2019 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Catheter Ablation of Ventricular Arrhythmias

Total Page:16

File Type:pdf, Size:1020Kb

2019 HRS/EHRA/APHRS/LAHRS Expert Consensus Statement on Catheter Ablation of Ventricular Arrhythmias 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias Edmond M. Cronin, MB, BCh, BAO, FHRS, CCDS, CEPS-A (Chair),1 Frank M. Bogun, MD (Vice-Chair),2 Philippe Maury, MD (EHRA Chair),3 Petr Peichl, MD, PhD (EHRA Vice-Chair),4 Minglong Chen, MD, PhD, FHRS (APHRS Chair),5 Narayanan Namboodiri, MBBS, MD (APHRS Vice-Chair),6 Luis Aguinaga, MD, PhD, FESC, FACC (LAHRS Chair),7 Luiz Roberto Leite, MD, PhD, FHRS (LAHRS Vice-Chair),8 Sana M. Al-Khatib, MD, MHS, FHRS, CCDS,9 Elad Anter, MD,10 Antonio Berruezo, MD, PhD,11,* David J. Callans, MD, FHRS, CCDS,12 Mina K. Chung, MD, FHRS,13,† Phillip Cuculich, MD,14 Andre d’Avila, MD, PhD,15,‡ Barbara J. Deal, MD, FACC,16,x Paolo Della Bella, MD,17,* Thomas Deneke, MD, PhD, FHRS,18,* Timm-Michael Dickfeld, MD, PhD, FACC, FHRS,19 Claudio Hadid, MD,20,{ Haris M. Haqqani, MBBS, PhD, FHRS,21,# G. Neal Kay, MD, CCDS,22 Rakesh Latchamsetty, MD, FHRS,2 Francis Marchlinski, MD, FHRS,12 John M. Miller, MD, FHRS,23,† Akihiko Nogami, MD, PhD,24,** Akash R. Patel, MD, FHRS, CEPS-P,25,†† Rajeev Kumar Pathak, MBBS, PhD, FHRS,26,# Luis C. Saenz Morales, MD,27,{ Pasquale Santangeli, MD, PhD,12 John L. Sapp, Jr., MD, FHRS,28 Andrea Sarkozy, MD, PhD, FEHRA,29,* Kyoko Soejima, MD,30,# William G. Stevenson, MD, FHRS,31 Usha B. Tedrow, MD, MS, FHRS,32 Wendy S. Tzou, MD, FHRS,33 Niraj Varma, MD, PhD,13 Katja Zeppenfeld, MD, PhD, FESC, FEHRA34,* Document Reviewers: Samuel J. Asirvatham, MD, FHRS; Eduardo Back Sternick, MD, PhD; Janice Chyou, MD; Sabine Ernst, MD, PhD; Guilherme Fenelon, MD, PhD; Edward P. Gerstenfeld, MD, MS, FACC; Gerhard Hindricks, MD; Koichi Inoue, MD, PhD; Jeffrey J. Kim, MD; Kousik Krishnan, MD, FHRS, FACC; Karl-Heinz Kuck, MD, FHRS; Martin Ortiz Avalos, MD; Thomas Paul, MD, FACC, FHRS; Mauricio I. Scanavacca, MD, PhD; Roderick Tung, MD, FHRS; Jamie Voss, MBChB; Takumi Yamada, MD; Teiichi Yamane, MD, PhD, FHRS From the 1Hartford Hospital, Hartford, Connecticut, 2University of Michigan, Ann Arbor, Michigan, 3University Hospital Rangueil, Toulouse, France, 4Institute for Clinical and Experimental Medicine, Prague, Czech Republic, 5Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China, 6Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India, 7Centro Privado de Cardiología, Tucuman, Argentina, 8Instituto Brasília de Arritmia, Brasília, Brazil, 9Duke University Medical Center, Durham, North Carolina, 10Beth Israel Deaconess Medical Center, Boston, Massachusetts, 11Heart Institute, Teknon Medical Center, Barcelona, Spain, 12University of Pennsylvania, Philadelphia, Pennsylvania, 13Cleveland Clinic, Cleveland, Ohio, 14Washington University School of Medicine, St. Louis, Missouri, 15Hospital Cardiologico SOS Cardio, Florianopolis, Brazil, 16Northwestern University Feinberg School of Medicine, Chicago, Illinois, 17Ospedale San Raffaele, Milan, Italy, 18Herz- und Gefaß-Klinik,€ Bad Neustadt, Germany, 19University of Maryland, Baltimore, Maryland, 20Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina, 21University of Queensland, The Prince Charles Hospital, 1547-5271/$-see front matter © 2019 The Heart Rhythm Society; the European