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方法/程序设置包括药物治疗无效的阵发性AF和持续性房颤患者32例。所有患者在手术前的知情同意书。 消融过程所有患者抗凝治疗至少1个月前的程序。华法林是停止了前一天的程序，其目的为国际标准化比值在1.8和2.0之间的手术当天。 3个月后，程序继续periprocedurally和抗心律失常药物。所有患者接受心脏MRI或心脏CT成像，在手术前评估左心房和肺静脉的解剖，并允许PV直径测量。 在消融过程中进行下清醒镇静。心电图记录在一个专门的的EP记录系统（EP杂志，圣犹达医疗，MN，美国）。 <ol><li>披在标准的方式来消融手术的患者。血管通路中得到的右和左股静脉。全身动脉压连续监测通过压力换能器经由左股动脉。 （ICE）心内超声探头（美国Acuson，西门子，GER）前进到右心房。 </li><li>使用标准的透视的意见和ICE指导，使用前言（生物传感韦伯斯特，CA）或SL1套（圣犹达医疗，MN）的跨室间隔穿刺。 AJ放倒0.035“导线被放置在左上和，反式室间隔鞘与Flexsheath交换。在反式室间隔访问之前，肝素丸剂注入静脉内，然后根据需要重复中ACT的基础上每20分钟检查执行维护活化的凝血时间，超过350秒的持续时间的程序。 </li><li>气球的大小选择与直径的P按照与基于心脏MRI或前心脏CT测量程序。通常情况下，一个28毫米cryoballoon利用如果任何的PV奥斯蒂亚有一个直径大于20毫米的直径。 </li><li>经过适当的准备，cryoballoon先进的左心房通过电线或达到导管生物传感韦伯斯特（CA），然后，使用ICE和透视指导，到胃窦每个PV。 </li><li>通常用于放射性碘造影剂注射通过远侧尖端的气球，气球有一个内腔。一种连续的压力监测系统被连接到管腔允许压力波形分析。具体而言，附着了3路歧管（Navylist医疗，CA）（ 图1）通过的Tuohy（优异医学，IRE）的cryoballoon。从系统中除去气泡是至关重要的，护理是采取彻底冲洗之前利用系统。歧管的三个端口是1。盐水冲洗（在压力下），2。对比和3。压力监测。压力监测端口，然后连接到一个标准的心脏导管插入术实验室压力传感器。 EP记录系统现场监视器（ 图2）上显示的压力波形。 </li><li> LA压力的规模为25毫米汞柱，扫描速度为50毫米/秒的录音。页面显示通道（一个或两个表面心电图的推导，CS心电图和动脉和LA压力）的最小数量。心电图记录的PV-LA结的消融（使用实现导管或一个单独的多极导管）。连续记录显示在一个单独的页面，EP系统，时闭塞评估。 </li></ol> 2。 PV闭塞<ol><li>瘪气球前进超过导引线或实现导管使用标准的透视意见和腔内超声光伏胃窦LA侧膨胀。 </li><li>的pressure的页面被显示的和压力线被打开以使得压力的换能器的气囊导管的前端（在此阶段住在静脉）从记录。 </li><li>当气球不阻塞的PV开口，记录的特性的LA压力。 A（心房）和V（心室）波在窦性节律，是一个典型的“等边三角形”形态的V波记录。然而，在房颤，目前还没有一致的A波（因为没有心房收缩）和V波形态被视为。使用透视或超声引导下的气球是先进的，并置于PV口的同位。 </li><li>实现闭塞时，有压力波形的急剧变化。在窦性节律，有亏损的A波和振幅的变化（增加）和V波的形态。由于现在的记录是反式毛细管肺动脉压，V波具有更快的速度上升和延迟下行冲程的典型特征。事实上，V波三角的顶点移动到右边时相比，LA压力V波记录。这是明显的窦性心律（ 图3）和心房纤维性颤动（ 图4）。这种特性的压力波形证实完全闭塞，没有进一步的向前的压力，或需要使用导管操作。在首次使用这种方法，在这个时候对比使用，可以用于进一步确认PV闭塞。 </li><li>一旦阻塞已经实现了，在冷冻过程可以开始了。在右侧肺静脉消融的过程中，膈神经起搏从位于上腔静脉的导管，以便及时发现膈神经损伤。对于第一个约15秒（取决于局部血流量），压力仍然可以被记录下来。一旦达到-10度温度监控Celsius时，内腔的气球冻结和压力不再能够被记录下来。在这个阶段，我们的心腔内电图页面切换“记录系统”页面展示“时间效应”的光电隔离。持续240秒cryoapplication。 </li><li>经过冷冻的过程完成后，和解冻已经发生，压力可以再次被记录和机动永久光电隔离认为必要的数目的次数，可以重复。 </li><li>冷冻治疗后，每一个PV的映射使用一个20针的环状标测导管直径可变的生物传感韦伯斯特（CA）。如果残余的开口处的潜力仍然记录，不同的心房附近的静脉起搏证明入口块的PV。在持久性传导的情况下，完成电气隔离，分段使用8毫米的冷冻消融导管（Freezor MAXR，美敦力，MN）或灌溉的导管射频（THERMOCOOL，生物传感韦伯斯特，CA）。该endpoiNT的程序是完整的电光电隔离，记录至少30分钟后，最后的应用程序。 </li></ol> Postablation护理手术后，华法林的恢复和皮下注射低分子肝素的管理，如有必要，直到国际标准化比值≥2.0。华法林是持续至少3个月。临床随访6周，3个月，6个月及十二个月，其中包括心电图在三个月在每次访问和事件监控。长期抗心律失常，抗凝血剂治疗的临床结果。

