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John P A Ioannidis - One of the best experts on this subject based on the ideXlab platform.
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Autonomic Denervation added to pulmonary vein isolation for paroxysmal atrial fibrillation a randomized clinical trial
Journal of the American College of Cardiology, 2013Co-Authors: Demosthenes G Katritsis, Evgeny Pokushalov, Alexander Romanov, Eleftherios Giazitzoglou, George C M Siontis, Sunny S Po, John A Camm, John P A IoannidisAbstract:Objectives The aim of this study was to investigate whether the combination of conventional pulmonary vein isolation (PVI) by circumferential antral ablation with ganglionated plexi (GP) modification in a single ablation procedure, yields higher success rates than PVI or GP ablation alone, in patients with paroxysmal atrial fibrillation (PAF). Background Conventional PVI transects the major left atrial GP, and it is possible that Autonomic Denervation by inadvertent GP ablation plays a central role in the efficacy of PVI. Methods A total of 242 patients with symptomatic PAF were recruited and randomized as follows: 1) circumferential PVI (n = 78); 2) anatomic ablation of the main left atrial GP (n = 82); or 3) circumferential PVI followed by anatomic ablation of the main left atrial GP (n = 82). The primary endpoint was freedom from atrial fibrillation (AF) or other sustained atrial tachycardia (AT), verified by monthly visits, ambulatory electrocardiographic monitoring, and implantable loop recorders, during a 2-year follow-up period. Results Freedom from AF or AT was achieved in 44 (56%), 39 (48%), and 61 (74%) patients in the PVI, GP, and PVI+GP groups, respectively (p = 0.004 by log-rank test). PVI+GP ablation strategy compared with PVI alone yielded a hazard ratio of 0.53 (95% confidence interval: 0.31 to 0.91; p = 0.022) for recurrence of AF or AT. Fluoroscopy duration was 16 ± 3 min, 20 ± 5 min, and 23 ± 5 min for PVI, GP, and PVI+GP groups, respectively (p Conclusions Addition of GP ablation to PVI confers a significantly higher success rate compared with either PVI or GP alone in patients with PAF. (Circumferential Versus Ganglionated Plexi Ablation for Atrial Fibrillation [AF]; NCT00671905 )
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Autonomic Denervation added to pulmonary vein isolation for paroxysmal atrial fibrillation a randomized clinical trial
Journal of the American College of Cardiology, 2013Co-Authors: Demosthenes G Katritsis, Evgeny Pokushalov, Alexander Romanov, Eleftherios Giazitzoglou, George C M Siontis, John A Camm, John P A IoannidisAbstract:Objectives The aim of this study was to investigate whether the combination of conventional pulmonary vein isolation (PVI) by circumferential antral ablation with ganglionated plexi (GP) modification in a single ablation procedure, yields higher success rates than PVI or GP ablation alone, in patients with paroxysmal atrial fibrillation (PAF). Background Conventional PVI transects the major left atrial GP, and it is possible that Autonomic Denervation by inadvertent GP ablation plays a central role in the efficacy of PVI. Methods A total of 242 patients with symptomatic PAF were recruited and randomized as follows: 1) circumferential PVI (n = 78); 2) anatomic ablation of the main left atrial GP (n = 82); or 3) circumferential PVI followed by anatomic ablation of the main left atrial GP (n = 82). The primary endpoint was freedom from atrial fibrillation (AF) or other sustained atrial tachycardia (AT), verified by monthly visits, ambulatory electrocardiographic monitoring, and implantable loop recorders, during a 2-year follow-up period. Results Freedom from AF or AT was achieved in 44 (56%), 39 (48%), and 61 (74%) patients in the PVI, GP, and PVI+GP groups, respectively (p = 0.004 by log-rank test). PVI+GP ablation strategy compared with PVI alone yielded a hazard ratio of 0.53 (95% confidence interval: 0.31 to 0.91; p = 0.022) for recurrence of AF or AT. Fluoroscopy duration was 16 ± 3 min, 20 ± 5 min, and 23 ± 5 min for PVI, GP, and PVI+GP groups, respectively (p Conclusions Addition of GP ablation to PVI confers a significantly higher success rate compared with either PVI or GP alone in patients with PAF.
