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المؤلفون: Oussama M. Wazni, D. Geoffrey Vince, Russell J. Fedewa, Mohamed Kanj, Walid Saliba, Scott Anjewierden
المصدر: Ultrasonic Imaging. 43:299-307
مصطلحات موضوعية: Radiofrequency Ablation, medicine.medical_specialty, Radiological and Ultrasound Technology, business.industry, Radiofrequency ablation, Myocardium, Inadequate monitoring, Ultrasound, Atrial fibrillation, medicine.disease, law.invention, Echocardiography, law, Internal medicine, Atrial Fibrillation, Catheter Ablation, medicine, Cardiology, Humans, Radiology, Nuclear Medicine and imaging, Atrial myocardium, Spectral analysis, Heart Atria, business
الوصف: Radiofrequency ablation (RFA) is a common treatment of atrial fibrillation. However, current treatment is associated with a greater than 20% recurrence rate, in part due to inadequate monitoring of tissue viability during ablation. Spectral parameters, in particular cyclic variation of integrated backscatter (CVIB), have shown promise as early indicators of myocardial recovery from ischemia. Our aim was to demonstrate the use of spectral parameters to differentiate atrial myocardium before and after radiofrequency ablation. An AcuNav 10 F catheter was used to collect radiofrequency signals from the posterior wall of the left atrium of patients before and immediately after RFA for AF. The normalized power spectrum was obtained and three spectral parameters (integrated backscatter [IB], slope, and intercept) were extracted across two continuous heart cycles. Parameters were gated for ventricular end-diastole and compared before and after ablation. Additionally, the cyclic variation of each of these three parameters was generated as an average of the variation across the two recorded heart cycles. Data from 14 patients before and after ablation demonstrated a significant difference in the magnitude of the cyclic variation of integrated backscatter (9.0 vs. 6.0 dB, p
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c525b82034ee4a575d1cce4282a4c128
https://doi.org/10.1177/01617346211046314 -
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المؤلفون: Walid Saliba, Mohamed Kanj, Koji Higuchi, Jakub Sroubek, Khaldoun G. Tarakji, Ayman A. Hussein, Oussama M. Wazni, Daniel J. Cantillon, Zachary P. Bubar, Elad Anter, Hagai D. Yavin
المصدر: Circulation. Arrhythmia and electrophysiology. 14(11)
مصطلحات موضوعية: Male, Time Factors, Radiofrequency ablation, medicine.medical_treatment, Pulmonary vein, law.invention, Body Temperature, Esophagus, law, Heart Conduction System, Physiology (medical), Atrial Fibrillation, Medicine, Humans, Esophageal Fistula, Aged, Retrospective Studies, Thermal injury, business.industry, Atrial fibrillation, medicine.disease, Ablation, Esophageal Tissue, medicine.anatomical_structure, Treatment Outcome, Pulmonary Veins, Catheter Ablation, Female, Cardiology and Cardiovascular Medicine, business, Nuclear medicine, Follow-Up Studies
الوصف: Background: High-power short-duration (HP-SD) radiofrequency ablation (RFA) has been proposed as a method for producing rapid and effective lesions for pulmonary vein isolation. The underlying hypothesis assumes an increased resistive heating phase and decreased conductive heating phase, potentially reducing the risk for esophageal thermal injury. The objective of this study was to compare the esophageal temperature dynamic profile between HP-SD and moderate-power moderate-duration (MP-MD) RFA ablation strategies. Methods: In patients undergoing pulmonary vein isolation, RFA juxtaposed to the esophagus was delivered in an alternate sequence of HP-SD (50 W, 8–10 s) and MP-MD (25 W, 15–20 s) between adjacent applications (distance, ≤4 mm). Esophageal temperature was recorded using a multisensor probe (CIRCA S-CATH). Temperature data included magnitude of temperature rise, maximal temperature, time to maximal temperature, and time return to baseline. In swine, a similar experimental design compared the effect of HP-SD and MP-MD on patterns of esophageal injury. Results: In 20 patients (68.9±5.8 years old; 60% persistent atrial fibrillation), 55 paired HP-SD and MP-MD applications were analyzed. The esophageal temperature dynamic profile was similar between HP-SD and MP-MD ablation