Premature Complexes
20.
Korean Circulation Journal ; : 346-357, 2020.
Article in English | WPRIM | ID: wpr-811365

ABSTRACT

BACKGROUND AND OBJECTIVES: The objective of this study was to evaluate the long-term clinical outcomes and the incidence of permanent pacemaker implantation after catheter ablation in patients with of atrial fibrillation (AF) and sinus node dysfunction (SND).METHODS: Among 3,068 total consecutive patients who underwent AF catheter ablation (AFCA), this study included 222 (9.5%; men 53.2%, 63.7±9.2 years of age, 81.5% paroxysmal AF) with underlying SND and a regular rhythm follow-up. We analyzed the rhythm outcomes, changes in the mean heart rate or heart rate variability, and permanent pacemaker implantation rate.RESULTS: During 47.5±28.8 months of follow-up, 25 (11.3%) patients received pacemaker implantations due to symptomatic SND. More than half (56.0%, 14/25) underwent a pacemaker implantation within 3 months of the AFCA, and the annual pacemaker implantation rate was 2.0% afterwards. Both the early (68.0% vs. 31.0%, p<0.001) and clinical AF recurrence (68.0% vs. 32.5%, p=0.001) rates and continuous antiarrhythmic drug use after 3 months (44.0% vs. 24.4%, p=0.036) were significantly higher in patients requiring pacemaker implantations than those that did not. An anterior linear ablation (odds ratio [OR], 9.37 [3.03–28.9]; p<0.001) and the E/Em (OR, 1.15 [1.02–1.28]; p=0.018) were independently associated with permanent pacemaker implantations after AFCA in patients with AF and SND.CONCLUSIONS: After AFCA in patients with AF and SND, 1 of 9 patients needed a pacemaker implantation and half needed implantations within 3 months. The AF recurrence rate was significantly higher in those who required pacemaker implantations after the AFCA.


Subject(s)
Atrial Fibrillation , Catheter Ablation , Catheters , Follow-Up Studies , Heart Rate , Humans , Incidence , Male , Pacemaker, Artificial , Recurrence , Sick Sinus Syndrome , Sinoatrial Node
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