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Autonomic Denervation added to pulmonary vein isolation for paroxysmal atrial fibrillation a randomized clinical trial
Journal of the American College of Cardiology, 2013Co-Authors: Demosthenes G Katritsis, Evgeny Pokushalov, Alexander Romanov, Eleftherios Giazitzoglou, George C M Siontis, Sunny S Po, John A Camm, John P A IoannidisAbstract:OBJECTIVES: The aim of this study was to investigate whether the combination of conventional pulmonary vein isolation (PVI) by circumferential antral ablation with ganglionated plexi (GP) modification in a single ablation procedure, yields higher success rates than PVI or GP ablation alone, in patients with paroxysmal atrial fibrillation (PAF). BACKGROUND: Conventional PVI transects the major left atrial GP, and it is possible that Autonomic Denervation by inadvertent GP ablation plays a central role in the efficacy of PVI. METHODS: A total of 242 patients with symptomatic PAF were recruited and randomized as follows: 1) circumferential PVI (n = 78); 2) anatomic ablation of the main left atrial GP (n = 82); or 3) circumferential PVI followed by anatomic ablation of the main left atrial GP (n = 82). The primary endpoint was freedom from atrial fibrillation (AF) or other sustained atrial tachycardia (AT), verified by monthly visits, ambulatory electrocardiographic monitoring, and implantable loop recorders, during a 2-year follow-up period. RESULTS: Freedom from AF or AT was achieved in 44 (56%), 39 (48%), and 61 (74%) patients in the PVI, GP, and PVI+GP groups, respectively (p = 0.004 by log-rank test). PVI+GP ablation strategy compared with PVI alone yielded a hazard ratio of 0.53 (95% confidence interval: 0.31 to 0.91; p = 0.022) for recurrence of AF or AT. Fluoroscopy duration was 16 ± 3 min, 20 ± 5 min, and 23 ± 5 min for PVI, GP, and PVI+GP groups, respectively (p < 0.001). Post-ablation atrial flutter did not differ between groups: 5.1% in PVI, 4.9% in GP, and 6.1% in PVI+GP. No serious adverse procedure-related events were encountered. CONCLUSIONS: Addition of GP ablation to PVI confers a significantly higher success rate compared with either PVI or GP alone in patients with PAF.
Freddy Penninckx - One of the best experts on this subject based on the ideXlab platform.
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long term outcome of laparoscopic ventral rectopexy for total rectal prolapse
British Journal of Surgery, 2004Co-Authors: Andre Dhoore, R Cadoni, Freddy PenninckxAbstract:BACKGROUND: Postoperative constipation is a common problem with most mesh suspension techniques used to correct rectal prolapse. Autonomic Denervation of the rectum subsequent to its complete mobilization has been suggested as a contributory factor. The aim of this study was to assess the long-term outcome of patients who underwent a novel, Autonomic nerve-sparing, laparoscopic technique for rectal prolapse. METHODS: Between 1995 and 1999, 42 patients had laparoscopic ventral rectopexy for total rectal prolapse. The long-term results after a median follow-up of 61 (range 29-98) months were analysed. RESULTS: There were no major postoperative complications. Late recurrence occurred in two patients. In 28 of 31 patients with incontinence there was a significant improvement in continence. Symptoms of obstructed defaecation resolved in 16 of 19 patients. During follow-up, new onset of mild obstructed defaecation was noted in only two patients. Symptoms suggestive of slow-transit colonic obstipation were not induced. CONCLUSION: Laparoscopic ventral rectopexy is an effective technique for the correction of rectal prolapse and appears to avoid severe postoperative constipation. The ventral position of the prosthesis may explain the beneficial effect on symptoms of obstructed defaecation.
