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Sagray E, Tomas L, Cannon B, Wackel P, O'Leary P, Ameduri R, Brown T, Johnson J. Safe and Effective Early Use of Betablockers after Pediatric Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Vecchio N, Ripa L, Orosco A, Tomas L, Mondragón I, Acosta A, Talavera L, Rivera S, Albina G, Diez M, Scazzuso F. Atrial Fibrillation in Heart Failure Patients with Preserved or Reduced Ejection Fraction. Prognostic significance of Rhythm control strategy with Catheter Ablation. J Atr Fibrillation 2019; 11:2128. [PMID: 31139301 DOI: 10.4022/jafib.2128] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/06/2018] [Accepted: 12/22/2018] [Indexed: 11/10/2022]
Abstract
Introduction Atrial fibrillation (AF) and heart failure (HF) often coexist with an increase in morbidity and mortality. AF catheter ablation (CA) has proved to be a safe and efficient option for HF patients, but long-term evolution and prognosis remain uncertain. The aim is to assess the efficacy and safety of CA in HF patients with AF, and analyze HF long-term evolution. Methods We prospectively analyzed consecutive patients with AF and congestive HF or left ventricular ejection fraction (EF) less than 45%, who underwent CA of AF between 2011 and 2016. We excluded patients who did not complete one year of follow-up. Results Seventy-nine patients were included. Mean age was 62.1 years, 72.4% were men, 67.2% had hypertension and 8.6% were diabetics. Mean EF was 49%, left atrial area was 26.5 cm2 and mean CHA2DS2-VASc score was 2. 70.6% were on NYHA FC II-III.The recurrence rate of AF was 60%, and after a second CA the rate decreased to 27.8%. Only persistent AF prior to the procedure was identified as independent predictor of recurrence. There was a significant NYHA FC improvement in the sinus rhythm (SR) group vs those with recurrence (63.6% vs 36.4%; p=0.047). None of the patients in SR were hospitalized, whereas six with recurrence were hospitalized due to HF (0% vs. 18.2%; p = 0.07). The rate of complications was 9.1%. Conclusions Catheter ablation of atrial fibrillation in heart failure presents an adequate success rate, improving symptoms and reducing rehospitalizations due to heart failure.
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Affiliation(s)
- Nicolás Vecchio
- Electrophysiology Fellowship. Instituto Cardiovascular de Buenos Aires
| | - Leonardo Ripa
- General Cardiology Fellowship. Hospital Central. Mendoza, Argentina
| | - Agustín Orosco
- Electrophysiology Fellowship. Instituto Cardiovascular de Buenos Aires
| | - Leandro Tomas
- Electrophysiology Fellowship. Instituto Cardiovascular de Buenos Aires
| | - Ignacio Mondragón
- Electrophysiology Fellowship. Instituto Cardiovascular de Buenos Aires
| | - Adriana Acosta
- Electrophysiology Fellowship. Instituto Cardiovascular de Buenos Aires
| | - Lujan Talavera
- Electrophysiology Fellowship. Instituto Cardiovascular de Buenos Aires
| | - Santiago Rivera
- Electrophysiology Fellowship. Instituto Cardiovascular de Buenos Aires
| | - Gastón Albina
- Electrophysiology Fellowship. Instituto Cardiovascular de Buenos Aires
| | - Mirta Diez
- Electrophysiology Fellowship. Instituto Cardiovascular de Buenos Aires
| | - Fernando Scazzuso
- Electrophysiology Fellowship. Instituto Cardiovascular de Buenos Aires
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Rivera S, Tomas L, Ricapito MDLP, Nicolas V, Reinoso M, Caro M, Mondragon I, Albina G, Giniger A, Scazzuso F. Updated results on catheter ablation of ventricular arrhythmias arising from the papillary muscles of the left ventricle. J Arrhythm 2019; 35:99-108. [PMID: 30805050 PMCID: PMC6373649 DOI: 10.1002/joa3.12137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/19/2018] [Accepted: 10/09/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Catheter ablation of ventricular arrhythmias (VAs) arising from the left ventricle`s (LV) papillary muscles (PM) is challenging. In this study we present results of catheter ablation using multiple energy sources and image-based approaches. METHODS Fifty-three patients (49 ± 17 years old; 34% females; median LV ejection fraction 53 ± 11%) underwent catheter cryoablation or radiofrequency (RF) ablation with non-contact force sensing (Non-CFS) catheters and cardiac computed tomography integration (CTII) into the electroanatomical mapping system or contact force sensing RF (CFS RF) ablation catheters and intracardiac echo-facilitated 3D electroanatomical mapping. Ventricular arrhythmias foci were mapped at either the anterolateral (ALPM) or posteromedial papillary muscles (PMPM). Ablation was performed using an 8-mm cryoablation catheter (CRYO); a Non-CFS 4-mm open-irrigated RF catheter; or a CFS RF 3.5-mm open-irrigated tip catheter, via transmitral or transaortic approach. RESULTS Acute success rate was 83% for Non-CFS RF/CTII; 100% for CRYO/CTII (n = 16) and CFS RF/ICE3D (n = 14) (P = 0.03). Catheter stability was achieved in all patients treated with Cryo/CTII. VA recurrence at 12 months follow-up was 48% (n = 11) for Non-CFS RF/CTII; 19% (n = 3) for CRYO/CTII; and 7% (n = 1) for CFS RF/ICE3D (P = 0.02). CONCLUSIONS Non-CFS/CTII was associated with an increased risk of recurrence of the clinical arrhythmia. Ablation with either CFS RF/ICE3D or CRYO/CTII showed high acute success rates and low recurrence rates during follow-up. Cryoablation provided stable contact and was less arrhythmogenic.
