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Douglas L Packer,
Robert C Kowal,
Kevin R Wheelan,
James M Irwin,
Jean Champagne,
Peter G Guerra,
Marc Dubuc,
Vivek Reddy,
Linda Nelson,
Richard G Holcomb,
John W Lehmann,
Jeremy N Ruskin
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ABSTRACT: BACKGROUND: Standard radiofrequency ablation is effective in eliminating atrial fibrillation (AF), but requires multiple lesion delivery at the risk of significant complications. OBJECTIVES: The STOP AF Pivotal Trial was intended to assess the safety and effectiveness of a novel cryoballoon ablation technology designed to achieve single-delivery pulmonary vein (PV) isolation. METHODS: Patients with documented symptomatic paroxysmal AF and previously failed therapy with ≥ 1 membrane active anti-arrhythmic drug underwent 2:1 randomization to either cryoballoon ablation (n=163) or drug therapy (n=82). A 90-day blanking period allowed for optimization of anti-arrhythmic drug therapy and re-ablation if necessary. Effectiveness of the cryoablation procedure, versus drug therapy was determined at 12 months. RESULTS: Patients had highly symptomatic AF (78% paroxysmal, 22% early persistent) and had failed at least 1 antiarrhythmic drug. Cryoablation produced acute isolation of ≥ 3 PVs in 98.2% and all 4 PVs in 97.6% of patients; PVs isolation was achieved with the balloon catheter alone in 83%. At 12 months, treatment success was 69.9% (114/163) of cryoablation patients compared to 7.3% of anti-arrhythmic drug patients, [absolute difference: 62.6% (p < 0.001)]. Sixty-five (79%) of drug-treated patients crossed over to cryoablation during 12 months of study follow-up due to recurrent, symptomatic AF constituting drug treatment failure.There were 7 of the resulting 228 cryoablated patients (3.1%) with a ≥ 75% reduction in PV area during 12 months of follow-up. Twenty nine of 259 procedures (11.2%) were associated with phrenic nerve palsy as determined by X-ray screening; 25 of these had resolved by 12 months. Cryoablation patients had significantly improved symptoms at 12 months. CONCLUSION: The STOP-AF Trial demonstrated that cryoballoon ablation is a safe and effective alternative to anti-arrhythmic medication for the treatment of patients with symptomatic paroxysmal AF, who have failed at least one anti-arrhythmic drug, with risks within accepted standards for ablation therapy.
Journal of the American College of Cardiology 03/2013; · 14.16 Impact Factor
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ABSTRACT: BACKGROUND: Endocardial ablation approaches targeting the retroatrial cardiac ganglia to treat atrial fibrillation (AF) have been proposed. However, the potential value using this approach is unknown. Disruption of the autonomic inputs with orthotropic heart transplant (OHT) provides a unique opportunity to study the effects of autonomic innervation on AF genesis and maintenance. We hypothesized that due to denervation, the risk of postoperative AF would be lower following OHT compared to surgical maze even though both groups get isolation of the pulmonary veins. METHODS AND RESULTS: We reviewed 155 OHTs (mean age 52 ± 11 years, 72% males) and used 1:1 age-, sex-, and date-of-surgery-matched two control groups from patients undergoing surgical maze or only coronary artery bypass grafting (CABG). Using conditional logistic regression we compared the odds of AF within 2 weeks following OHT versus controls. Postoperative AF occurred in 10/155 (6.5%) OHT patients. The conditional odds of postoperative AF were lower for OHT as compared to controls (vs maze: odds ratio [OR] 0.27 [95% confidence interval (CI) 0.13-0.57], vs CABG: OR 0.38 [0.17-0.81], P = 0.003; and on additional adjustment for left atrial enlargement, vs maze: OR 0.28 [0.13-0.60], vs CABG: OR 0.14 [0.04-0.47], P = 0.0009). CONCLUSIONS: Risk of postoperative AF is significantly lower with OHT as in comparison to surgical maze. As both surgeries entail isolation of the pulmonary veins but only OHT causes disruption of autonomic innervation, this observation supports a mechanistic role of autonomic nervous system in AF. The benefit of targeting the cardiac autonomic system to treat AF needs further investigation.