<ol>
	<li>Pappone, C., Rosanio, S., Oreto, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Circumferential+radiofrequency+ablation+of+pulmonary+vein+ostia:+A+new+anatomic+approach+for+curing+atrial+fibrillation.">Circumferential radiofrequency ablation of pulmonary vein ostia: A new anatomic approach for curing atrial fibrillation.</a> Circulation. 102 (21), 2619-2628 (2000).</li><li>Piccini, J. P., Daubert, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cryoablation+of+atrial+fibrillation.">Cryoablation of atrial fibrillation.</a> J. Interv. Card. Electrophysiol. 32 (3), 233-2342 (2011).</li><li>K&#252;hne, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cryoballoon+versus+radiofrequency+catheter+ablation+of+paroxysmal+atrial+fibrillation:+biomarkers+of+myocardial+injury,+recurrence+rates,+and+pulmonary+vein+reconnection+patterns.">Cryoballoon versus radiofrequency catheter ablation of paroxysmal atrial fibrillation: biomarkers of myocardial injury, recurrence rates, and pulmonary vein reconnection patterns.</a> Heart Rhythm. 7 (12), 1770-1776 (2010).</li><li>Kojodjojo, P., O'Neill, M. D., Lim, P. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pulmonary+venous+isolation+by+antral+ablation+with+a+large+cryoballoon+for+treatment+of+paroxysmal+and+persistent+atrial+fibrillation:+medium-term+outcomes+and+non-randomized+comparison+with+pulmonary+venous+isolation+by+radiofrequency+ablation.">Pulmonary venous isolation by antral ablation with a large cryoballoon for treatment of paroxysmal and persistent atrial fibrillation: medium-term outcomes and non-randomized comparison with pulmonary venous isolation by radiofrequency ablation.</a> Heart. 96 (17), 1379-1384 (2010).</li><li>Chao, T. F., Lin, Y. J., Chang, S. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Associations+between+renal+function,+atrial+substrate+properties+and+outcome+of+catheter+ablation+in+patients+with+paroxysmal+atrial+fibrillation.">Associations between renal function, atrial substrate properties and outcome of catheter ablation in patients with paroxysmal atrial fibrillation.</a> Circ J. 75 (10), 2326-2332 (2011).</li><li>Van Belle, Y., Janse, P., Rivero-Ayerza, M. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pulmonary+Vein+Isolation+Using+an+Occluding+Cryoballoon+for+Circumferential+Ablation:+Feasibility,+Complications,+and+Short-term+Outcome.">Pulmonary Vein Isolation Using an Occluding Cryoballoon for Circumferential Ablation: Feasibility, Complications, and Short-term Outcome.</a> Eur. Heart J. 28 (18), 2231-2237 (2007).</li><li>F&#252;rnkranz, A., K&#246;ster, I., Chun, K. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cryoballoon+temperature+predicts+acute+pulmonary+vein+isolation.">Cryoballoon temperature predicts acute pulmonary vein isolation.</a> Heart Rhythm. 8 (6), 821-825 (2011).</li><li>Siklody, C. H., Minners, J., Allgeier, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cryoballoon+pulmonary+vein+isolation+guided+by+transesophageal+echocardiography:+Novel+aspects+on+an+emerging+ablation+technique.">Cryoballoon pulmonary vein isolation guided by transesophageal echocardiography: Novel aspects on an emerging ablation technique.</a> J. Cardiovasc. Electrophysiol. 20 (11), 1197-1202 (2009).</li><li>Sikl&#243;dy, C., Minners, J., Allgeier, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pressure-guided+Cryoballoon+Isolation+of+the+Pulmonary+Veins+for+the+Treatment+of+Paroxysmal+Atrial+Fibrillation.">Pressure-guided Cryoballoon Isolation of the Pulmonary Veins for the Treatment of Paroxysmal Atrial Fibrillation.</a> J. Cardiovasc. Electrophysiol. 21 (2), 120-125 (2010).</li><li>Chierchia, G. B., de Asmundis, C., Sorgente, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anatomical+extent+of+pulmonary+vein+isolation+after+cryoballoon+ablation+for+atrial+fibrillation:+comparison+between+the+23+and+28+mm+balloons.">Anatomical extent of pulmonary vein isolation after cryoballoon ablation for atrial fibrillation: comparison between the 23 and 28 mm balloons.</a> J. Cardiovasc. Med. 12 (3), 162-166 (2011).</li></ol>