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Affiliation(s)
- Santiago Rivera
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Leandro Tomas
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Maria de la Paz Ricapito
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Vecchio Nicolas
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Marcelo Reinoso
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Milagros Caro
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Ignacio Mondragon
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Gaston Albina
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Alberto Giniger
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Fernando Scazzuso
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
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Galizia Brito V, March Vecchio N, Jarma J, Tomas L, Mondragon I, Orosco A, Rivera S, Albina G, Giniger A, Scazzuso F. P751Second generation cryoballoon vs. radiofrequency ablation in paroxysmal atrial fibrillation: outcomes beyond one-year follow-up time. Europace 2018. [DOI: 10.1093/europace/euy015.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V Galizia Brito
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - N March Vecchio
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - J Jarma
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - L Tomas
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - I Mondragon
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - A Orosco
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - S Rivera
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - G Albina
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - A Giniger
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - F Scazzuso
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
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Tomas L, Vecchio N, Orosco A, Vergara J, Mondragon I, Cruz P, Rivera S, Caro M, Albina G, Giniger A, Scazzuso F. P2654Paroxysmal atrial fibrillation ablation: the blanking period as a new recurrence predictor. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tomas L, Tomas L, Orosco A, Vergara JM, Mondragon F, Cruz P, Caro M, Reinoso M, Rivera S, Albina G, Giniger A, Scazzuso F. P880Paroxysmal atrial fibrillation ablation: the blanking period as a new recurrence predictor. Europace 2017. [DOI: 10.1093/ehjci/eux151.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tomas L, Björkbacka H, Edsfeldt A, Danielsson A, Wigren M, Grufman H, Persson A, Prehn C, Adamski J, Nilsson J, Gonçalves I. A lipid metabolite profile in atherosclerotic plaques associated with increased inflammation and cardiovascular risk. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rivera S, Ricapito MDLP, Tomas L, Parodi J, Bardera Molina G, Banega R, Bueti P, Orosco A, Reinoso M, Caro M, Belardi D, Albina G, Giniger A, Scazzuso F. Results of Cryoenergy and Radiofrequency-Based Catheter Ablation for Treating Ventricular Arrhythmias Arising From the Papillary Muscles of the Left Ventricle, Guided by Intracardiac Echocardiography and Image Integration. Circ Arrhythm Electrophysiol 2016; 9:e003874. [PMID: 27069089 DOI: 10.1161/circep.115.003874] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [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: 12/22/2015] [Accepted: 02/25/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Catheter radiofrequency ablation of ventricular arrhythmias (VAs) arising from the left ventricle's papillary muscles has been associated with inconsistent results. The use of cryoenergy versus radiofrequency has not been compared yet. This study compares outcomes and complications of catheter ablation of VA from the papillary muscles of the left ventricle with either cryoenergy or radiofrequency. METHODS AND RESULTS Twenty-one patients (40±12 years old; 47% males; median ejection fraction 59±7.3%) with drug refractory premature ventricular contractions or ventricular tachycardia underwent catheter cryoablation or radiofrequency ablation. VAs were localized using 3-dimensional mapping, multidetector computed tomography, and intracardiac echocardiography, with arrhythmia foci being mapped at either the anterolateral papillary muscle or posteromedial papillary muscles of the left ventricle. Focal ablation was performed using an 8-mm cryoablation catheter or a 4-mm open-irrigated radiofrequency catheter, via transmitral approach. Acute success rate was 100% for cryoenergy (n=12) and 78% for radiofrequency (n=9; P=0.08). Catheter stability was achieved in all patients (100%) treated with cryoenergy, and only in 2 (25%) patients treated with radiofrequency (P=0.001). Incidence of multiple VA morphologies was observed in 7 patients treated with radiofrequency (77.7%), whereas none was observed in those treated with cryoenergy (P=0.001). VA recurrence at 6 months follow-up was 0% for cryoablation and 44% for radiofrequency (P=0.03). CONCLUSIONS Cryoablation was associated with higher success rates and lower recurrence rates than radiofrequency catheter ablation, better catheter stability, and lesser incidence of polymorphic arrhythmias.
