Conventional Catheter Research Articles

A novel technique of endoscopic introducer-assisted transpapillary gallbladder aspiration prior to drainage in a patient with acute cholecystitis.

Endoscopic transpapillary gallbladder drainage (ET-GBD) is the preferred technique in patients with acute cholecystitis and cholangitis [1]. Meta-analyses have reported technical and clinical success rates of 83 % and 88.1 % respectively [1] [2]. Aspiration of the infected bile and saline irrigation using nasobiliary drainage is an acceptable method [1]; however, the performance of this maneuver during ET-GBD is time-consuming because of the high viscosity of the bile and the small caliber of the conventional endoscopic retrograde cholangiopancreatography catheter. Endoscopic introducer-assisted procedures have recently emerged as effective pancreaticobiliary interventions [3] [4]. This article describes gallbladder aspiration and irrigation using a novel dual-structure catheter.

Abstract Number ‐ 168: Conventional angiography versus non‐invasive imaging in the assessment of symptomatic carotid disease

Introduction The indication for carotid endarterectomy in symptomatic carotid stenosis of 50% or more was established based on catheter angiography. Yet, in practice, operative referral is still largely based on non‐invasive imaging. We sought to determine the discrepancy between the two modalities in our retrospective cohort. Methods We retrospectively collected data from consecutive symptomatic patients between 2019 and 2021 at our institution who were referred for evaluation and possible stenting of carotid disease based on non‐invasive imaging showing moderate to severe stenosis or occlusion. All patients underwent digitally subtracted angiography (DSA) and were treated with stenting if there was stenosis of 50% or above or if there was presence of a string sign. Otherwise, they were continued on best medical therapy. Results 98 total patients were referred for evaluation of carotid disease (Median age 60, 37% women). 21/98 were found to have a carotid occlusion on non‐invasive imaging, of those, 6 (28%) were found to have a string sign on CTA and were treated with stenting. 77/98 were found to have moderate to severe carotid artery stenosis based on non‐invasive imaging. Of those, 31 patients (40%), were not found to have significant carotid artery stenosis and were not treated with stenting. Out of total 99 patients who were referred for carotid intervention based on non‐invasive imaging, 38 (40%) patients had a change in the treatment plan. Conclusions 40% of the patients who were referred for revascularization based on non‐invasive imaging had a change in the treatment after conventional catheter angiography. Larger studies are warranted to confirm our findings.

Abstract No. 29 Tunneled Dialysis Catheter Placement within Intensive Care Unit (ICU) Patients: Influence of Catheter Tip Design on Clinical Performance

Tunneled dialysis catheter tip design may affect freedom from catheter dysfunction and/or infection; improved performance within a critical care setting may reduce costs and need for catheter guidewire exchange or removal. This study compared rates of catheter failure between a symmetrical, helical-tip catheter (VectorFlow) with a conventional split-tip catheter (Ash-Split) among ICU patients undergoing tunneled dialysis catheter placement. A retrospective database identified a total of 1734 tunneled dialysis catheters placed at an academic institution over a 7-year period. Of these, 340 catheters (19.6%) were placed within ICU patients, which included VectorFlow (n = 112, 32.9%) and Ash-Split (n = 228, 67.1%) catheters. Rates of catheter failure requiring guidewire exchange or removal from a composite outcome of malfunction or infection were compared with Kaplan-Meier estimates, and covariates potentially influencing catheter failure were assessed with Cox proportional hazards modeling. Catheter failure occurred within 90 days in 34.8 ± 3.4% of ICU patients. Among patients with VectorFlow catheters, primary unassisted patency at 30, 60, 90 and 180 days was 87.4 ± 3.6%, 78.0 ± 5.1%, 75.1 ± 5.0% and 60.1 ± 8.2% compared with 75.0 ± 3.3%, 62.8 ± 4.1%, 60.7 ± 4.2% and 44.3 ± 5.5% among patients with Ash-Split catheters (P = 0.022). Cox modeling of body mass index, patient age, sex, left jugular (vs. right) placement and indication for placement (initiation of hemodialysis access vs. failed surgical arteriovenous access) showed no effect on catheter patency; patients with Ash-Split catheters had a hazard ratio of catheter failure 1.72 times higher than patients with VectorFlow catheters (P = 0.024) in univariate modeling and a hazard ratio of 1.81 in multivariate modeling (P = 0.017). The VectorFlow catheter was associated with significantly higher rates of primary patency than the Ash-Split catheter among ICU patients, independent of multiple clinical and anatomic factors. These data support a VectorFlow-first placement strategy within this patient population.