生产和免费使用这篇文章是由美敦力公司博士。丹和威克利夫是美敦力公司布赖恩·琼斯的顾问公司，美敦力公司的雇员，其他作者有没有利益冲突的声明。

我们提出了一种新的直接评估完全性肺静脉阻塞cryoballoon消融治疗房颤的肺静脉压监测技术。期间的直接压力监测技术的应用和迅速下降，放射性碘对比，透视利用有限的培训后，我们已经展示了一个陡峭的学习曲线。该技术可以进行程序的工具通常可在大多数实验室和设置需要有限的额外preprocedure设置时间。 冷冻消融利用cryoballoon已成为侵入性的管理策略作为一种新型的用于治疗阵发性房颤2。程序成功与cryoballoon消融是高度依赖于肺静脉口和实现的肺静脉完全闭塞6 cryoballoon正确的并置。一些预测PV OCClusion和电气隔离进行了研究：1。相关的cryoapplication以及边坡复温过程中的最低温度达到与电气隔离7;然而，没有确切的临界值进行了评估，这种方法只可用于在一个回顾性的方式，不允许确认的PV闭塞前到冻结过程2开始。最常用的评估确认完全闭塞的静脉注射碘对比球囊扩张后，在肺静脉口6。球囊扩张后的对比泄漏透视和评估确认不完全性肺静脉闭塞的cryoballoon。经常需要多次注射后cryoballoon重新定位，导致重复病人暴露于放射性碘的对比度和辐射。因此，对比可能会在慢性肾脏疾病患者禁忌或已知的过敏对碘的反应。在初始气球的定位和通货膨胀的持续反馈的缺乏是一个额外的缺点透视评估PV闭塞3。最后，TEE引导下气球的定位已经得到了很好的描述，可以直接可视化的气球定位和PV闭塞的cryoballoon和持续的重新评估与生理盐水以及评价为“泄漏”彩色多普勒血流胃窦位置，但这项技术需要在全身麻醉下经食管超声心动图的永续利用，有可能增加，与全身麻醉和espophageal的插管相关的围手术期并发症的风险。 我们观察到一个陡峭的学习曲线，使有限的初步经验后压力波形的快速和一致的解释。对比度利用直接呈负相关的专业知识，在这个技术和utilization的透视，也大大降低了初始培训后压力监测。 压力监测超过上面提到的缺陷和允许的PV闭塞的精确和连续的评估。目前，一个气球设计，可为临床使用美敦力公司（MN）。此系统包括一个过度的穿线型气球导管，这是使用一氧化二氮冷却。对比度通常是通过注入的内腔;为我们所描述的方法，压力监测的目的，与利用一个单一的压力换能器，该内腔用于光伏压力的直接评估。因此，在其他比一个单一的3路歧管，无需额外的导管是此方法的应用所必需的。另外，如果必要的话，对比度可能仍然可以使用，如果需要进一步确认的PV闭塞，虽然我们已经证明，在一个单一的中心研究对比度利用率主要是ünnecessary一旦压力监测技术已经建立。 压力波形获得通过压力换能器连接到的内腔，并显示在屏幕上。气球进一步前进到肺静脉口和膨胀中所做的那样标准的冷冻治疗;没有在标准气球操纵方法的调整是必要的，当被施加的压力监测技术。急性物浮起的初始冷冻期间连续监测的压力监测技术也是可能的，直到测得的扫气的温度下降低于摄氏-10度。特别是，气球变位的PV口通常在最初的制冷剂注射产生的球囊扩张（“跳出”现象）和完善的气球定位观察，如果压力波形失去闭塞的压力特性，可以安全地执行。类似的技术部历史神游已动用的患者在窦性心律cryoballoon消融9。我们已观察到的患者在手术过程中与正在进行的心房颤动的闭塞的压力的准确测定。 目前，两种尺寸的cryoballoon导管是可用的，28毫米和23毫米直径10。是有限的，然而，压力监测技术没有球囊大小的影响，23毫米球囊的使用情况。压力监测技术是独立的节奏，并且是适用于呈现在心房纤颤的病人。至关重要的是，记录噪声被消除，获得准确的归零闭塞的压力点，以便准确地检测。显示全身动脉压力以及冠状静脉窦（CS）或表面心电图，重要的是确定“活”存在的A波和V波形态的变化。一个常见的​​口经常出现，特别是LY在左侧肺静脉。我们观察到在16/18 PV常见的口闭塞压力波形和完整的电气隔离。 subselective劣势和优越的分支布线，可以实现在共同口的存在。鉴于这些结果，存在一个共同的光伏口是不利用这种技术的一个限制因素。 最初的3个月后，消隐周期和重复PVI，12例（35％），14例（40％）房颤复发或心房扑动中指出。我们的研究结果与公开发表的文献，考虑患者持续性房颤以及6例患者曾接受PVI，这意味着更广泛的AF基板列入。有趣的是，尽管复发10例（6/10）多见于初步测试的利用率更高的对比度。在过去的15例患者中利用最小的对比（对比100.9毫升），四有房颤复发后的程序，对比利用率的显着减少，表明没有产生不利影响的临床结果。 限制鉴于无法记录一次的压力波形的所述管腔内的温度降低到低于-10度，后期气球位错不能被检测到。然而，这是不可能的，因为在这一点上cryoadherence已发生。此外，扰动在膈神经起搏和压力记录特性变得不那么准确后，立即在右肺静脉通胀的压力波形。心房颤动是没有压力监视应用程序的一个限制因素，但它可能使对于没有经验的操作员更加困难的波形解释。与空气被困在3路系统的潜在风险是有限的，但并非没有意义。但是，类似的风险空气栓塞所造成尿路感染lization内导管腔注射造影剂。 在这个试验研究，阳性预测值为有人指出，99％表示完全电气隔离观察闭塞的压力后，之前cryoapplication的可能性极高。相反，阴性预测值是低的（40％）和，非闭塞压力波形的频率驱动在RIPV。在所有患者中，有一个以上的的cryoapplications进行，因此，我们不能排除这种可能性最小的泄漏在每个cryoapplication最终完全电气隔离，由于以前没有烧蚀区域的静脉和同位语的气球精致的机动。这是特别真实的在其中的RIPV，由于其相对较陡进入胃窦部，气球方向的细微变化都需要实现有效的氩氦刀冷冻段的方法。因此，压力监测可能不会像HELPFUL在RIPV解剖变异。 在我们的系列中，我们观察到缺乏电气静脉隔离在两个静脉闭塞性压力，尽管示范。有几个可能的解释这种差异，包括存在的的心外膜肌肉纤维之间的胃窦和肺静脉或静脉球囊不匹配，导致部分的组织冷冻治疗无效。这种现象期间发生利用第一代cryoballoon和不大可能发生的cryoballoon进展，这将允许在PV口更平等地分配cryoenergy即将可用性。最后，该技术主要应用清醒镇静下接受cryoballoon消融患者，但是评估处的压力波形在插管患者呼气末理论上应提供相同的准确的结果。我们已观察到的结果一致，在SMA这里介绍的会子集进行全身麻醉的病人，虽然这不包括在分组分析。 结论压力辅助光电隔离技术是简单的，重复性好，安全。这大大降低了对比度负担和辐射暴露。冷冻过程开始后，由于压力可被记录，闭塞球囊冷却在最初的几秒钟的损失（由于“弹出式”的现象）的风险被最小化。气球定位的精细调整，可以安全地在头10秒的冷却与冷冻前发生。

