ABSTRACT
Although cardiac resynchronization therapy (CRT) is an important treatment of symptomatic heart failure patients in sinus rhythm with low left ventricular ejection fraction and ventricular dyssynchrony, its role is not well defined in patients with atrial fibrillation (AF). CRT is not as effective in patients with AF because of inadequate biventricular capture and loss of atrioventricular synchrony. Both can be addressed with catheter ablation of AF. It is still unclear if these therapies offer additive benefits in patients with ventricular dyssynchrony. This article discusses the role and techniques of catheter ablation of AF in patients with heart failure, and its application in CRT recipients.
Subject(s)
Atrial Fibrillation/surgery , Cardiac Resynchronization Therapy/methods , Catheter Ablation/methods , Heart Failure/therapy , Pulmonary Veins/surgery , Combined Modality Therapy , Comorbidity , Evidence-Based Medicine , Humans , Survival Rate , Treatment OutcomeABSTRACT
BACKGROUND: Disintegrin-like and Metalloproteinase with Thrombospondin Motifs (ADAMTS) proteins that are fundamentally located in the extracellular matrix (ECM) have critical roles on different cellular processes by altering the ECM architecture. It has been known that expression of some members of these proteinases increases in aneurismal and dissectional aortic tissue. The purpose of this study is to investigate ADAMTS1, 5, 16 and tissue inhibitors of metalloproteinases-1, -2 (TIMP-1, -2) levels in aortic tissue obtained from patients with thoracic aortic aneurysms and dissections and to achieve new insights about the function of ADAMTS family members. METHODS: We investigated ADAMTS1, 5, and 16 expression in human thoracic aortic aneurysms (TAA) (n = 22), thoracic aortic dissections (TAD) (n = 12), and thoracic aortas from age-matched control organ donors (n = 6) (a total number of 34 cases and 6 controls). The expression levels of ADAMTS proteins were determined by Western blot technique using anti-ADAMTS1, ADAMTS5, ADAMTS16, TIMP-1 and TIMP-2 antibodies. RESULTS: ADAMTS1, 5, and 16 protein expressions were significantly higher in thoracic aortic aneurysm and dissection tissues compared to control aortic tissues. Furthermore, TIMP-1 protein levels decreased in TAA and TAD tissues, TIMP-2 did not change. CONCLUSIONS: Under the light of our findings, increased expression of ADAMTS1, 5, and 16 proteins may promote deceleration in thoracic aortic aneurysm progression. This is the first study that demonstrates ADAMTS5 and ADAMTS16 proteolytic activity in aneurysm and dissection.
Subject(s)
ADAM Proteins/analysis , Aortic Aneurysm, Thoracic/metabolism , Aortic Dissection/metabolism , ADAMTS Proteins , ADAMTS1 Protein , ADAMTS5 Protein , Aged , Female , Humans , Male , Middle Aged , Tissue Inhibitor of Metalloproteinase-1/analysis , Tissue Inhibitor of Metalloproteinase-2/analysisABSTRACT
Although cardiac resynchronization therapy (CRT) is an important treatment of symptomatic heart failure patients in sinus rhythm with low left ventricular ejection fraction and ventricular dyssynchrony, its role is not well defined in patients with atrial fibrillation (AF). CRT is not as effective in patients with AF because of inadequate biventricular capture and loss of atrioventricular synchrony. Both can be addressed with catheter ablation of AF. It is still unclear if these therapies offer additive benefits in patients with ventricular dyssynchrony. This article discusses the role and techniques of catheter ablation of AF in patients with heart failure, and its application in CRT recipients.
Subject(s)
Atrial Fibrillation/mortality , Atrial Fibrillation/surgery , Cardiac Resynchronization Therapy/statistics & numerical data , Heart Failure/mortality , Heart Failure/prevention & control , Pulmonary Veins/surgery , Anti-Arrhythmia Agents/therapeutic use , Cardiac Resynchronization Therapy/mortality , Catheter Ablation/mortality , Catheter Ablation/statistics & numerical data , Combined Modality Therapy/mortality , Combined Modality Therapy/statistics & numerical data , Comorbidity , Evidence-Based Medicine , Heart Conduction System/surgery , Humans , Prevalence , Risk Factors , Survival Rate , Treatment OutcomeABSTRACT
Cardioesophageal fistulas (CEFs) are uncommon but life-threatening complications of radiofrequency (RF) catheter ablation of atrial fibrillation (AF). They are usually, but not exclusively, related to ablation of the left atrial posterior wall. We report a case of a 73-year-old man that presented with CEF following RF ablation in the coronary sinus, highlighting the importance of esophageal temperature monitoring whenever ablating in the posterior heart.