strategies. Specifically, the magnitude of temperature rise (2.1 °C [1.4–3] versus 2.0 °C [1.5–3]; P =0.22), maximal temperature (38.4 °C [37.8–39.3] versus 38.5 °C [37.9–39.4]; P =0.17), time to maximal temperature (24.9±7.5 versus 26.3±6.8 s; P =0.1), and time of temperature to return to baseline (110±23.2 versus 111±25.1 s; P =0.86) were similar between HP-SD and MP-MD ablation strategies. In 6 swine, esophageal injury was qualitatively similar between HP-SD and MP-MD strategies. Conclusions: Esophageal temperature dynamics are similar between HP-SD and MP-MD RFA strategies and result in comparable esophageal tissue injury. Therefore, when using a HP-SD RFA strategy, the shorter application duration should not prompt shorter intervals between applications.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::acae2d3127d84fb392239dcea33774a8
https://pubmed.ncbi.nlm.nih.gov/34706551 -
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المؤلفون: Islam Y. Elgendy, Omar M Abdelfattah, Walid Saliba, T. Jared Bunch, Ayman A. Hussein, Rohan Madhu Prasad, Amr F. Barakat, Mahmoud Elsayed, Amit Thosani, Jason G. Andrade, Ahmed Sayed, Oussama M. Wazni
المصدر: Journal of cardiovascular electrophysiologyREFERENCES. 33(2)
مصطلحات موضوعية: medicine.medical_specialty, Radiofrequency ablation, medicine.medical_treatment, Network Meta-Analysis, Catheter ablation, Cryosurgery, law.invention, Randomized controlled trial, law, Recurrence, Physiology (medical), Internal medicine, Atrial Fibrillation, medicine, Humans, Atrial tachycardia, Radiofrequency Ablation, business.industry, Cryoablation, Atrial fibrillation, Ablation, medicine.disease, Treatment Outcome, Cardiology, Catheter Ablation, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Anti-Arrhythmia Agents, Atrial flutter
الوصف: BACKGROUND Antiarrhythmic drugs (AADs) and catheter ablation are first line treatments of paroxysmal atrial fibrillation (PAF), however there exists a paucity of data regarding the potential benefit of different catheter ablation technologies versus AADs as an early rhythm strategy. OBJECTIVE To assess the safety and efficacy of cryoablation versus radiofrequency ablation vs AADs as a first line therapy of PAF. METHODS MEDLINE, Embase, Scopus and CENTRAL were searched to retrieve randomized clinical trials (RCTs) comparing cryoablation, radiofrequency ablation (RFA) or AADs to one another as first line therapies for AF. The primary outcome was overall freedom from arrhythmia recurrence [AF, atrial flutter (AFL), atrial tachycardia)]. Secondary outcomes included freedom from symptomatic arrhythmia recurrence, hospitalization, and serious adverse events. A random-effects Bayesian network meta-analysis was used to calculate odds ratios (OR) and 95% credible intervals (CrI). RESULTS Six RCTs (N = 1,212) met the inclusion criteria (605 AADs, 365 Cryoablation, and 245 RFA). Compared with AADs, overall recurrence was reduced with RFA (OR: 0.31; 95% CrI: 0.10 to 0.71) and cryoablation (OR: 0.39; 95% CrI: 0.16 to 1.00). Comparing ablation (cryoablation and RFA) with AADs in respect to freedom from symptomatic AF recurrence, neither cryoablation (OR: 0.35; 95% CrI: 0.06 to 1.96) nor RFA (OR: 0.34; 95% CrI: 0.07 to 1.27) resulted in statistically significant reductions individually compared to AADs, though pooled ablation with both technologies showed lower odds of arrhythmia recurrence (OR: 0.35; 95% CrI: 0.13 to 0.79). In terms of serious adverse events rates, neither cryoablation (OR: 0.77; 95% CrI: 0.44 to 1.39) nor RFA (OR: 1.45; 95% CrI: 0.67 to 3.23) were significantly different to AADs. RFA resulted in a statistically significant reduction in hospitalizations compared to AAD (OR: 0.08; 95% CrI: 0.01 to 0.99), whereas cryoablation did not (OR: 0.77; 95% CrI: 0.44 to 1.39). The surface under the cumulative ranking curve (SUCRA) showed RFA to be the most effective treatment at reducing overall rates of recurrence, symptomatic recurrence and hospitalizations; whereas cryoablation was most likely to reduce serious adverse events. CONCLUSION Cryoablation and RFA are both effective and safe first line therapies for AF compared to AADs, with RFA being the most effective at reducing recurrences. This article is protected by copyright. All rights reserved.