Quantification of Mechanical Characteristics of Conventional Steerable Ablation Catheters for Treatment of Atrial Fibrillation Using a Heart Phantom.

Accurate and reliable catheter navigation is important in formation of adequate lesions during radiofrequency cardiac catheter ablation. To inform future device design efforts and to characterize the limitations of conventional devices, the focus of this study is to assess and quantify the mechanical performance of manual ablation catheters for pulmonary vein isolation procedures within a phantom heart model. We measured three important metrics: accuracy of catheter tip navigation to target anatomical landmarks at the pulmonary veins (PVs), orientation of the catheter relative to the tissue at the targets, and the delivered force values and their stability and variations at those targets. A stereovision system was used for navigational guidance and to measure the catheter's tip position and orientation relative to the targets. To measure force, piezoelectric sensors were used which were integrated at the targets, whereby operators were instructed to stabilize the catheter to achieve a chosen reference force value. An overall positioning accuracy of 1.57 ± 1.71mm was achieved for all targets. No statistical significance was observed in position accuracy between the right and left PVs (p = 0.5138). The orientation of the catheter relative to tissue surface was 41° ± 21° with no statistical significance between targets. The overall force stability was 41 ± 6g with higher difficulty in force stabilization in the right compared to the left PV (40 ± 8 vs. 43 ± 2g, p < 0.0001). Based on our results, future improvements to manual catheter navigation for ablation should focus on improving device performance in orientation control and improved force stability.

Experimental Protocol and Phantom Design and Development for Performance Characterization of Conventional Devices for Peripheral Vascular Interventions.

Conventional catheter-based interventions for treating peripheral artery disease suffer high failure and complication rates. The mechanical interactions with the anatomy constrain catheter controllability, while their length and flexibility limit their pushability. Also, the 2D X-ray fluoroscopy guiding these procedures fails to provide sufficient feedback about the device location relative to the anatomy. Our study aims to quantify the performance of conventional non-steerable (NS) and steerable (S) catheters in phantom and ex vivo experiments. In a 10mm diameter, 30cm long artery phantom model, with four operators, we evaluated the success rate and crossing time in accessing 1.25mm target channels, the accessible workspace, and the force delivered through each catheter. For clinical relevance, we evaluated the success rate and crossing time in crossing ex vivo chronic total occlusions. For the S and NS catheters, respectively, users successfully accessed 69 and 31% of the targets, 68 and 45% of the cross-sectional area, and could deliver 14.2 and 10.2g of mean force. Using a NS catheter, users crossed 0.0 and 9.5% of the fixed and fresh lesions, respectively. Overall, we quantified the limitations of conventional catheters (navigation, reachable workspace, and pushability) for peripheral interventions; this can serve as a basis for comparison with other devices.