Pacing and Clinical Electrophysiology 02/2013; · 1.35 Impact Factor
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ABSTRACT: In the context of image-guided left atrial fibrillation therapy, relatively very little work has been done to consider the changes that occur in the tissue during ablation in order to monitor therapy delivery. Here we describe a technique to predict the lesion progression and monitor the radio-frequency energy delivery via a thermal ablation model that uses heat transfer principles to estimate the tissue temperature distribution and resulting lesion. A preliminary evaluation of the model was conducted in ex vivo skeletal beef muscle tissue while emulating a clinically relevant tissue ablation protocol. The predicted temperature distribution within the tissue was assessed against that measured directly using fiberoptic temperature probes and showed agreement within 5°C between the model-predicted and experimentally measured tissue temperatures at prescribed locations. We believe this technique is capable of providing reasonably accurate representations of the tissue response to radio-frequency energy delivery.
Studies in health technology and informatics 01/2013; 184:261-7.
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ABSTRACT: Patients with atrial fibrillation undergo structural remodeling resulting in increased pulmonary vein sizes. Studies have demonstrated that these changes are reversible following successful ablation therapy. To date, analyses of pulmonary vein structure have focused on measurements at the pulmonary vein ostia, and the full extent of reverse remodeling along the length of the pulmonary veins has not yet been fully characterized.
An automated, three-dimensional method is proposed that quantifies pulmonary vein geometry starting at the ostia and extending several centimeters into the veins. A centerline is tracked along the length of the pulmonary vein, and orthogonal planes are computed along the curve. The method was validated against manual measurements on each of the four pulmonary veins for 10 subjects. The proposed methodology was used to analyze the pulmonary veins in 21 patients undergoing cardiac ablation therapy with preoperative and postoperative computed tomographic scans.
Validation results demonstrated that the automated measurements closely followed the manual measurements, with an overall mean difference of 11.50 mm(2). Significant differences in cross-sectional area at the two time points were observed at all pulmonary vein ostia and extending for 2.0 cm (excluding the 0.5-cm interval) into the left inferior pulmonary vein, 3.5 cm into the left superior pulmonary vein, and 2.0 cm into the right superior pulmonary vein.
Quantitative analysis along the length of the pulmonary veins can be accomplished using centerline tracking and measurements from orthogonal planes along the curve. The patient study demonstrated that reverse structural remodeling following ablation therapy occurs not only at the ostia but for several centimeters extending into the pulmonary veins.
Academic radiology 08/2012; 19(11):1332-44. · 2.09 Impact Factor
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Amit Noheria,
Christopher V Desimone,
Nirusha Lachman,
William D Edwards,
Apoor S Gami,
Joseph J Maleszewski,
Paul A Friedman,
Thomas M Munger,
Stephen C Hammill,
David L Hayes, Douglas L Packer,
Samuel J Asirvatham
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ABSTRACT: Anatomy of the Coronary Venous System. Introduction: Cannulation of the coronary sinus (CS) is a prerequisite for left ventricular (LV) pacing and certain ablation procedures. The detailed regional anatomy for the coronary veins and potential anatomic causes for difficulty with these procedures has not been established. Methods and Results: Therefore, we performed macroscopic measurements in 620 autopsied hearts (mean age 60 ± 23 years, 44% female). The CS was preserved for analysis in 96%. Sixty-three percent had a Thebesian valve that covered the posterior aspect of the CS ostium with extension to the superior (50%) and inferior aspects (18%) and was obstructive with fenestrations in 3 specimens. Partial or near occlusive valves were present occasionally at the ostium of the great cardiac vein (Vieussens; 8%) and middle cardiac vein (5%). Ninety-three percent had left atrial branches, and 41% had at least one branch with lumen > 3 French. For CRT lead placement, the mid-lateral LV was accessible from the middle cardiac vein (20%), the left posterior vein (92%) or the anterior interventricular vein (86%). Among specimens where the left phrenic nerve was preserved it crossed the LV mid-lateral wall in 45%. Conclusions: Epicardial coronary vein anatomy is variable, and the mid-lateral LV wall can potentially be accessed through various tributaries of the epicardial veins. The orientation of the Thebesian valve favors cannulation of the CS from an anterior (ventricular) and inferior approach. Anterobasal, mid-lateral, and inferior apical LV coronary veins lie in proximity to the course of the phrenic nerve. (J Cardiovasc Electrophysiol, Vol. pp. 1-6).