肺静脉隔离（PVI）是一种被广泛使用的侵入性的方法来治疗心房纤维颤动。标准PVI技术包括射频（RF）导管消融，最近，冷冻利用一个cryoballoon的（北极接待，MDT公司，MN，USA）1，2。这两种技术在平等的长期疗效持久PVI和类似的临床结果3，4。鉴于更快速的静脉电隔离与利用的cryoballoon取得，这后一种方法已经得到了广泛的接受，由运营商和目前专门在房颤消融在大多数中心进行，。 这两种技术之间的重大差异，除其他外，包括完整的肺静脉（PV），以便闭塞与cryoballoon的要求，以实现有效的电气隔离。同位语的cryoballoon在光伏口通常是评估透视与T他利用静脉造影。因此，总金额cryoballoon消融期间使用的X线透视高于标准导管消融，从而增加的辐射损伤的风险。此外，风险与对比输液，如肾功能损伤和对比度过敏，这种技术是一个重要的限制，频繁共存的慢性肾脏病房颤患者5。 cryoballoon通胀的过程中，我们提出了一种新的方法直接PV压力监测。这种技术在一个共35例患者，并进行了验证，再现性和精度进行了评估。

<table border="1"><tbody><tr><td> 的试剂/材料名称 </td><td> 公司 </td><td> 目录编号 </td><td> 评论 </td></tr><tr><td>标准血管造影套件，与NAMIC歧管，三阀组经典流形右侧的端口和手柄（清除） </td><td>美国Navylist医疗， </td><td> 91301303 </td><td>单个组件的套件可以单独购买</td></tr><tr><td>图伊针</td><td>优异医疗，IRL </td><td> MAP 111 </td><td></td></tr><tr><td> EP MED系统</td><td>圣犹达医疗，MN，USA </td><td></td><td></td></tr><tr><td> TruWave一次性压力Trasnducer的压力监测套件</td><td>爱德华生命科学，CA，USA </td><td> PX284 </td><td></td></tr></tbody></table>

direct pressure monitoring accurately predicts pulmonary vein occlusion during cryoballoon ablation

Cryoballoon消融术（CBA）是一个既定的治疗心房纤维颤动（AF）。肺静脉（PV）闭塞实现胃窦接触和光电隔离，是必不可少的，通常是通过注射对比剂评估。我们提出了一种新的方法直接压力监测评估PV闭塞。 经导管压力监测的PV胃窦在气球进步。压力是通过一个单一的压力换能器连接到内腔的cryoballoon记录。压力曲线特征，结合X线透视或心腔内超声（ICE）指导被用来评估闭塞。 PV闭塞与PA压力特性的录音（没有A波和V波快速上行程）被证实，当观察到典型的左心房（LA）的压力波形的损失。完全性肺静脉闭塞评估这种技术已被证实利用，同时对比在初始测试的技术，并已被证明是非常准确和容易重现。 我们评估这种新技术在35例的疗效。进行了评估，共128静脉闭塞的压力监测技术的cryoballoon利用;，113静脉，造成肺静脉电隔离成功111矿脉（98.2％）表现在闭塞的压力。在最初的10个程序，后对比利用率迅速减少或消除闭塞压力波形的高精确度的识别与有限的初始训练，随后注射造影剂闭塞证实。 验证PV闭塞的压力，在CBA是一个新颖的方法来评估有效的光伏闭塞的，它准确地预测了电气隔离。利用此方法会导致显著减少透视时间和量续RAST。