Comparative study of in vitro biofilm formation between T-Control® catheter vs. a conventional Foley-type catheter

Comparative study of in vitro biofilm formation between T-Control® catheter vs. a conventional Foley-type catheter

3D Visualisation of Navigation Catheters for Endovascular Procedures Using a 3D Hub and Fiber Optic RealShape Technology: Phantom Study Results

Fiber Optic RealShape (FORS) is a new technology that visualises the full three dimensional (3D) shape of guidewires using an optical fibre embedded in the device. Co-registering FORS guidewires with anatomical images, such as a digital subtraction angiography (DSA), provides anatomical context for navigating these devices during endovascular procedures. The objective of this study was to demonstrate the feasibility and usability of visualising compatible conventional navigation catheters, together with the FORS guidewire, in phantom with a new 3D Hub technology and to understand potential clinical benefits. The accuracy of localising the 3D Hub and catheter in relation to the FORS guidewire, was evaluated using a translation stage test setup and a retrospective analysis of prior clinical data. Catheter visualisation accuracy and navigation success was assessed in a phantom study where 15 interventionists navigated devices to three pre-defined targets in an abdominal aortic phantom using an Xray or computed tomography angiography (CTA) roadmap. Additionally, the interventionists were surveyed about the usability and potential benefits of the 3D Hub. The location of the 3D Hub and catheter along the FORS guidewire was detected correctly 96.59% of the time. During the phantom study, all 15 interventionists successfully reached the target locations 100% of the time and the error in catheter visualisation was 0.69 mm. The interventionists agreed or strongly agreed that the 3D Hub was easy to use and the greatest potential clinical benefit over FORS is in offering interventionists choice over which catheter they used. This set of studies has shown that FORS guided catheter visualisation, enabled by a 3D Hub, is accurate and easy to use in a phantom setting. Further evaluation is needed to understand the benefits and limitations of the 3D Hub technology during endovascular procedures.

High-density Mapping Catheter (Advisor™ HD Grid) Usage for Intra-atrial Reentrant Tachycardia Ablation in Children and Young Adult Patients with Congenital Heart Disease.

We aimed to share our experience of intra-atrial reentrant tachycardia mapping and ablation with a new grid-style multielectrode high-density mapping catheter (Advisor™ HD Grid) in pediatric and young adult patients with operated congenital heart disease. All patients with operated congenital heart disease and intra-atrial reentrant tachycardia mapping with the new grid-style catheter between October 2019 and December 2022 were included (group 1), and the results were compared to those patients who operated with conventional catheter methods before this period (group 2). All procedures were performed using the EnSite Precision 3D mapping system (Abbott Laboratories, Abbott Park, Ill, USA) with a limited fluoroscopy approach. Data were evaluated retrospectively. In group 1 (n = 16; 9 male), the median age was 21 years (10-36), compared to 19years (9-27) in group 2 (n = 10; 5 male). While irrigated radiofrequency ablation was pre-ferred in all patients, the median number of 15 lesions (8-38) in group 1 was significantly less than the median of 30 lesions (8-71) in group 2 (P =.027). The median procedure duration of 159 minutes (110-233) in group 1 was significantly shorter compared to 280 minutes (180-370) in group 2 (P <.05). Acute procedural success was achieved in all patients (16/16; 100%) in group 1 compared to 8/10 patients (80%) in group 2. During the median follow-up of 27 months (11-36), there was only 1 intra-atrial reentrant tachycardia recurrence in group 1 (1/16; 6.2%) and 2 recurrences (2/8; 25%) in group 2 during the median follow-up of 110 months (56-151). No complications related to the mapping catheter itself occurred. In the intra-atrial reentrant tachycardia ablation of children with congenital heart disease to increase procedural success and shorten the mapping duration, the utility of Advisor™ HD Grid mapping catheter seems to be a feasible alternative.

Silent active device tracking for MR-guided interventional procedures.

