Dislodgement of circular mapping catheter electrode in the left atrium: A near miss.
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ABSTRACT:
SUBMITTER: Zhang F
PROVIDER: S-EPMC5778103 | biostudies-literature | 2017 Nov
REPOSITORIES: biostudies-literature
Publications
Dislodgement of circular mapping catheter electrode in the left atrium: A near miss.
Zhang Fengxiang F Tang Lijun L Yang Bing B Yang Gang G Zhu Yinsu Y Chen Minglong M
HeartRhythm case reports 20170725 11
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Project description:AimTo propose a standardized workflow for 3D-electroanatomical mapping guided pulmonary vein isolation in pigs.Materials and methodsDanish female landrace pigs were anaesthetized. Ultrasound-guided puncture of both femoral veins was performed and arterial access for blood pressure measurement established. Fluoroscopy- and intracardiac ultrasound-guided passage of the patent foramen ovale or transseptal puncture was performed. Then, 3D-electroanatomical mapping of the left atrium was conducted using a high-density mapping catheter. After mapping all pulmonary veins, an irrigated radiofrequency ablation catheter was used to perform ostial ablation to achieve electrical pulmonary vein isolation. Entrance- and exit-block were confirmed and re-assessed after a 20-min waiting period. Lastly, animals were sacrificed to perform left atrial anatomical gross examination.ResultsWe present data from 11 consecutive pigs undergoing pulmonary vein isolation. Passage of the fossa ovalis or transseptal puncture was uneventful and successful in all animals. Within the inferior pulmonary trunk 2-4 individual veins as well as 1-2 additional left and right pulmonary veins could be cannulated. Electrical isolation by point-by-point ablation of all targeted veins was successful. However, pitfalls including phrenic nerve capture during ablation, ventricular arrhythmias during antral isolation close to the mitral valve annulus and difficulties in accessing right pulmonary veins were encountered.ConclusionFluoroscopy- and intracardiac ultrasound-guided transseptal puncture, high-density electroanatomical mapping of all pulmonary veins and complete electrical pulmonary vein isolation can be achieved reproducibly and safely in pigs when using current technologies and a step-by-step approach.
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Project description:PurposeCatheter-based radiofrequency ablation for pulmonary vein isolation has become the first line of treatment for atrial fibrillation in recent years. This requires a rather accurate map of the left atrial sub-endocardial surface including the ostia of the pulmonary veins, which requires dense sampling of the surface and currently takes more than 10 min. The focus of this work is to provide left atrial visualization early in the procedure to ease procedure complexity and enable further workflows, such as using catheters that have difficulty sampling the surface.MethodsWe propose a dense encoder-decoder network with a novel regularization term to reconstruct the shape of the left atrium from partial data which is derived from simple catheter maneuvers. To train the network, we acquire a large dataset of 3D atria shapes and generate corresponding catheter trajectories, from which traversed point clouds are obtained. Once trained, we show that the suggested network can sufficiently approximate the atrium shape based on a given trajectory.ResultsWe compare several network solutions for the 3D atrium reconstruction. We demonstrate that the solution proposed produces realistic visualization using partial acquisition within a 3-min time interval using human clinical cases.
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Project description:Objective:To analyse and improve the Namibian maternity care system by implementing maternal near-miss surveillance during 1 October 2018 and 31 March 2019, and identifying the challenges and benefits of such data collection. Methods:From the results of an initial feasibility study, we adapted the World Health Organization's criteria defining a maternal near miss to the Namibian health-care system. We visited most (27 out of 35) participating facilities before implementation and provided training on maternal near-miss identification and data collection. We visited all facilities at the end of the surveillance period to verify recorded data and to give staff the opportunity to provide feedback. Findings:During the 6-month period, we recorded 37?106 live births, 298 maternal near misses (8.0 per 1000 live births) and 23 maternal deaths (62.0 per 100?000 live births). We observed that obstetric haemorrhage and hypertensive disorders were the most common causes of maternal near misses (each 92/298; 30.9%). Of the 49 maternal near misses due to pregnancies with abortive outcomes, ectopic pregnancy was the most common cause (36/298; 12.1%). Fetal or neonatal outcomes were poor; only 50.3% (157/312) of the infants born to maternal near-miss mothers went home with their mother. Conclusion:Maternal near-miss surveillance is a useful intervention to identify within-country challenges, such as lack of access to caesarean section or hysterectomy. Knowledge of these challenges can be used by policy-makers and programme managers in the development of locally tailored targeted interventions to improve maternal outcome in their setting.
