In the hyperadrenergic state of VT storm where shocks are psychologically and physiologically traumatizing, suppression of sympathetic outflow from the organ level of the heart up to higher braincenters plays a signif...In the hyperadrenergic state of VT storm where shocks are psychologically and physiologically traumatizing, suppression of sympathetic outflow from the organ level of the heart up to higher braincenters plays a significant role in reducing the propensity for VT recurrence. The autonomic nervous system continuously receives input from the heart （afferent signaling）, integrates them, and sends efferent signals to modify or maintain cardiac function and arrhythmogenesis. Spinal anesthesia with thoracic epidural infusion of bupivicaine and surgical removal of the sympathetic chain including the stellate ganglion has been shown to decrease recurrences of VT. Excess sympathetic outflow with catecholamine release can be modified with catheter-based renal denervation. The insights provided from animal experiments and in patients that are refractory to conventional therapy have significantly improved our working understanding of the heart as an end organ in the autonomic nervous system.展开更多
The feasibility and safety of intracardiac echocardiography(ICE)-guided catheter ablation for atrial fibrillation(AF)using a minimal/zero-fluoroscopy approach have recently been reported.This approach helps to reduce ...The feasibility and safety of intracardiac echocardiography(ICE)-guided catheter ablation for atrial fibrillation(AF)using a minimal/zero-fluoroscopy approach have recently been reported.This approach helps to reduce ionizing radiation exposure and orthopedic complications resulting from using lead aprons.The objectives of this planned prospective,multicenter randomized controlled trial(RCT)(paroxysmal AF(PAF)-ICE trial;ChiCTR2000033624)are to evaluate the efficacy and safety of ICE-guided minimal-fluoroscopy ablation in patients with PAF and the impact on occupational hazards among lab staff.Patients will be randomized in a 1:1 ratio to 2 groups:minimal fluoroscopy group(n=216)and traditional approach group(n=216).In the minimal fluoroscopy group,an ICE catheter will be used for geometry/anatomic construction,transseptal puncture,catheter tracking,and effusion monitoring.Pulmonary vein isolation(PVI)will be performed using an open-irrigated radiofrequency SmartTouch Surround Flow or SmartTouch catheter(Biosense Webster,Diamond Bar,California,USA),and confirmed by a multipolar Lasso or PentaRay catheter(Biosense Webster).In the traditional approach group,an ICE catheter will not be used.Transseptal puncture will be performed under fluoroscopic guidance,with all geometries constructed by mapping the catheters.The primary efficacy endpoint is freedom from AF recurrence(without antiarrhythmic medications)at 12months after ablation.Other endpoints include duration of lead apron use,measures of intra-procedural efficiency,and peri-procedural complications.This RCT will evaluate the efficacy and safety of ICE-guided minimal-fluoroscopy ablation in patients with PAF,also evaluate the benefits to lab staff(regarding reducing occupational hazards)related to this“minimal/zero-fluoroscopy”and“leadless”mode.展开更多
文摘In the hyperadrenergic state of VT storm where shocks are psychologically and physiologically traumatizing, suppression of sympathetic outflow from the organ level of the heart up to higher braincenters plays a significant role in reducing the propensity for VT recurrence. The autonomic nervous system continuously receives input from the heart （afferent signaling）, integrates them, and sends efferent signals to modify or maintain cardiac function and arrhythmogenesis. Spinal anesthesia with thoracic epidural infusion of bupivicaine and surgical removal of the sympathetic chain including the stellate ganglion has been shown to decrease recurrences of VT. Excess sympathetic outflow with catecholamine release can be modified with catheter-based renal denervation. The insights provided from animal experiments and in patients that are refractory to conventional therapy have significantly improved our working understanding of the heart as an end organ in the autonomic nervous system.
基金supported by the Investigator-Initiated Study Program of Biosense Webster,Inc.(Diamond Bar,California,USA).
文摘The feasibility and safety of intracardiac echocardiography(ICE)-guided catheter ablation for atrial fibrillation(AF)using a minimal/zero-fluoroscopy approach have recently been reported.This approach helps to reduce ionizing radiation exposure and orthopedic complications resulting from using lead aprons.The objectives of this planned prospective,multicenter randomized controlled trial(RCT)(paroxysmal AF(PAF)-ICE trial;ChiCTR2000033624)are to evaluate the efficacy and safety of ICE-guided minimal-fluoroscopy ablation in patients with PAF and the impact on occupational hazards among lab staff.Patients will be randomized in a 1:1 ratio to 2 groups:minimal fluoroscopy group(n=216)and traditional approach group(n=216).In the minimal fluoroscopy group,an ICE catheter will be used for geometry/anatomic construction,transseptal puncture,catheter tracking,and effusion monitoring.Pulmonary vein isolation(PVI)will be performed using an open-irrigated radiofrequency SmartTouch Surround Flow or SmartTouch catheter(Biosense Webster,Diamond Bar,California,USA),and confirmed by a multipolar Lasso or PentaRay catheter(Biosense Webster).In the traditional approach group,an ICE catheter will not be used.Transseptal puncture will be performed under fluoroscopic guidance,with all geometries constructed by mapping the catheters.The primary efficacy endpoint is freedom from AF recurrence(without antiarrhythmic medications)at 12months after ablation.Other endpoints include duration of lead apron use,measures of intra-procedural efficiency,and peri-procedural complications.This RCT will evaluate the efficacy and safety of ICE-guided minimal-fluoroscopy ablation in patients with PAF,also evaluate the benefits to lab staff(regarding reducing occupational hazards)related to this“minimal/zero-fluoroscopy”and“leadless”mode.