To evaluate a silent MR active catheter tracking sequence that allows conducting catheter interventions with low acoustic noise levels. To reduce the acoustic noise associated with MR catheter tracking, we implemented a technique previously used in conventional MRI. The gradient waveforms are modified to reduce the sound pressure level (SPL) and avoid acoustic resonances of the MRI system. The efficacy of the noise reduction was assessed by software-predicted SPL and verified by measurements. Furthermore, the quality of the catheter tracking signal was assessed in a phantom experiment and during interventional cardiovascular MRI sessions targeted at isthmus-related flutter ablation. The maximum measured SPL in the scanner room was 104dB(A) for real-time imaging, and 88dB(A) and 69dB(A) for conventional and silent tracking, respectively. The SPL measured at different positions in the MR suite using silent tracking were 65-69dB(A), and thus within the range of a normal conversation. Equivalent signal quality and tracking accuracy were obtained using the silent variant of the catheter tracking sequence. Our results indicate that silent MR catheter tracking capabilities are identical to conventional catheter tracking. The achieved acoustic noise reduction comes at no penalty in terms of tracking quality or temporal resolution, improves comfort and safety, and can overcome the need for MR-compatible communication equipment and background noise suppression during the actual interventional procedure.

Ablation versus anti-arrhythmic therapy for reducing all hospital episodes from recurrent atrial fibrillation: a prospective, randomized, multi-centre, open label trial.

There is rising healthcare utilization related to the increasing incidence and prevalence of atrial fibrillation (AF) worldwide. Simplifying therapy and reducing hospital episodes would be a valuable development. The efficacy of a streamlined AF ablation approach was compared to drug therapy and a conventional catheter ablation technique for symptom control in paroxysmal AF. We recruited 321 patients with symptomatic paroxysmal AF to a prospective randomized, multi-centre, open label trial at 13 UK hospitals. Patients were randomized 1:1:1 to cryo-balloon ablation without electrical mapping with patients discharged same day [Ablation Versus Anti-arrhythmic Therapy for Reducing All Hospital Episodes from Recurrent (AVATAR) protocol]; optimization of drug therapy; or cryo-balloon ablation with confirmation of pulmonary vein isolation and overnight hospitalization. The primary endpoint was time to any hospital episode related to treatment for atrial arrhythmia. Secondary endpoints included complications of treatment and quality-of-life measures. The hazard ratio (HR) for a primary endpoint event occurring when comparing AVATAR protocol arm to drug therapy was 0.156 (95% CI, 0.097-0.250; P < 0.0001 by Cox regression). Twenty-three patients (21%) recorded an endpoint event in the AVATAR arm compared to 76 patients (74%) within the drug therapy arm. Comparing AVATAR and conventional ablation arms resulted in a non-significant HR of 1.173 (95% CI, 0.639-2.154; P = 0.61 by Cox regression) with 23 patients (21%) and 19 patients (18%), respectively, recording primary endpoint events (P = 0.61 by log-rank test). The AVATAR protocol was superior to drug therapy for avoiding hospital episodes related to AF treatment, but conventional cryoablation was not superior to the AVATAR protocol. This could have wide-ranging implications on how demand for AF symptom control is met. Clinical Trials Registration: NCT02459574.

Safety profile and long-term efficacy of very high-power short-duration (60-70 W) catheter ablation for atrial fibrillation: results of a large comparative analysis.

This retrospective study sought to compare complication rates and efficacy of power-controlled very high-power short-duration (vHPSD) and conventional catheter ablation in a large cohort of patients with atrial fibrillation (AF). We analyzed 1115 consecutive patients with AF (38.7% paroxysmal, 61.3% persistent) who received first-time catheter ablation at our centre from 2015 to 2021. Circumferential pulmonary vein isolation ± additional substrate ablation using an irrigated-tip catheter was performed with vHPSD (70 W/5-7 s or 60 W/7-10 s) in 574 patients and with conventional power (30-35 W/15-30 s) in 541 patients. Baseline characteristics were well-balanced between groups (mean age 65.1 ± 11.2 years, 63.4% male). The 30-day incidence of cardiac tamponade [2/574 (0.35%) vs. 1/541 (0.18%), P = 0.598], pericardial effusion ≥ 10 mm [2/574 (0.35%) vs. 1/541 (0.18%), P = 0.598] and transient ischaemic attack [1/574 (0.17%) vs. 2/541 (0.37%), P = 0.529] was not significantly different between vHPSD and conventional ablation. No stroke, atrio-esophageal fistula, cardiac arrest or death occurred. Procedure (122.2 ± 46.8 min vs. 155.0 ± 50.5 min, P < 0.001), radiofrequency (22.4 ± 19.3 min vs. 52.9 ± 22.0 min, P < 0.001), and fluoroscopy (8.1 ± 7.2 vs. 9.2 ± 7.4, P = 0.016) duration were significantly shorter in the vHPSD group. At 12 months follow-up, freedom of any atrial arrhythmia was 44.1% vs. 34.2% (P = 0.010) in persistent AF and 78.1% vs. 70.2% in paroxysmal AF (P = 0.068). vHPSD ablation is as safe as conventional ablation and is associated with an improved long-term efficacy in persistent AF.