Journal of Cardiovascular Electrophysiology 08/2012; · 3.06 Impact Factor
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Christopher V Desimone,
Amit Noheria,
Nirusha Lachman,
William D Edwards,
Apoor S Gami,
Joseph J Maleszewski,
Paul A Friedman,
Thomas M Munger,
Stephen C Hammill, Douglas L Packer,
Samuel J Asirvatham
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ABSTRACT: Anatomy of Myocardial Extensions in Thoracic Veins. Introduction: Radiofrequency ablation for atrial fibrillation (AF) frequently involves energy delivery at the ostia of the thoracic veins. Detailed evaluation of the myocardium extending into the caval veins, vein of Marshall, as well as at the pulmonary vein ostia has not been completely evaluated. Methods and Results: Post-mortem assessment of 620 formalin-fixed hearts (mean age 60 ± 23 years, 44% female) was performed. The hearts were examined for integrity of venous structures and their atrial connections. Systematic gross anatomic evaluation including measurements on myocardial extensions in these veins was performed. Macroscopic myocardial extensions into pulmonary veins were noted in 99% of specimens evaluated and were circumferentially symmetric (99.6%). Myocardial extensions into the superior vena cava (SVC) occurred in 78% with the majority being circumferentially asymmetric (61%). Occasionally, myocardium extended into the azygos vein (6%). There were no myocardial extensions in the inferior vena cava (IVC). In some cases, the right atrial pectinate muscle extended into the coronary sinus (7%). The vein of Marshall was consistently located anterior to the left-sided pulmonary veins and posterior to the left atrial appendage, overlying the left atrial endocardial ridge. Conclusions: Myocardial extensions into the pulmonary veins are usually circumferential at the ostia validating the necessity for wide area rather than segmental ablation to isolate these veins during AF ablation. Myocardial extensions into the SVC are common and less likely to be circumferential, whereas extensions into the IVC are not present. The left atrial ridge is a reliable endocardial target for radiofrequency ablation of the vein of Marshall. (J Cardiovasc Electrophysiol, Vol. pp. 1-6).
Journal of Cardiovascular Electrophysiology 06/2012; · 3.06 Impact Factor
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Thomas M Munger,
Ying-Xue Dong,
Mitsuru Masaki,
Jae K Oh,
Sunil V Mankad,
Barry A Borlaug,
Samuel J Asirvatham,
Win-Kuang Shen,
Hon-Chi Lee,
Suzette J Bielinski,
David O Hodge,
Regina M Herges,
Traci L Buescher,
Jia-Hui Wu,
Changsheng Ma,
Yanhua Zhang,
Peng-Sheng Chen, Douglas L Packer,
Yong-Mei Cha
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ABSTRACT: The authors sought to characterize the left atrial (LA) and pulmonary vein (PV) electrophysiological and hemodynamic features in obese patients with atrial fibrillation (AF).
Obesity is associated with increased risk for AF.