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المؤلفون: Arun Sridhar, Ayman A. Hussein, Oussama M. Wazni
المصدر: Cleveland Clinic Journal of Medicine. 85:789-799
مصطلحات موضوعية: medicine.medical_specialty, Referral, Radiofrequency ablation, medicine.medical_treatment, Ablation of atrial fibrillation, MEDLINE, Referring Physician, macromolecular substances, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Internal medicine, Atrial Fibrillation, medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Referral and Consultation, Cardiac electrophysiology, business.industry, Atrial fibrillation, General Medicine, Ablation, medicine.disease, Catheter Ablation, cardiovascular system, Cardiology, business
الوصف: Radiofrequency ablation has become a safe and effective treatment for atrial fibrillation. We believe that referral to an electrophysiologist for consideration of ablation may allow for better rhythm control and outcomes by altering the natural history of atrial fibrillation progression.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::47dc261d2f65bff7a40a8917c3526fd3
https://doi.org/10.3949/ccjm.85a.17092 -
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المؤلفون: Ayman A. Hussein, Wael A. Jaber, Oussama M. Wazni
المصدر: Circulation: Arrhythmia and Electrophysiology. 14
مصطلحات موضوعية: medicine.medical_specialty, Radiofrequency ablation, medicine.medical_treatment, Atrial Appendage, Catheter ablation, law.invention, Electrical isolation, Left atrial, law, Physiology (medical), Internal medicine, Atrial Fibrillation, medicine, Humans, Propensity Score, Stroke, Appendage, business.industry, Anticoagulants, Atrial fibrillation, medicine.disease, Catheter Ablation, Cardiology, Cardiology and Cardiovascular Medicine, business
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f9637c7a216bbe8dc42d610ce14530ea
https://doi.org/10.1161/circep.120.009409 -
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المؤلفون: Arshneel Kochar, Oussama M. Wazni, Roy Chung, Taha Ahmed, Patrick J. Tchou, Eoin Donnellan
المصدر: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. 61(1)
مصطلحات موضوعية: medicine.medical_specialty, Radiofrequency ablation, medicine.medical_treatment, Catheter ablation, 030204 cardiovascular system & hematology, law.invention, Ventricular contraction, 03 medical and health sciences, 0302 clinical medicine, law, Physiology (medical), Internal medicine, Atrial Fibrillation, medicine, Tachycardia, Supraventricular, Fluoroscopy, Humans, 030212 general & internal medicine, Procedure time, Retrospective Studies, medicine.diagnostic_test, business.industry, Atrial fibrillation, medicine.disease, Ablation, Treatment Outcome, Cardiology, Catheter Ablation, Supraventricular tachycardia, Cardiology and Cardiovascular Medicine, business, Learning Curve
الوصف: To investigate the learning curve for atrial fibrillation (AF), supraventricular tachycardia (SVT), and premature ventricular contraction (PVC) radiofrequency ablation (RFA) using zero fluoroscopy. This is a retrospective, single-center study of 167 patients undergoing ablation between 2016 and 2019. Minimal fluoroscopy approach was initiated after the first 20 cases of PVI and SVT RFA. Procedures were divided consecutively into increments of 10 cases to determine operator learning curve. A total of 64 (38%) had SVT ablations, 26 (16%) had PVC ablations, and 77 (46%) had AF and underwent PVI. For SVT RFA, fluoroscopy time improved from 4.1 ± 3.5 min during the first 10 cases to 0.8 ± 1.2 min after 50 cases (p = 0.0001). Sixty-two out of 64 (97%) of cases were successful. In PVC RFA, fluoroscopy time was 7.7 ± 5.5 min for the first 5, 2.3 ± 3.4 min after 15, and 0 min after 20 cases (p = 0.0008). Twenty-four out of 26 (92%) of cases were acutely successful with recurrence in 2/26 (8%) of patients over 9 ± 9 months. In PVI, fluoroscopy time was 9.9 ± 3.3 min over the first 20 cases, 2.6 ± 2.3 min after 40 cases, and 0.1 min after 50 cases (p
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المؤلفون: Mina K. Chung, Khaldoun G. Tarakji, Ali H. Hakim, Mohamed Kanj, Amr F. Barakat, Mark Niebauer, Mohammed A. Chamsi-Pasha, Bruce D. Lindsay, Oussama M. Wazni, Andrea Natale, David O. Martin, Ayman A. Hussein, Thomas Dresing, Mandeep Bhargava, Thomas Callahan, Patrick J. Tchou, Mohammed Bassiouny, Daniel J. Cantillon, Rasha Al-Bawardy, Bryan Baranowski, Niraj Varma, Walid Saliba
