This document discusses ablation techniques for atrial fibrillation. It begins by describing the anatomical considerations for ablation, including pulmonary vein anatomy and the importance of reconstructing the virtual geometry. It then discusses different ablation strategies such as pulmonary vein trigger ablation and substrate modification. The document highlights some of the challenges and pitfalls of atrial fibrillation ablation. It concludes by emphasizing the importance of selecting appropriate patients for ablation and properly defining success criteria and long-term follow-up.
Idiopathic VT refers to VT occurring in structurally normal hearts in the absence of myocardial scarring. Classification of monomorphic idiopathic VT includes outflow tract VT, fascicular VT, papillary muscle VT,annular VT, and miscellaneous (VT from the body of the RV and crux of
the heart). It is commonly seen in young patients and usually has a benign course. The 12-lead lectrocardiogram is critical in distinguishing the specific form and locations of idiopathic VT. Treatment options include medical therapy specific to the underlying mechanism of VT or catheter
ablation.
Its crucial to diagnose arrythmias quickly and treat it promptly.
Here i have made small attempt to diagnose tachyarrythmias briefly and proceeds with its immediate managenent..
Ventricular tachycardia (VT) is a broad complex tachycardia originating from a ventricular ectopic focus. It is defined as three or more ventricular extrasystoles in succession at a rate of more than 120 beats per minute (bpm). Accelerated idioventricular rhythm refers to ventricular rhythms with rates of 100-120 bpm
Idiopathic VT refers to VT occurring in structurally normal hearts in the absence of myocardial scarring. Classification of monomorphic idiopathic VT includes outflow tract VT, fascicular VT, papillary muscle VT,annular VT, and miscellaneous (VT from the body of the RV and crux of
the heart). It is commonly seen in young patients and usually has a benign course. The 12-lead lectrocardiogram is critical in distinguishing the specific form and locations of idiopathic VT. Treatment options include medical therapy specific to the underlying mechanism of VT or catheter
ablation.
Its crucial to diagnose arrythmias quickly and treat it promptly.
Here i have made small attempt to diagnose tachyarrythmias briefly and proceeds with its immediate managenent..
Ventricular tachycardia (VT) is a broad complex tachycardia originating from a ventricular ectopic focus. It is defined as three or more ventricular extrasystoles in succession at a rate of more than 120 beats per minute (bpm). Accelerated idioventricular rhythm refers to ventricular rhythms with rates of 100-120 bpm
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Evaluation of antidepressant activity of clitoris ternatea in animals
2008 roma, convegno updating in cardiologia. l'ablazione della fibrillazione atriale
1. Stefano Nardi, MD, PhD
AZIENDA OSPEDALIERA SANTA MARIA TERNIAZIENDA OSPEDALIERA SANTA MARIA TERNI
DIPARTIMENTO CARDIOTORACOVASCOLAREDIPARTIMENTO CARDIOTORACOVASCOLARE
UNITA’ OPERATIVA DI ARITMOLOGIA CARDIACAUNITA’ OPERATIVA DI ARITMOLOGIA CARDIACA
La terapia ablativa dellaLa terapia ablativa della
Fibrillazione AtrialeFibrillazione Atriale
L’ entusiasmo dell’ elettrofisiologoL’ entusiasmo dell’ elettrofisiologo
C O N V E G N O
UPDATING
DI CARDIOLOGIA
15 novembre 2008
Auditorium ex I Clinica Medica
Policlinico Umberto I - ROMA
3. 9,6
13,4
15,3
18
25,7
28,9
49,8
0 10 20 30 40 50 60
SOLVD (II-III)
V-HeFT (II-III)
CHF-STAT (II-III)
ATLAS (III)
DIAMOND-CHF (II-III)
GESICA (II-IV)
CONSENSUS (IV)
Prevalenza FA (% )
• All AFib affected pts have an increased Morbidity
• The overall increased Mortality is 1,6-2,6%
(Manitoba and Framingham Studies)
• 5% year ischemic stroke
• 1/6 Cerebro-Vascular
Accident (CVA)
• Framingham Study
RHD 17 X rate of CVA
Risk of Stroke increased
with age (1,5% 50-59
yrs vs
23,5% at 80-89 yrs)
MagnitudeMagnitude
4. FA
CURA controllo clinico
controllo FARipristino RS
controllo clinico
parossistica permanentepersistente
Atrial FibrillationAtrial Fibrillation
different strategiesdifferent strategies
6. AFFIRM
STAFSTAF
PIAFPIAF
HOT CAFÉHOT CAFÉ
PAF-2PAF-2
RACERACE• Paroxysmal Atrial Fibirllation 2
(PAF2) Eur Heart J ’02
• Pharmacological Intervention in AF (PIAF)
Lancet ’00.