我们评估的准确性压力监测预测完整的光伏闭塞35例（男28例），阵发性组（n = 32）和持久性（N = 3）AF。有六前患者有房颤消融（17％）。球囊扩张过程中，共128个肺静脉压力监测与评估。被证明球囊扩张闭塞压力在113 PV值，其中111电气隔离与CBA（98.2％）。代表性的结果示于图5。 缺乏闭塞的压力波形，更频繁地在RIPV（15分之11PV）的指出。静脉证明闭塞的压力波形电连接的PV闭塞的静脉造影尽管并发示范。阳性预测值为99％。在的RIPV，我们观察到的一个要求高达三个cryoapplications每静脉闭塞压力时被观察到在90％的RIPVs的，而10％的静脉闭塞压力需要4 cryoapplications。与此相反，在RIPV闭塞的压力时，未观察到，在70％的RIPVs执行4或5 cryoapplications被。 一个常见的​​PV口发现9例（27.1％）。左常见的PV口所指出的8例和右PV在一个病人。与普通口，取得了16/18肺静脉闭塞压力。 压力监测技术，我们观察到了显着的效果，在降低总透视时间和放射性碘对比的利用率。平均X线透视时间为25.2±11.2分钟，平均对比度利用率为38±双禧，平均LA时间109±30.8分钟在cryoballoon消融。对比度和曝光时间在最初的10程序，利用技术（34.4±10.1比21.6±9.4分钟的透视，P = 0.001和74±28比23.6±23cc的对比，P = 0.00）显着下降，说明AV<html>红霉素陡峭的学习曲线。这一系列的患者中观察到的压力监测技术的利用有关的无并发症。 POST程序心律失常在一年内无瘤生存率为60％。 AF或心房扑动中有40％的患者导致重复PVI在35％的患者复发。 3/12例房颤复发，以前记录的持续性房颤和6/12的患者都接受PVI指数的程序之前。 <img src="/files/ftp_upload/50247/50247fig1.jpg" alt="图1"/> 图1。甲3路歧管通过管道连接的内腔cryoballoon和一个单一的压力传感器，用于连续的压力记录。 ghres.jpg“/&gt; 图2。在现场记录的标准监控屏幕。表面心电图，心内连拍和静脉和动脉血压记录。 <a href="https://www.jove.com/files/ftp_upload/50247/50247fig2large.jpg" target="_blank">点击此处查看大图</a> 。 <img src="/files/ftp_upload/50247/50247fig3.jpg" alt="图3" fo:content-width="5in" fo:src="/files/ftp_upload/50247/50247fig3highres.jpg"/> 图3 PV的压力波形记录在窦性心律。在最初并置的泄了气的气球（左图），特性LA波形记录与A和V波指出。随着初始通胀率（中间面板），变化的波形注意到，比较突出的V波和持续的低振幅A波，提示静脉闭塞不全。进一步的通货膨胀和成功的周同位语ŕesults消失的A波和V波朝中期舒张，确认完整的光伏闭塞（右图）。 <a href="https://www.jove.com/files/ftp_upload/50247/50247fig3large.jpg" target="_blank">点击此处查看大图</a> 。 <img src="/files/ftp_upload/50247/50247fig4.jpg" alt="图4" fo:content-width="4.8in" fo:src="/files/ftp_upload/50247/50247fig4highres.jpg"/> 图4。在心房纤维颤动，连续心房活动与小振幅V波（A波）当PV不结扎。在光伏口，损失小的连续心房A波V波振幅突然增加的cryoballoon有了进一步的操作中注明的压力波形，证实在房颤PV闭塞。 <a href="https://www.jove.com/files/ftp_upload/50247/50247fig4large.jpg" target="_blank">点击这里查看</a>较大的数字。 <table border="1"><tbody><tr><td>总的PV，N </td><td> 128 </td></tr><tr><td>肺静脉与闭塞的压力，正</td><td> 128分之113 </td></tr><tr><td>与CB隔离肺静脉闭塞的压力时，证明（n）和PPV（％） </td><td> 111/113，99 </td></tr><tr><td>在肺静脉闭塞压力与常见的窦口，正</td><td> 16/18 </td></tr><tr><td> Fluroscopy利用变化（25程序与最初的10程序），最小</td><td> 21.6±9.4比34.4±10.1 </td></tr><tr><td>对比度利用变化（25程序与最初的10程序），CC </td><td> 23.6.6±23比74±28 </td></tr><tr><td> 12个月的心律失常消融术后无瘤生存％ </td><td> 60 </td></tr></tbody></table> 图5的代表性结果。 缩略语 PV=肺静脉CBA = cryoballoon消融，AF =心房纤维颤动，ICE心腔内超声心动图，TEE经食管超声心动图，LA =左心房

Watch this Scientific Journal Video about Direct Pressure Monitoring Accurately Predicts Pulmonary Vein Occlusion During Cryoballoon Ablation at JoVE.com

Direct Pressure Monitoring Accurately Predicts Pulmonary Vein Occlusion During Cryoballoon Ablation

有效的肺静脉电隔离利用一个cryoballoon的依赖于完整的肺静脉闭塞。点，可以有效地预测闭塞球囊扩张过程中，使用一个简单的和可再生的技术直接分析的肺静脉压波形分析。

直接压力监测准确预测在Cryoballoon消融肺静脉阻塞

Cryoballoon  ablation (CBA) is an established therapy for atrial fibrillation (AF).  Pulmonary vein (PV) occlusion is essential for achieving antral ...

direct-pressure-monitoring-accurately-predicts-pulmonary-vein

Research

JoVE Journal

Medicine

19.8K 次观看.  Piedmont Heart Institute. 有效的肺静脉电隔离利用一个cryoballoon的依赖于完整的肺静脉闭塞。点，可以有效地预测闭塞球囊扩张过程中，使用一个简单的和可再生的技术直接分析的肺静脉压波形分析。

视频: Direct Pressure Monitoring Accurately Predicts Pulmonary Vein Occlusion During Cryoballoon Ablation

Optimized System for Cerebral Perfusion Monitoring in the Rat Stroke Model of Intraluminal Middle Cerebral Artery Occlusion

The translational potential of pre-clinical stroke research depends on the accuracy of experimental modeling. Cerebral perfusion monitoring in animal models of acute ischemic stroke allows to confirm successful arterial occlusion and exclude subarachnoid hemorrhage. Cerebral perfusion monitoring can also be used to study intracranial collateral circulation, which is emerging as a powerful determinant of stroke outcome and a possible therapeutic target. Despite a recognized role of Laser Doppler perfusion monitoring as part of the current guidelines for experimental cerebral ischemia, a number of technical difficulties exist that limit its widespread use. One of the major issues is obtaining a secure and prolonged attachment of a deep-penetration Laser Doppler probe to the animal skull. In this video, we show our optimized system for cerebral perfusion monitoring during transient middle cerebral artery occlusion by intraluminal filament in the rat. We developed in-house a simple method to obtain a custom made holder for twin-fibre (deep-penetration) Laser Doppler probes, which allow multi-site monitoring if needed. A continuous and prolonged monitoring of cerebral perfusion could easily be obtained over the intact skull.

Cerebral perfusion monitoring has been demonstrated to improve accuracy in ischemic stroke models. Technical difficulties often limit the use of this essential tool for cerebrovascular research. In this video, an optimized system is shown to obtain a single or multi-site hemodynamic monitoring during intraluminal middle cerebral artery occlusion in rats.