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long term outcome of laparoscopic ventral rectopexy for total rectal prolapse
British Journal of Surgery, 2004Co-Authors: Andre Dhoore, R Cadoni, Freddy PenninckxAbstract:Background: Postoperative constipation is a common problem with most mesh suspension techniques used to correct rectal prolapse. Autonomic Denervation of the rectum subsequent to its complete mobilization has been suggested as a contributory factor. The aim of this study was to assess the long-term outcome of patients who underwent a novel, Autonomic nerve-sparing, laparoscopic technique for rectal prolapse. Methods: Between 1995 and 1999, 42 patients had laparoscopic ventral rectopexy for total rectal prolapse. The long-term results after a median follow-up of 61 (range 29–98) months were analysed. Results: There were no major postoperative complications. Late recurrence occurred in two patients. In 28 of 31 patients with incontinence there was a significant improvement in continence. Symptoms of obstructed defaecation resolved in 16 of 19 patients. During follow-up, new onset of mild obstructed defaecation was noted in only two patients. Symptoms suggestive of slow-transit colonic obstipation were not induced. Conclusion: Laparoscopic ventral rectopexy is an effective technique for the correction of rectal prolapse and appears to avoid severe postoperative constipation. The ventral position of the prosthesis may explain the beneficial effect on symptoms of obstructed defaecation. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Demosthenes G Katritsis - One of the best experts on this subject based on the ideXlab platform.
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Autonomic Denervation added to pulmonary vein isolation for paroxysmal atrial fibrillation a randomized clinical trial
Journal of the American College of Cardiology, 2013Co-Authors: Demosthenes G Katritsis, Evgeny Pokushalov, Alexander Romanov, Eleftherios Giazitzoglou, George C M Siontis, Sunny S Po, John A Camm, John P A IoannidisAbstract:Objectives The aim of this study was to investigate whether the combination of conventional pulmonary vein isolation (PVI) by circumferential antral ablation with ganglionated plexi (GP) modification in a single ablation procedure, yields higher success rates than PVI or GP ablation alone, in patients with paroxysmal atrial fibrillation (PAF). Background Conventional PVI transects the major left atrial GP, and it is possible that Autonomic Denervation by inadvertent GP ablation plays a central role in the efficacy of PVI. Methods A total of 242 patients with symptomatic PAF were recruited and randomized as follows: 1) circumferential PVI (n = 78); 2) anatomic ablation of the main left atrial GP (n = 82); or 3) circumferential PVI followed by anatomic ablation of the main left atrial GP (n = 82). The primary endpoint was freedom from atrial fibrillation (AF) or other sustained atrial tachycardia (AT), verified by monthly visits, ambulatory electrocardiographic monitoring, and implantable loop recorders, during a 2-year follow-up period. Results Freedom from AF or AT was achieved in 44 (56%), 39 (48%), and 61 (74%) patients in the PVI, GP, and PVI+GP groups, respectively (p = 0.004 by log-rank test). PVI+GP ablation strategy compared with PVI alone yielded a hazard ratio of 0.53 (95% confidence interval: 0.31 to 0.91; p = 0.022) for recurrence of AF or AT. Fluoroscopy duration was 16 ± 3 min, 20 ± 5 min, and 23 ± 5 min for PVI, GP, and PVI+GP groups, respectively (p Conclusions Addition of GP ablation to PVI confers a significantly higher success rate compared with either PVI or GP alone in patients with PAF. (Circumferential Versus Ganglionated Plexi Ablation for Atrial Fibrillation [AF]; NCT00671905 )
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Autonomic Denervation added to pulmonary vein isolation for paroxysmal atrial fibrillation a randomized clinical trial
