Radiofrequency Catheter Ablation Of Arrhythmias Research Articles

Long-term follow-up in preschool children after radiofrequency catheter ablation of arrhythmias.

Radiofrequency ablation (RFA) is the standard method of treatment for tachyarrhythmias in school children, and it leads to complete recovery in children without structural heart disease. However, RFA in young children is limited by the risk of complications and unstudied remote effects of radiofrequency lesions. To present the experience of RFA of arrhythmias and the results of follow-up of younger children. RFA procedures (n=255) were performed in 209 children with arrhythmias from 0 to 7 years old. The arrhythmias were presented with atrioventricular reentry tachycardia withWolff-Parkinson-White(WPW) syndrome (56%), atrial ectopic tachycardia (21.5%), atrioventricular nodal reentry tachycardia (4.8%), and ventricular arrhythmia (17.2%). The overall effectiveness of RFA, considering the repeated procedures performed due to the primary ineffectiveness and recurrencies, was 94.7%. There was no mortality associated with RFA in patients, including young patients. All cases of "major" complications are associated with RFA of the left-sided accessory pathway and tachycardia foci and are represented by the mitral valve damage in three patients (1.4%). Tachycardia and preexcitation recurred in 44 (21%) patients. There was a correlation between recurrences and parameters of RFA (odds ratio 0.894; 95% confidence interval: 0.804-0.994; p=.039). Reducing the maximum power of effective applications in our study increased the risk of recurrence. The use of the minimum effective parameters of RFA in children reduces the risk of complications, but increases arrhythmia recurrence rate.

DEVELOPMENT OF NONINVASIVE TOPICAL DIAGNOSTICS OF CARDIAC ARRHYTHMIAS

Heart arrhythmias may accompany virtually any cardiac disease. The problem of the preprocedure topical diagnostics of various arrhythmias remains fundamentally important and relevant, which is confirmed by numerous algorithms aimed at non-invasive detection of the arrhythmogenic focus location. Today, many different methods are available for non-invasive topical diagnostics of the arrhythmogenic foci in both ventricular and atrial arrhythmias. A non-invasive imaging of cardiac electrophysiology (NICE), based on the solution of the inverse problem of the electrocardiography, is the most advanced new technology. The accuracy of NICE reaches 90%, however, it is still inferior in its capabilities to the “reference” method of the invasive intracardiac electrophysiological examination. Currently, the market presents devices for both invasive mapping and NICE. However, in the context of surgery, an integrated system of non-invasive electrophysiological mapping with invasive three-dimensional electroanatomic mapping is of high demand. The creation of hybrid systems will allow to visualize electrophysiological processes in the epi- and endocardial surface in the real time with very high accuracy and to carry out the radiofrequency catheter ablation of arrhythmias with the simultaneous reduction of the radiation load on the patient and medical personnel.

GW28-e1151 The analysis of complications on radiofrequency catheter ablation of arrhythmias in Chinese military hospitals

GW28-e1151 The analysis of complications on radiofrequency catheter ablation of arrhythmias in Chinese military hospitals

The Amigo™ Remote Catheter System: From Concept to Bedside.

