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Jacobson JM, Zahrieh D, Strand CA, Cruz-Correa M, Pungpapong S, Roberts LR, Mandrekar SJ, Rodriguez LM, Boyer J, Marrero I, Kraynyak KA, Morrow MP, Sylvester AJ, Pawlicki JM, Gillespie E, Barranco E, Richmond E, Umar A, Weiner DB, Limburg PJ. Phase I Trial of a Therapeutic DNA Vaccine for Preventing Hepatocellular Carcinoma from Chronic Hepatitis C Virus (HCV) Infection. Cancer Prev Res (Phila) 2023; 16:163-173. [PMID: 36534786 PMCID: PMC9992130 DOI: 10.1158/1940-6207.capr-22-0217] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/14/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
Chronic hepatitis C can lead to cirrhosis and hepatocellular carcinoma. We studied the safety and immunogenicity of a novel therapeutic hepatitis C virus (HCV) genotype 1a/1b consensus DNA vaccine, INO-8000, encoding HCV NS3, NS4A, NS4B, and NS5A proteins alone or co-administered with DNA-encoding IL12 (INO-9012), a human cytokine that stimulates cellular immune function, in individuals with chronic hepatitis C. This was a phase I, multisite dose-escalation trial with an expansion cohort evaluating doses of 0, 0.3, 1.0, and 3.0 mg of INO-9012 (IL12 DNA) as an addition to 6.0 mg of (INO-8000; HCV DNA vaccine). Vaccines were administered by intramuscular injection followed by electroporation at study entry and at weeks 4, 12, and 24. HCV-specific CD4+ and CD8+ T-cell immune responses were measured by IFNγ ELISpot and flow cytometry-based assays. Transient, mild-to-moderate injection site reactions unrelated to IL12 DNA dose were common. Increases in HCV-specific IFNγ production occurred in 15/20 (75%) participants. Increases in the frequency of HCV-specific CD4+ and CD8+ T cells occurred at all dose levels, with the greatest increases seen at 1.0 mg of INO-9012. HCV-specific CD8+ and CD4+ T-cell activities increased in 16/18 (89%) and 14/17 (82%) participants with available data, respectively. The vaccine regimen was safe and induced HCV-specific CD4+ and CD8+ cellular immune responses of modest magnitude in most HCV-infected participants. The addition of 1.0 mg of IL12 DNA provided the best enhancement of immune responses. The vaccine regimen had little effect on controlling HCV viremia. PREVENTION RELEVANCE The administration of IL12 DNA along with a hepatitis C viral antigen DNA vaccine enhanced the HCV-specific immune responses induced by the vaccine in individuals with chronic hepatitis C, an important cause of hepatocellular carcinoma. IL12 could be an effective adjuvant in vaccines targeting HCV and other oncogenic viruses.
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Affiliation(s)
| | | | | | | | | | | | | | - Luz Maria Rodriguez
- National Cancer Institute, Division of Cancer Prevention, Rockville, MD
- Walter Reed National Military Medical Center, Department of Surgery, Bethesda, MD
| | | | | | | | | | | | | | | | | | - Ellen Richmond
- National Cancer Institute, Division of Cancer Prevention, Rockville, MD
| | - Asad Umar
- National Cancer Institute, Division of Cancer Prevention, Rockville, MD
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Keshinro A, Butler P, Fayanju O, Khabele D, Newman E, Greene W, Ude Welcome A, Joseph KA, Stallion A, Backhus L, Frangos S, DiMaggio C, Berman R, Hasson R, Rodriguez LM, Stain S, Bukur M, Klein MJ, Henry-Tillman R, Barry L, Oseni T, Martin C, Johnson-Mann C, Smith R, Karpeh M, White C, Turner P, Pugh C, Hayes-Jordan A, Berry C. Examination of Intersectionality and the Pipeline for Black Academic Surgeons. JAMA Surg 2022; 157:327-334. [PMID: 35138327 PMCID: PMC8829744 DOI: 10.1001/jamasurg.2021.7430] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The lack of underrepresented in medicine physicians within US academic surgery continues, with Black surgeons representing a disproportionately low number. OBJECTIVE To evaluate the trend of general surgery residency application, matriculation, and graduation rates for Black trainees compared with their racial and ethnic counterparts over time. DESIGN, SETTING, AND PARTICIPANTS In this nationwide multicenter study, data from the Electronic Residency Application Service (ERAS) for the general surgery residency match and Graduate Medical Education (GME) surveys of graduating general surgery residents were retrospectively reviewed and stratified by race, ethnicity, and sex. Analyses consisted of descriptive statistics, time series plots, and simple linear regression for the rate of change over time. Medical students and general surgery residency trainees of Asian, Black, Hispanic or Latino of Spanish origin, White, and other races were included. Data for non-US citizens or nonpermanent residents were excluded. Data were collected from 2005 to 2018, and data were analyzed in March 2021. MAIN OUTCOMES AND MEASURES Primary outcomes included the rates of application, matriculation, and graduation from general surgery residency programs. RESULTS Over the study period, there were 71 687 applicants, 26 237 first-year matriculants, and 24 893 graduates. Of 71 687 applicants, 24 618 (34.3%) were women, 16 602 (23.2%) were Asian, 5968 (8.3%) were Black, 2455 (3.4%) were Latino, and 31 197 (43.5%) were White. Women applicants and graduates increased from 29.4% (1178 of 4003) to 37.1% (2293 of 6181) and 23.5% (463 of 1967) to 33.5% (719 of 2147), respectively. When stratified by race and ethnicity, applications from Black women increased from 2.2% (87 of 4003) to 3.5% (215 of 6181) (P < .001) while applications from Black men remained unchanged (3.7% [150 of 4003] to 4.6% [284 of 6181]). While the matriculation rate for Black women remained unchanged (2.4% [46 of 1919] to 2.3% [52 of 2264]), the matriculation rate for Black men significantly decreased (3.0% [57 of 1919] to 2.4% [54 of 2264]; P = .04). Among Black graduates, there was a significant decline in graduation for men (4.3% [85 of 1967] to 2.7% [57 of 2147]; P = .03) with the rate among women remaining unchanged (1.7% [33 of 1967] to 2.2% [47 of 2147]). CONCLUSIONS AND RELEVANCE Findings of this study show that the underrepresentation of Black physicians at every stage in surgical training pipeline persists. Black men are especially affected. Identifying factors that address intersectionality and contribute to the successful recruitment and retention of Black trainees in general surgery residency is critical for achieving racial and ethnic as well as gender equity.
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Affiliation(s)
- Ajaratu Keshinro
- Department of Surgery, New York University Grossman School of Medicine, New York
| | - Paris Butler
- Division of Plastic Surgery, University of Pennsylvania Health System, Philadelphia
| | | | - Dineo Khabele
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri
| | - Erika Newman
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor
| | - Wendy Greene
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Akuezunkpa Ude Welcome
- Department of Surgery, New York University Grossman School of Medicine, New York,Department of Surgery, NYC Health+ Hospitals/Bellevue, New York, New York
| | - Kathie-Ann Joseph
- Department of Surgery, New York University Grossman School of Medicine, New York,Department of Surgery, NYC Health+ Hospitals/Bellevue, New York, New York
| | - Anthony Stallion
- Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Leah Backhus
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Spiros Frangos
- Department of Surgery, New York University Grossman School of Medicine, New York,Department of Surgery, NYC Health+ Hospitals/Bellevue, New York, New York
| | - Charles DiMaggio
- Department of Surgery, New York University Grossman School of Medicine, New York,Department of Surgery, NYC Health+ Hospitals/Bellevue, New York, New York
| | - Russell Berman
- Department of Surgery, New York University Grossman School of Medicine, New York,Department of Surgery, NYC Health+ Hospitals/Bellevue, New York, New York
| | - Rian Hasson
- Department of Surgery, Geisel School of Medicine of Dartmouth College, Hanover, New Hampshire
| | - Luz Maria Rodriguez
- Gastrointestinal and Other Cancers Research Group, National Cancer Institute, Rockville, Maryland,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Steven Stain
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Marko Bukur
- Department of Surgery, New York University Grossman School of Medicine, New York,Department of Surgery, NYC Health+ Hospitals/Bellevue, New York, New York
| | - Michael J. Klein
- Department of Surgery, New York University Grossman School of Medicine, New York,Department of Surgery, NYC Health+ Hospitals/Bellevue, New York, New York
| | - Ronda Henry-Tillman
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock
| | - Linda Barry
- Department of Surgery, University of Connecticut Health, Farmington
| | - Tawakalitu Oseni
- MGH Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Colin Martin
- Department of Surgery, University of Alabama at Birmingham
| | | | - Randi Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Martin Karpeh
- Department of Surgery, Northwell Health, Huntington, New York
| | | | | | - Carla Pugh
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Andrea Hayes-Jordan
- Department of Surgery, University of North Carolina School of Medicine in Chapel Hill
| | - Cherisse Berry
- Department of Surgery, New York University Grossman School of Medicine, New York,Department of Surgery, NYC Health+ Hospitals/Bellevue, New York, New York
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Chaparro Tapias TA, Rangel Gualdron CM, Rodriguez HA, Rodriguez LM, Flores de Los Reyes L, Sánchez España JC. Bilateral enucleation due to multi-bacterial fulminant endogenous panophthalmitis. Arch Soc Esp Oftalmol (Engl Ed) 2020; 95:34-37. [PMID: 31767407 DOI: 10.1016/j.oftal.2019.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/01/2019] [Accepted: 10/10/2019] [Indexed: 06/10/2023]
Abstract
The case is presented of a 62 year-old woman with a rapid, progressive bilateral decrease in visual acuity and panuveitis with orbital cellulitis. She was also in poor general condition, with emesis and fever. Septicaemia due to Klebsiella pneumoniae and bilateral endogenous panophthalmitis were diagnosed. The ocular infection quickly progressed to sclerokeratitis and bilateral perforation despite broad spectrum systemic antibiotic management, and eventually the patient required bilateral enucleation. Microbiological cultures of the surgical pieces identified Klebsiella pneumoniae and Candida magnoliae. To our knowledge, this is the third published case that required bilateral enucleation or evisceration due to endogenous panophthalmitis, and the first case of endogenous ocular infection caused by Candida magnoliae.