优化系统的脑灌注监测在中风模型大鼠的大脑中动脉闭塞腔内

The translational potential of pre-clinical stroke research depends on the accuracy of experimental modeling. Cerebral perfusion monitoring in animal ...

科研

医学

Reduction of Iatrogenic Atrial Septal Defects with an Anterior and Inferior Transseptal Puncture Site when Operating the Cryoballoon Ablation Catheter

The cryoballoon catheter ablates atrial fibrillation (AF) triggers in the left atrium (LA) and pulmonary veins (PVs) via transseptal access. The typical transseptal puncture site is the fossa ovalis (FO) &#8211; the atrial septum&#8217;s thinnest section. A potentially beneficial transseptal site, for the cryoballoon, is near the inferior limbus (IL). This study examines an alternative transseptal site near the IL, which may decrease the frequency of acute iatrogenic atrial septal defect (IASD). Also, the study evaluates the acute pulmonary vein isolation (PVI) success rate utilizing the IL location. 200 patients were evaluated by retrospective chart review for acute PVI success rate with an IL transseptal site. An additional 128 IL transseptal patients were compared to 45 FO transseptal patients by performing Doppler intracardiac echocardiography (ICE) post-ablation to assess transseptal flow after removal of the transseptal sheath. After sheath removal and by Doppler ICE imaging, 42 of 128 (33%) IL transseptal patients demonstrated acute transseptal flow, while 45 of 45 (100%) FO transseptal puncture patients had acute transseptal flow. The difference in acute transseptal flow detection between FO and IL sites was statistically significant (P &#60;0.0001). Furthermore, 186 of 200 patients (with an IL transseptal puncture) did not need additional ablation(s) and had achieved an acute PVI by a &#8220;cryoballoon only&#8221; technique. An IL transseptal puncture site for cryoballoon AF ablations is an effective location to mediate PVI at all four PVs. Additionally, an IL transseptal location can lower the incidence of acute transseptal flow by Doppler ICE when compared to the FO. Potentially, the IL transseptal site may reduce later IASD complications post-cryoballoon procedures.

The goal of this study is to demonstrate the preferential location of transseptal puncture during a cryoballoon catheter ablation procedure for the treatment of atrial fibrillation.

与前伪劣间隔穿刺网站减少医源性房间隔缺损操作Cryoballoon消融导管时，

The cryoballoon catheter ablates atrial fibrillation (AF) triggers in the left atrium (LA) and pulmonary veins (PVs) via transseptal access. The typical ...

A Pulmonary Trunk Banding Model of Pressure Overload Induced Right Ventricular Hypertrophy and Failure

Right ventricular (RV) failure induced by sustained pressure overload is a major contributor to morbidity and mortality in several cardiopulmonary disorders. Reliable and reproducible animal models of RV failure are therefore warranted in order to investigate disease mechanisms and effects of potential therapeutic strategies. Banding of the pulmonary trunk is a common method to induce isolated RV hypertrophy but in general, previously described models have not succeeded in creating a stable model of RV hypertrophy and failure.
We present a rat model of pressure overload induced RV hypertrophy caused by pulmonary trunk banding (PTB) that enables different phenotypes of RV hypertrophy with and without RV failure. We use a modified ligating clip applier to compress a titanium clip around the pulmonary trunk to a pre-set inner diameter. We use different clip diameters to induce different stages of disease progression from mild RV hypertrophy to decompensated RV failure.
RV hypertrophy develops consistently in rats subjected to the PTB procedure and depending on the diameter of the applied banding clip, we can accurately reproduce different disease severities ranging from compensated hypertrophy to severe decompensated RV failure with extra-cardiac manifestations.
The presented PTB model is a valid and robust model of pressure overload induced RV hypertrophy and failure that has several advantages to other banding models including high reproducibility and the possibility of inducing severe and decompensated RV failure.

We present a surgical method to induce right ventricular hypertrophy and failure in rats.

压力超载诱发右室肥厚和衰竭的肺动脉扣条柱模型

Right ventricular (RV) failure induced by sustained pressure overload is a major contributor to morbidity and mortality in several cardiopulmonary ...

Minimizing Post-Infusion Portal Vein Bleeding during Intrahepatic Islet Transplantation in Mice

Although the liver is currently accepted as the primary transplantation site for human islets in clinical settings, islets are transplanted under the kidney capsule in most rodent preclinical islet transplantation studies. This model is commonly used because murine intrahepatic islet transplantation is technically challenging, and a high percentage of mice could die from surgical complications, especially bleeding from the injection site post-transplantation. In this study, two procedures that can minimize the incidence of post-infusion portal vein bleeding are demonstrated. The first method applies an absorbable hemostatic gelatin sponge to the injection site, and the second method involves penetrating the islet injection needle through the fat tissue first and then into the portal vein by using the fat tissue as a physical barrier to stop bleeding. Both methods could effectively prevent bleeding-induced mouse death. The whole liver section showing islet distribution and evidence of islet thrombosis post-transplantation, a typical feature for intrahepatic islet transplantation, were presented. These improved protocols refine the intrahepatic islet transplantation procedures and may help laboratories set up the procedure to study islet survival and function in pre-clinical settings.

Here we present refined surgical procedures on successfully performing intraportal islet transplantation, a clinically relevant but technically challenging surgical procedure, in mice.

尽量减少小鼠肝内胰岛移植期间输注后门静脉出血

Although the liver is currently accepted as the primary transplantation site for human islets in clinical settings, islets are transplanted under the ...

