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Vassallo F, Volponi C, Cunha C, Corcino L, Serpa E, Simoes A, Gasparini D, Barbosa LF, Schmidt A. Impact of weight adjusted high frequency low tidal volume ventilation and atrial pacing in lesion metrics in high-power short-duration ablation: Results of a pilot study. J Cardiovasc Electrophysiol 2024; 35:975-983. [PMID: 38482937 DOI: 10.1111/jce.16245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/17/2024] [Accepted: 02/27/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Lesion size index (LSI) was introduced with the use of Tacticath™ and as a surrogate of lesion quality. The metric used to achieve the predetermined values involves combined information of contact force (CF), power and radiofrequency time. Rapid atrial pacing (RAP) and high-frequency low-tidal volume ventilation (HFLTV) independently or in combination improve catheter stability and CF and quality of lesions. Data of the impact of body weight adjusted HFLTV ventilation strategy associated with RAP in the lesion metrics still lacking. The study aimed to compare the results of high-power short-duration (HPSD) atrial fibrillation ablation using simultaneous weight adjusted HFLTV and RAP and standard ventilation (SV) protocol. METHODS Prospective, nonrandomized study with 136 patients undergoing de novo ablation divided into two groups; 70 in RAP (100 ppm) + HFLTV with 4 mL/kg of tidal volume and 25 breaths/min (group A) and 66 patients with SV in intrinsic sinus rhythm (group B). Ablation using 50 W, CF of 5-10 g/10-20 g and 40 mL/minute flow rate on the posterior and anterior left atrial wall, respectively. RESULTS No procedure-related complications. Group A: Mean LSI points 70 ± 16.5, mean total lower LSI 3.4 ± 0.5, mean total higher LSI 8.2 ± 0.4 and mean total LSI 5.6 ± 0.6. Anterior and posterior wall mean total LSI was 6.0 ± 0.4 and 4.2 ± 0.3, respectively. Mean local impedance drop (LID) points were 118.8 ± 28.4, mean LID index (%) 12.9 ± 1.5, and mean LID < 12% points 55.9 ± 23.8. Anterior and posterior wall mean total LID index were 13.6 ± 2.0 and 11.9 ± 1.7, respectively. Recurrence in 11 (15.7%) patients. Group B: Mean LSI points 56 ± 2.7, mean total lower LSI 2.9 ± 0.7, mean total higher LSI 6.9 ± 0.9, and mean total LSI 4.8 ± 0.8. Anterior and posterior wall mean total LSI was 5.1 ± 0.3 and 3.5 ± 0.5, respectively. Mean LID points were 111.4 ± 21.5, mean LID index (%) 11.4 ± 1.2, and mean LID < 12% points 54.9 ± 25.2. Anterior and posterior wall mean total LID index were 11.8 ± 1.9 and 10.3 ± 1.7, respectively. Recurrence in 14 (21.2%) patients. Mean follow up was 15.2 ± 4.4 months. CONCLUSION Weight adjusted HFLTV ventilation with RAP HPSD ablation produced lower recurrence rate and better LSI and LID parameters in comparison to SV and intrinsic sinus rhythm.