A total of 63 consecutive patients with AF who had normal left ventricular (LV) ejection fraction and who underwent catheter ablation were studied. Atrial and PV electrophysiological studies were performed at the time of ablation with hemodynamic assessment by cardiac catheterization, and LA/LV structure and function by echocardiography. Patients were compared on the basis of body mass index (BMI): <25 kg/m(2) (n = 19) and BMI ≥30 kg/m(2) (n = 44).
At a 600-ms pacing cycle length, obese patients had shorter effective refractory period (ERP) in the left atrium (251 ± 25 ms vs. 233 ± 32 ms, p = 0.04), and in the proximal (207 ± 33 ms vs. 248 ± 34 ms, p < 0.001) and distal (193 ± 33 ms vs. 248 ± 44 ms, p < 0.001) PV than normal BMI patients. Obese patients had higher mean LA pressure (15 ± 5 mm Hg vs. 10 ± 5 mm Hg, p < 0.001) and LA volume index (28 ± 12 ml/m(2) vs. 21 ± 14 ml/m(2), p = 0.006), and lower LA strain (5.5 ± 3.1% vs. 8.8 ± 2.8%; p < 0.001) than normal BMI patients.
Increased LA pressure and volume, and shortened ERP in the left atrium and PV are potential factors facilitating and perpetuating AF in obese patients with AF.
Journal of the American College of Cardiology 06/2012; 60(9):851-60. · 14.16 Impact Factor
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Hugh Calkins,
Karl Heinz Kuck,
Riccardo Cappato,
Josep Brugada,
A John Camm,
Shih-Ann Chen,
Harry J G Crijns,
Ralph J Damiano,
D Wyn Davies,
John DiMarco, [......],
Stanley Nattel, Douglas L Packer,
Carlo Pappone,
Eric Prystowsky,
Antonio Raviele,
Vivek Reddy,
Jeremy N Ruskin,
Richard J Shemin,
Hsuan-Ming Tsao,
David Wilber
Heart rhythm: the official journal of the Heart Rhythm Society 03/2012; 9(4):632-696.e21. · 4.56 Impact Factor
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Hugh Calkins,
Karl Heinz Kuck,
Riccardo Cappato,
Josep Brugada,
A John Camm,
Shih-Ann Chen,
Harry J G Crijns,
Ralph J Damiano,
D Wyn Davies,
John DiMarco, [......],
Stanley Nattel, Douglas L Packer,
Carlo Pappone,
Eric Prystowsky,
Antonio Raviele,
Vivek Reddy,
Jeremy N Ruskin,
Richard J Shemin,
Hsuan-Ming Tsao,
David Wilber
Europace 03/2012; 14(4):528-606. · 1.98 Impact Factor
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Hugh Calkins,
Karl Heinz Kuck,
Riccardo Cappato,
Josep Brugada,
A John Camm,
Shih-Ann Chen,
Harry J G Crijns,
Ralph J Damiano,
D Wyn Davies,
John DiMarco, [......],
Stanley Nattel, Douglas L Packer,
Carlo Pappone,
Eric Prystowsky,
Antonio Raviele,
Vivek Reddy,
Jeremy N Ruskin,
Richard J Shemin,
Hsuan-Ming Tsao,
David Wilber
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ABSTRACT: This is a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation, developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology and the European Cardiac Arrhythmia Society (ECAS), and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). This is endorsed by the governing bodies of the ACC Foundation, the AHA, the ECAS, the EHRA, the STS, the APHRS, and the HRS.