The Use of Cardiac Stereotactic Radiation Therapy (SBRT) to Manage Ventricular Tachycardia: A Case Report, Review of the Literature and Technical Notes

among cardiac arrhythmias, ventricular tachycardia (VT) is one that can lead to cardiac death, although significant progress has been made in its treatment, including the use of implantable cardioverter-defibrillators (ICD) and radiofrequency catheter ablation. Nevertheless, long-term recurrence rates remain in about half of patients and drastically impact the patient's quality of life. Moreover, recurrent ICD shocks are painful and are associated with higher mortality and worsening of heart failure. Recently, more and more experiences are demonstrating potential efficacy in the use of stereotactic body radiotherapy (SBRT) (also called cardiac radio-ablation) to treat this condition. In this paper, we report our experience in the use of cardiac radio-ablation for the treatment of refractory ventricular tachycardia with a focus on the technique used, along with a review of the literature and technical notes. an 81-year-old male patient with a long history of non-ischemic dilated cardiomyopathy and mechanical mitral prosthesis underwent a biventricular cardioverter defibrillator implant after atrial ventricular node ablation. At the end of 2021, the number of tachycardias increased significantly to about 10 episodes per day. After failure of medical treatment and conventional RT catheter ablation, the patient was treated with SBRT for a total dose of 25 Gy in a single session at the site of the ectopic focus. No acute toxicity was recorded. After SBRT (follow-up 7 months) no other VT episodes were recorded. SBRT appears to be safe and leads to a rapid reduction in arrhythmic storms as treatment for VT without acute toxicity, representing one of the most promising methods for treating VT storms.

Cardiac radioablation does not worsen cardiac function: preliminary safety results of the prospective STARNL-1 trial

Abstract Background Cardiac radioablation for ventricular tachycardia (VT) appears to be highly effective and safe in patients with recurrent VT despite anti-arrhythmic therapy and catheter ablation(s), although global experience is currently very limited. Detailed echocardiographic strain analysis could provide important insights in (subclinical) functional safety. Importantly, current stereotactic cardiac radioablation techniques includes irradiation of the VT substrate but, inherently, also includes irradiation of the VT border zone and some healthy cardiac tissue. The latter particularly may result in detoriation of cardiac function after cardiac radioablation. Purpose To evaluate functional echocardiographic safety of cardiac radioablation. Methods The STARNL-1 trial is a prospective, monocenter, single-arm, pre-post intervention study. Six patients with recurrent VT despite high dose anti-arrhythmic drugs, after (single or multiple) conventional catheter ablation and deemed unsuited for repeat catheter ablation, were treated with a single fraction 25 Gy radiotherapy dose. Per protocol, patients underwent echocardiograms at baseline, 24 hours after treatment, and 3 months after treatment. Echocardiograms were analysed using 2D-speckle tracking. Mean radiotherapy dose per segment was calculated according to the AHA 17-segment model. Echocardiographic parameters were compared between baseline, 24 hours and 3 months, and correlated to radiotherapy dose. Results Patients were all male (age 55–83 years), all suffered from ischaemic cardiomyopathy, and all completed 3 month follow-up. At baseline, median left ventricle ejection fraction (LVEF) was 38% [30; 47] and median global longitudinal strain (GLS) −8% [−12; −5]. Interestingly, LVEF significantly improved 24 hours after treatment (42% [36; 49], p=0.046) but GLS did not change (−7% [−12; −5], p=0.833). At 3 months, both LVEF and GLS were unchanged compared to baseline (LVEF 39% [33; 49%], p=0.463; GLS −6% [−12; −5], p=0.893). The difference in longitudinal strain per segment before and after treatment did not correlate with the mean radiotherapy dose per segment, both 24 hours after treatment (Pearson coefficient −0.082, p=0.410) and 3 months after treatment (Pearson coefficient −0.005, p=0.957). In Figure 1 an illustrative case is presented. Conclusion(s) Cardiac radioablation for VT does not worsen (subclinical) cardiac function within the first 3 months after treatment. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation