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Affiliation(s)
- Fabricio Vassallo
- Santa Rita Cassia Hospital, Vitoria, Espirito Santo, Brazil
- Santa Casa Misericordia Hospital, Vitória, Espirito Santo, Brazil
- Cardiology Division of Ribeirao Preto Medical School - University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Carlos Volponi
- Santa Rita Cassia Hospital, Vitoria, Espirito Santo, Brazil
- Santa Casa Misericordia Hospital, Vitória, Espirito Santo, Brazil
| | - Christiano Cunha
- Santa Rita Cassia Hospital, Vitoria, Espirito Santo, Brazil
- Santa Casa Misericordia Hospital, Vitória, Espirito Santo, Brazil
| | - Lucas Corcino
- Santa Rita Cassia Hospital, Vitoria, Espirito Santo, Brazil
- Santa Casa Misericordia Hospital, Vitória, Espirito Santo, Brazil
- Cardiology Division of Ribeirao Preto Medical School - University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Eduardo Serpa
- Santa Rita Cassia Hospital, Vitoria, Espirito Santo, Brazil
- Santa Casa Misericordia Hospital, Vitória, Espirito Santo, Brazil
| | - Aloyr Simoes
- Santa Rita Cassia Hospital, Vitoria, Espirito Santo, Brazil
- Santa Casa Misericordia Hospital, Vitória, Espirito Santo, Brazil
| | - Dalbian Gasparini
- Santa Rita Cassia Hospital, Vitoria, Espirito Santo, Brazil
- Santa Casa Misericordia Hospital, Vitória, Espirito Santo, Brazil
| | | | - Andre Schmidt
- Cardiology Division of Ribeirao Preto Medical School - University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
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Vassallo F, Cancellieri JP, Cunha C, Corcino L, Serpa E, Simoes A, Hespanhol D, Volponi C, Gasparini D, Schmidt A. Comparison between weight-adjusted, high-frequency, low-tidal-volume ventilation and atrial pacing with normal ventilation in high-power, short-duration atrial fibrillation ablation: Results of a pilot study. Heart Rhythm O2 2023; 4:483-490. [PMID: 37645264 PMCID: PMC10461207 DOI: 10.1016/j.hroo.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Background Better contact force (CF) and catheter stability (CS) during atrial fibrillation (AF) ablation are associated with higher success rate. Changes in CF and CS are observed during respiratory movements and cardiac contraction. Previous studies have suggested that rapid atrial pacing (RAP) and high-frequency, low-tidal-volume ventilation (HFLTV) independently or in combination improve CS and CF and quality of lesions. Data from a body weight-adjusted HFLTV strategy associated with RAP in AF high-power, short-duration (HPSD) ablation are still lacking. Objective This study aimed to compare the results of HPSD AF ablation using simultaneous weight-adjusted HFLTV and RAP and standard ventilation (SV) protocol. Methods This was a prospective, nonrandomized study with 136 patients undergoing de novo ablation were divided into 2 groups: 70 in RAP (100 ppm) + HFLTV with 4 mL/kg of tidal volume and 25 breaths/min (group A) and 66 patients with SV in intrinsic sinus rhythm (group B). The ablation used 50 W, CF of 5 to 10 g and 10 to 20 g, and 40 mL/min flow rate on the posterior and anterior left atrial walls, respectively. Results There were no procedure-related complications. In group A, left atrial and total ablation times were 53.5 ± 8.3 minutes and 67.4 ± 10.1 minutes, respectively. Radiofrequency time was 19.7 ± 5.7 minutes, radioscopy time was 3.4 ± 1.8 minutes, 62 (88.6%) patients had first-pass isolation, 23 (33.3%) patients had elevation of luminal esophageal temperature, and 7 (10%) patients had recurrence. In group B, left atrial time was 56.7 ± 10.8 minutes, total ablation time was 72.4 ± 11.5 minutes, radiofrequency time was 22.4 ± 6.2 minutes, radioscopy time was 3.6 ± 3 minutes, 58 (87.9%) patients had first-pass isolation, and 20 (30.3%) patients had luminal esophageal temperature elevation. Conclusion Weight-adjusted HFLTV with RAP in comparison with SV and intrinsic sinus rhythm in HPSD ablation is safe with no CO2 retention. The approach produced significantly reduced radiofrequency, left atrial, and total ablation times and better CF and local impedance drop indexes.
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Affiliation(s)
- Fabricio Vassallo
- Cardiology Department, Electrophysiology Section, Santa Rita Cassia Hospital, Vitoria, Brazil
- Cardiology Department, Electrophysiology Section, Santa Casa Misericordia Hospital, Vitória, Brazil
- Cardiology Division, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Joao Pedro Cancellieri
- Cardiology Department, Electrophysiology Section, Santa Rita Cassia Hospital, Vitoria, Brazil
| | - Christiano Cunha
- Cardiology Department, Electrophysiology Section, Santa Rita Cassia Hospital, Vitoria, Brazil
- Cardiology Department, Electrophysiology Section, Santa Casa Misericordia Hospital, Vitória, Brazil