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Affiliation(s)
- T A Chaparro Tapias
- Departamento de Cirugía Plástica Ocular, Oncológica y Órbita, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia
| | - C M Rangel Gualdron
- Departamento de Cirugía Plástica Ocular, Oncológica y Órbita, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia
| | - H A Rodriguez
- Departamento de Cirugía Plástica Ocular, Oncológica y Órbita, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia; Departamento de Oftalmología, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | - L M Rodriguez
- Departamento de Cirugía Plástica Ocular, Oncológica y Órbita, Fundación Oftalmológica de Santander (FOSCAL), Floridablanca, Santander, Colombia
| | - L Flores de Los Reyes
- Departamento de Oftalmología, Hospital General de Granollers, Granollers, Barcelona, España.
| | - J C Sánchez España
- Departamento de Oftalmología, Hospital General de Granollers, Granollers, Barcelona, España
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4
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Zell JA, McLaren CE, Morgan TR, Lawson MJ, Rezk S, Albers CG, Chen WP, Carmichael JC, Chung J, Richmond E, Rodriguez LM, Szabo E, Ford LG, Pollak MN, Meyskens FL. A Phase IIa Trial of Metformin for Colorectal Cancer Risk Reduction among Individuals with History of Colorectal Adenomas and Elevated Body Mass Index. Cancer Prev Res (Phila) 2019; 13:203-212. [PMID: 31818851 DOI: 10.1158/1940-6207.capr-18-0262] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 07/09/2019] [Accepted: 12/03/2019] [Indexed: 12/17/2022]
Abstract
Obesity is associated with risk of colorectal adenoma (CRA) and colorectal cancer. The signaling pathway activated by metformin (LKB1/AMPK/mTOR) is implicated in tumor suppression in ApcMin/+ mice via metformin-induced reduction in polyp burden, increased ratio of pAMPK/AMPK, decreased pmTOR/mTOR ratio, and decreased pS6Ser235/S6Ser235 ratio in polyps. We hypothesized that metformin would affect colorectal tissue S6Ser235 among obese patients with recent history of CRA. A phase IIa clinical biomarker trial was conducted via the U.S. National Cancer Institute-Chemoprevention Consortium. Nondiabetic, obese subjects (BMI ≥30) ages 35 to 80 with recent history of CRA were included. Subjects received 12 weeks of oral metformin 1,000 mg twice every day. Rectal mucosa biopsies were obtained at baseline and end-of-treatment (EOT) endoscopy. Tissue S6Ser235 and Ki-67 immunostaining were analyzed in a blinded fashion using Histo score (Hscore) analysis. Among 32 eligible subjects, the mean baseline BMI was 34.9. Comparing EOT to baseline tissue S6Ser235 by IHC, no significant differences were observed. Mean (SD) Hscore at baseline was 1.1 (0.57) and 1.1 (0.51) at EOT; median Hscore change was 0.034 (P = 0.77). Similarly, Ki-67 levels were unaffected by the intervention. The adverse events were consistent with metformin's known side-effect profile. Among obese patients with CRA, 12 weeks of oral metformin does not reduce rectal mucosa pS6 or Ki-67 levels. Further research is needed to determine what effects metformin has on the target tissue of origin as metformin continues to be pursued as a colorectal cancer chemopreventive agent.
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Affiliation(s)
- Jason A Zell
- Department of Medicine, University of California, Irvine, California. .,Department of Epidemiology, University of California, Irvine, California.,Chao Family Comprehensive Cancer Center, University of California, Irvine, California
| | - Christine E McLaren
- Department of Epidemiology, University of California, Irvine, California.,Chao Family Comprehensive Cancer Center, University of California, Irvine, California
| | - Timothy R Morgan
- Medical Service, VA Long Beach Healthcare System, Long Beach, California
| | - Michael J Lawson
- Division of Gastroenterology, Kaiser Permanente Sacramento Medical Center, Sacramento, California
| | - Sherif Rezk
- Department of Pathology, University of California, Irvine, California
| | - C Gregory Albers
- Department of Medicine, University of California, Irvine, California
| | - Wen-Pin Chen
- Chao Family Comprehensive Cancer Center, University of California, Irvine, California
| | | | - Jinah Chung
- Chao Family Comprehensive Cancer Center, University of California, Irvine, California
| | - Ellen Richmond
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - L M Rodriguez
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland.,Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Eva Szabo
- Department of Oncology, McGill University, Montreal, Canada
| | - Leslie G Ford
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | | | - Frank L Meyskens
- Department of Medicine, University of California, Irvine, California.,Chao Family Comprehensive Cancer Center, University of California, Irvine, California.,Department of Biological Chemistry, University of California, Irvine, California
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5
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Xu L, Zhang Y, Xue X, Liu J, Li ZS, Yang GY, Song Y, Pan Y, Ma Y, Hu S, Wen A, Jia Y, Rodriguez LM, Tull MB, Benante K, Khan SA, Cao Y, Jovanovic B, Richmond E, Umar A, Bergan R, Wu K. A Phase I Trial of Berberine in Chinese with Ulcerative Colitis. Cancer Prev Res (Phila) 2019; 13:117-126. [PMID: 31619442 DOI: 10.1158/1940-6207.capr-19-0258] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/10/2019] [Accepted: 10/07/2019] [Indexed: 11/16/2022]
Abstract
The Chinese natural product, berberine, has biological properties that support its potential efficacy as a colon cancer prevention agent. Its longstanding use in China to treat gastrointestinal tract and rheumatologic disorders is generally regarded as safe, supporting initial investigations in an at-risk population, such as individuals with ulcerative colitis. However, the safety of berberine in this population is not established. Individuals living in China with biopsy-proven ulcerative colitis, ≤grade 2 dysplasia, and with a ulcerative colitis disease activity index (UCDAI) score ≤1 on mesalamine, were randomized 3:1 in a double-blind phase I trial to berberine 900 mg/day or placebo for 3 months, with the primary objective of assessing safety. Blood samples and biopsies of the colorectum, from prespecified locations, were collected prior to and following therapy. Secondary endpoints included changes in UCDAI score, and in tissue and plasma markers of inflammation. Of toxicities at least possibly related, one episode of grade 3 elevation in transaminases and one episode of grade 1 nausea were observed among 12 individuals on berberine, and none were observed among 4 on placebo. The mean plasma berberine concentration was 3.5 nmol/L after berberine treatment, significantly higher than 0.5 nmol/L with placebo. Berberine significantly decreased the Geboes grade in colonic tissue, but had a nonsignificant effect on other tissue or blood biomarkers related to cell growth and inflammation. The combination of berberine and mesalamine is well tolerated in Chinese with ulcerative colitis and may enhance mesalamine's anti-inflammatory effects in colonic tissue.
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Affiliation(s)
- Li Xu
- Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yujie Zhang
- Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xianmin Xue
- Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jie Liu
- Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zeng-Shan Li
- Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Guang-Yu Yang
- Department of Pathology, Northwestern University, Chicago, Illinois
| | - Ying Song
- Department of Pharmacology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yan Pan
- Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yueyun Ma
- Department of Clinical Laboratory Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Sijun Hu
- Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Aidong Wen
- Department of Pharmacology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yanyan Jia
- Department of Pharmacology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Luz Maria Rodriguez
- Division of Cancer Prevention, NCI, Bethesda, Maryland.,Walter Reed Military Medical Center, Department of Surgery, Bethesda, Maryland
| | - Mary Beth Tull
- Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois
| | - Kelly Benante
- Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois
| | - Seema A Khan
- Department of Surgery and Northwestern University, Chicago, Illinois
| | - Ying Cao
- Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Borko Jovanovic
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | | | - Asad Umar
- Division of Cancer Prevention, NCI, Bethesda, Maryland
| | - Raymond Bergan
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.
| | - Kaichun Wu
- Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
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6
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Gillen DL, Meyskens FL, Morgan TR, Zell JA, Carroll R, Benya R, Chen WP, Mo A, Tucker C, Bhattacharya A, Huang Z, Arcilla M, Wong V, Chung J, Gonzalez R, Rodriguez LM, Szabo E, Rosenberg DW, Lipkin SM. A phase IIa randomized, double-blind trial of erlotinib in inhibiting epidermal growth factor receptor signaling in aberrant crypt foci of the colorectum. Cancer Prev Res (Phila) 2015; 8:222-30. [PMID: 25604134 DOI: 10.1158/1940-6207.capr-14-0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Colorectal cancer progresses through multiple distinct stages that are potentially amenable to chemopreventative intervention. Epidermal growth factor receptor (EGFR) inhibitors are efficacious in advanced tumors including colorectal cancer. There is significant evidence that EGFR also plays important roles in colorectal cancer initiation, and that EGFR inhibitors block tumorigenesis. We performed a double-blind randomized clinical trial to test whether the EGFR inhibitor erlotinib given for up to 30 days had an acceptable safety and efficacy profile to reduce EGFR signaling biomarkers in colorectal aberrant crypt foci (ACF), a subset of which progress to colorectal cancer, and normal rectal tissue. A total of 45 patients were randomized to one of three erlotinib doses (25, 50, and 100 mg) with randomization stratified by nonsteroidal anti-inflammatory drug (NSAID) use. There were no unanticipated adverse events with erlotinib therapy. Erlotinib was detected in both normal rectal mucosa and ACFs. Colorectal ACF phosphorylated ERK (pERK), phosphorylated EGFR (pEGFR), and total EGFR signaling changes from baseline were modest and there was no dose response. Overall, this trial did not meet is primary efficacy endpoint. Colorectal EGFR signaling inhibition by erlotinib is therefore likely insufficient to merit further studies without additional prescreening stratification or potentially longer duration of use.
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Affiliation(s)
- Daniel L Gillen
- Department of Statistics, University of California at Irvine, Irvine, California. Chao Family Comprehensive Cancer Center, University of California at Irvine, Irvine, California
| | - Frank L Meyskens
- Chao Family Comprehensive Cancer Center, University of California at Irvine, Irvine, California
| | - Timothy R Morgan
- Chao Family Comprehensive Cancer Center, University of California at Irvine, Irvine, California. Department of Medicine, VA Long Beach Health Care System, Long Beach, California
| | - Jason A Zell
- Chao Family Comprehensive Cancer Center, University of California at Irvine, Irvine, California. Department of Epidemiology, University of California at Irvine, Irvine, California
| | - Robert Carroll
- Department of Medicine, University of Illinois Medical Center at Chicago, Chicago, Illinois
| | - Richard Benya
- Department of Medicine, University of Illinois Medical Center at Chicago, Chicago, Illinois
| | - Wen-Pin Chen
- Chao Family Comprehensive Cancer Center, University of California at Irvine, Irvine, California
| | - Allen Mo
- Center for Molecular Medicine, University of Connecticut Health, Farmington, Connecticut
| | | | - Asmita Bhattacharya
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| | - Zhiliang Huang
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| | - Myra Arcilla
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York
| | - Vanessa Wong
- Chao Family Comprehensive Cancer Center, University of California at Irvine, Irvine, California
| | - Jinah Chung
- Chao Family Comprehensive Cancer Center, University of California at Irvine, Irvine, California
| | - Rachel Gonzalez
- Department of Medicine, VA Long Beach Health Care System, Long Beach, California
| | - Luz Maria Rodriguez
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland. Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Eva Szabo
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Daniel W Rosenberg
- Center for Molecular Medicine, University of Connecticut Health, Farmington, Connecticut
| | - Steven M Lipkin
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York.