Ultrasound-Guided Catheterization Using a Driller-Tipped Guidewire With Combined Magnetic Navigation and Drilling Motion

The endovascular intervention has been widely used to treat occlusive peripheral vascular disease (PVD). However, the current procedure has concerns such as low successful rate, undesired trauma, and radiation exposure. This article proposes a robotic solution to mitigate these limitations. A miniature magnetic driller-tipped guidewire (MDG) is designed, which performs 1) controllable bending under directional magnetic fields to navigate in complex vasculature and 2) mechanical drilling under rotating magnetic fields to pass through clogged regions. An integrated actuation system is adopted for magnetic control and ultrasound (US) imaging in a large workspace. A control framework composed of the preoperative and intraoperative stages is developed, which internally coordinates all system modules, addresses noisy US imaging, and provides convenient operation. Demonstrations under an optical camera verify the flexible steering ability and effective unclogging motion of the MDG. Furthermore, US image-monitored <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">in vitro</i> experiments validate the overall hardware platform and control strategy. The designed MDG realizes dual objectives, including controllability at bifurcations and penetrability at clots. The introduced US imaging modality largely reduces radiation hazards in conventional catheterization. This article studies the intervention of the MDG under electromagnetic field navigation and US imaging guidance. The proposed workflow has the potential to improve operational safety and clinical outcomes of the occlusive PVD treatment.

Magnetic resonance imaging-guided conventional catheter ablation of isthmus-dependent atrial flutter using active catheter imaging.

Interventional cardiac magnetic resonance (iCMR) has been established as a radiation-free alternative compared to standard fluoroscopy-guided catheter ablation for cavotricuspid isthmus (CTI)-dependent atrial flutter to image anatomy, structural alterations, and further catheter guidance. The purpose of this study was to explore the safety, feasibility, and efficacy of CTI ablations performed completely in the iCMR suite using active catheter imaging. Consecutive patients underwent iCMR-guided catheter ablation for CTI-dependent atrial flutter. Procedures were performed in a 1.5-T magnetic resonance (MR) imaging unit with MR-conditional ablation catheters. Catheter guidance was achieved using active catheter imaging via integrated MR receive tip coils. Acute success, periprocedural complications, and short-term follow-up were collected for further analysis. All patients (N = 15; 73% male; median age 70 years; interquartile range [67-82]) achieved acute procedural success without any complication. Median procedural time was 43 minutes [33-58] with median radiofrequency delivery time of 18 minutes [12-26]. Postprocedural lesion visualization scanning was completed in a median of 32 minutes [10-42]. None of the patients with 6-month follow-up had atrial flutter recurrence. In the iCMR suite, CTI-dependent atrial flutter ablation could be achieved safely using active catheter imaging without any complication. It further allows detailed anatomic visualization of the CTI, intraprocedural lesion visualization, and exclusion of pericardial effusion.