Heart Rhythm https://doi.org/10.1016/j.hrthm.2019.03.002 Association, a registered branch of the European Society of Cardiology; the Asia Pacific Heart Rhythm Society; and the Latin American Heart Rhythm Society Published by Elsevier Inc./Oxford University Press/ Wiley. This article is published under the Creative Commons CC-BY license. PGL 5.5.0 DTD HRTHM7935_proof 7 May 2019 6:26 pm ce e2 Heart Rhythm, Vol -,No-, - 2019 Chermside, Australia, 22University of Alabama at Birmingham, Birmingham, Alabama, 23Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana, 24University of Tsukuba, Ibaraki, Japan, 25University of California San Francisco Benioff Children’s Hospital, San Francisco, California, 26Australian National University, Canberra Hospital, Canberra, Australia, 27CardioInfantil Foundation, Cardiac Institute, Bogota, Columbia, 28Queen Elizabeth II Health Sciences Centre, Halifax, Canada, 29University Hospital Antwerp, University of Antwerp, Antwerp, Belgium, 30Kyorin University School of Medicine, Tokyo, Japan, 31Vanderbilt University Heart and Vascular Center, Nashville, Tennessee, 32Brigham and Women’s Hospital, Boston, Massachusetts, 33University of Colorado Denver, Aurora, Colorado, and 34Leiden University Medical Center, Leiden, the Netherlands. *Representative of the European Heart Rhythm Association (EHRA) †Representative of the American College of Cardiology (ACC) ‡Representative of the Sociedade Brasileira de Arritmias Cardíacas (SOBRAC) xRepresentative of the American Heart Association (AHA) {Representative of the Latin American Heart Rhythm Society (LAHRS) #Representative of the Asia Pacific Heart Rhythm Society (APHRS) **Representative of the Japanese Heart Rhythm Society (JHRS) ††Representative of the Pediatric and Congenital Electrophysiology Society (PACES) KEYWORDS Catheter ablation; Clinical document; Electrical storm; resonance imaging; NCSV 5 noncoronary sinus of Valsalva; Electroanatomical mapping; Electrocardiogram; Expert consensus state- NICM 5 nonischemic cardiomyopathy; NIPS 5 noninvasive pro- ment; Imaging; Premature ventricular complex; Radiofrequency ablation; grammed stimulation; NYHA 5 New York Heart Association; Ventricular arrhythmia; Ventricular tachycardia OR 5 odds ratio; OT 5 outflow tract; PES 5 programmed electrical ABBREVIATIONS AAD 5 antiarrhythmic drug; ACT 5 activated stimulation; PET 5 positron emission tomography; clotting time; AF 5 atrial fibrillation; AHD 5 acute hemodynamic pLVAD 5 percutaneous left ventricular assist device; decompensation; AI 5 anatomical isthmus; AIV 5 anterior inter- PPI 5 postpacing interval; PVC 5 premature ventricular complex; ventricular vein; AMC 5 aortomitral continuity; ANS 5 autonomic RBB 5 right bundle branch; RBBB 5 right bundle branch block; nervous system; ARVC 5 arrhythmogenic right ventricular cardio- RCT 5 randomized controlled trial; RF 5 radiofrequency; myopathy; ATP 5 antitachycardia pacing; AV 5 atrioventricular; RSV 5 right sinus of Valsalva; RV 5 right ventricle; RVOT 5 right BBR 5 bundle branch reentry; BBRVT 5 bundle branch reentrant ventricular outflow tract; RWI 5 relationship with industry and ventricular tachycardia; cAMP 5 cyclic adenosine monophos- other entities; SD 5 standard deviation; SHD 5 structural heart phate; CCM 5 Chagas cardiomyopathy; CHD 5 congenital heart disease; SHFM 5 Seattle Heart