Radiation exposure is a serious concern during fluoroscopic procedures, including electrophysiology (EP) studies and radiofrequency catheter ablation of arrhythmias. Operators typically don lead aprons to protect themselves from radiation, but wearing lead can result in greater fatigue and orthopedic injury during long procedures. To address this problem, two robotic catheter systems (RCS) have previously been introduced on the market, the Niobe® (Stereotaxis Inc., St. Louis, MO, USA) and Sensei® X (Hansen Medical, Inc., Mountain View, CA, USA) systems. However, the widespread adoption of these systems has been limited by both cost and ease of use. In contrast, the Amigo™ RCS (Catheter Precision, Inc., Mount Olive, NJ, USA) was developed to provide a simple, lower profile, and less expensive remote catheter manipulation solution. Approved by the United States Food and Drug Administration (FDA), this technology allows for operators to remotely manipulate electrophysiology (EP) catheters from outside the fluoroscopy field. Notably, the Amigo™ RCS (Catheter Precision, Inc., Mount Olive, NJ, USA) first underwent an early study in dogs in 2008 to demonstrate its safety and efficacy in an animal model. After a clinical trial evaluating its safety and mapping capabilities in humans was completed in 2010, the Amigo™ RCS (Catheter Precision, Inc., Mount Olive, NJ, USA) underwent several scientific studies to examine its ability to assist in the mapping and ablation of various arrhythmias in comparison with the conventional manual approach. The Amigo™ RCS (Catheter Precision, Inc., Mount Olive, NJ, USA) achieved mapping and ablation success rates that were similar to those achieved with manual catheter manipulation, and no complications due to its use were observed. It was approved by the FDA for use in diagnostic EP studies of the right atrium and ventricle in 2012, with this indication later expanded in 2014 to include radiofrequency ablations. The device is currently compatible with the Blazer™ (Boston Scientific, Natick, MA, USA) and EZ STEER™ (Biosense Webster, Inc., Diamond Bar, CA, USA) catheter handles. Here, we present a clinical report in which the Amigo™ RCS (Catheter Precision, Inc., Mount Olive, NJ, USA) was employed to map and ablate symptomatic supraventricular tachycardia. Dr. Cohen’s clinical experience with this robotic system is also reviewed.

Diagnosis and treatment of cardiac tamponade during radiofrequency catheter ablation for arrhythmias

Background: To explore the clinical manifestations of cardiac tamponade during radiofrequency catheter ablation (RFCA) for cardiac arrhythmias and investigate its diagnosis and treatment strategies. Methods: The clinical data including clinical manifestations, diagnosis and treatment and prognosis of 21 patients who had suffered from cardiac tamponade during RFCA for cardiac arrhythmias were retrospectively analyzed. Results: The incidence of cardiac tamponade gradually decreased along with the extension of learning curve. It was significantly higher in females than in males (5.4‰ vs . 1.2‰, P vs . 1.2‰, P Conclusions: Cardiac tamponade during RFCA is associated with learning curve, gender (female), and age. The condition should be timely identified based on clinical manifestations and X-ray findings and appropriately managed.

Pacemakers implantation and radiofrequency catheter ablation procedures during medical missions in Morocco: an 8-year experience.

Radiofrequency catheter ablation (RFCA) for arrhythmias in the context of short-term medical missions (MM) in a developing country has not been reported so far. We describe here our experience with RFCA and pacemaker implantation in Morocco with a fully portable electrophysiological (EP) system under the auspice of the Monaco-Morocco Cardiology Association. Since November 2007, two to three MM (mean duration 4 days including transportation) per year were conducted (including two physicians and one nurse from Monaco) and were alternately located in Marrakech, Fes, Agadir, Casablanca, Rabat, Essaouira, and Oujda. All patients' files were sent by local teams and/or referring Moroccan cardiologists before MM. Each case was discussed with the Monaco EP team before the MM. Pacemakers and leads were donated by companies (Sorin Group, Medtronic, Saint-Jude Medical). The EP system (EP Tracer, CardioTek) as well as diagnostic/ablation catheters were brought for RFCA procedures. After the procedures, follow-up was performed by local teams. Procedures took place in gynaecological or orthopaedic operating room, or, when available, in the interventional cardiology cathlab. Thirty-one RFCA were performed during 11 MM (atrioventricular node re-entrant tachycardia = 12; atrioventricular re-entrant tachycardia/Mahaïm fibre = 15; typical atrial flutter = 3; ventricular ectopy = 1). Acute success was 93.5% for RFCA. Two major RFCA-related complications occurred (air embolism and complete atrioventricular block). No complication was related to pacemaker implantations (n = 44; mean 4 pacemakers per mission). Radiofrequency catheter ablation for arrhythmias in developing countries is technically challenging but feasible, despite technical and cultural difficulties.