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Redondo MJ, Rodriguez LM, Haymond MW, Hampe CS, Smith EO, Balasubramanyam A, Devaraj S. Serum adiposity-induced biomarkers in obese and lean children with recently diagnosed autoimmune type 1 diabetes. Pediatr Diabetes 2014; 15:543-9. [PMID: 24978596 PMCID: PMC4423898 DOI: 10.1111/pedi.12159] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/24/2014] [Accepted: 05/06/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Obesity increases the risk of cardiovascular disease and diabetic complications in type 1 diabetes. Adipokines, which regulate obesity-induced inflammation, may contribute to this association. We compared serum adipokines and inflammatory cytokines in obese and lean children with new-onset autoimmune type 1 diabetes. SUBJECTS AND METHODS We prospectively studied 32 lean and 18 obese children (age range: 2-18 yr) with new-onset autoimmune type 1 diabetes and followed them for up to 2 yr. Serum adipokines [leptin, total and high molecular weight (HMW) adiponectin, omentin, resistin, chemerin, visfatin], cytokines [interferon (IFN)-gamma, interleukin (IL)-10, IL-12, IL-6, IL-8, and tumor necrosis factor (TNF)-alpha] and C-reactive protein (CRP) were measured at a median of 7 wk after diagnosis (range: 3-16 wk). RESULTS Lean children were 71.9% non-Hispanic White, 21.9% Hispanic, and 6.3% African-American, compared with 27.8, 55.6, and 16.7%, respectively, for obese children (p = 0.01). Compared with lean children, obese children had significantly higher serum leptin, visfatin, chemerin, TNF-alpha and CRP, and lower total adiponectin and omentin after adjustment for race/ethnicity and Tanner stage. African-American race was independently associated with higher leptin among youth ≥10 yr (p = 0.007). Leptin levels at onset positively correlated with hemoglobin A1c after 1-2 yr (p = 0.0001) independently of body mass index, race/ethnicity, and diabetes duration. Higher TNF-alpha was associated with obesity and female gender, after adjustment for race/ethnicity (p = 0.0003). CONCLUSION Obese children with new-onset autoimmune type 1 diabetes have a proinflammatory profile of circulating adipokines and cytokines that may contribute to the development of cardiovascular disease and diabetic complications.
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Affiliation(s)
- MJ Redondo
- Department of Pediatrics, Section of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - LM Rodriguez
- Department of Pediatrics, Section of Diabetes and Endocrinology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - MW Haymond
- Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - CS Hampe
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - EO Smith
- Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - A Balasubramanyam
- Translational Metabolism Unit, Diabetes Research Center, Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA
| | - S Devaraj
- Pathology and Immunology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
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Lipkin S, Lee J, Imagawa D, Hewitt SM, Tucker C, Zell JA, Wong V, Garcia A, Gonzalez R, Della Zanna G, Richmond E, Rodriguez LM, Bigg M, Schnoll-Sussmans F, Meyskens F. Phase IIA trial testing erlotinib as an intervention against intraductal pancreatic mucinous neoplasms. Cancer Prev Res (Phila) 2011; 4:512-3. [PMID: 21464031 DOI: 10.1158/1940-6207.capr-10-0373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intraductal papillary mucinous neoplasms (IPMN) are a distinct type of precursor lesions that cause about 5% of pancreatic adenocarcinoma (1, 2). Four-year survival rates of 40% to 75% are reported (3-7). There is currently no chemotherapy specifically approved for treating IPMNs. The number of IPMN cases has significantly increased over the last decade (8).
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Affiliation(s)
- Steven Lipkin
- Department of Medicine and Chao Family NCI Designated Comprehensive Cancer Center, University of California Irvine, Irvine, California, USA.
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Alzand BSN, Timmermans CCMM, Wellens HJJ, Dennert R, Philippens SAM, Portegijs PJM, Rodriguez LM. Unmappable ventricular tachycardia after an old myocardial infarction. Long-term results of substrate modification in patients with an implantable cardioverter defibrillator. J Interv Card Electrophysiol 2011; 31:149-56. [PMID: 21340515 PMCID: PMC3141830 DOI: 10.1007/s10840-011-9549-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 01/26/2011] [Indexed: 01/15/2023]
Abstract
Purpose The frequent occurrence of ventricular tachycardia can create a serious problem in patients with an implantable cardioverter defibrillator. We assessed the long-term efficacy of catheter-based substrate modification using the voltage mapping technique of infarct-related ventricular tachycardia and recurrent device therapy. Methods The study population consisted of 27 consecutive patients (age 68 ± 8 years, 25 men, mean left ventricular ejection fraction 31 ± 9%) with an old myocardial infarction and multiple and/or hemodynamically not tolerated ventricular tachycardia necessitating repeated device therapy. A total of 31 substrate modification procedures were performed using the three-dimensional electroanatomical mapping system. Patients were followed up for a median of 23.5 (interquartile range 6.5–53.2) months before and 37.8 (interquartile range 11.7–71.8) months after ablation. Antiarrhythmic drugs were not changed after the procedure, and were stopped 6 to 9 months after the procedure in patients who did not show ventricular tachycardia recurrence. Results Median ventricular tachycardias were 1.6 (interquartile range 0.7–6.7) per month before and 0.2 (interquartile range 0.00–1.3) per month after ablation (P = 0.006). Nine ventricular fibrillation episodes were registered in seven patients before and two after ablation (P = 0.025). Median antitachycardia pacing decreased from 1.6 (interquartile range 0.01–5.5) per month before to 0.18 (interquartile range 0.00–1.6) per month after ablation (P = 0.069). Median number of shocks decreased from 0.19 (interquartile range 0.04–0.81) per month before to 0.00 (interquartile range 0.00–0.09) per month after ablation (P = 0.001). One patient had a transient ischemic attack during the procedure, and another developed pericarditis. Nine patients died during follow-up, eight patients due to heart failure and one patient during valve surgery. Conclusion Catheter-based substrate modification using voltage mapping results in a long-lasting reduction of cardioverter defibrillator therapy in patients with multiple and/or hemodynamically not tolerated infarct-related ventricular tachyarrhythmia.
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Affiliation(s)
- B S N Alzand
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.
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Sternick EB, Lokhandwala Y, Timmermans C, Rodriguez LM, Gerken LM, Scarpelli R, Soares F, Wellens HJ. The atrioventricular interval during pre-excited tachycardia: A simple way to distinguish between decrementally or rapidly conducting accessory pathways. Heart Rhythm 2009; 6:1351-8. [DOI: 10.1016/j.hrthm.2009.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 05/23/2009] [Indexed: 11/27/2022]
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Wijffels MCEF, Timmermans CCMM, van Suylen RJ, Rodriguez LM. Internal atrial shock delivery by standard diagnostic electrophysiology catheters in goats: effects on atrial electrogram amplitude and tissue architecture. ACTA ACUST UNITED AC 2007; 9:203-7. [PMID: 17350984 DOI: 10.1093/europace/eum007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/14/2022]
Abstract
AIMS In this study, we evaluated the effects of atrial shock delivered via diagnostic electrophysiology catheters. METHODS AND RESULTS In 11 anaesthetized goats, decapolar catheters were positioned in the right atrial appendage (RAA) and coronary sinus (CS). Three different catheters and two cardioversion protocols were evaluated. In four goats, 50 J shocks were delivered using catheters with 1 mm electrodes (surface area 70 mm(2)). In 6 goats, catheters with 2 mm electrodes (area 140 mm(2)) were used. In three of the six goats, 50 J shocks were given while in the other 3, 10 J shocks were delivered. In 1 goat 50 J shocks were delivered via 5 mm electrode catheters (area 310 mm(2)). No persisting adverse effects occurred. However, the electrogram amplitude at the RAA and CS decreased by >50-98% (P > 0.01). The amount of amplitude decrease was most pronounced at the CS site and for 50 J shocks. Goats were sacrificed after 9 +/- 1 days. Macroscopy revealed endocardial lesions at the electrode locations. Microscopy showed endocardial thrombosis, and necrosis with formation of granulation tissue. Changes were most marked with diagnostic catheters and 50 J shocks. CONCLUSIONS Atrial shock delivery via diagnostic catheters causes local ablation lesions. The amount of amplitude decrease, macroscopic and microscopic damages were related to the energy applied and electrode surface area.
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Affiliation(s)
- M C E F Wijffels
- Department of Cardiology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Richardson DK, Schneider J, Fourcaudot MJ, Rodriguez LM, Arya R, Dyer TD, Almasy L, Blangero J, Stern MP, Defronzo RA, Duggirala R, Jenkinson CP. Association between variants in the genes for adiponectin and its receptors with insulin resistance syndrome (IRS)-related phenotypes in Mexican Americans. Diabetologia 2006; 49:2317-28. [PMID: 16955209 DOI: 10.1007/s00125-006-0384-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Accepted: 06/12/2006] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to examine whether genetic variation in ADIPOQ, ADIPOR1 and ADIPOR2 may contribute to increased susceptibility to components of the insulin resistance syndrome (IRS). MATERIALS AND METHODS We genotyped single-nucleotide polymorphisms (SNPs) in ADIPOQ, ADIPOR1 and ADIPOR2 in Mexican American subjects (N=439) and performed an association analysis of IRS-related traits. RESULTS Of the eight SNPs examined in the ADIPOQ gene, rs4632532 and rs182052 exhibited significant associations with BMI (p=0.029 and p=0.032), fasting specific insulin (p=0.023 and p=0.026), sum of skin folds (SS) (p=0.0089 and p=0.0084) and homeostasis model assessment of insulin sensitivity (HOMA-%S) (p=0.015 and p=0.016). Two other SNPs, rs266729 and rs2241767, were significantly associated with SS (p=0.036 and p=0.013). SNP rs7539542 of ADIPOR1 was significantly associated with BMI, SS and waist circumference (p=0.025, p=0.047 and p=0.0062). Fourteen of the ADIPOR2 SNPs were found to be significantly (p<0.05) associated with fasting plasma triglyceride concentrations. Four of these SNPs (rs10848569, rs929434, rs3809266 and rs12342) were in high pairwise linkage disequilibrium (r (2)=0.99) and were strongly associated with fasting triglyceride levels (p=0.00029, p=0.00016, p=0.00027 and p=0.00021). Adjusting for the effects of BMI and HOMA-%S on triglyceride concentrations increased significance to p=0.000060 for SNP rs929434. Bayesian quantitative trait nucleotide analysis was used to examine all possible models of gene action. Again, SNP rs929434 provided the strongest statistical evidence of an effect on triglyceride concentrations. CONCLUSIONS/INTERPRETATION These results provide evidence for association of SNPs in ADIPOQ and its receptors with multiple IRS-related phenotypes. Specifically, several genetic variants in ADIPOR2 were strongly associated with decreased triglyceride levels.