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Project description:Pericardial fat pad in transverse sinus adjacent to left atrial appendage (LAA) is a rare condition that may resemble LAA thrombosis especially in suspected cases. More Trans-esophageal echocardiography (TEE) angulations and also 3D TEE images are helpful tools to confirm the diagnosis.
| S-EPMC8077295 | biostudies-literature
Project description:Biophysical models of the atrium provide a physically constrained framework for describing the current state of an atrium and allow predictions of how that atrium will respond to therapy. We propose a work flow to simulate patient specific electrophysiological heterogeneity from clinical data and validate the resulting biophysical models. In 7 patients, we recorded the atrial anatomy with an electroanatomical mapping system (St Jude Velocity); we then applied an S1-S2 electrical stimulation protocol from the coronary sinus (CS) and the high right atrium (HRA) whilst recording the activation patterns using a PentaRay catheter with 10 bipolar electrodes at 12 ± 2 sites across the atrium. Using only the activation times measured with a PentaRay catheter and caused by a stimulus applied in the CS with a remote catheter we fitted the four parameters for a modified Mitchell-Schaeffer model and the tissue conductivity to the recorded local conduction velocity restitution curve and estimated local effective refractory period. Model parameters were then interpolated across each atrium. The fitted model recapitulated the S1-S2 activation times for CS pacing giving a correlation ranging between 0.81 and 0.98. The model was validated by comparing simulated activations times with the independently recorded HRA pacing S1-S2 activation times, giving a correlation ranging between 0.65 and 0.96. The resulting work flow provides the first validated cohort of models that capture clinically measured patient specific electrophysiological heterogeneity.
| S-EPMC5998385 | biostudies-literature
Project description:Atrial fibrillation (AF) is known to cause adverse remodeling of left atrium (LA). Radiofrequency catheter ablation (RFCA) of AF is associated with decrease in LA volume. However, the impact of RFCA on left atrial appendage (LAA) volume and hemodynamic function is not fully understood. We analyzed 123 patients who underwent cardiac magnetic resonance imaging (MRI) evaluation before and after RFCA in Korea University Anam Hospital. LA and LAA volume were measured before and after RFCA based on cardiac MRI. Baseline LA volume was 99.5 ± 38.4 cm3 and decreased to 74.6 ± 28.5 cm3 after RFCA (p < 0.001). LA diameter measured with transthoracic echocardiography was also decreased after RFCA (43.3 ± 6.2 mm at baseline and 39.9 ± 5.9 mm at follow up; p < 0.001). However, LAA volume was significantly increased after RFCA (19.4 ± 8.5 cm3 at baseline and 23.7 ± 13.3 cm3 at follow up; p < 0.001). Total ablation time and additional substrate modification was associated with change in LA volume. After RFCA, average LAA velocity measured by transesophageal echocardiography was increased to 51.0 cm/sec from 41.1 cm/sec (p < 0.001). In conclusion, LAA volume was increased after RFCA in contrast to LA volume. Our data raise a concern about worsening hemodynamics of LA and LAA following RFCA and long term clinical significance of enlarged LAA after RFCA needs further evaluation.
| S-EPMC5959897 | biostudies-literature
Project description:BackgroundThree-dimensional electroanatomical mapping is of potential interest in equine cardiology to identify arrhythmia mechanisms, characterise electroanatomical substrates and guide ablation strategies.ObjectivesTo describe three-dimensional electroanatomical mapping in standing horses.Study designResearch methodology, proof of concept study.MethodsFour Standardbred horses (2 geldings, 2 mares, median age 4.5 [4-9] years, mean bodyweight 485 [440-550] kg) were sedated and placed in stocks. Via the jugular vein, a high-density multipolar grid catheter (Advisor™ HD Grid Mapping Catheter with EnSite VelocityTM, Abbott Medical) was used for endocardial mapping of the right atrium. The P-wave on the surface ECG was used as a timing reference for simultaneous local activation time- and bipolar voltage-mapping. For a positional reference a 10-pole catheter (Abbott Medical) was placed in the caudal vena cava.ResultsEndocardial right atrial mapping guided by the three-dimensional mapping system and local electrograms was successfully performed in all four horses. A median of 32719 [25499-65078] points, covering the entire right atrium, were collected. Three-dimensional electroanatomical mapping provided detailed information about activation patterns and electrogram-characteristics of the sinoatrial node, intervenous tubercle and cavotricuspid isthmus. Additionally, transvenous biopsy forceps connected to the mapping system were visualised on screen to guide biopsy collection.Main limitationsThe feasibility of electroanatomical mapping for the left atrium and in larger breeds requires further study.ConclusionsHigh-density three-dimensional electroanatomical mapping of the right atrium is feasible in the standing horse.
| S-EPMC7818172 | biostudies-literature