Journal of Interventional Cardiac Electrophysiology 03/2012; 33(2):171-257. · 1.17 Impact Factor
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Christine M Albert,
Peng-Sheng Chen,
Mark E Anderson,
Michael E Cain,
Glenn I Fishman,
Sanjiv M Narayan,
Jeffrey E Olgin,
Peter M Spooner,
William G Stevenson,
David R Van Wagoner, Douglas L Packer
Heart rhythm: the official journal of the Heart Rhythm Society 12/2011; 8(12):1992-3. · 4.56 Impact Factor
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Christine M Albert,
Peng-Sheng Chen,
Mark E Anderson,
Michael E Cain,
Glenn I Fishman,
Sanjiv M Narayan,
Jeffrey E Olgin,
Peter M Spooner,
William G Stevenson,
David R Van Wagoner, Douglas L Packer
Heart rhythm: the official journal of the Heart Rhythm Society 10/2011; 8(12):e1-12. · 4.56 Impact Factor
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Mahmoud Suleiman,
Celeste Koestler,
Amir Lerman,
Francisco Lopez-Jimenez,
Regina Herges,
David Hodge,
David Bradley,
Yong-Mei Cha,
Peter A Brady,
Thomas M Munger,
Samuel J Asirvatham, Douglas L Packer,
Paul A Friedman
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ABSTRACT: It is known that statins are effective in preventing atrial fibrillation (AF) in patients undergoing cardiac surgery.
The purpose of this study was to evaluate the efficacy of statins in preventing AF recurrence following left atrial ablation.
One hundred twenty-five patients who had no statin indication undergoing catheter ablation due to drug-refractory paroxysmal (n = 90) or persistent (n = 35) AF were randomized in a prospective, double-blind, placebo-controlled trial to receive 80 mg atorvastatin (n = 62) or placebo (n = 63) for 3 months. The primary endpoint was freedom from symptomatic AF at 3 months. Secondary endpoints included freedom from any atrial arrhythmia recurrence irrespective of symptoms, quality of life (QoL), and reduction in C-reactive protein (CRP).
At 3 months, 95% of patients in the atorvastatin group were free of symptomatic AF compared with 93.5% in the placebo group (P = .75). Similarly, 85% of patients treated in the atorvastatin group remained free of any recurrent atrial arrhythmia vs 88% of patients in the placebo group (P = .37). Mean CRP levels decreased in the atorvastatin group (mean change -0.75 ± 3, P = .02) and increased in the placebo group (mean change 2.1 ± 19.9, P = .48). Mean QoL score improved significantly in both groups (mean change 13.14 ± 18.2 in the atorvastatin group and 11.10 ± 17.7 in the placebo group, P = .53).
In patients with no standard indication for statin therapy, treatment with atorvastatin 80 mg/day following AF ablation does not decrease the risk of AF recurrence in the first 3 months and should not be routinely administered to prevent periprocedural arrhythmias.
Heart rhythm: the official journal of the Heart Rhythm Society 09/2011; 9(2):172-8. · 4.56 Impact Factor
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Yong-Mei Cha,
Anita Wokhlu,
Samuel J Asirvatham,
Win-Kuang Shen,
Paul A Friedman,
Thomas M Munger,
Jae K Oh,
Kristi H Monahan,
Janis M Haroldson,
David O Hodge,
Regina M Herges,
Stephen C Hammill, Douglas L Packer
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ABSTRACT: The efficacy of radiofrequency ablation for atrial fibrillation (AF) in patients with left ventricular (LV) systolic dysfunction and isolated diastolic dysfunction is uncertain.
A prospective cohort of patients with normal and abnormal LV function underwent ablation for antiarrhythmic drug (AAD)-refractory AF. Three groups were compared: 111 patients with systolic dysfunction, defined as LV ejection fraction (LVEF) ≤40%; 157 patients with isolated diastolic dysfunction but preserved LVEF ≥50%; and 100 patients with normal LV function. The primary end point was AAD-free AF elimination at 1 year after ablation. This end point was achieved in 62% of patients with systolic dysfunction, 75% of those with diastolic dysfunction, and 84% of controls (P=0.007). AF control on or off AADs was achieved in 76% of patients with systolic dysfunction, 85% of those with diastolic dysfunction, and 89% of controls (P=0.08). In the systolic dysfunction group, 49% experienced an increase in LVEF by ≥5% after ablation, of which 64% achieved normal LVEF. In the diastolic dysfunction group, 30% of patients demonstrated at least 1 grade improvement in diastolic dysfunction. Multivariable analysis demonstrated an increased relative risk of arrhythmia recurrence of 1.8 (95% CI, 1.1 to 3.1; P=0.02) in systolic dysfunction and 1.7 (1.0 to 2.7; P=0.04) in isolated diastolic dysfunction compared with normal function.