Failure Model; SOO 5 site of origin; disease; ChD 5 Chagas disease; CIED 5 cardiovascular implant- SPECT 5 single-photon emission computerized tomography; able electronic device; CL 5 cycle length; CMR 5 cardiac magnetic SV 5 sinus of Valsalva; SVT 5 supraventricular tachycardia; resonance imaging; COR 5 class of recommendation; CRT 5 3D 5 three-dimensional; VA 5 ventricular arrhythmia; cardiac resynchronization therapy; CS 5 coronary sinus; VAD 5 ventricular assist device; VF 5 ventricular fibrillation; CSD 5 cardiac sympathetic denervation; CT 5 computed tomogra- VSD 5 ventricular septal defect; VT 5 ventricular tachycardia phy; DCM 5 dilated cardiomyopathy; D-TGA 5 d-transposition of (Heart Rhythm 2019;-:e1–e153) the great arteries; EAM 5 electroanatomical mapping; ECG 5 electrocardiogram; ECGI 5 electrocardiographic imaging; 5 5 5 Developed in partnership with and endorsed by the European Heart Rhythm EF ejection fraction; GCV great cardiac vein; HCM hypertro- fi 5 5 Association (EHRA), the Asia Paci c Heart Rhythm Society (APHRS), and the phic cardiomyopathy; HR hazard ratio; HS hemodynamic sup- Latin American Heart Rhythm Society (LAHRS). Developed in collaboration 5 5 port; IABP intra-aortic balloon pump; ICD implantable with and endorsed by the American College of Cardiology (ACC), the American cardioverter defibrillator; ICE 5 intracardiac echocardiography; Heart Association (AHA), the Japanese Heart Rhythm Society (JHRS), the ICM 5 ischemic cardiomyopathy; IHD 5 ischemic heart disease; Pediatric and Congenital Electrophysiology Society (PACES), and the Socie- LAF 5 left anterior fascicle; LAVA 5 local abnormal ventricular ac- dade Brasileira de Arritmias Cardíacas (SOBRAC). Endorsed by the Canadian tivity; LBB 5 left bundle branch; LBBB 5 left bundle branch block; Heart Rhythm Society. For copies of this document, please contact the Elsevier LGE 5 late gadolinium enhancement; LMNA 5 lamin A/C; Inc. Reprint Department ([email protected]). Permissions: Multiple copies, fi LOE 5 level of evidence; LP 5 late potential; LPF 5 left posterior modi cation, alteration, enhancement, and/or distribution of this document are fascicle; LSV 5 left sinus of Valsalva; LV 5 left ventricle; not permitted without the express permission of the Heart Rhythm Society. Instructions for obtaining permission are located at https://www.elsevier.com/ LVAD 5 left ventricular assist device; LVEF 5 left ventricular ejec- 5 5 about/our-business/policies/copyright/permissions. This article has been tion fraction; LVNC left ventricular noncompaction; LVOT left copublished in Europace and the Journal of Arrhythmia. Correspondence: Heart fl 5 ventricular out ow tract; MDCT multidetector cardiac computed Rhythm Society, 1325 G Street NW, Suite 400, Washington, DC 20005. E-mail tomography; MI 5 myocardial infarction; MRI 5 magnetic address: [email protected]. PGL 5.5.0 DTD HRTHM7935_proof 7 May 2019 6:26 pm ce Cronin
Recommended publications
  • Cardiac Arrhythmia and Catheter Ablation UK