Health care policy and regulatory implications on medical device innovations: a cardiac rhythm medical device industry perspective.

Keywords Medicaldevices .Regulatorybarriers .Regulatorycosts .Comparativeeffectiveness1 Introduction“How wonderful that we have met with a paradox.Now we have some hope of making progress.”—NielsBohr [1]The medical technology industry in the early twenty-firstcentury is marked by a puzzling paradox. The industry hascontributed to decades of life-saving innovations: the intro-duction of technologies like the implantable cardioverterdefibrillator, radiofrequency catheter ablation for cardiacarrhythmias, and cardiac resynchronization therapy, andwe have witnessed remarkable reductions in mortality andmorbidity due to cardiovascular disease [2, 3]. Nevertheless,we are simultaneously witnessing escalating concerns frompoliticians, the plaintiff’s bar, the general public, physicians,researchers, and patients over whether our technologiestruly are safe and effective [4–6]. Behind this paradox liesanother, more subtle paradox: a vigorously innovative med-ical technology industry requires strong and complex under-pinnings, but there is a growing sense that overlyburdensome and complex regulations threaten to choke offcontinued innovation. Our intent is to explore this paradox,by expressing the authors opinions based on their medicaldevice industry viewpoint, focusing on three areas of con-cern: the threat posed by a globally discordant patchwork ofdifferent regulatory approaches and standards, the threatposed by a particularly burdensome regulatory processwith-in the USA, and the implications of inappropriate use ofcomparative effectiveness with respect to medical devices.2 The global environment for innovation: regulatorydiscord or harmonyThe requirements to introduce new medical devices can varydramatically around the world. For example—consider thedifferences between the USA and the European Union. Inthe USA, the foundations of the regulatory requirements formedical products are defined statutorily in the Federal Food,Drug and Cosmetic Act and implemented in the Code ofFederalRegulations[7].Perthisconstruct,higherriskdevices(e.g., U.S. Class II and Class III) may only enter the USmarket after they have been demonstrated to provide a rea-sonable assurance of safety and effectiveness for the intendeduse in the labeled intended patient population. In contrast,under the European regulatory framework, manufacturersmust establish the safety and performance of the proposeddevice—a subtly different standard (Council Directive93/42/EEC) [8]. Furthermore, despite the similarity in thenomenclatures used for classification in the USA and theEU, the criteria used to classify, and thus identify those devi-ces which must meet higher premarket thresholds, are quitedifferent in these two regions. The net result of both thesefactors can be dramatically different requirements to placenew medical technologies into the market for use withpatients. There are two very different (and valid) perspectives

Catheter Ablation of Tachyarrhythmias From the Aortic Sinuses of Valsalva

The aortic root is at the center of the heart. Each of the aortic sinuses of Valsalva, positioned at the base of the aortic root, is in contact with the atrial myocardium and/or ventricular myocardium at their bases, which enables mapping and ablating of some ventricular arrhythmias with an outflow tract origin and supraventricular tachycardias (ie, atrial tachycardia, accessory pathways) from the aortic sinuses of Valsalva. These arrhythmias have characteristic electrocardiographic findings associated with their origins, and almost all are difficult to ablate from an atrial or ventricular endocardial site. Site-specific and potential complications, such as a coronary artery occlusion or atrioventricular block, can occur with catheter ablation at the aortic sinuses of Valsalva. Therefore, accurate diagnosis and proper ablation at the aortic sinuses of Valsalva are required for a cure. This review describes the anatomic features of the aortic sinuses of Valsalva and focuses on the diagnosis and radiofrequency catheter ablation of arrhythmias that can be ablated from this site. (Circ J 2012; 76: 791-800).