• Comparison of rate control and rhythm
control in pts with AF (AFFIRM)
NEJM ‘02.
• Randomized trial of rate-control
versus rhythm CTR in PeAF: the
Strategies of Treatment of AF (STAF)
study. JACC ‘03.
• Effect of rate or rhythm control on QoL
in PeAF: results from the Rate CTR vs
ECV (RACE) Study. JACC ‘ 04.
• How to treat C-AF (HOT-CAFÉ`) New DehliNew Dehli
Atrial FibrillationAtrial Fibrillation
Randomized TrialsRandomized Trials
7. - Strategies based to maintaining SR at 1 yrs FU
without AADs is <30% (recurrence between 50-70%) ....
Pooled (meta-analysis) data from
PAF2, PIAF,
STAF, AFFIRM e RACE
- … however in most cases AADs based strategies are
not able to prevent RECURRENCE of A Fib.
• Global acute efficacy 40-50% (reduce in long term FU)
25% interruption of treatment !
• SIDE EFFECTS
– Until 20% of cases (3-5% TdP)
8. • Arrhythmia-free survival after
ECV in pts with PeAF
Lower Curve
Outcome after a single shock when
no prophylactic AADs was given
Upper curve
Outcome with repeated ECV in
conjunction with AADs
prophylaxis
Pooled (meta-analysis) data from
PAF2, PIAF,
STAF, AFFIRM e RACE
17. Action Potential, Ca++ and
Contractility in AFib pts
1.1. Reduction in amplitude and increase in duration of APReduction in amplitude and increase in duration of AP
ControlControl A FibA Fib
AP (EAP (Emm))
[Ca[Ca2+2+
]]ii
ContractionContraction
2.2. Reduction in the upslope and downslop of the CaReduction in the upslope and downslop of the Ca++++
transienttransient
3. Parallel reduction in the upslope and downslop of the peak
developed tension
ContractionContraction
[Ca2+]i[Ca2+]iAP (EmAP (Em))
18. Atrial Fibrillation
histopathology
• Karpawich (‘90) – Canine mod.
– LA myofibril disarray was found
after 4 months of AFib
– Appearance of prominent cells in
subendocardium, variable-sized
mitochondria, and dystrophic
calcification
• Adomain (‘86)
– Myofibril disarray was found in 75% of
canine hearts after 3 months of pacing
from AFib
• Karpawich (‘99) – Pediatric Pts
– Myofibril hypertrophy, intracellular
vacuolation, degenerative fibrosis,
and fatty deposits in the LA after
more than 3 years of AFib
19. Left common trunk 3 right lower veins
Normal
Pulmonary vein anatomy
TRIGGERTRIGGER
53. 137 pz (età media: 62 a)
FA parossistica o persistente
Randomizzazione a tx
antiaritmica da sola o in
associazione ad ablazione
transcatetere (ablazione
circonferenziale, lesioni lineari in
AD e AS)
End-point: assenza di recidive
aritmiche (>30 s) ad un f.u. di 1
anno
Recidive aritmiche: 91.3% farmaci
vs 44.1% farmaci + ablazione
Complicanze maggiori: 4.4% (solo
in relazione all’ablazione)
54. • Anatomia avversa e variabile
per la realizzazione di un
isolamento elettrico completo
• Rischio di recidiva di conduzione
attraverso una linea di blocco
INCOMPLETA
OSTACOLO CONSEGUENZA
• Difficoltà alla realizzazione di
lesioni transmurali all’orifizio
delle VP
• Rimodellamento elettrico
• Volume consistente di tessuto
aritmogeno tra l’orifizio della
VP e la linea di blocco
• Vulnerabilità all’innesco di FA
in risposta a triggers non
clinici (BESV da siti innocenti)
Atrial Fibrillation ablationAtrial Fibrillation ablation
PITFALLPITFALL
55. tipo di FAtipo di FA
cardiopatia sottostantecardiopatia sottostante
isolamento delle VPisolamento delle VP
(ostiale, antrale, ecc)(ostiale, antrale, ecc)
ablazione circonferenzialeablazione circonferenziale
lesioni lineari aggiuntivelesioni lineari aggiuntive
ablazione in aree aablazione in aree a
conduzione rallentataconduzione rallentata
effettivo isolamento VP
Riduzione/modifica del
substrato
Δ tono autonomico
creazione di barriere
elettriche complete e non
non inducibilità della FA
recidive aritmicherecidive aritmiche
sintomatiche/asintomatichesintomatiche/asintomatiche
utilizzo terapia antiaritmicautilizzo terapia antiaritmica
DisomogeneitàDisomogeneità
delle popolazionidelle popolazioni
arruolatearruolate
Differenze dellaDifferenze della
tecnica ablativatecnica ablativa
End-pointEnd-point
procedurali nonprocedurali non
uniformiuniformi
Metodologia delMetodologia del
follow-upfollow-up
57. 181/777181/777 Laboratori in tutto il mondoLaboratori in tutto il mondo
8.7458.745 pz da 90 Laboratoripz da 90 Laboratori
10.19910.199 ATC x FA (90% in ASn)ATC x FA (90% in ASn)
PERIODOPERIODO:: 1995 – 20021995 – 2002
SUCCESSO CLINICOSUCCESSO CLINICO::