Characterization of high-power and very-high-power short-duration radiofrequency lesions performed with a new-generation catheter and a temperature-control ablation mode.

High-power short-duration (HPSD) has been proposed to shorten procedure times while maintaining efficacy and safety. We evaluated the differences in size and geometry between radiofrequency lesions obtained with this method and conventional ones. Twenty-eight sets of 10 perpendicular radiofrequency applications were performed with two commercially available catheters: a temperature-controlled HPSD catheter (QDot-Micro) and a conventional power-controlled catheter (Thermocool SmartTouch) on porcine left ventricle. Different power settings (35, 40, 50, and 90 W), contact force (CF; 10 and 20 g), ablation index (AI; 400 and 550), and application times were combined to create conventional (35-40 W), HPSD (50 W) and very-high-power short-duration (VHPSD; 90 W) lesions, that were cross-sectioned and measured. About 4-sVHPSD lesions were smaller, shallower, and thinner than HPSD performed with the QDot-Micro catheter in any scenario of CF or AI (61 ± 7.8 mm3 , 6.1 ± 0.3 mm wide, and 2.9 ± 0.1 mm deep with 10 g; 72.2 ± 0.5 mm3 , 6.8 ± 0.3 mm wide, and 2.9 ± 0.2 mm deep with 20 g). Conventional and HPSD lesions performed with the temperature-controlled catheter were generally bigger, deeper, and wider than the ones obtained with the power-controlled catheter, as well as more consistent in size. This was especially true with the lower CF and AI scenario, while differences were less notable with other setting combinations. VHPSD lesions performed with QDot-Micro catheter were smaller than any other lesions, which is especially attractive for posterior left atrial wall ablation. On the contrary, conventional-powered and HPSD lesions performed with this catheter were equally sized (or even bigger with lower CF and AI objectives), as well as more consistent in size, which would guarantee transmurality in other locations.

Celiac artery compression syndrome in children

The manifestation of celiac artery compression syndrome in childhood is rarely described. At the same time, celiac artery compression syndrome remains one of the most discussed vascular diseases due to an unclear pathophysiological mechanism, difficulties in differential diagnosis, and the lack of a generally accepted algorithm for treating patients. In connection with the above, it seems relevant to analyze the features of managing children with celiac artery compression syndrome. As a result of the analysis of the scientific literature, we have come to the following conclusions: 1. Typical clinical characteristics of celiac artery compression syndrome include abdominal pain, epigastric murmur and weight loss associated with compression of the celiac artery and possibly celiac ganglia by the median arcuate ligament. 2. CT angiography and conventional catheter angiography are the gold standard for diagnosis. However, imaging findings should not be interpreted in isolation from clinical manifestations. 3. Surgical decompression of the celiac artery by resection of the median arcuate ligament is the treatment of choice for this syndrome. Both open surgery and laparoscopic techniques are safely performed with minimal morbidity and mortality. Endovascular treatment of compression celiac stenosis may have limited success.

The advantage of the mini-electrode-equipped catheter for the radiofrequency ablation of paroxysmal supraventricular tachycardia.