377 Electrophysiological properties and radiofrequency catheter ablation for arrhythmias in adults associated with congenital heart disease

377 Electrophysiological properties and radiofrequency catheter ablation for arrhythmias in adults associated with congenital heart disease

377 Electrophysiological properties and radiofrequency catheter ablation for arrhythmias in adults associated with congenital heart disease

377 Electrophysiological properties and radiofrequency catheter ablation for arrhythmias in adults associated with congenital heart disease

Radiofrequency catheter ablation of arrhythmias in infants and small children

The issue of the proper use of radiofrequency catheter ablation in infants and small children is controversial. Rarely, catheter ablation techniques are indicated to cure malignant arrhythmias in the pediatric population. Indications, techniques, complications and success rates are reviewed.

ABSTRACT SESSION 7: RADIOFREQUENCY CATHETER ABLATION OF ARRHYTHMIAS

Pacing and Clinical ElectrophysiologyVolume 18, Issue 5 p. 1121-1122 ABSTRACT SESSION 7: RADIOFREQUENCY CATHETER ABLATION OF ARRHYTHMIAS First published: May 1995 https://doi.org/10.1111/j.1540-8159.1995.tb04764.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume18, Issue5May 1995Pages 1121-1122 RelatedInformation

The Multicentre European Radiofrequency Survey (MERFS): complications of radiofrequency catheter ablation of arrhythmias. The Multicentre European Radiofrequency Survey (MERFS) investigators of the Working Group on Arrhythmias of the European Society of Cardiology.

Radiofrequency (RF) catheter ablation has developed into a new non-pharmacological therapy for the definitive treatment of patients with cardiac arrhythmias. Although an increasing number of recent reports have indicated the widespread use of the procedure, no data are available to estimate the number of procedures performed in Europe. Furthermore, currently no data on a large series of patients are available that provide information on the risk of procedure-related complications. This report presents the results of the Multicentre European Radiofrequency Survey (MERFS) that was conducted by the Working Group on Arrhythmias of the European Society of Cardiology. The objectives of this voluntary retrospective survey were to assess the number of radiofrequency catheter ablation procedures performed in 86 European institutions from January 1987 until March 1992 and the incidence of procedure-related complications with respect to the different types of ablative procedures. A total of 4398 patients were reported on from 68 out of 86 institutions (79%) from 15 European countries that agreed to participate in MERFS. From 1987 to 1991, the number of patients who underwent RF ablation per year increased from 45 to 2000. In the first 3 months of 1992, a total of 1640 patients were reported on. The number of patients reported on in relation to the different types of ablative procedures were: ablation of atrial tachycardialatrial flutter: n = 141 (3.2%); ablation of the atrioventricular junction: n = 900 (20.5%); modification of the atrioventricular junction in atrioventricular nodal reentrant tachycardia: n = 815 (18.5%); ablation of accessory pathway: n = 2222 (50.5%); ablation of ventricular tachycardia: n = 320 (7.3%). Procedure-related complications occurred in 223 patients (5.1%). The incidence of complications in relation to the ablative procedure was: ablation of atrial tachycardia/atrial flutter: 5.0%; ablation of the atrioventricular junction: 3.2%; modification of the atrioventricular junction in atrioventricular nodal reentrant tachycardia: 8.0%; ablation of accessory pathway: 4.4%; ablation of ventricular tachycardia: 7.5%. Complications occurred significantly more often in patients who underwent modification of the atrioventricular junction in atrioventricular nodal reentrant tachycardia, when compared to ablation of the atrioventricular junction (P < 0.001) or ablation of accessory pathway (P < 0.001), and in patients who underwent ablation of ventricular tachycardia, when compared to ablation of the atrioventricular junction (P < 0.002) or ablation of accessory pathway (P < 0.02). The highest incidence of complications was reported after modification of the atrioventricular junction in atrioventricular nodal reentrant tachycardia.(ABSTRACT TRUNCATED AT 400 WORDS)