Journal of the American College of Cardiology, 2013Co-Authors: Demosthenes G Katritsis, Evgeny Pokushalov, Alexander Romanov, Eleftherios Giazitzoglou, George C M Siontis, John A Camm, John P A IoannidisAbstract:Objectives The aim of this study was to investigate whether the combination of conventional pulmonary vein isolation (PVI) by circumferential antral ablation with ganglionated plexi (GP) modification in a single ablation procedure, yields higher success rates than PVI or GP ablation alone, in patients with paroxysmal atrial fibrillation (PAF). Background Conventional PVI transects the major left atrial GP, and it is possible that Autonomic Denervation by inadvertent GP ablation plays a central role in the efficacy of PVI. Methods A total of 242 patients with symptomatic PAF were recruited and randomized as follows: 1) circumferential PVI (n = 78); 2) anatomic ablation of the main left atrial GP (n = 82); or 3) circumferential PVI followed by anatomic ablation of the main left atrial GP (n = 82). The primary endpoint was freedom from atrial fibrillation (AF) or other sustained atrial tachycardia (AT), verified by monthly visits, ambulatory electrocardiographic monitoring, and implantable loop recorders, during a 2-year follow-up period. Results Freedom from AF or AT was achieved in 44 (56%), 39 (48%), and 61 (74%) patients in the PVI, GP, and PVI+GP groups, respectively (p = 0.004 by log-rank test). PVI+GP ablation strategy compared with PVI alone yielded a hazard ratio of 0.53 (95% confidence interval: 0.31 to 0.91; p = 0.022) for recurrence of AF or AT. Fluoroscopy duration was 16 ± 3 min, 20 ± 5 min, and 23 ± 5 min for PVI, GP, and PVI+GP groups, respectively (p Conclusions Addition of GP ablation to PVI confers a significantly higher success rate compared with either PVI or GP alone in patients with PAF.
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Autonomic Denervation added to pulmonary vein isolation for paroxysmal atrial fibrillation a randomized clinical trial
Journal of the American College of Cardiology, 2013Co-Authors: Demosthenes G Katritsis, Evgeny Pokushalov, Alexander Romanov, Eleftherios Giazitzoglou, George C M Siontis, Sunny S Po, John A Camm, John P A IoannidisAbstract:OBJECTIVES: The aim of this study was to investigate whether the combination of conventional pulmonary vein isolation (PVI) by circumferential antral ablation with ganglionated plexi (GP) modification in a single ablation procedure, yields higher success rates than PVI or GP ablation alone, in patients with paroxysmal atrial fibrillation (PAF). BACKGROUND: Conventional PVI transects the major left atrial GP, and it is possible that Autonomic Denervation by inadvertent GP ablation plays a central role in the efficacy of PVI. METHODS: A total of 242 patients with symptomatic PAF were recruited and randomized as follows: 1) circumferential PVI (n = 78); 2) anatomic ablation of the main left atrial GP (n = 82); or 3) circumferential PVI followed by anatomic ablation of the main left atrial GP (n = 82). The primary endpoint was freedom from atrial fibrillation (AF) or other sustained atrial tachycardia (AT), verified by monthly visits, ambulatory electrocardiographic monitoring, and implantable loop recorders, during a 2-year follow-up period. RESULTS: Freedom from AF or AT was achieved in 44 (56%), 39 (48%), and 61 (74%) patients in the PVI, GP, and PVI+GP groups, respectively (p = 0.004 by log-rank test). PVI+GP ablation strategy compared with PVI alone yielded a hazard ratio of 0.53 (95% confidence interval: 0.31 to 0.91; p = 0.022) for recurrence of AF or AT. Fluoroscopy duration was 16 ± 3 min, 20 ± 5 min, and 23 ± 5 min for PVI, GP, and PVI+GP groups, respectively (p < 0.001). Post-ablation atrial flutter did not differ between groups: 5.1% in PVI, 4.9% in GP, and 6.1% in PVI+GP. No serious adverse procedure-related events were encountered. CONCLUSIONS: Addition of GP ablation to PVI confers a significantly higher success rate compared with either PVI or GP alone in patients with PAF.
Robin M Mcallen - One of the best experts on this subject based on the ideXlab platform.