Although an ablative approach for AF in patients with systolic or diastolic dysfunction is associated with an increased long-term recurrence risk, there is potential for substantial quality-of-life improvement and LV functional benefit.
Circulation Arrhythmia and Electrophysiology 07/2011; 4(5):724-32. · 6.46 Impact Factor
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Bruce D Lindsay,
Samuel J Asirvatham,
Anne B Curtis,
Melanie T Gura,
David L Hayes,
Jose Jalife,
George J Klein,
Bradley P Knight,
Rachel Lampert,
Andrea Natale, Douglas L Packer,
Richard L Page,
Melvin M Scheinman,
Amit J Shanker,
Paul J Wang,
Jonathan P Weiss,
Bruce L Wilkoff,
Chris D Busky
Heart rhythm: the official journal of the Heart Rhythm Society 07/2011; 8(7):e19-23. · 4.56 Impact Factor
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N A Mark Estes,
Ralph L Sacco,
Sana M Al-Khatib,
Patrick T Ellinor,
Judy Bezanson,
Alvaro Alonso,
Charles Antzelevitch,
Randall G Brockman,
Peng-Sheng Chen,
Sumeet S Chugh, [......],
Richard Lee, Douglas L Packer,
Sunny S Po,
Eric N Prystowsky,
Susan Redline,
Yves Rosenberg,
David R Van Wagoner,
Kathryn A Wood,
Lixia Yue,
Emelia J Benjamin
Circulation 06/2011; 124(3):363-72. · 14.74 Impact Factor
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Heart rhythm: the official journal of the Heart Rhythm Society 03/2011; 8(5):800-3. · 4.56 Impact Factor
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Freddy Del Carpio Munoz,
Faisal F Syed,
Amit Noheria,
Yong-Mei Cha,
Paul A Friedman,
Stephen C Hammill,
Thomas M Munger,
K L Venkatachalam,
Win-Kuang Shen, Douglas L Packer,
Samuel J Asirvatham
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ABSTRACT: Frequent premature ventricular complexes (PVCs) can cause a decline in left ventricular ejection fraction (LVEF). We investigated whether the site of origin and other PVC characteristics are associated with LVEF.
We retrospectively studied 70 consecutive patients (mean age 42 ± 17 years, 40 [57%] female) with no other cause of cardiomyopathy undergoing ablation of PVCs. We analyzed the association of a reduced LVEF, defined by LVEF <50% on echocardiography, with features of PVCs obtained from electrocardiography, 24- or 48-hour Holter monitor and electrophysiology study.
Patients with reduced LVEF (n = 17) as compared to normal LVEF (n = 53) had an increased burden of PVCs (29.3 ± 14.6% vs 16.7 ± 13.7%, P = 0.004), higher prevalence of nonsustained ventricular tachycardia (VT) [13 (76%) vs 21 (40%), P = 0.01], longer PVC duration (154.3 ± 22.9 vs 145.6 ± 20.8 ms, P = 0.03) and higher prevalence of multiform PVCs [15 (88%) vs 31 (58%), P = 0.04]. There was no significant difference in prevalence of sustained VT, QRS duration of normally conducted complexes, PVC coupling interval, or delay in PVC intrinsicoid deflection. Patients with fascicular PVCs (n = 5) had higher mean LVEF compared to others (66.2 ± 4.0% vs 53.0 ± 10.0%, P = 0.002). There was no association of LVEF with other PVC foci or with left-bundle versus right-bundle branch block morphologies. The threshold burden of PVCs associated with reduced LVEF was lower for right as compared to left ventricular PVCs.