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Affiliation(s)
- D K Richardson
- Division of Diabetes MC 7886, Department of Medicine, The University of Texas Health Science Centre at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
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Nabar A, Timmermans C, Medeiros A, Polymeropoulos K, Polymeropoulous K, Crijns HJGM, Rodriguez LM. Radiofrequency ablation of atrial arrhythmias after previous open-heart surgery. Europace 2005; 7:40-9. [PMID: 15670966 DOI: 10.1016/j.eupc.2004.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2003] [Accepted: 09/22/2004] [Indexed: 11/16/2022] Open
Abstract
AIM To report the results of ablation of atrial arrhythmias (AA) after previous open-heart surgery. METHODS Nineteen patients [50+/-11 years, 11 women] underwent ablation of symptomatic AAs after previous open-heart surgery. In 11 patients mapping was performed using conventional multielectrode catheters. In the other eight patients CARTO electro-anatomical mapping system was used to supplement conventional mapping. RESULTS After conventional mapping, 10/11 patients (91%) were found to have typical atrial flutter (AFL). The cavotricuspid isthmus was successfully ablated in these 10 patients. CARTO combined with conventional mapping showed that 7 of 8 patients had one macro-reentry right atrial circuit. The remaining patient had two focal atrial tachycardias. CARTO-guided ablation was successful in all eight patients (100%). After follow-up of 12+/-11 months, 2/18 patients (11%) had recurrence of either the same (n=1) or a new (n=1) AA. CONCLUSIONS AAs after previous open-heart surgery can be ablated successfully (>90%) with a low recurrence rate (11%) at 1-year follow-up. Typical AFL was found frequently (14/19 patients, 72%). This could be ablated successfully, often, after conventional mapping alone. CARTO helps to uncover peri-scar reentry and guide the ablation by creating a line of block connecting the scar to another landmark (unconventional isthmus).
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Affiliation(s)
- A Nabar
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Academic Hospital Maastricht, P.Debyelaan 25, 6202 AZ, Post box 5800, Maastricht, Limburg, The Netherlands.
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Abstract
There is debate concerning the distal insertion of Mahaim fibers. Some findings favor an atriofascicular fiber connected with the distal right bundle branch. Other findings favor a long atrioventricular (AV) structure inserting into the myocardium. A patient having a decrementally conducting accessory pathway is reported. Proximal and distal Mahaim potentials were recorded during sinus rhythm, atrial pacing, and antidromic tachycardia. Both proximal and distal M potentials always preceded the QRS complex during sinus rhythm and antidromic tachycardia earlier than the right bundle branch potential. During tachycardia, the distal M potential was recorded 6 ms before the retrograde right bundle potential. Other arguments consistent with an AV connection were a change in the QRS configuration during tachycardia after the first radiofrequency pulse at the site of the distal M potential and absence of right bundle branch block after successful ablation. Conduction through the proximal part of the Mahaim fiber was unaltered after ablation, as assessed by recording the proximal M potential. Electrophysiologic evidence is presented suggesting a long AV accessory pathway inserting close to the distal right bundle branch rather than an atriofascicular connection in this patient with a Mahaim fiber.
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van Opstal JM, Hoorntje CR, Rodriguez LM. A hormonal FBI. Neth Heart J 2004; 12:409-411. [PMID: 25696374 PMCID: PMC2497183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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Polymeropoulos KP, Rodriguez LM, Timmermans C, Wellens HJJ. Images in cardiovascular medicine. Radiofrequency ablation of a focal atrial tachycardia originating from the Marshall ligament as a trigger for atrial fibrillation. Circulation 2002; 105:2112-3. [PMID: 11980693 DOI: 10.1161/01.cir.0000016168.49833.ce] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rodriguez LM, Ottea JA, Reagan TE. Selection, egg viability, and fecundity of the sugarcane borer (Lepidoptera: Crambidae) with tebufenozide. J Econ Entomol 2001; 94:1553-1557. [PMID: 11777063 DOI: 10.1603/0022-0493-94.6.1553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Two separate attempts to select the sugarcane borer, Diatraea saccharalis (F.), for resistance to tebufenozide were unsuccessful. Both selected colonies were lost after the fourth generation due to a lack of oviposition. Differences were not detected in fecundity or percent egg viability for 5-d-old third instars exposed to concentrations (EC5, EC15, and EC30) of tebufenozide for 7 d. Decreases (P < or = 0.01) in mean female pupal weights were detected in larvae exposed to EC15 and EC30 concentrations. An ovicidal impact using serial dilutions of tebufenozide (10, 100, and 200 ppm) also was detected. Percent viability was reduced from 98% for untreated eggs to 61% for eggs dipped in 10 ppm and below 6% for eggs dipped in > or = 100 ppm. Eggs treated with 200 ppm did not hatch. Though some embryonic development was observed on eggs treated with the high concentrations (100 and 200 ppm), sclerotization of head capsule was not apparent. The ovicidal property of tebufenozide may enhance its effectiveness in controlling populations of the D. saccharalis on an area-wide basis. Fecundity and egg viability were affected in later generations of selection; however, separate studies assessing individuals that were exposed to sublethal concentration (EC5, EC15, and EC30) of tebufenozide as third instars for 7 d in one generation did not detect differences.
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Affiliation(s)
- L M Rodriguez
- Department of Entomology, Louisiana State University Agricultural Center, Baton Rouge 70803, USA
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18
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Abstract
Dosage-mortality baselines were determined for first and newly molted third instars of the sugarcane borer, Diatraea saccharalis (F.), with tebufenozide incorporated into an artificial diet. Using death as an endpoint for these assays, LC50 and LC90 values were estimated to be 0.17 and 0.41 ppm for the first and 0.87 and 3.67 ppm for third instars, respectively. Developmental effects also were observed and were defined to include mortality as well as physical impairment and retarded or prolonged development with absence of feeding. Concentrations causing developmental effects in treated larvae (EC50 and EC90) were 5.8- and 3.8-fold lower than the LC50 and LC90, respectively. The critical time of exposure to tebufenozide was determined for developmentally synchronous third instars to be less than 12 h postecdysis. Mortality through adult emergence significantly decreased from 92% (treatment at 0 h postecdysis) to 30% (treatment at 12 h postecdysis), when exposed to tebufenozide at the EC50. For surviving larvae, length of development time until pupation was significantly increased and female pupal weight significantly decreased when larvae were treated at 0 h postecdysis into the third instar. In addition, to modifying the traditional ways of assessing mortality 0-3 d postapplication, this study points out the value of using other approaches to pesticide assessment, especially where insect growth regulators are involved.
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Affiliation(s)
- L M Rodriguez
- Department of Entomology, Louisiana State University Agricultural Center, Baton Rouge 70803, USA
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Abstract
BACKGROUND The aim of this study was to determine the biatrial activation pattern in isthmus-dependent atrial flutter (AFL) to understand the functional interatrial connections and the activation pattern of the left atrium (LA). METHODS AND RESULTS Biatrial activation was performed, using an electroanatomic mapping system, in 10 patients undergoing right atrial isthmus ablation for counterclockwise (n=7) or clockwise (n=3) AFL. The AFL circuit was peritricuspid and propagated slowly (0.5+/-0.2 m/s) through the isthmus. LA was activated by two wave fronts, with discrete breakthroughs in the superior, mid, or inferior atrial septum. The activation of LA overlapped 50+/-16% of the AFL cycle length. In counterclockwise AFL, at least one breakthrough was located in the inferior atrial septum. LA activation began immediately after the exit of the flutter wave from the isthmus and was directed inferosuperiorly in all patients, being synchronous with the atrial septal activation. The septal breakthroughs in patients with clockwise AFL were variably located. The direction of LA activation was superoinferior in 2 and inferosuperior in 1 patient. CONCLUSIONS The circuit of isthmus-dependent AFL was entirely in the right atrium. LA activation was a bystander and followed trans-septal conduction across the inferior coronary sinus-LA connection, Bachmann's bundle, and/or fossa ovalis.
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Affiliation(s)
- L M Rodriguez
- Department of Cardiology, Academic Hospital Maastricht, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
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Nabar A, Rodriguez LM, Timmermans C, van Mechelen R, Wellens HJ. Class IC antiarrhythmic drug induced atrial flutter: electrocardiographic and electrophysiological findings and their importance for long term outcome after right atrial isthmus ablation. Heart 2001; 85:424-9. [PMID: 11250970 PMCID: PMC1729704 DOI: 10.1136/heart.85.4.424] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the electrocardiographic and electrophysiological findings of new atrial flutter developing in patients taking class IC antiarrhythmic drugs for recurrent atrial fibrillation, and to report the long term results of right atrial isthmus ablation in relation to the ECG pattern of spontaneous atrial flutter. DESIGN Retrospective analysis. SETTING Tertiary care academic hospital. PATIENTS 24 consecutive patients with atrial fibrillation (age 54 (12) years; 5 female, 19 male) developing atrial flutter while taking propafenone (n = 12) or flecainide (n = 12). RESULTS The ECG was classified as typical (n = 13; 54%) or atypical atrial flutter (n = 8) or coarse atrial fibrillation (n = 3). Counterclockwise atrial flutter was the predominant arrhythmia. Acute success after isthmus ablation was similar in patients with typical (12/13) and atypical (8/8) atrial flutter. After long term follow up (13 (6) months, range 6-26 months), continuation of antiarrhythmic drug treatment appeared to result in better control of recurrences of atrial fibrillation in patients with typical atrial flutter (11/13) than in those with atypical atrial flutter (4/8), but the difference was not significant. Ablation for coarse atrial fibrillation was unsuccessful. CONCLUSIONS New atrial flutter developing in patients taking class IC antiarrhythmic drugs for recurrent atrial fibrillation has either typical or atypical flutter wave morphology on ECG. The endocardial activation pattern and the acute results of ablation suggest that the flutter circuit was located in the right atrium and that the isthmus was involved in the re-entry mechanism. There appeared to be better long term control of recurrent atrial fibrillation in patients with typical (85%) as compared with atypical atrial flutter (50%). Patients developing coarse atrial fibrillation may not be candidates for this strategy.
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Affiliation(s)
- A Nabar
- Department of Cardiology, Academic Hospital Maastricht, Cardiovascular Research Institute Maastricht, P Debyelaan 25, 6202 AZ, Postbox 5800, Maastricht, Netherlands
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Nabar A, Rodriguez LM, Timmermans C, Wellens HJ. Use of a saline-irrigated tip catheter for ablation of ventricular tachycardia resistant to conventional radiofrequency ablation: early experience. J Cardiovasc Electrophysiol 2001; 12:153-61. [PMID: 11232612 DOI: 10.1046/j.1540-8167.2001.00153.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Radiofrequency (RF) catheter ablation of ventricular tachycardia (VT) may fail if the critical isthmus is located intramyocardially or epicardially. The design of a saline-irrigated tip (SIT) catheter (Thermo-Cool, Cordis-Webster) involves active cooling of the tip electrode, which allows creation of larger ablation lesions. METHODS AND RESULTS Eight patients (6 men, age 59 +/- 12 years) in whom the clinical target VT (cycle length 430 +/- 97 msec) could not be ablated using a conventional 4-mm tip RF ablation catheter underwent additional attempts to ablate this VT using a SIT catheter. Six patients had an old myocardial infarction, 1 patient had a dilated cardiomyopathy, and 1 patient had a structurally normal heart. Ablation of the clinical target VT using a SIT catheter was attempted from the left ventricle in 6 (septal, posterobasal, and inferior: 2 each) and from the right ventricle in 2 patients (both septal), by entrainment (n = 6), activation (n = 1), or pace mapping (n = 1). A mean of 6 +/- 5 (range 2 to 15) pulses were delivered. Target VT ablation was successful in 5 patients (63%). After successful ablation, at a mean follow-up of 6.5 +/- 4 months and while taking antiarrhythmic drugs, all 5 patients were free of VT recurrences. CONCLUSION The clinical target VT could be ablated using a SIT catheter in 5 (63%) of the 8 patients in whom ablation using a conventional RF catheter was unsuccessful. In the 2 patients with septal VT, a biventricular approach to mapping and ablation was required.