Real-Time Electrocardiogram Monitoring During Treadmill Training in Mice

Regular physical exercise is a major contributor to cardiovascular health, influencing various metabolic as well as electrophysiological processes. However, in certain cardiac diseases such as inherited arrhythmia syndromes, e.g., arrhythmogenic cardiomyopathy (ACM) or myocarditis, physical exercise may have negative effects on the heart leading to a proarrhythmogenic substrate production. Currently, the underlying molecular mechanisms of exercise-related proarrhythmogenic remodeling are largely unknown, thus it remains unclear which frequency, duration, and intensity of exercise can be considered safe in the context of disease(s).
The proposed method allows to study proarrhythmic/antiarrhythmic effects of physical exercise by combining treadmill training with real-time monitoring of the ECG. Implantable telemetry devices are used to continuously record the ECG of freely moving mice over a period of up to 3 months both at rest and during treadmill training. Data acquisition software with its analysis modules is used to analyze basic ECG parameters such as heart rate, P wave duration, PR interval, QRS interval, or QT duration at rest, during and after training. Furthermore, heart rate variability (HRV) parameters and occurrence of arrhythmias are evaluated. In brief, this manuscript describes a step-by-step approach to experimentally explore exercise induced effects on cardiac electrophysiology, including potential proarrhythmogenic remodeling in mouse models.

Electrocardiogram (ECG) is the key variable to understanding cardiac electrophysiology. Physical exercise has beneficial effects but may also be harmful in the context of cardiovascular diseases. This manuscript provides a method of recording real-time ECG during exercise, which can serve to investigate its effects on cardiac electrophysiology in mice.

小鼠跑步机训练期间的实时心电图监测

Regular physical exercise is a major contributor to cardiovascular health, influencing various metabolic as well as electrophysiological processes. ...

Establishment and Evaluation of a Porcine Vein Graft Disease Model

Venous graft disease (VGD) is the leading cause of coronary artery bypass graft (CABG) failure. Large animal models of CABG-VGD are needed for the investigation of disease mechanisms and the development of therapeutic strategies. 
To perform the surgery, we enter the cardiac chamber through the third intercostal space and carefully dissect the internal mammary vein and immerse it in normal saline. The right main coronary artery is then treated for ischemia. The target vessel is incised, a shunt plug is placed, and the distal end of the graft vein is anastomosed. The ascending aorta is partially blocked, and the proximal end of the graft vein is anastomosed after perforation. The graft vein is checked for patency, and the proximal right coronary artery is ligated. 
CABG surgery is performed in minipigs to harvest the left internal mammary vein for its use as a vascular graft. Serum biochemical tests are used to evaluate the physiological status of the animals after surgery. Ultrasound examination shows that the proximal, middle, and distal end of the graft vessel are unobstructed. In the surgical model, turbulent blood flow in the graft is observed upon histological examination after the CABG surgery, and venous graft stenosis associated with intimal hyperplasia is observed in the graft. The study here provides detailed surgical procedures for the establishment of a repeatable CABG-induced VGD model.

In this protocol, novel pig vein bypass grafting was performed through a small incision in the left chest wall without cardiopulmonary bypass. A postoperative pathology study was done, which showed intimal thickening.

猪静脉移植病模型的建立与评价

Venous graft disease (VGD) is the leading cause of coronary artery bypass graft (CABG) failure. Large animal models of CABG-VGD are needed for the ...

Reduced Procedure Time and Variability with Active Esophageal Cooling During Radiofrequency Ablation for Atrial Fibrillation

Various methods are utilized during radiofrequency (RF) pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) to protect the esophagus from inadvertent thermal injury. Active esophageal cooling is increasingly being used over traditional luminal esophageal temperature (LET) monitoring, and each approach may influence procedure times and the variability around those times. The objective of this study is to measure the effects on procedure time and variability in procedure time of two different esophageal protection strategies utilizing advanced informatics techniques to facilitate data extraction. Trained clinical informaticists first performed a contextual inquiry in the catheterization laboratory to determine laboratory workflows and observe the documentation of procedural data within the electronic health record (EHR). These EHR data structures were then identified in the electronic health record reporting database, facilitating data extraction from the EHR. A manual chart review using a REDCap database created for the study was then performed to identify additional data elements, including the type of esophageal protection used. Procedure duration was then compared using summary statistics and standard measures of dispersion.&#160;A total of 164 patients underwent radiofrequency PVI over the study timeframe; 63 patients (38%) were treated with LET monitoring, and 101 patients (62%) were treated with active esophageal cooling. The mean procedure time was 176 min (SD of 52 min) in the LET monitoring group compared to 156 min (SD of 40 min) in the esophageal cooling group (P = 0.012). Thus, active esophageal cooling during PVI is associated with reduced procedure time and reduced variation in procedure time when compared to traditional LET monitoring.

This study utilized advanced informatics techniques to compare procedure duration in patients undergoing radiofrequency atrial ablation treated with active esophageal cooling to those treated with traditional luminal esophageal temperature monitoring. Contextual inquiry, workflow analysis, and data mapping were utilized. The findings demonstrated reduced procedure time and variability with active cooling.

通过主动食管冷却减少心房颤动射频消融术的手术时间和可变性

Various methods are utilized during radiofrequency (RF) pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) to protect the ...

Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography

Heart transplantation remains the gold standard treatment for advanced heart failure. However, the current critical organ shortage has resulted in the allocation of a growing number of donor hearts with extended criteria. These marginal grafts are associated with a high risk of primary graft failure and may benefit from ex situ perfusion before transplant. This technology allows for extended organ preservation using warm oxygenated blood perfusion with continuous metabolic monitoring. The only NESP device currently available for clinical practice perfuses the organ in an unloaded non-working state, which does not allow for functional assessment of the beating heart. We therefore developed an original platform of NESP in working mode conditions with adjustment of left ventricular preload and afterload. This protocol was applied in porcine hearts. Ex situ functional assessment of the heart was achieved with intracardiac conductance catheterization and surface echocardiography. Along with a description of the experimental protocol, we herein report the main results, as well as pearls and pitfalls associated with the acquisition of pressure-volume loops and myocardial power during NESP. Correlations between hemodynamic findings and ultrasound variables are of major interest, especially for further rehabilitation of donor hearts before transplantation. This protocol aims to improve the assessment of donor hearts to both increase the donor pool and reduce the incidence of primary graft failure.

Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography

A reliable noninvasive approach for functional assessment of the donor heart during normothermic ex situ heart perfusion (NESP) is lacking. We herein describe a protocol for ex situ assessment of myocardial performance using the epicardial echocardiography and conductance catheter method.

非原位灌注期间供体心脏的功能评估：来自压力-容量环和表面超声心动图的见解

Heart transplantation remains the gold standard treatment for advanced heart failure. However, the current critical organ shortage has resulted in the ...

Occlusion of the Great and Small Saphenous Vein Using Copolymeric Glue Based on N-Butyl Cyanoacrylate and Methacryloxy Sulfolane

We present the preliminary results of a longitudinal observational study aimed at evaluating the effectiveness and safety at different short- and long-term follow-ups of vascular occlusion of the great saphenous vein (GSV) and small saphenous vein (SSV) affected by severe pathological reflux, using an innovative modified cyanoacrylate surgical glue composed of N-butyl cyanoacrylate and methacryloxy sulfolane (NBCA+MS). Ninety patients, prospectively recruited for 1 year, underwent the study with EcoColor-Doppler (ECD) to evaluate the maximum diameters of the GSV and SSV in the orthostatic position and the reflux time (RT). An RT greater than 0.5 s was considered pathologic. Clinical, etiology, anatomy, and pathophysiology (CEAP) assessment was used for the complete evaluation of each patient in the study. All the patients were treated by NBCA+MS glue to obtain vein occlusion and observed before treatment (baseline; T0), within 6 h after treatment (T1), 1 month after treatment (T2), 3 months after treatment (T3), 6 months after treatment (T4), and 1 year after treatment (T5). Chi-square (&#967;) analysis was performed to evaluate the effectiveness and safety of the treatment. All the patients participated in the entire duration of the study. Complete occlusion was maintained in 100% of patients at T1, 98.9% at T2 and T3, and 97.8% at T4 and T5 (p &lt; 0.001). None of the patients suffered from post-surgical thrombosis. No blue hyperpigmentation, or paresthesia was observed during the entire observation period. Immediately after treatment, 7.7% of patients needed painkillers; 1 week after treatment, 100% of patients returned to normal life. Vascular occlusion of the great or small saphenous vein using NBCA+MS glue is a safe procedure with persistent benefits after a 1 year follow-up. This procedure can be performed with local anesthesia, allowing a quick return to normal life. Thanks to its low invasiveness, the treatment is not painful.

Here, we present a protocol to treat the great saphenous vein (GSV) and the small saphenous vein (SSV) affected by severe pathological reflux, using an original sclerosing and embolizing cyanoacrylate-based glue composed of N-butyl cyanoacrylate and methacryloxy sulfolane (NBCA+MS).

使用基于氰基丙烯酸正丁酯和甲基丙烯酰氧基环丁基磺烷的共聚物胶咬合大隐脉和小隐脉

We present the preliminary results of a longitudinal observational study aimed at evaluating the effectiveness and safety at different short- and ...

基于 ICE 的左心房和肺静脉 3D 重塑

Three-Dimensional Modeling of the Left Atrium and Pulmonary Veins with a Precise Intracardiac Echocardiography Approach

Intracardiac echocardiography (ICE) is a novel tool for estimating cardiac anatomy during pulmonary vein isolation procedures, particularly the left atrium (LA) anatomy and pulmonary vein structures. ICE is widely used to establish a three-dimensional (3D) left atrial structural model during ablation procedures. However, it is unclear whether using ICE in a precise 3D modeling method can provide a more accurate left atrial 3D model and the transseptal approach. This study proposes a protocol to model the left atrium and pulmonary veins with ICE and fast anatomical mapping (FAM) catheter remodeling. It evaluates the accuracy of the models produced using the two methods through observer scoring. We included 50 patients who underwent ICE-based 3D remodeling and 45 who underwent FAM 3D remodeling based on pulmonary vein isolation procedures. The pulmonary vein antrum remodeling is estimated by comparing the antrum area acquired by remodeling and left atrial computed tomography angiography (CTA). The observer scores for the modeling in the ICE and FAM groups were 3.40 &#177; 0.81 and 3.02 &#177; 0.72 (P &#60; 0.05), respectively. The pulmonary vein antrum area obtained using the ICE- and FAM-based methods showed a correlation with the area acquired by left atrium CT. However, the 95% confidence interval bias was narrower in ICE-acquired models than in FAM-acquired models (-238 cm2 to 323 cm2 Vs. -363 cm2 to 386 cm2, respectively) using Bland-Altman analysis. Therefore, precise ICE possesses high accuracy in estimating the left atrial structure, becoming a promising approach for future cardiac structure estimation.

作者聚焦：用于心房解剖评估的心内超声心动图的进展 

Accurate intracardiac echocardiography (ICE) shows significant accuracy in estimating the left atrial structure, a prospective and promising cardiac structure estimation method. Here we propose a protocol for three-dimensional modeling of the left atrium and pulmonary veins with ICE and fast anatomical mapping (FAM) catheter remodeling.

使用精确的心内超声心动图方法对左心房和肺静脉进行三维建模

Intracardiac echocardiography (ICE) is a novel tool for estimating cardiac anatomy during pulmonary vein isolation procedures, particularly the left ...