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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. -
Overview of Partial Left Ventriculectomy
Prepared by ASERNIP-S NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of Partial Left Ventriculectomy Introduction This overview has been prepared to assist members of IPAC advise on the safety and efficacy of an interventional procedure previously reviewed by SERNIP. It is based on a rapid survey of published literature, review of the procedure by specialist advisors and review of the content of the SERNIP file. It should not be regarded as a definitive assessment of the procedure. Procedure name Partial Left Ventriculectomy The Batista Procedure Specialty society Society of Cardiothoracic Surgeons of Great Britain and Ireland Executive Summary Left partial ventriculectomy (PLV) seeks to treat dilated cardiomyopathy by reducing cardiac volume and hence heart wall pressure through the resection of a portion of the left ventricle. Patients receiving it are generally suitable for cardiac transplant but unable to receive it, often for social or economic reasons. PLV is an emerging procedure and the vast majority of evidence is case series, although there has been one retrospective comparative study of PLV and transplantation. Hospital mortality was reported for up to 30% of patients and overall mortality was around 40% of patients. Thirty day survival ranged from 50% to 99%, and no significant difference was found between PLV and transplant. One-year survival ranged from 46% to 80% and three- year survival was reported in one study as 60%. Event-free survival was reported as 80% at 30 days, 49% at 1 year and 26% at three years. Use of a left ventricular assist device or relisting for cardiac surgery was reported in one study at between 5% and 15% of patients at 30 days and in 43% at 1 year and 58% at 3 years. -
Reduction Ventriculoplasty for Dilated Cardiomyopathy : the Batista Procedure Shahram Salemy Yale University
Yale University EliScholar – A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine 1999 Reduction ventriculoplasty for dilated cardiomyopathy : the Batista procedure Shahram Salemy Yale University Follow this and additional works at: http://elischolar.library.yale.edu/ymtdl Recommended Citation Salemy, Shahram, "Reduction ventriculoplasty for dilated cardiomyopathy : the Batista procedure" (1999). Yale Medicine Thesis Digital Library. 3123. http://elischolar.library.yale.edu/ymtdl/3123 This Open Access Thesis is brought to you for free and open access by the School of Medicine at EliScholar – A Digital Platform for Scholarly Publishing at Yale. It has been accepted for inclusion in Yale Medicine Thesis Digital Library by an authorized administrator of EliScholar – A Digital Platform for Scholarly Publishing at Yale. For more information, please contact [email protected]. SlDDCITOM VENTRICULOPIASTy FOR DILATED CARDIOMYOPATHY THE BATISTA PROCEDURE W«M * (e,yx»> ShaLramSalemy YALE DNIVERSriY YALE UNIVERSITY CUSHING/WHITNEY MEDICAL LIBRARY Permission to photocopy or microfilm processing of this thesis for the purpose of individual scholarly consultation or reference is hereby granted by the author. This permission is not to be interpreted as affecting publication of this work or otherwise placing it in the public domain, and the author reserves all rights of ownership guaranteed under common law protection of unpublished manuscripts. Signature of Author Date REDUCTION VENTRICULOPLASTY FOR DILATED CARDIOMYOPATHY: THE BATISTA PROCEDURE Shahram Salemy B.S., George Tellides M.D., Ph.D., and John A. Elefteriades M.D. February 5, 1999 r 113 f'Uh (e(e.cl 0 REDUCTION VENTRICULOPLASTY FOR DILATED CARDIOMYOPATHY: THE BATISTA PROCEDURE. -
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 -
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. -
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. -
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. -
TAKING HEART from 20 YEARS of PROGRESS P10 Dear Colleagues
INSIDE THIS ISSUE Introducing the Wound Care for Tetralogy of Cardiovascular ‘No Option’ Fallot in Adults Specialty Network Patients – p14 – p17 – p3 Cardiac Consult Heart and Vascular News from Cleveland Clinic | Fall 2014 | Vol. XXIV No. 3 TAKING HEART FROM 20 YEARS OF PROGRESS p10 Dear Colleagues: Cardiac Consult is a forward-thinking publication. But in this issue’s cover story (p. 10), we look back over the past 20 years of cardiovascular achievement. The piece is both a fun way to take stock of how our discipline has evolved and a not-so-subtle reminder that for every one of those 20 years, Cleveland Clinic has been ranked No. 1 for heart care in U.S. News & World Report’s “Best Hospitals” survey. If you wonder how Cleveland Clinic is able to consistently earn this standing year after year, the remaining articles in this issue might give some clues. The feature on p. 3 profiles our new Cardiovascular Specialty Network and other heart care-focused affiliations and alliances with hospitals and Cardiac Consult offers updates on advanced providers nationwide. The network and affiliations are made possible by diagnostic and management techniques Cleveland Clinic’s standardized approach to patient care. Our cardiovascu- from specialists in Cleveland Clinic’s Sydell and Arnold Miller Family Heart & Vascular lar specialists strive for predictable outcomes through close observation of Institute. Please direct correspondence to: data, evidence-based practices and continuous quality improvement. These Medical Editors specialists’ services are coordinated elements of a single Heart & Vascular Amar Krishnaswamy, MD Institute comprising cardiovascular and thoracic surgery, vascular surgery, [email protected] and cardiovascular medicine. -