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Affiliation(s)
- A Nabar
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands
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Rodriguez LM, Penetrante RB, Nowak NJ, Rodriguez-Bigas M, Driscoll DL, Hoover E, Petrelli NJ, Shows TB. p16 (cdkN2/MTS1/INK4A) expression in sporadic colorectal carcinomas. Curr Surg 2000; 57:638. [PMID: 11120318 DOI: 10.1016/s0149-7944(00)00359-7] [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] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Affiliation(s)
- LM Rodriguez
- From the Roswell Park Cancer Institute/State University of New York, Buffalo, New York, USA
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Hammer Castellanos V, Rodriguez LM. Gram values and intakes: correction. J Am Diet Assoc 2000; 100:1137. [PMID: 11043694 DOI: 10.1016/s0002-8223(00)00330-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Timmermans C, Rodriguez LM, Ayers GM, Masset S, Reuter DG, Wellens HJ. Decreasing the number of leads required for an implantable atrial defibrillator: use of a new 2-lead system. Am Heart J 2000; 140:e11. [PMID: 10966542 DOI: 10.1067/mhj.2000.107552] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the use of a new 2-lead system for detection of atrial fibrillation (AF) and atrial defibrillation. METHODS In 16 patients undergoing elective cardioversion of AF, a 2-lead system was compared with the conventional 3-lead system in a randomized trial. The new 2-lead system consisted of a catheter with a distal bipolar right ventricular electrode pair and a proximal right atrial shock electrode coil and a separate decapolar defibrillation catheter in the coronary sinus. For the 3-lead system, an additional decapolar catheter was placed in the right atrium. AF and sinus rhythm signal amplitude detection and atrial defibrillation threshold (ADFT) were compared in each patient with both systems. RESULTS Successful defibrillation was obtained in all patients. ADFT for the 2-lead system was significantly higher compared with the 3-lead system (370 +/- 112 vs 316 +/- 100 V, P < .05; 9.3 +/- 5.2 vs 6.8 +/- 4.2 J, P < .05). In contrast, there was an increase in impedance for the 3-lead system (77 +/- 16 ohms vs 68 +/- 13 ohms; P < .05). AF had a lower signal amplitude compared with sinus rhythm for both systems (P < .05), and the 2-lead system had a lower signal amplitude compared with the 3-lead system for both rhythms (P < .05). CONCLUSION The use of a 2-lead system with this configuration is not superior to the 3-lead system regarding AF signal amplitude detection and ADFT. Further study is needed with implantable-quality leads in place of the temporary catheters used in this study.
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Affiliation(s)
- C Timmermans
- Department of Cardiology, Academic Hospital Maastricht, Maastricht, The Netherlands.
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Timmermans C, Rodriguez LM, Reuter D, Stappers J, Barenbrug PJ, Cheriex EC, Wellens HJ. Management of atrial arrhythmias secondary to severe congenital heart disease with the Atrioverter. Pacing Clin Electrophysiol 2000; 23:1181-3. [PMID: 10914379 DOI: 10.1111/j.1540-8159.2000.tb00924.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An atrial defibrillator was implanted in a patient with congenitally corrected transposition of the great arteries, associated cardiac abnormalities, and persistent atrial arrhythmias. During a 15-month follow-up, 14 of 20 spontaneous episodes of his arrhythmias were successfully treated with the device. Two of these episodes were converted to sinus rhythm during ambulatory use of the device. Successful use of the device required implantation of a third defibrillation lead in the persistent left-sided superior caval vein and rigid control of congestive heart failure. An atrial defibrillator may be a valid treatment option in patients with congenital heart disease crippled by atrial fibrillation.
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Affiliation(s)
- C Timmermans
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands.
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Abstract
Two patients were presented, and two previously unreported observations were made. Patient 1, a 50 year old man with episodic palpitations and dizziness for 10 years, exhibited initiation of idiopathic ventricular tachycardia (VT) by atrial fibrillation (AF). Patient 2, a 43 year old woman with a structurally normal heart but recurrent palpitations for one year, demonstrated fusion and capture beats during simultaneous VT and AF. An explanation is given as to why the latter phenomenon is rarely observed.
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Affiliation(s)
- A Nabar
- Department of Cardiology, Academic Hospital Maastricht, P Debyelaan 25, 6202 AZ, Post bus 5800, Maastricht, Netherlands
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Finley JW, Gibbs JF, Rodriguez LM, Letourneau R, Driscoll D, Kraybill W. Pathologic and clinical features influencing outcome of thin cutaneous melanoma: correlation with newly proposed staging system. Am Surg 2000; 66:527-31; discussion 531-2. [PMID: 10888127] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The incidence of malignant melanoma is increasing. Because of increased awareness, early recognition of malignant melanoma has become more common. In 1997, a new staging system for cutaneous melanoma was proposed, with reclassification of thin melanoma < 1 mm, with and without ulceration. This report evaluates the pathologic and clinical features of thin melanomas influencing recurrence and survival from a tertiary cancer center in an attempt to correlate findings with the proposed staging system. A review of the Roswell Park Cancer Institute tumor registry identified 352 patients with thin cutaneous melanomas (< 1.0 mm) seen during an 18-year period ending August 30, 1998. Overall survival was 93 and 87 per cent at 5 and 10 years, respectively. Disease-free survival was 94 and 93 per cent at 5 and 10 years, respectively. Local recurrence occurred in 3 per cent of patients, regional recurrence in 3 per cent, and metastatic disease in 3 per cent, for an overall recurrence of 7 per cent, with a median follow-up of 118 months. Only the presence of ulceration was a significant prognostic factor for recurrence by both univariate and multivariate analysis. Failure rates (any recurrence) by Clark levels I, II, and III/IV were 3, 5, and 10 per cent, respectively (P = 0.14). Failure rates by tumor thickness (mm), for 0.0-0.24, 0.25-0.49, 0.50-0.74, and 0.75-0.99 were 3, 4, 7, and 10 per cent, respectively (P = 0.49). Ten-year disease-free survival for ulceration versus no ulceration was 40 and 94 per cent, respectively (P < 0.0001). We conclude that thin cutaneous melanoma carries an excellent prognosis with appropriate treatment. Our findings support inclusion of ulceration in a new staging system. Lesions 0.76 to 0.99 mm and Clark level III and IV may warrant close observation as a separate subgroup.
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Affiliation(s)
- J W Finley
- Geisinger Medical Center, Danville, Pennsylvania, USA
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Abstract
OBJECTIVE To investigate the effect of providing free access to several fat-modified foods on dietary energy and macronutrient intake in people with and without diabetes mellitus. DESIGN Five low-fat or no-fat products or their regular-fat counterparts were provided to volunteers to take home and use for 3 days (low-fat condition or regular-fat condition) in a repeated-measures crossover design. People with diabetes were case matched to people without diabetes. Food intakes were determined through a weighed food diary and by weighing the food provided before consumption and the uneaten portions after consumption. SUBJECTS Thirty men and women, aged 20 to 60 years, with (n = 15) and without (n = 15) diabetes participated. STATISTICAL ANALYSES Repeated-measures analysis of variance was used to determine the effects of diabetes and use of fat-modified foods on nutrient and energy intake. RESULTS People with diabetes responded the same way to fat-modified foods as people without diabetes. There was a significant reduction in the grams of fat consumed during the low-fat condition compared with the regular-fat condition (average decrease = 8 g, P < .05). Energy intake from experimental foods was significantly lower during the low-fat condition (271 +/- 181 kcal) compared with the regular-fat condition (353 +/- 256 kcal), but total energy intake was not different. Percentage of energy from fat was significantly decreased in the low-fat condition (27 +/- 7) compared with the regular-fat condition (34 +/- 9; P < .05). There was a corresponding increase in the percentage of energy from carbohydrates in the low-fat condition compared with the regular-fat condition, but no significant increase in grams of carbohydrate consumed. Cholesterol and saturated fat intakes were significantly less in the low-fat condition than in the regular-fat condition. CONCLUSION Consumption of fat-modified foods by individuals with diabetes may help decrease intake of fat, cholesterol, and saturated fat.
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Timmermans C, Lévy S, Ayers GM, Jung W, Jordaens L, Rosenqvist M, Thibault B, Camm J, Rodriguez LM, Wellens HJ. Spontaneous episodes of atrial fibrillation after implantation of the Metrix Atrioverter: observations on treated and nontreated episodes. Metrix Investigators. J Am Coll Cardiol 2000; 35:1428-33. [PMID: 10807443 DOI: 10.1016/s0735-1097(00)00579-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We sought to evaluate the number and duration of device-treated and self-terminating, nontreated episodes of atrial fibrillation (AF) after implantation of the Metrix Atrioverter. BACKGROUND A recent study has shown that the Atrioverter can rapidly restore sinus rhythm in patients with AF; however, the effect of the device on the clinical course of the arrhythmia in these patients is unknown. METHODS The Atrioverter was implanted in 51 patients with symptomatic, recurrent, drug-refractory AF. The device was programmed to periodically monitor the cardiac rhythm. Defibrillation of AF episodes was performed under physician observation. RESULTS During a mean follow-up of 260 +/- 144 days, 1,161 episodes of AF were observed during valid monitoring periods in 45 of 51 patients. Forty-one patients experienced 231 episodes for which they sought defibrillation therapy. The average duration of the treated episodes during valid monitoring periods (190 of 231 episodes in 39 of 41 patients) was significantly longer than that of the nontreated episodes (38 +/- 44 vs. 10 +/- 8 h; p < 0.05). The time between episodes requiring Atrioverter therapy increased, and the risk of having an episode requiring treatment decreased. No changes were observed in the number and duration of the short-lasting, nontreated episodes as time since implantation of the device increased. CONCLUSIONS In patients with symptomatic, recurrent, drug-refractory AF, the frequency of long-lasting episodes, which were treated under observation with repeated defibrillation using the Atrioverter, decreased. The number and duration of short-lasting, nontreated episodes did not change during the 20-month study period. The effect of ambulatory use of the device on the recurrence of short-lasting episodes needs to be evaluated.
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Affiliation(s)
- C Timmermans
- Department of Cardiology, Academic Hospital, Maastricht, The Netherlands.
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Rodriguez LM, Nabar A, Timmermans C, Wellens HJ. Comparison of results of an 8-mm split-tip versus a 4-mm tip ablation catheter to perform radiofrequency ablation of type I atrial flutter. Am J Cardiol 2000; 85:109-12, A9. [PMID: 11078249 DOI: 10.1016/s0002-9149(99)00618-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thirty consecutive patients with type I atrial flutter were randomized to undergo radiofrequency ablation using an 8-mm split-tip versus a 4-mm tip catheter. Procedural success was high in both groups (100% vs 93%). However, requirement of a fewer number of radiofrequency pulses and fluoroscopy time suggests superiority of the 8-mm split-tip over the 4-mm tip ablation catheter.