    Media backgrounder Cardiac Arrhythmia and Catheter Ablation Technique Cardiac arrhythmia – when the heart falls out of rhythm Cardiac arrhythmias (CA) represent a group of conditions with an abnormal heart rhythm or heart rate. This may involve the heart beating too fast (over 100 bpm), too slow (less than 60 bpm) or irregularly.1 Arrhythmias are often caused by problems with the electrical system that regulates the steady heartbeat and can originate in the lower chambers of the heart (ventricles) or in the upper chambers (atria).2 There are various types of arrhythmia; the most common forms include atrial fibrillation (AF), atrial flutter and atrioventricular nodal re-entrant tachycardia. Noticeable warning symptoms include fluttering in the chest, shortness of breath, fatigue, chest pain, dizziness or fainting.3 Many people experience irregular heartbeats at some point in their lives. Most of the time they are harmless, especially when not associated with other heart conditions. However, some arrhythmias can be serious and even life-threatening if left untreated. For example, atrial fibrillation is the most common cardiac arrhythmia and an independent contributor to mortality, morbidity and impaired quality of life.4,5 According to data from the long-term, ongoing Framingham heart study, AF is associated with a 1.5- to 1.9-fold higher risk of death. This is in part attributed to the strong association between AF and thromboembolic events (where the blood in the heart can clot).6 Overall, AF is estimated to be responsible for approximately 15 percent of all strokes7,8,9 and 20 percent of all ischemic strokes.10 Cardiac arrhythmia – a growing global burden • Anyone can develop arrhythmias, even young adults without previous heart problems.
    [Show full text]
  • Radiofrequency Catheter Ablation of Persistent Atrial Fibrillation with Myotonic Dystrophy and Achalasia-Like Esophageal Dilatation Bong Joon Kim
    CASE REPORTS International Journal of Arrhythmia 2017;18(4):205-208 doi: http://dx.doi.org/10.18501/arrhythmia.2017.031 Radiofrequency Catheter Ablation of Persistent Atrial Fibrillation with Myotonic Dystrophy and Achalasia-like Esophageal Dilatation Bong Joon Kim Bong-Joon Kim, MD; Tae-Joon Cha, ABSTRACT MD, PhD, FHRS Myotonic dystrophy, a multi-systemic disease with cardiac involve- Division of Cardiology, Kosin University Gospel ment, is the most common inherited neuromuscular disease. Here, Hospital, Busan, Republic of Korea we report the results of radiofrequency catheter ablation of persis- tent atrial fibrillation in a patient with myotonic dystrophy and acha- Received: September 25, 2017 Accepted: September 29, 2017 lasia-like esophageal dilatation. Correspondence: Tae-Joon Cha, MD, PhD, FHRS Division of Cardiology, Kosin University Gospel Hospital, 262, Gamchen-Ro, Seo-Gu, Busan 49267, Republic of Korea Tel: +82-51-990-6105, Fax: +82-51-990-3047 E-mail: [email protected] Copyright © 2017 The Official Journal of Korean Heart Rhythm Society Editorial Board and EUM & Communications Key Words: ■Atrial Fibrillation ■Myotonic Dystrophy Introduction Case Myotonic dystrophy (dystrophia myotonica [DM]) is an On March 7, 2009, a 46-year-old man presented with autosomal-dominant, multi-systemic disease for which the clinical palpitation that had persisted for several years. He had undergone presentation includes myotonia, muscular dystrophy, cardiac DC cardioversion for AF 8 months prior. He did not have a involvement, posterior iridescent cataracts, and endocrine history of hypertension, diabetes mellitus, dyslipidemia, or disorders.1 The incidence of myotonic dystrophy type 1 (DM1) ischemic heart disease; however, he had a stroke 4 years prior.
