Noninvasive stereotactic radioablation for the treatment of atrial fibrillation: First-in-man experience.

PURPOSE: Catheter ablation is an effective therapy for atrial fibrillation (AF). However, risks remain, and improved efficacy is desired. Stereotactic body radiotherapy (SBRT) is a well-established therapy used to noninvasively treat malignancies and functional disorders with precision. We evaluated the feasibility of stereotactic radioablation for treating paroxysmal AF. METHODS: Two patients with drug-refractory paroxysmal AF underwent pulmonary vein isolation with SBRT. After placement of a percutaneous active fixation temporary pacing lead tracking fiducial, computed tomography (CT) angiography was performed to define left atrial anatomy. A tailored planning treatment volume was created to deliver contiguous linear ablations to isolate the pulmonary veins and posterior wall. Patients were treated on an outpatient basis in the radioablation suite. Clinical follow-up was performed through at least 24 months after therapy. RESULTS: Both patients successfully underwent SBRT planning and treatment without significant early or long-term side effects up to 48 months of follow-up. One patient had AF recurrence after 6 months free of arrhythmia, while the second patient remains free of AF after 24 months with fibrosis detected on MRI scan consistent with the ablation lesion set. An incidentally noted small pericardial effusion occurred in one patient. CONCLUSION: Stereotactic radioablation may be feasible for the treatment of drug-refractory AF. Further evaluation is warranted.

Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging Post-robotic Radiosurgical Pulmonary Vein Isolation (RRPVI): First Case in the World.

Pulmonary vein isolation using robotic radiosurgery system CyberKnife is a new non-invasive treatment of atrial fibrillation, currently in clinical phase. Robotic radiosurgical pulmonary vein isolation (RRPVI) uses stereotactic, non-invasive (painless) pinpoint radiation energy delivery to a small, precise area to accomplish ablation. The purpose of this report is to describe the finding of an increase in the enhancement of the left atrium demonstrated with the use of cardiac magnetic resonance imaging using late gadolinium enhancement (LGE-CMR) as a result of RRPVI in the first case in the world in humans using CyberKnife as a treatment for paroxysmal atrial fibrillation (PAF).

Large vessel vasculitis and occlusion associated to antiphospholipid antibodies in systemic lupus erythematosus

Anticorpos anticardiolipina (ACL) e anticoagulante lúpico (LAC) estao fortemente associados com trombose no lúpus eritematoso sistêmico, mas oclusao e vasculite de grandes artérias sao considerados aspectos fora do comum. Sao relatados três pacientes portadores de lúpus eritematoso sistêmico e anticorpos antifosfolipídios (APLA) que desenvolveram oclusoes de grande artéria, sendo que um deles também foi demonstrada vasculite da artéria femoral

Síndrome de Sjögren com nefrite intersticial e insuficiência renal / Sjögren's syndrome with interstitial nephritis and renal failure

É apresentado um caso de síndrome de Sjögren, salientando-se a presença de nefrite tubulo-intersticial. Além de complicaçäo infrequente na condiçäo, foi ela responsável por quadro severo de uremia, que reverteu com o tratamento a base de corticosteróide. Literatura pertinente foi revista