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Affiliation(s)
- L M Rodriguez
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands.
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Timmermans C, Rodriguez LM, Ayers GM, Siu A, Smeets J, Barenbrug P, Wellens HJ. Design and preliminary data of the Metrix Atrioverter expanded indication trial. J Interv Card Electrophysiol 2000; 4 Suppl 1:197-9. [PMID: 10590508 DOI: 10.1023/a:1009871724481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The Metrixtrade mark Atrioverter Expanded Indication Trial evaluates the safety and efficacy of an implantable atrial defibrillator in patients with symptomatic, recurrent and drug refractory atrial fibrillation who also have structural heart disease. In this ongoing multicenter study, all patients are anticoagulated and concomitant antiarrhythmic drug treatment is left to the preference of the physician. Holter monitoring is performed prior to enrollment in the study. Spontaneous episodes of atrial fibrillation (AF) are treated under physician observation and when patients are ambulatory, the device is programmed in a monitoring mode. The atrial defibrillation threshold is measured at implantation and at 3, 6 and 12 months thereafter. The performance of the AF detection and R-wave synchronization algorithm is assessed at implantation, at regular follow-up intervals, and each time the patient visits the hospital for treatment of a spontaneous episode of AF. An echocardiogram is performed prior to implantation, at 3 and 6 month follow-up and for patients with an implanted heart valve, after 20 and 50 atrial defibrillation shocks have been delivered. The study started on October 1997 and will end after the last patient enrolled completes his/her six-month post-implantation follow-up, unless a safety issue arises. As of September 1998, 6 patients (2 patients with tachycardia induced cardiomyopathy, 1 patient with a mitral valve prosthesis, 2 patients with hypertrophic cardiomyopathy and 1 patient with congenital heart disease) have been enrolled in the study. Over 350 shocks have been delivered for atrial defibrillation testing or termination of spontaneous AF episodes. There have been no reported cases of ventricular proarrhythmia or inaccurately synchronized shocks and no complications of device therapy in this population.
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Affiliation(s)
- C Timmermans
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands.
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Freiwald WA, Valdes P, Bosch J, Biscay R, Jimenez JC, Rodriguez LM, Rodriguez V, Kreiter AK, Singer W. Testing non-linearity and directedness of interactions between neural groups in the macaque inferotemporal cortex. J Neurosci Methods 1999; 94:105-19. [PMID: 10638819 DOI: 10.1016/s0165-0270(99)00129-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.0] [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: 10/18/2022]
Abstract
Information processing in the visual cortex depends on complex and context sensitive patterns of interactions between neuronal groups in many different cortical areas. Methods used to date for disentangling this functional connectivity presuppose either linearity or instantaneous interactions, assumptions that are not necessarily valid. In this paper a general framework that encompasses both linear and non-linear modelling of neurophysiological time series data by means of Local Linear Non-linear Autoregressive models (LLNAR) is described. Within this framework a new test for non-linearity of time series and for non-linearity of directedness of neural interactions based on LLNAR is presented. These tests assess the relative goodness of fit of linear versus non-linear models via the bootstrap technique. Additionally, a generalised definition of Granger causality is presented based on LLNAR that is valid for both linear and non-linear systems. Finally, the use of LLNAR for measuring non-linearity and directional influences is illustrated using artificial data, reference data as well as local field potentials (LFPs) from macaque area TE. LFP data is well described by the linear variant of LLNAR. Models of this sort, including lagged values of the preceding 25 to 60 ms, revealed the existence of both uni- and bi-directional influences between recording sites.
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Affiliation(s)
- W A Freiwald
- Institute for Brain Research, University of Bremen, Germany.
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Abstract
BACKGROUND The low shock energy used during internal atrial defibrillation may decrease the need for sedation during defibrillation with an implantable atrial defibrillator. METHODS AND RESULTS The atrial defibrillator (Metrix Atrioverter) was implanted in 12 patients. During the in-hospital treatment of atrial fibrillation (AF) episodes, intravenous sedation was given only on patient request. The Atrioverter was programmed for ambulatory therapy in 4 patients. Efficacy, number of shocks delivered, and sedation requirements were recorded. A total of 393 shocks (1.8+/-1. 6 shocks/AF episode) were delivered to treat 213 AF episodes; 85 of 213 AF episodes (40%) were treated away from the hospital. Sinus rhythm was restored in 195 AF episodes (92%). Five patients never requested sedation. No sedation was needed for ambulatory-treated AF episodes. During the treatment of 26 of 213 AF episodes (12%), 75 shocks were delivered after patients received sedation. The number of shocks required to treat an AF episode determined the need for sedation (4.3+/-2.1 shocks for AF episodes requiring sedation versus 2+/-1 shocks for AF episodes requiring no sedation; P<0.001). These additional shocks were needed to treat immediate reinitiation of AF (14 episodes) or initial failure to cardiovert (4 episodes). For 8 AF episodes, sedation was requested before the first shock. CONCLUSIONS This study suggests that, in a selected group of patients, AF can be treated with Atrioverter therapy without sedation. Successful ambulatory treatment of AF episodes with the Atrioverter, programmed to deliver </=2 shocks, did not require sedation. When multiple shocks were required to treat an AF episode, the need for sedation increased and included patients initially not requesting sedation.
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Affiliation(s)
- C Timmermans
- Department of Cardiology, Academic Hospital Maastricht, Maastricht, The Netherlands.
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Rodriguez LM, Timmermans C, Wellens HJ. Are electrophysiological changes induced by longer lasting atrial fibrillation reversible? :observations using the atrial defibrillator. Circulation 1999; 100:113-6. [PMID: 10402438 DOI: 10.1161/01.cir.100.2.113] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies in animal hearts have shown shortening of the atrial effective refractory period (AERP) and loss of the relation between the AERP and heart rate after prolonged periods of atrial fibrillation (AF). The purposes of this study were (1) to evaluate atrial electrophysiology after a long period of sinus rhythm in patients who had longer lasting recurrent AF that was successfully treated with the Metrix Atrioverter and (2) to analyze the effect of prompt cardioversion on subsequent AF episodes and the duration of sinus rhythm. METHODS AND RESULTS Four patients with recurrent AF (duration, 3 to 21 years; mean+/-SD, 13+/-7.6 years) were studied after the implantation of an Atrioverter. The Atrioverter stores and analyzes 3 minutes of cardiac rhythm every hour. Before implantation, AERP was measured. During a mean follow-up of 14 months, 52 spontaneous (39 treated and 18 nontreated) AF episodes occurred while the patients were on antiarrhythmic drugs. All patients were electrophysiologically studied after they had been in sinus rhythm for at least 1000 hours (range, 1052 to 2675 hours). Before Atrioverter implantation, AF was induced by 1 atrial premature beat in 3 patients and not induced in the remaining patient. After a long period in sinus rhythm (>1000 hours), AF could be induced in the same 3 patients in the same way as before implantation. In the patient in whom no AF was induced, right AERP values measured using the single extrastimulus technique at 3 pacing cycle lengths (600, 500, and 430 ms) were similar to those before implantation. CONCLUSIONS AF was still inducible by a single atrial premature beat after long episodes of sinus rhythm in 3 of 4 patients with previously longer lasting AF. In the patient in whom no AF was induced, AERP behaved like it did before implantation. In these patients with longer lasting recurrent AF, no return to "normal" atrial electrophysiology could be demonstrated.
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Affiliation(s)
- L M Rodriguez
- Department of Cardiology, Academic Hospital, Maastricht, The Netherlands.
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Nabar A, Rodriguez LM, Timmermans C, Smeets JL, Wellens HJ. Isoproterenol to evaluate resumption of conduction after right atrial isthmus ablation in type I atrial flutter. Circulation 1999; 99:3286-91. [PMID: 10385504 DOI: 10.1161/01.cir.99.25.3286] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND After radiofrequency (RF) ablation of atrial flutter (AFL), the demonstration of bidirectional isthmus conduction (BIC) block is considered the hallmark of a successful procedure. The purpose of our study was to test the persistence of BIC block after isoproterenol administration and to evaluate the importance of this finding with regard to AFL recurrences. METHODS AND RESULTS RF ablation of AFL was performed in 44 consecutive patients with type I AFL by linear ablation of the posterior isthmus (n=29 patients), septal isthmus (n=4 patients), or both right atrial (RA) isthmi (n=11 patients). The procedural end point was complete BIC block and noninducibility of AFL. In case of noninducibility and apparent BIC block, the pacing protocol was repeated under isoproterenol infusion (1 to 3 microgram/min). Reversal of apparent BIC block occurred in 7 (15.9%) of 44 patients. Six patients had bidirectional and 1 had unidirectional resumption of isthmus conduction. Counterclockwise AFL could be reinduced in 4 of these patients. Two to 24 (median, 4) additional RF applications were required to achieve permanent BIC block. At a mean follow-up of 7.3+/-7.6 months (range, 2 to 31 months), 2 (4.5%) of 44 patients had AFL recurrences. CONCLUSIONS Partial linear RF ablation could possibly aggravate preexisting nonuniform anisotropic conduction in the RA isthmus, resulting in profound conduction slowing and apparent BIC block. Isoproterenol can unmask apparent BIC block, thus providing an opportunity to assess the possibility of reversal of BIC block and completeness of isthmus ablation during the same procedure. The low incidence (4.5%) of AFL recurrences at follow-up suggests that noninducibility and BIC block under isoproterenol infusion may be a better end point for successful AFL ablation.
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Affiliation(s)
- A Nabar
- Department of Cardiology, Academic Hospital Maastricht, Maastricht, The Netherlands
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Timmermans C, Rodriguez LM, Ayers GM, Lambert H, Smeets JL, Vlaeyen JW, Albert A, Wellens HJ. Effect of butorphanol tartrate on shock-related discomfort during internal atrial defibrillation. Circulation 1999; 99:1837-42. [PMID: 10199880 DOI: 10.1161/01.cir.99.14.1837] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with atrial fibrillation, intracardiac atrial defibrillation causes discomfort. An easily applicable, short-acting analgesic and anxiolytic drug would increase acceptability of this new treatment mode. METHODS AND RESULTS In a double-blind, placebo-controlled manner, the effect of intranasal butorphanol, an opioid, was evaluated in 47 patients with the use of a step-up internal atrial defibrillation protocol (stage I). On request, additional butorphanol was administered and the step-up protocol continued (stage II). Thereafter, if necessary, patients were intravenously sedated (stage III). After each shock, the McGill Pain Questionnaire was used to obtain a sensory (S), affective (A), evaluative (E), and total (T) pain rating index (PRI) and a visual analogue scale analyzing pain (VAS-P) and fear (VAS-F). For every patient, the slope of each pain or fear parameter against the shock number was calculated and individual slopes were averaged for the placebo and butorphanol group. All patients were cardioverted at a mean threshold of 4.4+/-3.3 J. Comparing both patient groups for stage II, the mean slopes for PRI-T (P=0.0099), PRI-S (P=0.019), and PRI-E (P=0.015) became significantly lower in the butorphanol group than in the placebo group. Comparing patients who received the same shock intensity ending stage I and going to stage II, in those patients randomized to placebo the mean VAS-P (P=0.023), PRI-T (P=0. 029), PRI-S (P=0.030), and PRI-E (P=0.023) became significantly lower after butorphanol administration. CONCLUSIONS During a step-up internal atrial defibrillation protocol, intranasal butorphanol decreased or stabilized the value of several pain variables and did not affect fear. Of the 3 qualitative components of pain, only the affective component was not influenced by butorphanol. The PRI evaluated pain more accurately than the VAS.