Novel ablation catheters equipped with mini-electrodes (ME) offer high resolution mapping for target tissue. This study aimed to evaluate the mapping performance and efficacy of ME catheters in radiofrequency ablation (RFA) of paroxysmal supraventricular tachycardias (PSVTs). We prospectively enrolled 136 patients undergoing RFA of PSVT including 76 patients with atrioventricular nodal reentrant tachycardia (AVNRT) and 60 patients with atrioventricular reentrant tachycardia (AVRT) or Wolff-Parkinson-White (WPW) syndrome. Patients were randomized to the ME group (ablation using ME catheters) or the control group (ablation using conventional catheters). The number of ablation attempt and cumulative ablation time to ablation endpoints, which was defined as an emergence of junctional rhythm in AVNRT or accessory pathway (AP) block in AVRT/WPW syndromes were compared. During ablation procedures, discrete slow pathway or AP electrograms were found in 27 (39.7%) patients in the ME group and 13 (19.1%) patients in the control group. The primary study outcomes were significantly lower in the ME group (ablation attempt number: 2.0 [1-4] vs. 3.0 [2-7] in the ME and control group, p = .032; ablation time: 23.5 [5.0-111.5] vs. 64.5 [16.0-185.0] s, p = .013). According to the PSVT diagnosis, ablation time to junctional rhythm was significantly shorter in the ME group in AVNRT. In AVRT/WPW syndrome, both ablation attempt number and ablation time to AP block were nonsignificantly lower in the ME group. The novel ME catheter was advantageous for identifying pathway potentials and reducing initial ablation attempt number and ablation time to reach acute ablation endpoint for PSVTs(ClinicalTrials.gov number, NCT04215640).

Mid-term success rate of single stage hybrid ablation of persistent and long-term persistent atrial fibrillation.

Single stage thoracoscopic radiofrequency ablation (RFA) is a treatment method for persistent and long-term persistent atrial fibrillation (AF) offering the possibility for patients otherwise inconsolable by conventional catheter RFA. We present a pilot group of patients after the introduction of the new method at our clinical center. Patients group: A total of 52 patients aged 61.82 ± 9.7 years underwent single stage hybrid ablation (thoracoscopic isolation of pulmonary veins and box lesion followed by catheter verification of the surgical procedure effectivness) for symptomatic persistent and long-term persistent AF with significantly dilated left atrium 57.9 ± 11.0mm in the period September 2016-March 2019. The median duration of the procedure was 232 minutes and the median duration of hospitalization was 10 days. At discharge, 52 patients (100%) had sinus rhythm. 48 of 52 patients (92.3%) had a 6-month follow-up. 41 of 48 (85.4%) and 38 of 44 (86.4%) of patients were AF free at 3-month and 6-month follow-up, respectively. Acute complications were: one left atrial perforation resolved successfully by suture and one transient ischaemic attack without permanent sequelae. Late complications involved one massive pulmonary embolization and an atrioesophageal fistula. There was no periprocedural myocardial infarction or stroke with permanent sequelae. Hybrid thoracoscopic-catheter ablation performed during one procedure is an effective and relatively safe mini-invasive method of treatment for long-term persistent atrial fibrillation.

Initial experience of novel over the wire type decapolar catheter for ventricular arrhythmias originating from left ventricular summit.

Previously, direct monitoring of local activation at the communicating vein (CV) has been reported to be useful for the ablation of ventricular arrhythmias (VAs) originating from the left ventricular (LV) summit. In this study, we evaluated the performance of the novel over-the-wire (OTW)-type decapolar catheter for VAs originating from the LV summit. Overall, 17 patients who underwent catheter ablation for idiopathic VAs originating from the LV summit were included in this study. Of these, seven patients underwent mapping of the epicardial LV outflow tract with the novel 2.7 Fr OTW-type decapolar catheter (EPstar FIX AIV), and ten underwent mapping with the standard 2.0 Fr octopolar catheter (EPstar FIX 2F) procedure (AIV group = EPstar FIX AIV and control group = EPstar FIX 2F). No significant differences in the baseline characteristics were observed between the two groups. In the AIV group, all patients achieved successful catheter positioning in the target CV, whereas in the control group, two patients failed to achieve the same. The novel catheter not only advanced to the target vessels using a 0.014-in guidewire but it was also used for contrast injection from the catheter lumen, which enabled accurate and safe positioning. As a result, the earliest activation time preceding QRS onset during the VA, recorded at the CV, was significantly earlier when compared with the control group (44.66 ± 11.23ms vs. 32.16 ± 4.26ms, P = 0.007). Compared with the conventional electrode catheter, this novel multipolar electrode catheter is more effective for mapping local activation at the CV.