Browsing by Subject "Radiofrequency ablation"

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    2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias
    (Oxford University Press, 2019-08) Cronin, Edmond M.; Bogun, Frank M.; Maury, Philippe; Peichl, Petr; Chen, Minglong; Namboodiri, Narayanan; Aguinaga, Luis; Leite, Luiz Roberto; Al-Khatib, Sana M.; Anter, Elad; Berruezo, Antonio; Callans, David J.; Chung, Mina K.; Cuculich, Phillip; d’Avila, Andre; Deal, Barbara J.; Bella, Paolo Della; Deneke, Thomas; Dickfeld, Timm-Michael; Hadid, Claudio; Haqqani, Haris M.; Kay, G. Neal; Latchamsetty, Rakesh; Marchlinski, Francis; Miller, John M.; Nogami, Akihiko; Patel, Akash R.; Pathak, Rajeev Kumar; Sáenz Morales, Luis C.; Santangeli, Pasquale; Sapp, John L, Jr.; Sarkozy, Andrea; Soejima, Kyoko; Stevenson, William G.; Tedrow, Usha B.; Tzou, Wendy S.; Varma, Niraj; Zeppenfeld, Katja; Medicine, School of Medicine
    Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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    Ablative Therapy in Non-HCC Liver Malignancy
    (MDPI, 2023-02-14) Robinson, Tyler P.; Pebror, Travis; Krosin, Matthew E.; Koniaris, Leonidas G.; Surgery, School of Medicine
    Surgical extirpation of liver tumors remains a proven approach in the management of metastatic tumors to the liver, particularly those of colorectal origin. Ablative, non-resective therapies are an increasingly attractive primary therapy for liver tumors as they are generally better tolerated and result in far less morbidity and mortality. Ablative therapies preserve greater normal liver parenchyma allowing better post-treatment liver function and are particularly appropriate for treating subsequent liver-specific tumor recurrence. This article reviews the current status of ablative therapies for non-hepatocellular liver tumors with a discussion of many of the clinically available approaches.
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    Endoscopic Ultrasound-Guided Treatments for Pancreatic Cancer: Understanding How Endoscopic Ultrasound Has Revolutionized Management of Pancreatic Cancer
    (MDPI, 2024-12-30) Singh, Sahib; Facciorusso, Antonio; Vinayek, Rakesh; Dutta, Sudhir; Dahiya, Dushyant Singh; Aswath, Ganesh; Sharma, Neil; Inamdar, Sumant; Medicine, School of Medicine
    Pancreatic cancer is associated with high rates of morbidity and mortality. Endoscopic ultrasound (EUS)-guided biopsy has become the standard diagnostic modality per the guidelines. The use of EUS has been growing for providing various treatments in patients with pancreatic cancers: biliary and gallbladder drainage for those with malignant biliary obstruction, gastroenterostomy for malignant gastric outlet obstruction, celiac plexus/ganglia neurolysis for pain control, radiofrequency ablation, placement of fiducial markers, and injection of local chemotherapeutic agents. In this review, we explore the recent clinical studies evaluating the EUS-guided treatments in pancreatic cancer.