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Affiliation(s)
- C Timmermans
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands.
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Nabar A, Rodriguez LM, Timmermans C, van den Dool A, Smeets JL, Wellens HJ. Effect of right atrial isthmus ablation on the occurrence of atrial fibrillation: observations in four patient groups having type I atrial flutter with or without associated atrial fibrillation. Circulation 1999; 99:1441-5. [PMID: 10086967 DOI: 10.1161/01.cir.99.11.1441] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The goal of this study was to test the hypothesis that the occurrence of atrial fibrillation (AF), in at least some patients with coexisting type I atrial flutter (AFL), is based on macro-reentry around the tricuspid valve orifice, including the right atrial (RA) isthmus, by evaluation of AF recurrences after successful ablation of AFL. METHODS AND RESULTS Eighty-two consecutive patients with type I AFL, with or without concomitant AF, underwent radiofrequency ablation (RFA) of the RA isthmus by an anatomical approach. The results were analyzed in 4 groups of patients: group 1 (only AFL; 29 patients), group 2 (AFL >AF; 22 patients), group 3 (AF >AFL; 15 patients), and group 4 (developing AFL while receiving class IC antiarrhythmic drug therapy for AF, the "class IC atrial flutter"; 16 patients). In all groups, RFA of type I AFL was performed with a high (>/=93%) procedural success rate. In group 1, only 2 patients (8%) had AF after (18+/-14 months) AFL ablation. These figures were 38% (20+/-14 months) and 86% (13+/-8 months) in groups 2 and 3, respectively. Group 4 patients (4+/-2 months) had a 73% freedom of AF recurrences with continuation of the class IC agent. CONCLUSIONS The low incidence of new AF during long-term follow-up after RFA of type I AFL makes it unlikely that radiofrequency lesions promote the development of AF. The impact of isthmus ablation on AF recurrences differs according to the clinically predominant atrial arrhythmia and suggests a possible role of the RA isthmus in the occurrence of AF in some patients. Ablation of class IC atrial flutter in patients with therapy-resistant AF is a novel approach to management of this patient subset. Careful classification of AF patients plays a role in the selection of the site of ablation therapy.
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Affiliation(s)
- A Nabar
- Department of Cardiology, Academic Hospital Maastricht, Maastricht, The Netherlands
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Abstract
In some patients with atrial fibrillation, atrial flutter develops after administration of class IC antiarrhythmic drugs, the so-called class IC atrial flutter. Radiofrequency ablation of the right atrial isthmus results in clinical improvement in 85% of patients and provides an alternative management strategy for a subset of patients with therapy-resistant atrial fibrillation.
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Affiliation(s)
- A Nabar
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands
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Rodriguez LM, Leunissen J, Hoekstra A, Korteling BJ, Smeets JL, Timmermans C, Vos M, Daemen M, Wellens HJ. Transvenous cold mapping and cryoablation of the AV node in dogs: observations of chronic lesions and comparison to those obtained using radiofrequency ablation. J Cardiovasc Electrophysiol 1998; 9:1055-61. [PMID: 9817557 DOI: 10.1111/j.1540-8167.1998.tb00883.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Radiofrequency (RF) is the most commonly used energy source for the treatment of cardiac arrhythmias. Surgical experience has shown that cryoablation also is effective for ablating arrhythmias. The aims of this study were to (1) investigate the feasibility of inducing permanent complete AV block (CAVB), (2) investigate the value of cold mapping to select the cryoablation site to produce permanent CAVB, (3) study the macro- and microscopic lesion characteristics 6 weeks later, and (4) compare them to those produced with RF energy. METHODS AND RESULTS A new steerable 8.5-French bipolar electrode catheter having a thermocouple with a 3-mm tip using N2O as the refrigerant controlled by a cryoconsole was used. Six mongrel dogs were anesthetized, and the catheter was positioned via the femoral vein across the tricuspid valve to record a large low right atrial and a small His-bundle potential. After cold mapping (-15 degrees to -20 degrees C tip temperature) resulted in ECG modifications, cryothermia (-70 degrees C) was given twice, lasting 5 minutes each, to create permanent CAVB (Cryo group). Additionally, RF catheter ablation of the AV node was performed in two anesthetized mongrel dogs (RF group). In the Cryo group, a permanent proximal CAVB was created in four dogs (block occurred within 10 to 20 sec of cryothermia). Permanent right bundle branch block was obtained in one dog and transient CAVB in the remaining dog. In both dogs of the RF group, permanent CAVB was obtained. The cryolesions consisted of well-circumscribed, homogeneous areas of fibrotic tissue without viable cardiomyocytes. Lesions produced with RF were less circumscribed and inhomogeneous, with clear evidence of viable cardiomyocytes and cartilage formation (patchy lesions). CONCLUSIONS (1) Permanent CAVB can be created by using a steerable cryoablation catheter. (2) Histologically, cryoablated sites were homogeneous and showed fibrotic tissue without signs of chronic inflammation and no evidence of viable myocytes. (3) Lesions created with RF were less homogenous and still contained viable myocytes within the lesion and cartilage formation. (4) The arrhythmogenic significance of these differences requires further study. (5) The technology of using reversible cold mapping has the potential to identify the successful ablation site and warrants further clinical study.
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Affiliation(s)
- L M Rodriguez
- Department of Cardiology, Academic Hospital, Maastricht, The Netherlands.
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Smeets JL, Ben-Haim SA, Rodriguez LM, Timmermans C, Wellens HJ. New method for nonfluoroscopic endocardial mapping in humans: accuracy assessment and first clinical results. Circulation 1998; 97:2426-32. [PMID: 9641695 DOI: 10.1161/01.cir.97.24.2426] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Accurate mapping of the site of origin and activation sequence of a cardiac arrhythmia is essential for a successful catheter ablation procedure. To achieve this, precise and reproducible catheter manipulation is mandatory. The aim of this study was (1) to assess the accuracy of a new nonfluoroscopic mapping system in humans and (2) to report the first result of endocardial activation mapping with this system during sinus rhythm and several types of supraventricular and ventricular tachycardias. METHODS AND RESULTS Fifteen patients were studied. Accuracy measurements were performed in 5 of them (patients 5, 6, 7, 8, and 14). The distances between two subsequent catheter positions in the inferior caval vein as determined by the nonfluoroscopic mapping system were compared with measurements made with calipers by four independent investigators using identification marks on the catheter shaft. The difference between these two methods was 0.95+/-0.8 mm. In 15 patients, activation of the right atrium and/or the right or left ventricle was recorded during sinus rhythm. Three-dimensional activation maps were constructed in patients with atrial and ventricular tachycardias and Wolff-Parkinson-White syndrome. CONCLUSIONS With this new nonfluoroscopic mapping technique, accurate positioning of the catheter tip is possible. A three-dimensional activation map can be reconstructed during sinus rhythm and during supraventricular and ventricular tachycardias of different compartments of the heart.
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Affiliation(s)
- J L Smeets
- Department of Cardiology of the University Hospital Maastricht, The Netherlands.
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Abstract
INTRODUCTION Catheter-based electrodes have been used previously to terminate episodes of atrial fibrillation in animals and man. Typically, these electrodes span 6 to 7 cm, and lowest energy requirements are achieved when these electrodes are positioned in the distal coronary sinus and in the right atrium. The purpose of this study was to evaluate the use of longer electrode lengths for atrial defibrillation. METHODS AND RESULTS In 15 patients, two decapolar catheters were inserted, one into the distal coronary sinus and one in the right atrium. To provide longer electrodes lengths, a third catheter was inserted and alternated positioned in the right atrium or coronary sinus. A 6-cm electrode span was obtained by using the distal 8 rings on the coronary sinus catheter or 8 consecutive electrodes on the right atrial catheter and increased from 6 to 11 cm by connecting 5 consecutive, nonoverlapping rings of the third catheter with the 10 rings of the initial right atrial or coronary sinus catheter. Atrial defibrillation thresholds were determined twice, in a randomized order, in each patient for each of the three combinations of electrode lengths. All 15 patients could be successfully converted to sinus rhythm without complications; however, one patient could be converted reproducibly with only 2 of the 3 electrode combinations. Mean thresholds were 306 +/- 102 V, 5.9 +/- 4.0 J for the 6 cm/6 cm electrode length combination with an impedance of 72 +/- 18 omega. For the electrode combination using the 11-cm electrode in the right atrium, the defibrillation threshold was 296 +/- 107 V, 5.8 +/- 3.9 J with an impedance of 61 +/- 17 omega and was 294 +/- 91 V, 5.6 +/- 3.6 J with an impedance of 55 +/- 11 omega for the 11-cm electrode in the coronary sinus. There were no significant differences in defibrillation voltage or energy (P > 0.05) associated with the longer electrode lengths; however, the longer electrode lengths did significantly lower shock impedance (P < 0.05). CONCLUSION The use of longer electrodes, when using the right atrium to coronary sinus shock vector, does not lower the defibrillation requirements for restoration of sinus rhythm.
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Affiliation(s)
- C Timmermans
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands.