In addition to the PVC burden, other characteristics like a longer PVC duration, presence of nonsustained VT, multiform PVCs and right ventricular PVCs might be associated with cardiomyopathy.
Journal of Cardiovascular Electrophysiology 02/2011; 22(7):791-8. · 3.06 Impact Factor
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ABSTRACT: Certain outflow tract tachyarrhythmias require ablation above the semilunar valves. Understanding of the regional anatomy of these arrhythmogenic sites is required to avoid complications.
We examined 603 formalin-fixed autopsy hearts from October 1998 to July 2003. Three hundred forty-two of 603 (57%) had myocardial extensions above the aortic valve, and 446 of 602 (74%) had extensions above the pulmonary valve. Extensions were noted above the aortic right coronary cusp (RCC) in 332 of 603 (55%; 2.8 ± 1.2 mm), left coronary cusp (LCC) in 145 of 603 (24%; 1.5 ± 0.5 mm), and non-coronary/posterior cusp in four of 603 (0.66%; 1.3 ± 0.5 mm; p < 0.0001), intercuspally in 295 of 603 (49%; 2.2 ± 1.1 mm) and into the cusps in 13 of 603 (2.2%). Extensions were noted above the pulmonary right cusp in 360 of 602 (60%; 4.0 ± 2.5 mm), posterior/left cusp in 313 of 602 (52%; 3.6 ± 2.1 mm), and anterior cusp in 268 of 602 (45%; 3.7 ± 2.2 mm; p < 0.0001), intercuspally in 438 of 602 (73%; 3.4 ± 1.8 mm) and into the cusps in ten of 602 (1.7%). The left main coronary artery was closer to the myocardial extensions above the nearest pulmonary valve cusp (posterior) than those above the nearest aortic valve cusp (LCC; 4.8 ± 1.7 vs. 16.3 ± 3.3 mm, p = 0.0005).
Myocardial extensions are common into the great arteries above the semilunar cusps and intercuspally, and rarely into the cusps themselves. The extensions are larger and more symmetric above the pulmonary cusps as compared to the aortic cusps, the most prominent aortic extensions being above the RCC. The left main coronary artery courses close to the extensions above the posterior pulmonary cusp.
Journal of Interventional Cardiac Electrophysiology 01/2011; 30(1):5-15. · 1.17 Impact Factor
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ABSTRACT: Chronic Percutaneous Epicardial Appendage Closure.
To assess the chronic safety and feasibility of percutaneous epicardial closure of the left atrial appendage (LAA) guided by electrical navigation.
Atrial fibrillation (AF) is associated with stroke, and LAA occlusion may be a useful nonpharmacologic strategy for stroke prevention in AF.
Percutaneous epicardial access was obtained in 6 dogs under general anesthesia. The ligation system included a grabber that captures the LAA guided by local electrograms (EGMs) and a looped hollow suture preloaded with a central wire enabling control and visualization. After a satisfactory position is confirmed the loop is tightened remotely, and the suture cut. Transesophageal echocardiography (TEE) assessed LAA dimensions and flow. LAA EGMs were recorded pre- and postclosure, and neurohormonal markers measured. Pathologic examination was performed.
LAA ligation was successful in all dogs. LAA flow was immediately abolished in 5 of 6 dogs. Disappearance of local LAA EGMs following ligation was observed in all animals. Follow-up TEE at mean 54 days (range 23-75 days) documented residual flow in only the first 2 dogs. Prior to necropsy the LAA was examined at thoracotomy in 3 animals. Following a minor design change, complete closure and fibrosis with a remnant atretic LAA was noted in all animals. No damage to adjacent structures was noted. Neurohormonal markers were unchanged.
Percutaneous epicardial LAA ligation guided by electrical navigation is feasible with promising intermediate-term results in the canine model. The technique may be useful as an alternative to existing methods of LAA obliteration in humans.
Journal of Cardiovascular Electrophysiology 01/2011; 22(1):64-70. · 3.06 Impact Factor
