isolation-characterization-cardiac-mesenchymal-stromal-cells-from

Isolation and Characterization of Cardiac Mesenchymal Stromal Cells from Endomyocardial Bioptic Samples of Arrhythmogenic Cardiomyopathy Patients

A normal adult heart is composed of several different cell types, among which cardiac mesenchymal stromal cells represent an abundant population. The ...

Endomyocardial biopsy (EMB) has a low sensitivity. Electroanatomic voltage mapping (EVM) is effective in guiding EMB thanks to its ability in identifying and locating low-voltage regions. The analysis of unipolar EVM can correlate with epicardial pathological involvement. We evaluated the unipolar EVM in EMB areas to determine whether it can increase EMB sensitivity in diagnosing epicardial diseases.

Feasibility of combined unipolar and bipolar voltage maps to improve sensitivity of endomyocardial biopsy.

Previous studies reported the usefulness of an irrigated circular radiofrequency ablation catheter (nMARQ(TM), Biosense Webster) for pulmonary vein isolation (PVI). We evaluated the role of intracardiac echocardiography (ICE) to optimize the manipulation of nMARQ(TM) catheter.

Usefulness of intracardiac echocardiography during pulmonary vein isolation with the novel multipolar irrigated ablation catheter (nMARQ™).

Hybrid percutaneous and surgical minimally invasive, thoracoscopy-guided removal of a pacemaker lead subacutely perforating the right ventricle.

Contact with cardiac tissue is an important determinant of lesion efficacy during atrial fibrillation (AF) ablation. The Sensei X™ robotic navigation system (RNS) (Hansen Medical, Mountain View, CA, USA) has been validated for contact force (CF) sensing expressed in grams (g). The Thermocool® SmartTouch™ catheter enables the measurement of catheter tip CF and direction inside the heart. We aimed to investigate the catheter CF with and without RNS during pulmonary vein isolation (PVI) procedures.

Analysis of catheter contact force during atrial fibrillation ablation using the robotic navigation system: results from a randomized study.

Introduction. Cryoballoon (CB) ablation has emerged as a novel treatment for pulmonary vein isolation (PVI) for patients with paroxysmal atrial fibrillation (PAF). The second-generation Arctic Front Advance (ADV) was redesigned with technical modifications aiming at procedural and outcome improvements. We aimed to compare the efficacy of the two different technologies over a long-term follow-up. Methods. A total of 120 patients with PAF were enrolled. Sixty patients underwent PVI using the first-generation CB and 60 patients with the ADV catheter. All patients were evaluated over a follow-up period of 2 years. Results. There were no significant differences between the two groups of patients. Procedures performed with the first-generation CB showed longer fluoroscopy time (36.3 ± 16.8 versus 14.2 ± 13.5 min, resp.; p = 0.00016) and longer procedure times as well (153.1 ± 32 versus 102 ± 24.8 min, resp.; p = 0.019). The overall long-term success was significantly different between the two groups (68.3 versus 86.7%, resp.; p = 0.017). No differences were found in the lesion areas of left and right PV between the two groups (resp., p = 0.61 and 0.57). There were no significant differences in procedural-related complications. Conclusion. The ADV catheter compared to the first-generation balloon allows obtaining a significantly higher success rate after a single PVI procedure during the long-term follow-up. Fluoroscopy and procedural times were significantly shortened using the ADV catheter.

Comparison between First- and Second-Generation Cryoballoon for Paroxysmal Atrial Fibrillation Ablation.

Most of interventional procedures in cardiology are carried out under fluoroscopic imaging guidance. Besides other peri-interventional risks, radiation exposure should be considered for its stochastic (inducing malignancy) and deterministic effects on health (tissue reactions like erythema, hair loss and cataracts). In this article we analized the radiation risk from cardiovascular imaging to both patients and medical staff and discusses how customize the X-ray system and how to implement shielding measures in the cath lab. Finally, we reviewed the most recent developments and the latest findings in catheter navigation and 3D electronatomical mapping systems that may help to reduce patient and operator exposure.

The Growing Culture Of A Minimally Fluoroscopic Approach In Electrophysiology Lab.

The cornerstone of the new imaging technologies to treat complex arrhythmias is the electroanatomic (EAM) mapping. It is based on tissue characterization and in particular on determination of low potential region and dense scar definition. Recently, the identification of fractionated isolated late potentials increased the specificity of the information derived from EAM. In addition, non-invasive tools and their integration with EAM, such as cardiac magnetic resonance imaging and computed tomography scanning, have been shown to be helpful to characterize the arrhythmic substrate and to guide the mapping and the ablation. Finally, intracardiac echocardiography, known to be useful for several practical uses in the setting of electrophysiological procedures, it has been also demonstrated to provide important informations about the anatomical substrate and may have potential to identify areas of scarred myocardium.

New Imaging Technologies To Characterize Arrhythmic Substrate.

During the past years, endomyocardial biopsy (EMB) has gradually spread into clinical practice. However, the role of EMB in the diagnosis and treatment of cardiovascular diseases remains a controversial issue, especially in the setting of unexplained ventricular arrhythmias. Areas covered: This review describes the methodology of EMB guided by combined use of three-dimensional electroanatomical mapping systems and intracardiac echo and summarizes the classical, fluoroscopy-guided EMB technique. Finally, the personal experience acquired with the 'electrophysiologist-made' integration methodology has been reported. Expert commentary: Since EMB has been considered in the setting of arrhythmogenic cardiomyopathy, myocarditis, cardiac sarcoidosis, drug toxicity, and/or other diseases causing malignant ventricular arrhythmias, the electrophysiologists have started to perform firsthand biopsy. The electrophysiologists introduced the use of electroanatomical mapping systems and intracardiac echo. This new methodology improved significantly biopsy diagnostic yield and allowed to reduce complications.

Electroanatomical mapping systems and intracardiac echo integration for guided endomyocardial biopsy.

Transvenous extraction of Riata lead could be a challenging procedure due to insulation failure and conductor cables' externalization through the eroded outer insulation. In this case, a complete lead extraction was achieved through a combined LASER and femoral approach because of the massive conductors' externalization.

Article	Year
Feasibility of combined unipolar and bipolar voltage maps to improve sensitivity of endomyocardial biopsy. Circulation. Arrhythmia and electrophysiology\| PubMed ID: 25829163	2015
Usefulness of intracardiac echocardiography during pulmonary vein isolation with the novel multipolar irrigated ablation catheter (nMARQ™). Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing\| PubMed ID: 26099283	2015
Hybrid percutaneous and surgical minimally invasive, thoracoscopy-guided removal of a pacemaker lead subacutely perforating the right ventricle. Minerva cardioangiologica\| PubMed ID: 26426299	2016
Analysis of catheter contact force during atrial fibrillation ablation using the robotic navigation system: results from a randomized study. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing\| PubMed ID: 26798037	2016
Comparison between First- and Second-Generation Cryoballoon for Paroxysmal Atrial Fibrillation Ablation. Cardiology research and practice\| PubMed ID: 27069711	2016
The Growing Culture Of A Minimally Fluoroscopic Approach In Electrophysiology Lab. Journal of atrial fibrillation\| PubMed ID: 27957101	2014
New Imaging Technologies To Characterize Arrhythmic Substrate. Journal of atrial fibrillation\| PubMed ID: 27957131	2014
Electroanatomical mapping systems and intracardiac echo integration for guided endomyocardial biopsy. Expert review of medical devices\| PubMed ID: 28678556	2017
Combined LASER and femoral approach to remove a previous failure of Riata lead extraction. Clinical case reports\| PubMed ID: 28878903	2017

Fabrizio Tundo

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