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Hatzinikolaou H, Rodriguez LM, Smeets JL, Timmermans C, Vrouchos G, Grecas G, Wellens HJ. Isoprenaline and inducibility of atrioventricular nodal re-entrant tachycardia. Heart 1998; 79:165-8. [PMID: 9538310 PMCID: PMC1728591 DOI: 10.1136/hrt.79.2.165] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To examine the effect of isoprenaline on slow and fast pathway properties and tachycardia initiation. DESIGN Consecutive patients, prospective study. SETTING Referral centre for cardiology, academic hospital. PATIENTS 24 patients suffering from common type atrioventricular nodal reentrant tachycardia (AVNRT). INTERVENTIONS Programmed electrical stimulation and radiofrequency catheter ablation of the slow pathway. MEASUREMENTS AND MAIN RESULTS AVNRT was induced before and after the administration of isoprenaline in nine patients (group 1), before isoprenaline only in five (group 2), and after isoprenaline only in 10 (group 3). The anterograde effective refractory period of the fast pathway was prolonged significantly during isoprenaline administration in group 1 (405 (31) v 335 (34) ms, p < 0.001) and shortened in group 2 (308 (57) v 324 (52) ms, p = 0.005). There was also significant shortening in group 3 (346 (85) v 395 (76) ms, p < 0.001). Isoprenaline administration did not result in a significant change of the anterograde effective refractory period of the slow pathway in groups 1 and 3, but eliminated slow pathway conduction in group 2. Isoprenaline significantly shortened the minimal and maximal atrial to His bundle conduction interval recording in response to each extrastimulus of the slow pathway (210 (24) v 267 (25) ms, p < 0.001 and 275 (25) v 328 (25) ms, p < 0.001, respectively) in group 1 and significantly prolonged these intervals (331 (34) v 274 (34) ms and 407 (33) v 351 (33) ms, respectively) in group 3. In all groups only minimal changes in the refractory period of the atrium occurred after isoprenaline administration. The effect of isoprenaline was also measured on the ventricular effective refractory period and on the minimal and maximal length of the ventriculoatrial (V2-A2) interval during ventricular pacing. Isoprenaline did not result in a significant change of the ventricular effective refractory period in groups 1 and 2 nor of the shortest and longest V2-A2 interval. In group 3, however, the ventricular effective refractory period and the shortest and longest V2-A2 interval shortened significantly after isoprenaline administration. CONCLUSIONS In group 1 isoprenaline did not affect inducibility of AVNRT because it prolonged the fast pathway refractory period without affecting slow pathway conduction. In group 2 isoprenaline shortened the fast pathway refractory period and appeared to abolish slow pathway conduction. Consequently, isoprenaline prevented induction of AVNRT. In group 3 isoprenaline facilitated induction of AVNRT. This effect seemed primarily to be the result of shortening of retrograde refractoriness of the fast pathway with prolongation of slow pathway anterograde conduction and refractory period.
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Affiliation(s)
- H Hatzinikolaou
- Department of Cardiology, G Papanikolaou General Hospital, Exohi, Thessaloniki, Greece
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Abstract
INTRODUCTION Although the recurrence rate of atrial fibrillation has been reported to be similar to that after external and internal cardioversion, little is known about immediate reinitiation of atrial fibrillation (IRAF) following internal cardioversion. METHODS AND RESULTS Thirty-eight patients (24 men; mean age 63 +/- 13 years) underwent internal atrial defibrillation. Catheter-based defibrillation electrodes were positioned in the anterolateral right atrium and the coronary sinus. All patients were cardioverted at a mean threshold of 4.6 +/- 3.4 J. Five of 38 patients (13%) had 1 to 4 episodes of IRAF. No difference in clinical and echocardiographic characteristics were observed when patients with and without IRAF were compared. Atrial fibrillation was always reinitiated by an atrial premature beat. When the earliest atrial endocardial activation time on the defibrillation catheters was analyzed, these atrial premature beats did not seem to originate from the defibrillation catheters. Twenty-one patients had atrial premature beats without IRAF. When the coupling intervals of the first atrial premature beat in patients without and with IRAF after conversion were compared, a significant difference was found (661 +/- 229 vs 418 +/- 79 msec, P < 0.05). IRAF was successfully treated with repeated shock delivery after the administration of atropine in 1 patient and intravenous flecainide in 2. Only repeated shock delivery was sufficient to treat IRAF in another 2 patients. Late recurrences of atrial fibrillation occurred in 3 of 5 with IRAF and in 19 of 33 patients without IRAF (P = NS). CONCLUSION IRAF after internal atrial defibrillation occurred in 13% of patients, was always initiated by an atrial premature beat having a short coupling interval not originating from the defibrillation catheters, and was prevented by repeated shock delivery with or without preceding administration of pharmacologic agents. IRAF did not predict early recurrences of the arrhythmia after discharge from the hospital, emphasizing the necessity to treat immediate reinitiation promptly to achieve a successful cardioversion.
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Affiliation(s)
- C Timmermans
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands.
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Wellens HJ, Doevendans P, Smeets J, Rodriguez LM, Dulk KD, Timmermans C, Vos M. Arrhythmia risk: electrophysiological studies and monophasic action potentials. Pacing Clin Electrophysiol 1997; 20:2560-5. [PMID: 9358503 DOI: 10.1111/j.1540-8159.1997.tb06105.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Shortly after in the introduction of programmed electrical stimulation (PES) of the heart to study and localize cardiac arrhythmias in the intact human heart, the technique was used for risk stratification of the arrhythmia patient. Two decades later we have to conclude that especially in ventricular arrhythmias the technique of PES did not live up to our expectations and the left ventricular function is a better long-term predictor than the induction of ventricular arrhythmias or the ability to find an antiarrhythmic drug able to prevent the initiation of the classically documented ventricular arrhythmia. Another sobering finding came from the analysis of the characteristics of the patient dying suddenly out-of-hospital, which showed that most of those patients could not be classified before the event as being at high risk using noninvasive or invasive testing, not even in those with a previous cardiac history. Monomorphic action potential (MAP) recordings have been of importance in our understanding of torsade de pointe arrhythmias in congenital and acquired QT prolongation. A major problem in case of a less generalized electrophysiological abnormality is the identification of the appropriate place where to put the MAP-electrode.
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Affiliation(s)
- H J Wellens
- Department of Cardiology, Academic Hospital, Maastricht, The Netherlands
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Abstract
Sudden death can be the first manifestation of the Wolff-Parkinson-White (WPW) syndrome. The underlying mechanism being atrial fibrillation with a very high ventricular rate, because of a short anterograde refractory period of the accessory atrioventricular pathway (AP), deteriorating into ventricular fibrillation. Information on the anterograde refractory period of the AP is therefore important to recognize asymptomatic people with the WPW ECG at risk for dying suddenly. Several noninvasive tests are available to identify the low risk patient. Decision making when to interrupt the AP in asymptomatic WPW patients not at low risk requires an invasive study to document the electrophysiological properties of the AP and to determine its exact location.
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Affiliation(s)
- H J Wellens
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands
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Timmermans C, Rodriguez LM, Smeets JL. Cycle length and QRS alternation during a narrow QRS tachycardia. J Cardiovasc Electrophysiol 1997; 8:963-4. [PMID: 9261723 DOI: 10.1111/j.1540-8167.1997.tb00858.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- C Timmermans
- Department of Cardiology, University Hospital Maastricht, The Netherlands.
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Abstract
We performed radiofrequency catheter ablation of idiopathic ventricular tachycardia in six children. In four, the ventricular tachycardia originated in the left ventricle, in two it originated in the right ventricular outflow tract. In 5/6 (83%) the RF procedure was successful; there were no complications.
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Affiliation(s)
- J L Smeets
- Department of Cardiology, Academic Hospital Maastricht, Limburg, The Netherlands.
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Rodriguez LM, Smeets JL, Timmermans C, Blommaert D, van Dantzig JM, de Muinck EB, Wellens HJ. Radiofrequency catheter ablation of sustained monomorphic ventricular tachycardia in hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 1997; 8:803-6. [PMID: 9255687 DOI: 10.1111/j.1540-8167.1997.tb00838.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Incessant monomorphic ventricular tachycardia (VT) with a right bundle branch block morphology and a northwest axis is a rare arrhythmic complication in a patient with hypertrophic cardiomyopathy and apical left ventricular aneurysm. METHODS AND RESULTS The origin of this VT was localized using the following criteria: the presence of entrainment without fusion, equal intervals from the stimulus to the beginning of the QRS complex and from the electrogram to the QRS complex during VT, and the first postpacing interval identical to the tachycardia cycle length. Radiofrequency energy applied to the septoapical part of the apical left ventricular aneurysm terminated the tachycardia within 2 seconds. CONCLUSION Using criteria to guide radiofrequency (RF) ablation of VT in patients with coronary artery disease, an incessant monomorphic VT in a patient with hypertrophic cardiomyopathy was successfully ablated.
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Affiliation(s)
- L M Rodriguez
- Department of Cardiology, University Hospital Maastricht, The Netherlands.
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Abstract
This study reports on predictors for successful radiofrequency (RF) ablation of idiopathic ventricular tachycardia (VT) in 48 patients--35 with right ventricular (RV) outflow tract and 13 with left ventricular VT. In RV outflow tract idiopathic VT, RF ablation was successful in 29 of 35 patients (83%). The following information allowed differentiation between patients with and without a successful RF ablation: > 1 induced VT morphology (O vs 3); presence of delta wave-like beginning of the QRS (2 vs 3) and > or = 11 of 12 leads showing a "match" between the clinical VT and the pacemap (28 vs 1). Endocardial activation times were not different between both groups (-15 +/- 18 vs -4 +/- 5 ms). In left ventricle idiopathic VT, RF ablation was successful in 12 of 13 patients (92%). In patients who underwent successful ablation, 1 VT morphology was induced and no delta wave-like beginning of the QRS was present; a correlation between clinical VT and the pacemap > or = 11 of 12 leads was found and the endocardial activation time preceded the QRS (range of -5 to -58 ms [mean -30 +/- 14]). Purkinje activity was observed in 5 of 7 patients with an idiopathic VT originating from the inferoposterior region but not from the inferoapical region of the left ventricle. Four patients (14%) with RV outflow tract idiopathic VT had recurrence during a mean follow-up of 2 to 50 months (mean 30 +/- 12). Thus, (1) in RV outflow tract idiopathic VT a good pacemap was more important than an early endocardial activation time; (2) an optimal pacemap as well as an early endocardial activation time were important predictors for successful ablation of the left ventricle idiopathic VT; (3) Purkinje activity was recorded in VTs arising in the inferoposterior region of the left ventricle; and (4) factors for unsuccessful ablation for idiopathic VT were > 1 induced VT morphology, a delta wave-like beginning of the QRS, and a VT/pacemap correlation < 11 of 12 leads. Idiopathic VT can be successfully ablated with both immediate and long-term success.
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Affiliation(s)
- L M Rodriguez
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands
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Rodriguez LM, Smeets JL, Timmermans C, Trappe HJ, Wellens HJ. Radiofrequency catheter ablation of idiopathic ventricular tachycardia originating in the anterior fascicle of the left bundle branch. J Cardiovasc Electrophysiol 1996; 7:1211-6. [PMID: 8985810 DOI: 10.1111/j.1540-8167.1996.tb00500.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Idiopathic ventricular tachycardia (VT) originating in or close to the anterior fascicle of the left bundle is rare. A patient with no structural heart disease and VT with a right bundle branch block configuration and right-axis deviation underwent an electrophysiologic examination. METHODS AND RESULTS Both endocardial activation mapping during VT and pacemapping were performed via a transseptal approach to localize the site of origin of the VT. Endocardial recordings of the His bundle and the posterior and anterior fascicles of the left bundle branch revealed an origin of the VT in or close to the anterior fascicle. The Purkinje potential at that site preceded the QRS complex by 20 msec, with pacemapping showing an optimal match between the paced rhythm and the clinical VT. RF energy delivered at this site terminated the VT. A left anterior hemiblock appeared after RF ablation. Ten months later, the patient is free from recurrences of VT. CONCLUSIONS Idiopathic VT originating in or close to the anterior fascicle was cured by RF ablation. A Purkinje potential preceding the QRS during tachycardia and an optimal pacemap were used to guide RF ablation.
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Affiliation(s)
- L M Rodriguez
- Department of Cardiology, University Hospital Maastricht, The Netherlands.
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