| | - Lucas Corcino
- Cardiology Department, Electrophysiology Section, Santa Rita Cassia Hospital, Vitoria, Brazil
- Cardiology Department, Electrophysiology Section, Santa Casa Misericordia Hospital, Vitória, Brazil
- Cardiology Division, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Eduardo Serpa
- Cardiology Department, Electrophysiology Section, Santa Rita Cassia Hospital, Vitoria, Brazil
- Cardiology Department, Electrophysiology Section, Santa Casa Misericordia Hospital, Vitória, Brazil
| | - Aloyr Simoes
- Cardiology Department, Electrophysiology Section, Santa Rita Cassia Hospital, Vitoria, Brazil
- Cardiology Department, Electrophysiology Section, Santa Casa Misericordia Hospital, Vitória, Brazil
| | - Dalton Hespanhol
- Cardiology Department, Electrophysiology Section, Santa Rita Cassia Hospital, Vitoria, Brazil
- Cardiology Department, Electrophysiology Section, Santa Casa Misericordia Hospital, Vitória, Brazil
| | - Carlos Volponi
- Cardiology Department, Electrophysiology Section, Santa Rita Cassia Hospital, Vitoria, Brazil
- Cardiology Department, Electrophysiology Section, Santa Casa Misericordia Hospital, Vitória, Brazil
| | - Dalbian Gasparini
- Cardiology Department, Electrophysiology Section, Santa Rita Cassia Hospital, Vitoria, Brazil
- Cardiology Department, Electrophysiology Section, Santa Casa Misericordia Hospital, Vitória, Brazil
| | - Andre Schmidt
- Cardiology Division, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
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Santarone M, Piscitello L, Volponi C, Vigevano F, Fusco L. Focal non-motor seizures and subsequent focal motor seizures as the main clinical expression of GLUT-1 deficiency. Epilepsy Behav Rep 2022; 20:100571. [DOI: 10.1016/j.ebr.2022.100571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/09/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
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Vassallo F, Silva ED, Meigre LL, Cunha C, Serpa E, Simões Jr A, Carloni H, Volponi C. Initial Experience with Fractionation Mapping in the Identification of Vagal Ganglionated Plexus During Cardioneuroablation. J Cardiac Arrhtythmias 2021. [DOI: 10.24207/jca.v34i3.3461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This is a series case report of five symptomatic patients presented with diagnosis of sinus bradycardia, first and second degrees atrioventricular (AV) blocks, that were referred to pacemaker implantation. During the screening, a functional cause for the bradycardia and AV blocks were documented by treadmill stress test, 24-hour Holter monitoring and atropine test. After the confirmation of the diagnosis, patients were submitted to cardioneuroablation on an anatomical basis supported by a tridimensional electroanatomical fractionation mapping software. The technique and the acute and short-term results of the cardioneuroablation are described.
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Rodrigues Neto M, Carmo P, Volponi C, Carmo J, Carvalho MS, Cavaco D, Morgado FB, Costa FM, Vaz E, Canuto AR, Adragao P, Mendes M. P6639Can adjustments in voltage criteria unmask conducting channels in patients with post-infarction ventricular tachycardia? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - P Carmo
- Hospital de Santa Cruz, Lisbon, Portugal
| | - C Volponi
- Hospital de Santa Cruz, Lisbon, Portugal
| | - J Carmo
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | - D Cavaco
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | - F M Costa
- Hospital de Santa Cruz, Lisbon, Portugal
| | - E Vaz
- Hospital de Santa Cruz, Lisbon, Portugal
| | - A R Canuto
- Hospital de Santa Cruz, Lisbon, Portugal
| | - P Adragao
- Hospital de Santa Cruz, Lisbon, Portugal
| | - M Mendes
- Hospital de Santa Cruz, Lisbon, Portugal
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Carmo J, Ferreira J, Costa F, Cavaco D, Carmo P, Morgado F, Carvalho MS, Santos I, Volponi C, Mesquita J, Neto M, Adragao P. 523Ischemic stroke and mortality reduction after atrial fibrillation ablation: a propensity matched analysis. Europace 2018. [DOI: 10.1093/europace/euy015.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Carmo
- Hospital de Santa Cruz, Lisbon, Portugal
| | - J Ferreira
- Hospital de Santa Cruz, Lisbon, Portugal
| | - F Costa
- Hospital de Santa Cruz, Lisbon, Portugal
| | - D Cavaco
- Hospital de Santa Cruz, Lisbon, Portugal
| | - P Carmo
- Hospital de Santa Cruz, Lisbon, Portugal
| | - F Morgado
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | - I Santos
- Hospital de Santa Cruz, Lisbon, Portugal
| | - C Volponi
- Hospital de Santa Cruz, Lisbon, Portugal
| | - J Mesquita
- Hospital de Santa Cruz, Lisbon, Portugal
| | - M Neto
- Hospital de Santa Cruz, Lisbon, Portugal
| | - P Adragao