    [Show full text]
  • Supraventricular Tachycardia: from Fetus to Adult
    Supraventricular Tachycardia: From Fetus to Adult Mohamed Hamdan, MD Learning Objectives Define type of SVT by age Describe clinical approach Describe prenatal and postnatal management of SVT 2 SVT Across the Ages Narrow-complex Wide complex: VT Tachycardia HR >160: fetuses HR >220: infants HR >180: children HR >120: adults Above AV junction Types of SVT Re-entrant Automatic 1. Sudden onset and 1. Warms-up and cools offset down 2. Accessory pathway 2. Sensitive to 3. Terminates with catecholamines adenosine or 3. Does not respond to cardioversion either Most common: AVRT Most common: EAT Mechanism of SVT Re-entrant Automatic 90% <1% 10% AVN dependant AVN independant AVRT Atrial flutter AET AVNRT Atrial fib. CAR PJRT SNRT JET Mahaim Tachycardia IART 5 Re-entrant Automatic Fetal SVT Definition HR > 160 not associated with contraction or periodic decelerations Epidemiology Incidence ~1/1000 of all pregnancies Fetal arrhythmia: 1/3 of referrals to fetal echo lab CHD in 3% Copel et al., Am J Obstet Gynecol 2000 7 Clinical Approach to Fetal SVT 1. Define type SVT vs Flutter vs Fibrillation 2. Define absolute HR 3. Presence of CHD 4. Presence of hydrops 8 1. Type of SVT Best: 16-32 weeks Methods Phonocardiography Fetal echo Magnetocardiography (MCG) Fetal scalp electrode Fetal QRS Maternal QRS 9 Assessment of Rhythm by Fetal Echo Doppler SVC Aorta PAC Normal 10 Assessment of Rhythm by Fetal Echo M-Mode RV RA Atrium Rate~ 500 Ventricle Rate~240 11 2. Determine HR Atrial Rate Variability A:V Ventricular (bpm) Conduction Rate Normal 120-160 >10 bpm 1:1 120-160 Sinus 180-220 5-15 bpm 1:1 180-220 tachycardia SVT >220 No 1:1 >220 Atrial flutter 300-500 No 2-5:1 60-200 Atrial 300-500 Yes, due to 2-5:1 60-200 fibrillation variable AV conduction Bergmans et al., Obstet Gynecol Surv 1985 12 3.
    [Show full text]
  • CT Coronary Angiography for Detection of Coronary Artery Obstruction, Without the Need for Further Imaging Studies Or Additional Radiation Exposure
    IAEA Department of Technical Cooperation And Nuclear Medicine Section RAS 6/063 Strengthening the Application of Nuclear Medicine in the Management of Cardiovascular Diseases Cardiac Imaging CT and MR Prof Lin Tun Tun Head of Department of Radiology University of Medicine (1) Yangon General Hospital CARDIAC CT Advances in CT Technology • Increased image quality • Improvements in hardware and software such as refined image reconstruction methods. • lower radiation exposure of cardiac CT especially for coronary CTA INDICATIONS FOR CARDIAC CT • Chest pain with intermediate pretest probability of CAD • Acute coronary syndrome with intermediate pretest probability of CAD (no ECG changes and negative serial enzymes negative) Evaluation of bypass grafts and coronary anatomy • Evaluation of complex congenital heart disease (anomalies of coronary circulation, great vessels, and cardiac chambers and valves) • Evaluation of cardiac masses or pericardial conditions • Evaluation of pulmonary vein anatomy before radiofrequency ablation, coronary vein • Evaluation of suspected aortic dissection, aortic aneurysm, or pulmonary embolism. History • EBCT – mid 1990 – 1.5 to 3mm slice thickness • 4 MSCT -2000- 1mm s thickness (30 heart beats minimum over all image-acquisition time) • 4-16-64 MSCT - 2004 -0.5 to 0.75 mm (4-8 heart beats) EBCT- Electron Beam CT Evolution of CT - 40 years ‘72. …85…… 89…..91 …….95 ……98.99…01..02..04…05…2006----2012 1st CT Slip Ring Spiral Twin ub sec ½ sec 64 DSCT 256 / ……640/ CT detector MSCT /FPD DSCT/DECT 0.33sec/ritation Multidetector, Multisource CT New detector technologies Data Handling, Dose management Dual source CT 2005- Dual Source CT 2 X-ray sources and 2 detectors Faster than every beating heart DSCT became available around the year 2005, with 2 64 simultaneously acquired slices and a rotation time of 33 milliseconds and More recently, with 2 128 simultaneously acquired slices and a gantry rotation time of 0.28 seconds.
