Heart failure is a dynamic condition with high morbidity and mortality and its prognosis should be reassessed frequently, particularly in patients for whom critical treatment decisions may depend on the results of pro...Heart failure is a dynamic condition with high morbidity and mortality and its prognosis should be reassessed frequently, particularly in patients for whom critical treatment decisions may depend on the results of prognostication. In patients with heart failure, nuclear cardiology techniques are useful to establish the etiol-ogy and the severity of the disease, while fewer studies have explored the potential capability of nuclear cardi-ology to guide cardiac resynchronization therapy （CRT） and to select patients for implantable cardioverter defbrillators （ICD）. Left ventricular synchrony may be assessed by radionuclide angiography or gated single-photon emission computed tomography myocardial perfusion scintigraphy. These modalities have shown promise as predictors of CRT outcome using phase analysis. Combined assessment of myocardial viability and left ventricular dyssynchrony is feasible using posi-tron emission tomography and could improve conven-tional response prediction criteria for CRT. Preliminary data also exists on integrated positron emission tomog-raphy/computed tomography approach for assessing myocardial viability, identifying the location of biven-tricular pacemaker leads, and obtaining left ventricular functional data, including contractile phase analysis. Fi-nally, cardiac imaging with autonomic radiotracers may be useful in predicting CRT response and for identifying patients at risk for sudden cardiac death, therefore po-tentially offering a way to select patients for both CRT and ICD therapy. Prospective trials where imaging is combined with image-test driven therapy are needed to better defne the role of nuclear cardiology for guiding device therapy in patients with heart failure.展开更多
OBJECTIVES: We assessed feasibility of magnetic catheter guidance in patients with atrial fibrillation(AF) undergoing circumferential pulmonary vein ablation( CPVA). BACKGROUND: No data are available on feasibility of...OBJECTIVES: We assessed feasibility of magnetic catheter guidance in patients with atrial fibrillation(AF) undergoing circumferential pulmonary vein ablation( CPVA). BACKGROUND: No data are available on feasibility of remote navigation for AF ablation. METHODS: Forty patients underwent CPVA for symptomatic AF using th e NIOBE II remote magnetic system(Stereotaxis Inc., St. Louis, Missouri). Ablati on was performed with a 4-mm tip, magnetic catheter(65℃, maximum 50 W, 15 s). The catheter tip was guided by a uniform magnetic field(0.08-T), and a motor dr ive(Cardiodrive unit, Stereotaxis Inc.). Left atrium maps were created using an integrated CARTO RMT system(Stereotaxis Inc.). End point of ablation was voltage abatement >90%of bipolar electrogram amplitude. RESULTS: Remote ablation was s uccessful in 38 of 40 patients without complications. The median mapping and abl ation time was 152.5 min(range, 90 to 380 min) but was much longer in the first 12 patients(192.5 min vs. 148 min; p=0.012). Median ablation time was 49.5 min(r ange, 17 to 154 min), but it was much shorter in the last 28 patients than in th e first 12 patients(49 min vs. 70 min; p=0.021). Patients receiving remote ablat ion had longer procedure times than control patients(p< 0.001) with similar mapp ing time but shorter ablation time on right-sided pulmonary veins. Many more ma pping points regardless of their location were collected remotely(p< 0.001). CON CLUSIONS: Remote magnetic navigation for AF ablation is safe and feasible with a short learning curve. Although all pro cedures were performed by a highly experienced operator, remote AF ablation can be performed even by less experienced operators.展开更多
文摘Heart failure is a dynamic condition with high morbidity and mortality and its prognosis should be reassessed frequently, particularly in patients for whom critical treatment decisions may depend on the results of prognostication. In patients with heart failure, nuclear cardiology techniques are useful to establish the etiol-ogy and the severity of the disease, while fewer studies have explored the potential capability of nuclear cardi-ology to guide cardiac resynchronization therapy （CRT） and to select patients for implantable cardioverter defbrillators （ICD）. Left ventricular synchrony may be assessed by radionuclide angiography or gated single-photon emission computed tomography myocardial perfusion scintigraphy. These modalities have shown promise as predictors of CRT outcome using phase analysis. Combined assessment of myocardial viability and left ventricular dyssynchrony is feasible using posi-tron emission tomography and could improve conven-tional response prediction criteria for CRT. Preliminary data also exists on integrated positron emission tomog-raphy/computed tomography approach for assessing myocardial viability, identifying the location of biven-tricular pacemaker leads, and obtaining left ventricular functional data, including contractile phase analysis. Fi-nally, cardiac imaging with autonomic radiotracers may be useful in predicting CRT response and for identifying patients at risk for sudden cardiac death, therefore po-tentially offering a way to select patients for both CRT and ICD therapy. Prospective trials where imaging is combined with image-test driven therapy are needed to better defne the role of nuclear cardiology for guiding device therapy in patients with heart failure.
文摘OBJECTIVES: We assessed feasibility of magnetic catheter guidance in patients with atrial fibrillation(AF) undergoing circumferential pulmonary vein ablation( CPVA). BACKGROUND: No data are available on feasibility of remote navigation for AF ablation. METHODS: Forty patients underwent CPVA for symptomatic AF using th e NIOBE II remote magnetic system(Stereotaxis Inc., St. Louis, Missouri). Ablati on was performed with a 4-mm tip, magnetic catheter(65℃, maximum 50 W, 15 s). The catheter tip was guided by a uniform magnetic field(0.08-T), and a motor dr ive(Cardiodrive unit, Stereotaxis Inc.). Left atrium maps were created using an integrated CARTO RMT system(Stereotaxis Inc.). End point of ablation was voltage abatement >90%of bipolar electrogram amplitude. RESULTS: Remote ablation was s uccessful in 38 of 40 patients without complications. The median mapping and abl ation time was 152.5 min(range, 90 to 380 min) but was much longer in the first 12 patients(192.5 min vs. 148 min; p=0.012). Median ablation time was 49.5 min(r ange, 17 to 154 min), but it was much shorter in the last 28 patients than in th e first 12 patients(49 min vs. 70 min; p=0.021). Patients receiving remote ablat ion had longer procedure times than control patients(p< 0.001) with similar mapp ing time but shorter ablation time on right-sided pulmonary veins. Many more ma pping points regardless of their location were collected remotely(p< 0.001). CON CLUSIONS: Remote magnetic navigation for AF ablation is safe and feasible with a short learning curve. Although all pro cedures were performed by a highly experienced operator, remote AF ablation can be performed even by less experienced operators.
