Pitvarfibrilláció, pitvarlebegés strukturálisan ép szívű betegen: mi legyen az elsődleges ablációs célpont? - Meddig antikoaguláljunk?

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Learning curve in circular multipolar phased radiofrequency ablation of atrial fibrillation

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Learning curve in circular multipolar phased radiofrequency ablation of atrial fibrillation

Background: Although atrial fibrillation (AF) ablation is considered a technically challenging procedure, studies on the learning curve of different pulmonary vein isolation (PVI) techniques are limited. We investigated the time-dependent changes in procedural parameters, complication rates, and in the 1-year clinical outcome during our initial experience with circular multipolar phased radiofrequency (RF) ablation. Methods and results: The first 132 consecutive patients (40 female; age: 56.6 ± 10.4 years) who underwent PVI with phased RF ablation for paroxysmal or persistent AF at our center were included in the study. Procedural parameters and atrial arrhythmia-free survival were compared in the first, second and third group of 44 successive patients. All pulmonary veins were successfully isolated in 44 (100%), 41 (93.8%) and 42 (95.5%) patients in Tierce 1, 2 and 3, respectively (p = 0.233). The number of RF applications (per vein) required for isolation and fluoroscopy times demonstrated a significant decrease with experience, and a trend towards lower procedure times in Tierces 2 and 3 was also observed. Atrial arrhythmia-free survival rates at 12 months postablation were 68.18%, 75%, and 70.75% in Tierce 1, Tierce 2 and Tierce 3, respectively (p = 0.772). Pericardial tamponade requiring percutaneous subxi­phoid drainage occurred in 1 patient (Tierce 3) as the only significant procedural complication. Conclusions: A learning curve effect was demonstrated in fluoroscopy times and in the number of RF applications but not in the acute success and in the long-term arrhythmia-free survival with circular multipolar RF ablations.

Cerebral micro-embolization during pulmonary vein isolation: relation to post-ablation silent cerebral ischemia

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Cerebral microembolization during pulmonary vein isolation performed with the circular multipolar radiofrequency catheter

Fázisos RF ablációk során rutinszerűen alkalmazott cerabrális mikroembólus detektálással végzett vizsgálataink eredményeként az alábbi megállapításokat tehetjük: 1. A GENius generátor korábbi, 14.3 verziójával végzett ablációk szignifikánsan több mikroembólust generáltak mint a Cryoballonnal végzett ablációk. Az abláció alatti heparinizálás szignifikánsan nem befolyásolta a MES-k számát a PVAC-vel végzett beavatkozások során. 2. A mikroembólusok keletkezése Cryoballon ablációk alatt egyenletes volt, PVAC ablációknál ezzel szemben döntően az energia közlések idejére koncentrálódott. 3. A MES-k mintegy 80 %-a gáz természetű, mindkét ablációs módszer esetén. 4. Statisztikailag igazolt korreláció áll fenn a TCD-vel detektált MES számok és az ICE képernyőn megjelenő mikrobuborék képződés intenzitása között. 5. A GENius 14.4 generátor hőmérséklet és teljesítmény görbéinek elemzése a MES képződés hátterében igazolta, hogy mind a leadott össz teljesítmény, mind az egyszerre bekapcsolt elektródák száma szignifikánsan korrelál a mikroembólusok képződésével. 6. A PVAC első és utólsó elektródáinak szimultán aktiválása növeli a MES-k számát akkor is, ha az elektróda pozíciót röntgenen ellenőrizzük az abláció előtt. 7. A nem megfelelő, vagy intermittáló katéter kontaktusra utaló valamennyi paraméter, úgy mint az átlagos hőmérséklet, a hőmérsékleti túllövés, a negativ templát deviációs és a respirációs kontaktus hiba score a mikroembolizáció független prediktorának bizonyult. The summary of our research investigating Cerebral microembolization during pulmonary vein isolation performed with the circular multipolar radiofrequency catheter was given in this thesis. Our new observations: 1. The earlier version of the GENius generator (GENius 14.3) was associated with significantly increased MES production as compared with the Cryoballoon. However, the level of intraprocedural heparinization did not affect the amount of emboli generation during PVAC ablations. 2. During Cryoballoon ablation an even distribution of microbubble formation was observed, while emboli generation was concentrated to energy delivery in case of PVAC procedures. 3. 80% of detected microebmoli are gaseous in nature with both single-shot techniques. 4. An excellent correlation was found between the absolute numbers of detected MESs by TCD and the semiquantitative scale of bubble production on ICE. 5. Based on the analysis of temperature and power curves registrated during energy deliveries with the PVAC it was demonstrated that the total energy delivered and the number of concomittantly active poles were associated with increased MES production. 6. Simultaneous use of E1 and E10 resulted in increased MES formation despite fluoroscopic assessement of a large interelectrode distance between them. 7. All parameters related to an improper or an intermittent tissue-catheter contact, including mean temperature, integral over 62 oC, negative template deviation score, respiration generated contact failure score were independent predictors of MES formation.N

Relationship between cardiovascular diseases and circulating cell-free nucleic acids in human plasma

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Relationship between cardiovascular diseases and circulating cell-free nucleic acids in human plasma

Cardiovascular diseases (CVDs) are the main cause of human morbidity and mortality worldwide. Early diagnosis could improve the efficiency of treatments. New biomarkers are needed for the identification of high-risk populations in order to make accurate diagnosis and therapy monitoring. Circulating cell-free nucleic acids (cf-NAs) offer a promising new noninvasive tool. These have a role in the regulation of normal physiological functions and in the development of pathological alterations. There is extended research on the clinical application and utilization of cell-free genomic DNA, mtDNA, mRNA, miRNA and long noncoding RNA in CVDs. These molecules could serve as components of new generation therapeutics. Our review focuses on the role of cf-NAs in the pathogenesis of CVDs and we are discussing also possible diagnostic applications and therapeutic implications