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letter to the editor parasympathetic innervation of the rodent spleen
American Journal of Physiology-heart and Circulatory Physiology, 2015Co-Authors: C R Anderson, M J Mckinley, Robin M Mcallen, Davide MartelliAbstract:to the editor: In a recent issue of the American Journal of Physiology-Heart and Circulatory Physiology , we were interested to read the article, “Splenic Autonomic Denervation increases inflammatory status, but does not aggravate atherosclerotic lesion development,” in which Kooijman and
Michael J Mack - One of the best experts on this subject based on the ideXlab platform.
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pulmonary vein isolation and Autonomic Denervation for the management of paroxysmal atrial fibrillation by a minimally invasive surgical approach
The Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: James R Edgerton, Tara Weaver, Syma L Prince, Morley A. Herbert, William T Brinkman, Daniel Culica, Michael J MackAbstract:Background Advances in technology such as epicardial bipolar radiofrequency pulmonary vein isolation, ganglionated plexi identification, and isolation and thoracoscopic left atrial appendage exclusion have enabled less invasive surgical options for management of atrial fibrillation. Methods We performed a prospective, nonrandomized study of consecutive patients with symptomatic paroxysmal atrial fibrillation undergoing a video-assisted, minimally invasive surgical ablation procedure. The procedure consisted of bilateral, epicardial pulmonary vein isolation with bipolar radiofrequency, partial Autonomic Denervation, and selective excision of the left atrial appendage. Minimum follow-up was 1 year with long-term monitoring (24-hour continuous, 14-day event or pacemaker interrogation). Results Between March 2005 and January 2008, 52 patients (35 male), mean age 60.3 years (range, 42–79 years) underwent the procedure. The left atrial appendage was isolated in 88.0% (44/50). Average hospital stay was 5.2 days (range 3–10 days). There were no operative deaths or major adverse cardiac events. On long-term monitoring, freedom from atrial fibrillation/flutter/tachycardia was 86.3% (44/51) and 80.8% (42/52) at 6 and 12 months, respectively. Antiarrhythmic drugs were stopped in 33 of 37 patients and warfarin in 30 of 37 of the patients in whom ablation was successful at 12 months. Freedom from symptoms attributed to atrial fibrillation/flutter/tachycardia was 78.0% (39/50) at 6 months and 63.8% (30/47) at 12 months. Conclusions Minimally invasive surgical ablation is effective in the management of paroxysmal atrial fibrillation as evidenced by freedom from atrial arrythmias by long-term monitoring at 12 months. Measuring success using clinical symptoms underestimated clinical success as compared with long-term monitoring.
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minimally invasive pulmonary vein isolation and partial Autonomic Denervation for surgical treatment of atrial fibrillation
The Annals of Thoracic Surgery, 2008Co-Authors: James R Edgerton, Zachary J Edgerton, Tara Weaver, Kellie Reed, Syma L Prince, Morley A. Herbert, Michael J MackAbstract:Background We seek to demonstrate the rationale and efficacy of a minimally invasive surgical approach to the treatment of atrial fibrillation (AF) that combines pulmonary vein antral isolation with targeted partial Autonomic Denervation. Methods The literature supporting the rationale of this approach is reviewed. Seventy-four patients underwent video-assisted bilateral pulmonary vein antral isolation with confirmation of block and partial Autonomic Denervation with follow-up of 6 months or greater and have a long-term rhythm monitor at 6 months. Results Success was defined as no episodes greater than 15 seconds of AF on long-term monitoring. Treatment was successful in 83.7% of patients with paroxysmal AF and 56.5% of patients with persistent/long-standing persistent AF. Conclusions There are evidence-based data that support both pulmonary vein electrical isolation and targeted partial Autonomic Denervation in the treatment of AF. These techniques can be combined in a minimally invasive surgical approach. Early data suggest this is a safe and efficacious approach for the treatment of paroxysmal AF. Techniques are being developed for the minimally invasive surgical treatment of persistent AF from an epicardial approach.