- Hospital de Santa Cruz, Lisbon, Portugal
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Carmo J, Cavaco D, Carmo P, Morgado FB, Costa F, Parreira L, Santos I, Volponi C, Mesquita J, Neto M, Adragao P. P409Leadless pacemaker: initial experience of two centres in Portugal. Europace 2018. [DOI: 10.1093/europace/euy015.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Carmo
- Hospital de Santa Cruz, Lisbon, Portugal
| | - D Cavaco
- Hospital de Santa Cruz, Lisbon, Portugal
| | - P Carmo
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | - F Costa
- Hospital de Santa Cruz, Lisbon, Portugal
| | | | - I Santos
- Hospital de Santa Cruz, Lisbon, Portugal
| | - C Volponi
- Hospital de Santa Cruz, Lisbon, Portugal
| | - J Mesquita
- Hospital de Santa Cruz, Lisbon, Portugal
| | - M Neto
- Hospital de Santa Cruz, Lisbon, Portugal
| | - P Adragao
- Hospital de Santa Cruz, Lisbon, Portugal
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Oliveira LH, Coutinho E, Uellendahl M, Ferreira GM, Raimundi F, Dietrich C, Volponi C, Luize CM, Cirenza C, de Paola A. Ablation of epicardial ventricular tachycardia in a chagasic patient with situs inversus totalis: A case report. HeartRhythm Case Rep 2017; 3:562-565. [PMID: 29296575 PMCID: PMC5741799 DOI: 10.1016/j.hrcr.2017.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Lucas Hollanda Oliveira
- Address reprint requests and correspondence: Lucas Hollanda Oliveira, Department of Electrophysiology, Federal University of São Paulo, 715 Napoleão de Barros St, Vila Clementino, São Paulo, Brazil.Department of ElectrophysiologyFederal University of São Paulo715 Napoleão de Barros StVila ClementinoSão PauloBrazil
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Di Capua M, Volponi C, Fraietta M, Silvestri D, Alessandri B, Pro S. 44. Utility of mn-sep subcortical N13b-P13 in pediatric subjects with cranio-cervical junction alteration of different etiologies. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Agati L, Funaro S, Veneroso G, Volponi C, De Maio F, Madonna MP, Fedele F. Non-invasive assessment of myocardial perfusion by intravenous contrast echocardiography: state of the art. Ital Heart J 2001; 2:403-7. [PMID: 11453574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Many technical problems, related to both imaging instrumentation and contrast agents, have to be taken into account before attempting non-invasive evaluation of myocardial perfusion by intravenous contrast media injection. Potentials and pitfalls of first generation contrast agents (i.e. Levovist, Schering AG, Berlin, Germany) using intermittent harmonic angio imaging and of second generation contrast media (i.e. SonoVue, Bracco SpA, Milan, Italy) using real-time perfusion imaging in the non-invasive assessment of myocardial perfusion were described and discussed. We still need more solid data before introducing intravenous myocardial echocardiography into the clinical arena. However, convincing data from several research laboratories are paving the way for the widespread use of this new method in clinical practice.
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Affiliation(s)
- L Agati
- Department of Cardiology, La Sapienza University of Rome, Italy.
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Carrera V, Moroni A, Martegani E, Volponi C, Cool RH, Alberghina L, Vanoni M. Mutations at position 1122 in the catalytic domain of the mouse ras-specific guanine nucleotide exchange factor CDC25Mm originate both loss-of-function and gain-of-function proteins. FEBS Lett 1998; 440:291-6. [PMID: 9872389 DOI: 10.1016/s0014-5793(98)01481-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The role of two residues within the catalytic domain of CDC25Mm, a mouse ras-specific guanine nucleotide exchange factor (GEF), was investigated by site-directed mutagenesis. The function of the mutant proteins was tested in vivo in both a Saccharomyces cerevisiae cdc25 complementation assay and in a mammalian fos-luciferase assay, and in in vitro assays on human and yeast Ras proteins. Mutants CDC25Mm(E1048K) and CDC25Mm(S1122V) were shown to be (partly) inactive proteins, similar to their yeast homologs. Mutant CDC25Mm(S1122A) showed higher nucleotide exchange activity than the wild type protein on the basis of both in vitro and in vivo assays. Thus, alanine and valine substitutions at position 1122 within the GEF catalytic domain originate mutations with opposite biological properties, indicating an important role for position 1122 in GEF function.
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Affiliation(s)
- V Carrera
- Dipartimento di Fisiologia e Biochimica Generali Sezione di Biochímica Comparata, Università degli Studi di Milano, Milan, Italy
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