    [Show full text]
  • Pulmonary Vein Isolation Induces Changes in Vectorcardiogram P-Wave Loops
    Pulmonary Vein Isolation Induces Changes in Vectorcardiogram P-wave Loops Nuria Ortigosa1, Oscar´ Cano2, Frida Sandberg3 1 I.U. Matematica´ Pura y Aplicada, Universitat Politecnica` de Valencia,` Spain 2 Servicio de Cardiolog´ıa, Hospital Universitari i Politecnic` La Fe. Valencia, Spain 3 Department of Biomedical Engineering, Lund University, Sweden Abstract ful AF ablation has been the durable PVI [6] and it is there- fore desirable to study changes induced by the procedure Pulmonary vein isolation (PVI) is considered a stan- that may be linked to durability of the PVI. dard treatment of paroxysmal atrial fibrillation aiming to Previous studies have analysed how PVI changes the restore and maintain sinus rhythm. The purpose of this surface ECG signal by decreasing the P-wave duration [7, study is to analyse how the PVI treatment affects the elec- 8], and P-wave amplitude and duration dispersion [9–11]. trical conduction pattern in the atria. We have compared In this study we propose to analyse the vectorcardio- the morphology of P wave loops extracted from the vector- gram (VCG) to assess how PVI affects the electrical con- cardiogram (VCG) before and after PVI. duction pattern in the atria. Based on the 12-lead surface Ten patients suffering from paroxysmal atrial fibrillation ECG of patients with paroxysmal AF in sinus rhythm, we who underwent PVI were included in the study. All patients have extracted the VCG, and then compared the morphol- were in sinus rhythm before as well as after the procedure. ogy of P-wave loops before and after PVI to reveal changes Vectorcardiogram was obtained using the Kors matrix and induced by the procedure.
    [Show full text]
  • Thursday Poster Assignment
    Corresponding Author Paper Title Board Assignment Number ‐ Thursday Classification of Typical Developing and Autism Spectrum Disorder Using Connectivity A.R., Jac Fredo Matrix and Support Vector Machine 111 Abbaszadeh, Behrooz Probabilistic Prediction of Epileptic Seizures Using SVM 220 Abe, Takuto Surrogate Modeling for Neuroprotective Focal Brain Cooling Device 110 Comprehensive Comparison of 2D vs. 3D Resource Usage in Large Volumetric Medical Agris, Jacob Image Segmentation 109 On Smartphone Sensability of Bi‐Phasic User Intoxication Levels from Diverse Walk Agu, Emmanuel Types in Standardized Field Sobriety Tests 327 The Effect of Perceived Sound Quality of Speech in Noisy Speech Perception by Akbarzadeh, Sara Normal Hearing and Hearing Impaired Listeners 370 Towards the Development of an Optrode Biopotential Sensor: Characterization Using Al Abed, Amr in Vitro Cardiac Tissue Recordings 108 Spatially Filtered Low‐Density EMG and Time‐Domain Descriptors Improves Hand Al‐Jumaily, Adel Movement Recognition 419 Optimizing Stimulation Strategies for Retinal Electrical Stimulation: A Modelling Study Alqahtani, Abdulrahman 287 An Automatic Navigation and Pressure Monitoring for Guided Insertion Procedure Alsunaydih, Fahad Nasser 326 A Statistical Determination of the Energy Delivered to Muscular Tissue in Amador, Alejandro Electrostimulation Protocols 149 Analysis of Muscle Fatigue During Exercise and Exercise Combined with Electrostimulation 151 Signal‐To‐Noise Ratio Determination in a Hybrid System of Electrostimulation and Electromiography 150 Continuous Prediction of Cognitive State Using a Marked‐Point Process Modeling Amidi, Yalda Framework 286 Antônio Freire Teixeira, Marcos Automatic Counting of Erythrocytes Using Image Processing 153 Feature Extraction from Radiographic Images for Bone Age Identification 152 Arantes, Ana Paula Bittar Britto Towards the Improvement of Algorithms Used in Robot‐Assisted Therapies 107 Arce‐Diego, José L.