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. -
S41231-020-00064-Z.Pdf
Boano et al. Translational Medicine Communications (2020) 5:11 Translational Medicine https://doi.org/10.1186/s41231-020-00064-z Communications RESEARCH Open Access Biochemical response to cryothermal and radiofrequency exposure of the human myocardium at surgical ablation of atrial fibrillation: a randomized controlled trial Gabriella Boano1, Meriam Åström Aneq2, Giannis Spyrou3, Helena Enocsson4, Emmanouil Charitakis5 and Farkas Vánky1* Abstract Background: Surgical cryothermia and radiofrequency (RF) ablations for atrial fibrillation (AF) seem to result in similar sinus rhythm restoration, but the biochemical consequences of the two methods are unclear. We aimed to compare the biochemical responses to the two ablative methods in concomitant mitral valve surgery (MVS). Methods: Sixty mitral valve surgery patients with AF were prospectively included. Forty-one patients planned for ablation were randomized to cryothermia (n = 20) or radiofrequency (n = 21) ablation and 19 served as controls. Markers for myocardial injury, inflammation, cell stress, apoptosis, and heart failure were analyzed pre- and postoperatively at different time points. Results: Troponin T and creatine kinase isoenzyme MB (CK-MB) peak levels were significantly higher in the cryothermia group compared with the RF group (12,805 [6140–15,700] vs. 2790 [1880–4180] ng/L; P = 0.002 and 271 [217–357] vs. 79 [66–93] μg/L; P < 0.001, respectively). Both groups had significantly higher levels than the no- ablation group. There were no group differences in C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), but there were correlations between pre- and postoperative levels of both CRP (rs = 0.41, P = 0.001) and NT-proBNP (rs = 0.48, P < 0.001). -
1 IJTCVS, Jan–Mar, 2002
IJTCVS 2002; 18: 1 IJTCVS, Jan–Mar, 2002 Prevention of Phrenic Nerve Palsy During CABG "OP-CAB" Surgery – An Initial Experience of Puri D, Puri N, Dhaliwal RS, Gupta PK 1 22 Cases with Indigenous Equipments 3 CTV Surgery PGIMER, Chandigarh & Anatomy Srivastava CP, Devgarha S, Singh R, Nathani V, Sharma A, IGMC Shimla Kushwaha KK, Mathur BM Department of CTVS, SMS Medical College and Hospital, Jaipur Introduction: Close proximity of phrenic nerves to internal mammary arteries and pericardium makes them liable to injury during Introduction: Minimal invasive CABG is getting more popular CABG. Injury can occur directly due to transection or secondary to all over the world. It has the advantage of decreased blood loss, rapid compromised vascularity or hypothermia. recovery and short hospital stay. Thus if offer chances for CABG in Methods: We studied in detail the intra thoracic course of IMA sick and elderly patients. and phrenic nerves in 100 cadavers. This information was utilized Methods: "OP-CAB" was performed in 22 cases of CAD admitted while harvesting IMA during CABG. The pericardiophrenic branch in department of CTVS, SMS Hospital, Jaipur from October 1998 to of IMA, a major source of blood supply to the phrenic nerves was October 2001. Out of the 22 cases 15 cases had 1 graft and 7 cases had preserved. Intermittent cooled saline (4°C) was used for topical cooling 2 grafts with average of 1.5. instead of ice slush. Elevation of hemidiaphragm on postoperative Results: Mean age of patients for "OP-CAB" has been 55±10 years. chest roentgenogram and paradoxical movements of diaphragm on All patients had significantly shorter post-op length of stay in hospital fluoroscopy were taken as evidence of phrenic nerve palsy. -
Hip Joint Nerve Block/ Radiofrequency Ablation
Hip/leg Hip Joint Nerve Block/ Radiofrequency Ablation 1 Piriformis Injection 3 Hip Joint Nerve Block/ Trochanteric Bursa Injection 5 Genicular Nerve Block/Radiofrequency Ablation 7 Radiofrequency Knee Viscosupplementation Injection 9 Ischial Bursa Injection 10 Ablation Lateral Femoral Cutaneous Nerve Block 12 Knee Joint Injection 14 Hip Joint Injection 16 An obturator nerve radiofrequency ablation treats hip pain Conditions treated and inflammation and is a potential solution for individuals You might benefit from a hip who want to avoid surgery or have pain after surgery. It is a joint radiofrequency ablation if you suffer from: two-step process including a diagnostic injection prior to • Chronic hip pain the radiofrequency treatment. • Osteoarthritis of the hip How is it performed? Prior to the radiofrequency treatment, you will undergo a diagnostic injection. This diagnostic injection will involve a small amount of local anesthetic which will be injected in two spots around the hip. These injections are done under fluoroscopic x-ray guidance to help ensure proper placement of the needle. If you experience an adequate amount of pain relief with these injections, you will be eligible for the radiofrequency treatment. The radiofrequency treatment will then entail creating a heat lesion around the identified nerves which will help to prevent pain signals from traveling to the brain. Prior to your appointment You will have the option of receiving no sedation or: • oral sedation – or – • intravenous sedation If choosing sedation, you must not eat for six hours or drink anything for four hours before the procedure. To schedule a procedure You may continue taking all medications except blood thinners before the Please contact the nurse navigators procedure.