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    Intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: a prospective randomized double-blind sham-controlled multi-center study
    (Springer, 2019-04-30) Fischgrund, Jeffrey S.; Rhyne, Alfred; Franke, Jörg; Sasso, Rick; Kitchel, Scott; Bae, Hyun; Yeung, Christopher; Truumees, Eeric; Schaufele, Michael; Yuan, Philip; Vajkoczy, Peter; DePalma, Michael; Anderson, David G.; Thibodeau, Lee; Meyer, Bernhard; Orthopaedic Surgery, School of Medicine
    PurposeTo evaluate the safety and efficacy of radiofrequency (RF) ablation of the basivertebral nerve (BVN) for the treatment of chronic low back pain (CLBP) in a Food and Drug Administration approved Investigational Device Exemption trial. The BVN has been shown to innervate endplate nociceptors which are thought to be a source of CLBP.MethodsA total of 225 patients diagnosed with CLBP were randomized to either a sham (78 patients) or treatment (147 patients) intervention. The mean age within the study was 47 years (range 25–69) and the mean baseline ODI was 42. All patients had Type I or Type II Modic changes of the treated vertebral bodies. Patients were evaluated preoperatively, and at 2 weeks, 6 weeks and 3, 6 and 12 months postoperatively. The primary endpoint was the comparative change in ODI from baseline to 3 months.ResultsAt 3 months, the average ODI in the treatment arm decreased 20.5 points, as compared to a 15.2 point decrease in the sham arm (p = 0.019, per-protocol population). A responder analysis based on ODI decrease ≥ 10 points showed that 75.6% of patients in the treatment arm as compared to 55.3% in the sham control arm exhibited a clinically meaningful improvement at 3 months.ConclusionPatients treated with RF ablation of the BVN for CLBP exhibited significantly greater improvement in ODI at 3 months and a higher responder rate than sham treated controls. BVN ablation represents a potential minimally invasive treatment for the relief of chronic low back pain.Graphical abstract These slides can be retrieved under Electronic Supplementary Material. Open image in new window
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    Mechanical suppression of premature ventricular complexes during catheter ablation procedures
    (Indian Pacing and Electrophysiology Group, 2021) Jain, Rahul; Barmeda, Mamta; Jain, Rohit; Shirazi, Jonathan; Miller, John M.; Medicine, School of Medicine
    Introduction: Mechanical suppression of premature ventricular complexes (PVCs) is not a well-known observation. We retrospectively reviewed this phenomenon in the Ventricular Arrhythmia (VA) ablation procedures performed at Richard L. Roudebush Veterans Health Administration (VHA) center. Methods: Data from 40 consecutive patients who underwent VA ablation at VHA, Indianapolis, IN, with 44 VA was included in the study. Demographic and electrophysiological parameter data was collected. Results: Overall the mean age of the population was 64 ± 11 years. The phenomenon of mechanical suppression was seen in 11 PVCs. The mean age was 59 ± 15 years in the group in which mechanical suppression was seen. Of the 11 cases, the site of earliest activation was seen in the coronary sinus in 8 and in the pulmonary artery in 3. In one case catheter ablation was not performed because of proximity to the left coronary artery system. However, sustained pressure at the site with earliest electrograms (-35 ms) and 95% pacematch resulted in long-term suppression of PVCs. In the cases in which mechanical suppression was seen, there was a statistically significant reduction in PVC burden compared to pre ablation PVC load (1.1% ± 1.50% (post ablation) versus 24.04% ± 13.07% (pre ablation) versus p < 0.05). In all the 11 cases the site of mechanical suppression was also the site with earliest electrograms. Conclusion: This case series illustrates phenomenon of mechanical suppression of PVCs as an indication for good site for successful ablation in unique veteran patient population.
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    Unique features of epicardial ventricular arrhythmias/premature ventricular complexes ablated from coronary venous system in veteran population
    (Elsevier, 2020-02-18) Mar, Philip L.; Barmeda, Mamta; Stucky, Marcelle A.; Devabahktun, Subodh R.; Garlie, Jason; Miller, John M.; Jain, Rahul; Medicine, School of Medicine
    Introduction: Ventricular arrhythmias/premature ventricular complexes (VA/PVCs) that can be ablated from within the coronary venous system (CVS) have not been described in the United States Veterans Health Administration (VHA) population. We retrospectively studied the VA/PVCs ablations that were performed in the VHA population. Methods: Data from 42 consecutive patients who underwent VA/PVCs ablation at Veterans Affairs Hospital, Indianapolis, IN, with 44 VA/PVCs was included in the study. Patients were divided into two groups (CVS group [n = 10], and non-CVS group [n = 32]) based on where the earliest pre-systolic activation was seen with >95% pacematch. Results: The mean age in CVS group was 65 ± 8 years versus 64 ± 12 years (p = 0.69) in non-CVS group. Overall there was a statistically significant reduction in PVC burden post ablation (27.7% (pre-ablation) versus 4.7% (post-ablation). In the 10 patients in the CVS group, either ablation or catheter-related mechanical trauma resulted in complete (n = 6 [60%]) or partial (n = 4 [40%]) long-term suppression of VA/PVCs. Right bundle branch block-type VA/PVC (9/11: 82%) was the most common morphology in the CVS group, whereas in the non-CVS group, this type was seen in only 3/33 (9%). The CVS group (25% of total VA/PVCs) had shorter activation time compared to non CVS group. Conclusion: In our experience VA/PVCs with electrocardiograms suggestive of epicardial origin can often be safely and successfully ablated within the coronary venous system. These arrhythmias have unique features in Veterans patient population.