    [Show full text]
  • Transcatheter Ablation for the Treatment of Supraventricular Tachycardia in Adults
    Medical Coverage Policy Effective Date ............................................. 4/15/2021 Next Review Date ....................................... 4/15/2022 Coverage Policy Number .................................. 0529 Transcatheter Ablation for the Treatment of Supraventricular Tachycardia in Adults Table of Contents Related Coverage Resources Overview .............................................................. 1 Cardiac Electrophysiological (EP) Studies Coverage Policy ................................................... 1 Nonpharmacological Treatments for Atrial Fibrillation General Background ............................................ 2 Medicare Coverage Determinations .................. 12 Coding/Billing Information .................................. 12 References ........................................................ 13 INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly
    [Show full text]
  • Discharge Advice After Atrial Fibrillation Ablation
    Oxford University Hospitals NHS Trust Oxford Heart Centre Discharge advice after Atrial Fibrillation ablation Information for patients page 2 This booklet contains important advice about discharge after your Atrial Fibrillation (AF) ablation. It contains information about what to do when you get home. Contents 1. Discharge summary 4 Follow-up 4 Transport 4 2. What to do when you get home 5 Puncture site care 5 Bleeding 6 Sedation/General Anaesthetic 6 After the catheter ablation 6 Recurrence of AF symptoms - what to do 6 Driving 7 Return to work 8 3. Medication 8 4. How to contact us 9 5. Further information 10 6. Message for doctor reviewing this patient 10 page 3 1. Discharge summary Your Consultant at the John Radcliffe Hospital is: ………………………….…............................................................…….. Follow-up You will be sent an appointment for follow-up in the Arrhythmia clinic. (This appointment will be sent in the post. If you do not receive a date for an appointment within 8 weeks, please call the John Radcliffe Hospital and ask to speak to the secretary of your Consultant. Follow-up appointments are currently planned approximately 3 to 4 months after your procedure.) Transport to your outpatient appointments If you have difficulty getting to your outpatient appointments your GP surgery may have the phone numbers of voluntary transport schemes which operate at subsidised rates. A directory of these services is available at www.oxonrcc.org.uk for residents of the Oxfordshire area. page 4 2. What to do when you get home When you are discharged home, you should have a quiet few days resting to recover from your procedure.
    [Show full text]
  • Radiofrequency Ablation: Technique and Clinical Applications
    Diagn Interv Radiol 2012; 18:508–516 INTERVENTIONAL RADIOLOGY © Turkish Society of Radiology 2012 REVIEW Radiofrequency ablation: technique and clinical applications Servet Tatlı, Ümit Tapan, Paul R. Morrison, Stuart G. Silverman ABSTRACT n last decade, there has been a rapid advancement in the utiliza- Radiofrequency ablation is the most commonly used percu- tion of percutaneous, image-guided tumor ablation methods. taneous ablation technique and well-documented in the lit- erature on focal therapies. It has become the image-guided I Radiofrequency (RF) ablation has become the method of choice be- ablation method of choice because of its efficacy, safety, and cause of its safety and efficacy. Image-guided RF ablation is minimally ease of use. Radiofrequency ablation has shown promise in treating selected solid tumors, particularly those involving the invasive and usually appropriate for inoperable patients with other co- liver, kidneys, lungs, and the musculoskeletal system. It is a morbidities. It requires a minimal hospital stay or can be performed on minimally invasive technique often used in inoperable patients an outpatient basis. It preserves more normal organ tissue and is less with other comorbidities. Radiofrequency ablation requires a minimal hospital stay or can be performed on an outpatient expensive than surgery (1–3). The procedures are generally performed by basis. The aim of this article is to review radiofrequency abla- using 14–21 G, partially insulated electrodes that are placed under guid- tion techniques and their clinical applications. ance (computed tomography [CT], magnetic resonance imaging [MRI], Key words: • radiofrequency catheter ablation • tumor or ultrasonography [US]) into the tumor to be ablated.