52% (52% (3,866 pts) senza f. antiaritmicisenza f. antiaritmici
75.9% (7408 pts) con f. antiaritmici75.9% (7408 pts) con f. antiaritmici
Worldwide AFib SurveyWorldwide AFib Survey
Cappato R, Circulation ‘04
Atrial Fibrillation ablationAtrial Fibrillation ablation
62. What is success?
• Complete freedom of AF, off drug RX?
• No symptoms, but drug Rx required?
• Dramatic decrease in symptoms, but AADs
still required?
• QoL
• How do we detect asymptomatic episodes?
• Anticoagulation ………………...?
QUESTIONSQUESTIONS
63. Mickelson S, JICE ‘05
Cappato R, Circulation ‘05
In US EP believe 29% of pts with
AF are candidates for RFCA
• Lower volume centres have lower
success rates and higher
complication rate
Atrial Fibrillation ablationAtrial Fibrillation ablation
64. Scientific Paper
• Results coud beResults coud be
matched withmatched with
hystoricalhystorical
clinical dataclinical data
Registry
“Real life”
results
Clinical Practice
Acceptance degree of
randomized studies in clinical
practice
Prospectic data retrived of
clinical aspects in pts already
implanted with a PM
Evaluation of clinical benefits
due to specific PM functions
(ex. Impact of special
modality on several specific
“end-point”)
Hp,
Control
groups,
economic
evaluation
CLINICAL Practice VS Registries
Courtesy of Dr. Botto
TherapyTherapy
The prevailing opinion on the issue of why, how and when to maintain sinus rhythm in patients with Atrial Fibrillation has been recently questioned by three recently published trials comparing the two pharmacological strategies in atrial fibrillation: rhythm and rate control.
The landmark AFFIRM study found a trend toward increased mortality in the arm of patients treated with antiarrhythmic drugs to restore and thereafter maintain SR;
Indeed, subgroup analyses shows that the hypothesized advantage of rate controlling, is more pronounced in older patients, with ischemic heart disease and/or cardiac comorbidities.
Thus, it can be speculated that this advantage in controlling heart rate may have resulted from antiarrhythmic drug toxicity and failure in patients with structural heart disease.
Mr. Chairman and colleagues:
Atrial Fibrillation (AF) is a hot topic and an “arrhythmia en vogue” these days for many reasons. The management of this extremely common and vexing heart rhythm disturbance, which is associated with a significant high risk of stroke, heart failure and death compared to normal sinus rhythm, has become more complex.
(SLIDE 8) However, PVs anatomy and LA/PVs junction can be very changeable in morphology and anatomic variation, as you can see in this pictures (such as left or right common trunk, or numeber or anatomic variation in PVs numbers). At this purpose even if SOCA has clearly demonstrated to be very effective in AFib treatment, performing this procedure using the fluoroscopy technique alone could be technically challenging especially if LA three-dimensional (3D) geometry is particularly complex or atypical. A this purpose, the positioning of a circular mapping catheter or a repositioning after displacement could be imprecise under only fluoroscopic view and renders the creation of several lesions sometimes extremely difficult.
From stable primary mother wave impulses spread away with fibrillatory conduction along well oriented fibers around PVs, as you can see in this slide. Thus, it is important, when delivering circular lesions, to seek for anatomical orientation of myocardial fibers, so as to disconnect more appropriately PVs from the LA.
(SLIDE 3) However, at this purpose it’s clearly evident that pulmonary veins (PVs) can play a dominant role for initiation and maintenance AF, especially in Paroxismal AF or in mild or moderate LA enlargement, since Dr. Haissaguerre and colleagues firstly discovered that ectopic beats or rapidly firing foci, predominantly located in the muscle sleeves within pulmonary veins (PVs) or around the left atrium (LA) – PV junction, can start AF.