مصطلحات موضوعية: Male, medicine.medical_specialty, Time Factors, Radiofrequency ablation, medicine.drug_class, medicine.medical_treatment, Catheter ablation, 030204 cardiovascular system & hematology, Article, law.invention, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, law, Heart Conduction System, Risk Factors, Physiology (medical), Internal medicine, Atrial Fibrillation, Natriuretic peptide, Medicine, Humans, 030212 general & internal medicine, Heart Atria, Ultrasonography, Interventional, Retrospective Studies, medicine.diagnostic_test, business.industry, Hazard ratio, Atrial fibrillation, Atrial Remodeling, Middle Aged, medicine.disease, Ablation, Confidence interval, Treatment Outcome, Cardiology, Catheter Ablation, Female, Cardiology and Cardiovascular Medicine, business, Biomarkers, Follow-Up Studies
الوصف: Background— Various ablation strategies of persistent atrial fibrillation (PersAF) have had disappointing outcomes, despite concerted clinical and research efforts, which could reflect progressive atrial fibrillation–related atrial remodeling. Methods and Results— Two-year outcomes were assessed in 1241 consecutive patients undergoing first-time ablation of PersAF (2005–2012). The time intervals between the first diagnosis of PersAF and the ablation procedures were determined. Patients had echocardiograms and measures of B-type natriuretic peptide and C-reactive protein before the procedures. The median diagnosis-to-ablation time was 3 years (25th–75th percentiles 1–6.5). With longer diagnosis-to-ablation time (based on quartiles), there was a significant increase in recurrence rates in addition to an increase in B-type natriuretic peptide levels ( P =0.01), C-reactive protein levels ( P P =0.03). The arrhythmia recurrence rates over 2 years were 33.6%, 52.6%, 57.1%, and 54.6% in the first, second, third, and fourth quartiles, respectively ( P categorical P P categorical Conclusions— In patients with PersAF undergoing ablation, the time interval between the first diagnosis of PersAF and the catheter ablation procedure had a strong association with the ablation outcomes, such as shorter diagnosis-to-ablation times were associated with better outcomes and in direct association with markers of atrial remodeling.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f008ecceb452de84b20c13ec7fe6591a
https://europepmc.org/articles/PMC5349298/ -
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المؤلفون: Oussama M. Wazni, Minerva Sherman, Deven Patel, Michelle Williams-Andrews, David O. Martin, Mustafa Banna, Walid Saliba, Bruce D. Lindsay, Thomas Callahan, Andrea Natale, Salwa Beheiry, Ayman A. Hussein, Mohamed Kanj, Thomas Dresing, Omar Batal, Saima Karim, Mandeep Bhargava, Luigi Di Biase, Patrick J. Tchou
المصدر: Heart Rhythm. 6:1425-1429
مصطلحات موضوعية: Male, medicine.medical_specialty, Radiofrequency ablation, medicine.medical_treatment, Hemorrhage, Pulmonary vein, law.invention, Postoperative Complications, law, Physiology (medical), Atrial Fibrillation, medicine, Humans, cardiovascular diseases, Stroke, business.industry, Warfarin, Anticoagulants, Atrial fibrillation, Heparin, Middle Aged, medicine.disease, Ablation, Surgery, Pulmonary Veins, Catheter Ablation, Female, Tamponade, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies, medicine.drug
الوصف: Background The best periprocedural anticoagulation strategy at the time of pulmonary vein isolation (PVI) is not known. Most centers stop administering warfarin (Coumadin) and use bridging with heparin or enoxaparin. Objective The purpose of this study was to evaluate the efficacy and safety of PVI under therapeutic international normalized ratio (INR). Methods Between January 2005 and December 2008, PVI was performed in 3,052 patients with therapeutic INR (≥1.8) at the time of ablation. All patients were evaluated for ischemic strokes and bleeding complications. Results Mean INR was 2.53 ± 0.62. Only 3 (0.098%) patients had ischemic strokes. One patient had a hemorrhagic stroke on the third day postablation but recovered completely by 1-week follow-up. Bleeding complications occurred in 34 (1.11%) patients; most were minor (0.79%). Major hemorrhagic complications occurred in 10 (0.33%) patients (tamponade in 5, hematomas requiring intervention in 2, transfusion necessary in 3). Conclusion In a large patient population, continuation of Coumadin at a therapeutic INR at the time of PVI without use of heparin or enoxaparin for bridging is a safe and efficacious periprocedural anticoagulation strategy. It is an acceptable and potentially better alternative to strategies that use bridging with heparin or enoxaparin.