    [Show full text]
  • Atrial Fibrillation Ablation
    Atrial Fibrillation Ablation Atrial Fibrillation Ablation This handout will help you learn about atrial fibrillation ablation, also called pulmonary vein isolation. © Hamilton Health Sciences, 2008 PD 6062 – 02/2012 dpc/pted/LrgBk/AtrialFibrillationAblation-trh.doc dt/February 27, 2012 2 15 Atrial Fibrillation Ablation Atrial Fibrillation Ablation How does the heart work? Notes: To understand atrial fibrillation, you need to know how the heart’s electrical system works. __________________________________________________________ The sinoatrial node (SA node) is a natural pacemaker. It starts the __________________________________________________________ electrical signal that travels across the upper 2 chambers or atria of the heart to the atrioventricular node (AV node). __________________________________________________________ The AV node transfers the electrical signal from the upper part of the heart to the lower 2 pumping chambers or ventricles. The bundle branches are __________________________________________________________ specialized tissue that help send electrical impulses through the ventricles. This makes a normal heart beat, called normal sinus rhythm. __________________________________________________________ __________________________________________________________ __________________________________________________________ SA node __________________________________________________________ Bundle branches __________________________________________________________ AV node __________________________________________________________
    [Show full text]
  • Artificial Pneumothorax Improves Radiofrequency Ablation Of
    Zuo et al. BMC Cancer (2021) 21:505 https://doi.org/10.1186/s12885-021-08223-7 RESEARCH ARTICLE Open Access Artificial pneumothorax improves radiofrequency ablation of pulmonary metastases of hepatocellular carcinoma close to mediastinum Taiyang Zuo1,2†, Wenli Lin1†, Fengyong Liu1,2 and Jinshun Xu1,2,3* Abstract Background: To investigate the feasibility, safety and efficacy of percutaneous radiofrequency ablation (RFA) of pulmonary metastases from hepatocellular carcinoma (HCC) contiguous with the mediastinum using the artificial pneumothorax technique. Method: A total of 40 lesions in 32 patients with pulmonary metastases from HCC contiguous with the mediastinum accepted RFA treatment from August 2014 to May 2018 via the artificial pneumothorax technique. After ablation, clinical outcomes were followed up by contrast enhanced CT. Technical success, local tumor progression (LTP), intrapulmonary distant recurrence (IDR), and adverse events were evaluated. Overall survival (OS) and local tumor progression free survival (LTPFS) were recorded for each patient. Results: The tumor size was 1.4 ± 0.6 cm in diameter. RFA procedures were all successfully performed without intra- ablative complications. Technical success was noted in 100% of the patients. Five cases of LTP and 8 cases of IDR occurred following the secondary RFA for treatment. Slight pain was reported in all patients. No major complications were observed. The 1, 2, and 3-year LTPFS rates were 90.6, 81.2, and 71.8%, and the 1, 2, and 3-year OS rates were 100, 100 and 87.5%, respectively. Conclusion: Artificial pneumothorax adjuvant RFA is a feasible, safe, and efficient method for treatment of pulmonary metastases from HCC contiguous with the mediastinum.
    [Show full text]
  • Radiofrequency Ablation for Spinal Pain
    Radiofrequency Ablation for Spinal Pain Last Review Date: October 9, 2020 Number: MG.MM.ME.39cC2v2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth the clinical evidence that the patient meets the criteria for the treatment or surgical procedure. Without this documentation and information, EmblemHealth will not be able to properly review the request for prior authorization. The clinical review criteria expressed below reflects how EmblemHealth determines whether certain services or supplies are medically necessary. EmblemHealth established the clinical review criteria based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). EmblemHealth expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information. Each benefit program defines which services are covered. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered and/or paid for by EmblemHealth, as some programs exclude coverage for services or supplies that EmblemHealth considers medically necessary. If there is a discrepancy between this guideline and a member's benefits program, the benefits program will govern. In addition, coverage may be mandated by applicable legal requirements of a state, the Federal Government or the Centers for Medicare & Medicaid Services (CMS) for Medicare and Medicaid members.
    [Show full text]