PVs can play a dominant role as source of trigger and in the maintenance of AF and, defined the pivotal role played by PVs and considering the dominant role played by the excitable tissues located around the PVs ostia, the next step was limited the EP interactions between these areas and the remaining LA tissue.
(SLIDE 3) However, at this purpose it’s clearly evident that pulmonary veins (PVs) can play a dominant role for initiation and maintenance AF, especially in Paroxismal AF or in mild or moderate LA enlargement, since Dr. Haissaguerre and colleagues firstly discovered that ectopic beats or rapidly firing foci, predominantly located in the muscle sleeves within pulmonary veins (PVs) or around the left atrium (LA) – PV junction, can start AF.
PVs can play a dominant role as source of trigger and in the maintenance of AF and, defined the pivotal role played by PVs and considering the dominant role played by the excitable tissues located around the PVs ostia, the next step was limited the EP interactions between these areas and the remaining LA tissue.
Similar to the previous slide, the altered strain patterns in the left ventricle can induce cellular and sub-cellular remodeling, as well as, fibrosis and calcification. Note: this occurs a distance from the pacing lead location.
(SLIDE 8) However, PVs anatomy and LA/PVs junction can be very changeable in morphology and anatomic variation, as you can see in this pictures (such as left or right common trunk, or numeber or anatomic variation in PVs numbers). At this purpose even if SOCA has clearly demonstrated to be very effective in AFib treatment, performing this procedure using the fluoroscopy technique alone could be technically challenging especially if LA three-dimensional (3D) geometry is particularly complex or atypical. A this purpose, the positioning of a circular mapping catheter or a repositioning after displacement could be imprecise under only fluoroscopic view and renders the creation of several lesions sometimes extremely difficult.
(SLIDE 12) Anatomo-patologic studies reveals a non-uniform distribution of the myocardial sleeves that extent from LA into PVs so that their disposition could not be circumferencial rather segmental. In this fashion to disconnect PVs from adiacent LA tissue and blocked the conduction, could not be necessary performed an encircling line around the PVs ostia as reported with CLAA.
(SLIDE 7) This last one approach has the ambitious convincement that the electrical isolation of PVs from the LA have been showed to be reliable for eliminating AF in an high percentage of selected patients. At this purpose, even if SOCA has been guided by EP mapping, novel strategies have emerged over the last decade, mostly based on anatomic considerations that support the adjunctive role of a 3D mapping.
AVI movie
Here’s a quick illustration to show you how the chamber maps are built. At the start of an EnSite procedure, the catheter is inserted in the chamber and validated by the system.
(click on map image)
As a catheter is moved within the chamber, the system records three-dimensional points. The operator can also give certain points special emphasis (indicated by white squares)—these are called locked points, to help define key areas of the anatomy, such as the isthmus or crista. As seen in the published literature, chamber maps or geometries can be built in as little as five minutes. Thereafter, there is no need for fluoroscopy, since the system provides superior orientation to fluoroscopy through the 3D model and superior catheter orientation through the 3D catheter display.
When the geometry is finished, event data can then be recorded.
(SLIDE 7) This last one approach has the ambitious convincement that the electrical isolation of PVs from the LA have been showed to be reliable for eliminating AF in an high percentage of selected patients. At this purpose, even if SOCA has been guided by EP mapping, novel strategies have emerged over the last decade, mostly based on anatomic considerations that support the adjunctive role of a 3D mapping.
(SLIDE 25 ) Because atrio-esophageal fistula is very rare but its occurrence is dramatic and devastating, we utilized lower RF energy applications when ablating particularly on the LA posterior wall, and to make the pulses on the posterior wall near to the roof of the LA, where the LA is not in direct contact with the esophagus. Anatomical-guided electrophysiological ablation procedures have been shown to be effective for curing AF.
(SLIDE 7) This last one approach has the ambitious convincement that the electrical isolation of PVs from the LA have been showed to be reliable for eliminating AF in an high percentage of selected patients. At this purpose, even if SOCA has been guided by EP mapping, novel strategies have emerged over the last decade, mostly based on anatomic considerations that support the adjunctive role of a 3D mapping.
(SLIDE 7) This last one approach has the ambitious convincement that the electrical isolation of PVs from the LA have been showed to be reliable for eliminating AF in an high percentage of selected patients. At this purpose, even if SOCA has been guided by EP mapping, novel strategies have emerged over the last decade, mostly based on anatomic considerations that support the adjunctive role of a 3D mapping.