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المؤلفون: Oussama M. Wazni, Atul Verma, Charles R. Kerr, Carlos A. Morillo, Yaariv Khaykin, Andrea Natale, Allan C. Skanes, Karin H. Humphries, Xiaoyin Wang
المصدر: Journal of Cardiovascular Electrophysiology. 20:7-12
مصطلحات موضوعية: Male, Canada, medicine.medical_specialty, Radiofrequency ablation, Cost-Benefit Analysis, medicine.medical_treatment, Catheter ablation, law.invention, Pharmacotherapy, Randomized controlled trial, law, Physiology (medical), Atrial Fibrillation, medicine, Humans, Computer Simulation, Intensive care medicine, health care economics and organizations, Health economics, Cost–benefit analysis, business.industry, Atrial fibrillation, Health Care Costs, medicine.disease, Models, Economic, Treatment Outcome, Emergency medicine, Economic evaluation, Catheter Ablation, Female, Cardiology and Cardiovascular Medicine, business, Anti-Arrhythmia Agents
الوصف: Introduction: Radiofrequency ablation (RFA) has become an accepted therapy for atrial fibrillation (AF). The objective of this study was to perform an economic evaluation of RFA versus antiarrhythmic drug therapy (AAD) as first-line treatment of symptomatic paroxysmal AF. Methods: To estimate and compare the costs of RFA versus AAD, a decision analytic model was developed using data on AF recurrence, hospitalization rates, AAD use, and treatment crossover rates derived directly from the Randomized Trial of RFA versus AAD as First-Line Treatment of Symptomatic Atrial Fibrillation (RAAFT). Resource utilization was modeled to reflect Canadian clinical practice in AF management. Unit costs of healthcare interactions were based on available Canadian government resources and published literature. Costs were assessed based on intention-to-treat. Total expected costs were computed to include initial treatment, hospital stay, physician fees, diagnostic tests, and outpatient visits. Sensitivity analyses were performed to account for the uncertainties. The study was conducted from the third party payer's perspective and costs are reported in 2005 Canadian dollars with 3% discount rate used in the analysis. Results: During the 2-month blanking period following therapy selection, total average costs for RFA and AAD were $10,465 and $2,556, respectively; at 1-year follow-up, these were $12,823 and $6,053; and total 2-year cumulative total average costs were $15,303 and $14,392. Sensitivity analyses did not alter the results, suggesting the model is robust. Conclusions: RFA as first-line treatment strategy in patients with symptomatic paroxysmal AF was cost neutral 2 years after the initial procedure compared to AAD.
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المؤلفون: Tamer S. Fahmy, Oussama M. Wazni, Sergio Thal, David O. Martin, Mohamed Kanj, Andrea Natale, Dhanunjaya R. Lakkireddy, J. David Burkhardt, Walid Saliba, Robert A. Schweikert
المصدر: Journal of the American College of Cardiology. 48:1405-1409
مصطلحات موضوعية: medicine.medical_specialty, Cox maze procedure, Radiofrequency ablation, business.industry, medicine.medical_treatment, Atrial fibrillation, Catheter ablation, medicine.disease, law.invention, Surgery, Cardiac surgery, Catheter, law, Internal medicine, cardiovascular system, medicine, Cardiology, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, Atrial flutter, Coronary sinus
الوصف: Objectives We describe the clinical and electrophysiologic characteristics and management of post “cut and sew” Maze arrhythmias in symptomatic patients. Background The Cox Maze procedure was developed as a surgical treatment of atrial fibrillation. Until recently, invasive electrophysiologic studies in patients with symptomatic post-operative arrhythmias in this patient population have not been described. Methods The management and clinical course of consecutive patients with post-Maze arrhythmias refractory to antiarrhythmic drugs (AADs) between January 2000 and December 2003 are presented. Results Twenty-three patients (15 men) presented 14 ± 14 months after Maze surgery for treatment of atrial fibrillation (AF). Eight patients underwent “cut and sew” Maze for lone AF with no other surgical indication. Fifteen patients underwent the “cut and sew” Maze procedure in addition to another surgical procedure: mitral valve surgery (11 patients) and coronary artery bypass graft surgery (4 patients). Eight patients (35%) had recurrent AF secondary to recovered conduction around the lines encircling the pulmonary veins. Five patients were documented to have focal atrial tachycardia, which was mapped to the coronary sinus in 3 patients, to the posterolateral right atrium in 1 patient, and to the left atrial (LA) septum in 1 patient. Four patients had right atrium incisional atrial flutter (AFL), and 6 had LA incisional AFL, which was mapped around the mitral valve annulus in 4 patients and around the right pulmonary veins in 2 patients. Twenty-two of the 23 patients were treated successfully with radiofrequency ablation. At 1-year follow-up, 19 patients were arrhythmia-free and taking no AADs. Conclusions After surgical “cut and sew” Maze, approximately one-third of patients experiencing atrial arrhythmias have AF secondary to pulmonary vein-left atrium conduction recovery. Moreover, incisional AFL seems to be a common finding in this group of patients. Catheter-based mapping and ablation of these arrhythmias seems to be feasible and effective.
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