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Affiliation(s)
- Santiago Rivera
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina.
| | - Maria de la Paz Ricapito
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Leandro Tomas
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Josefina Parodi
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo Bardera Molina
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Rodrigo Banega
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Pablo Bueti
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Agustin Orosco
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Marcelo Reinoso
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Milagros Caro
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Diego Belardi
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Gaston Albina
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Alberto Giniger
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | - Fernando Scazzuso
- From the Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
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Rivera S, Ricapito MDLP, Parodi J, Tomas L, Albina G, Giniger A, Scazzuso F. 136-34: Cryo-energy Vs Radiofrequency Based Catheter Ablation for Treating Ventricular Arrhythmias Arising from the Papillary Muscles of the Left Ventricle, Guided by Intracardiac Echocardiography and Image Integration. Europace 2016. [DOI: 10.1093/europace/18.suppl_1.i98c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Seco JL, Velasco F, Manuel JS, Serrano SR, Tomas L, Velasco A. Retroperitoneal Castleman's disease. Surgery 1992; 112:850-5. [PMID: 1440235] [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: 12/27/2022]
Abstract
A case of Castleman's disease localized in the retroperitoneal space is reported. A 29-year-old patient had a mass 15 cm in diameter with radial calcification. After surgical resection, both the patient's anemia and hypergammaglobulinemia disappeared. Castleman's disease should be considered when facing a solid retroperitoneal or mesenteric mass, mainly if anemia and hypergammaglobulinemia are present. Previous reports about this unusual condition are reviewed.
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Affiliation(s)
- J L Seco
- Department of Surgery, Hospital General Yagüe, Burgos, Spain
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Guiteras P, Tomas L, Varas C, Augé JM, Masotti M, Crexells C, Oriol A. Five years of angiographic and clinical follow-up after successful percutaneous transluminal coronary angioplasty. Eur Heart J 1989; 10 Suppl G:42-8. [PMID: 2627948 DOI: 10.1093/eurheartj/10.suppl_g.42] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [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: 01/01/2023] Open
Abstract
The first 67 consecutive patients (77 lesions) who underwent successful coronary angioplasty (PTCA) at our hospital were clinically followed with serial exercise testing over a 5-year (4 to 7) observation period. Two sequential angiographic controls were performed 6.9 +/- 4.6 (64 patients) and 49.5 +/- 21.6 (42 patients) months after PTCA. The 5-year risk of cardiac death was 8%, of myocardial infarction 2%, or coronary artery bypass grafting 16% and of repeat PTCA 8%. At 5 years, 67% of the patients remain asymptomatic. Restenosis greater than or equal to 70% diameter was observed within the first year after PTCA in 30% of the patients. Progression of coronary artery disease (CAD) was observed in 13 patients (20%). In the first angiographic control, CAD progression was 4% (3/77) in dilated and 3% (3/115) in non-dilated arteries (ns). In the second angiographic control, it was 7% (3/45) and 10% (8/81), respectively (ns). Thus good clinical and angiographic results are still observed after 5 years. Restenosis is an early, self-limited, time-restricted phenomenon that occurs in 30% of patients. Angioplasty does not appear to accelerate CAD progression.
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Affiliation(s)
- P Guiteras
- Department of Hemodynamics, Hospital de la Santa Creu and Sant Pau, Barcelona, Spain
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