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Frank Bogun - One of the best experts on this subject based on the ideXlab platform.
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temporal stability of the location of the Esophagus in patients undergoing a repeat left atrial ablation procedure for atrial fibrillation or flutter
Journal of Cardiovascular Electrophysiology, 2008Co-Authors: Robert T Kennedy, Eric Good, Hakan Oral, Elizabeth Huether, Frank Bogun, Frank Pelosi, Fred Morady, Aman ChughAbstract:Background: The Esophagus may be mobile during a left atrial (LA) ablation procedure for atrial fibrillation (AF). Objective: The goal of the study was to determine whether the location of the Esophagus is stable in patients undergoing a repeat LA ablation procedure. Methods: Forty-two patients underwent repeat LA ablation a mean of 7 ± 2 months after the initial procedure. Cinefluoroscopic images of the Esophagus during a barium swallow were recorded and the course of the Esophagus was tagged on the 3D map. The position of the Esophagus at the index and repeat procedure were compared. Results: At the index procedure, the Esophagus was located near the left pulmonary veins (PVs) in 20 (48%), right PVs in 13 (31%), and at the mid LA in 9 (21%) patients. During the repeat procedure, the Esophagus was found to be near the left PVs in 22 (52%), right PVs in 11 (26%), and at the mid LA in 9 patients (21%). In 35 of the 42 patients (83%), there was no change in the esophageal location, and in the remaining seven patients (17%), its position had shifted by ≥1 cm (range 1.0–4.0 cm). Conclusions: In more than 80% of patients presenting for a repeat LA ablation procedure, the Esophagus is in the same position relative to the PVs as during the initial procedure. Therefore, if radiofrequency ablation at a particular location was limited by the position of the Esophagus, safe ablation at that site is unlikely to be feasible during a repeat procedure.
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computed tomographic analysis of the anatomy of the left atrium and the Esophagus implications for left atrial catheter ablation
Circulation, 2004Co-Authors: Kristina Lemola, Eric Good, Aman Chugh, Michael Sneider, Benoit Desjardins, Ian Case, Jihn Han, Kamala Tamirisa, Ariane Tsemo, Frank BogunAbstract:Background— During left atrial (LA) catheter ablation, an atrioesophageal fistula can develop as a result of thermal injury of the Esophagus during ablation along the posterior LA. No in vivo studies have examined the relationship of the Esophagus to the LA. The purpose of this study was to describe the topographic anatomy of the Esophagus and the posterior LA by use of CT. Methods and Results— A helical CT scan of the chest with 3D reconstruction was performed in 50 patients (mean age, 54±11 years) with atrial fibrillation before an ablation procedure. Consecutive axial and sagittal sections of the CT scan were examined to determine the relationship, size, and thickness of the tissue layers between the LA and the Esophagus. The mean length and width of the Esophagus in contact with the posterior LA were 58±14 and 13±6 mm, respectively. The Esophagus had a variable course along the posterior LA. The Esophagus was close (10±6 mm from the ostia) and parallel to the left-sided pulmonary veins (PVs) in 56% of...
Aman Chugh - One of the best experts on this subject based on the ideXlab platform.
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temporal stability of the location of the Esophagus in patients undergoing a repeat left atrial ablation procedure for atrial fibrillation or flutter
Journal of Cardiovascular Electrophysiology, 2008Co-Authors: Robert T Kennedy, Eric Good, Hakan Oral, Elizabeth Huether, Frank Bogun, Frank Pelosi, Fred Morady, Aman ChughAbstract:Background: The Esophagus may be mobile during a left atrial (LA) ablation procedure for atrial fibrillation (AF). Objective: The goal of the study was to determine whether the location of the Esophagus is stable in patients undergoing a repeat LA ablation procedure. Methods: Forty-two patients underwent repeat LA ablation a mean of 7 ± 2 months after the initial procedure. Cinefluoroscopic images of the Esophagus during a barium swallow were recorded and the course of the Esophagus was tagged on the 3D map. The position of the Esophagus at the index and repeat procedure were compared. Results: At the index procedure, the Esophagus was located near the left pulmonary veins (PVs) in 20 (48%), right PVs in 13 (31%), and at the mid LA in 9 (21%) patients. During the repeat procedure, the Esophagus was found to be near the left PVs in 22 (52%), right PVs in 11 (26%), and at the mid LA in 9 patients (21%). In 35 of the 42 patients (83%), there was no change in the esophageal location, and in the remaining seven patients (17%), its position had shifted by ≥1 cm (range 1.0–4.0 cm). Conclusions: In more than 80% of patients presenting for a repeat LA ablation procedure, the Esophagus is in the same position relative to the PVs as during the initial procedure. Therefore, if radiofrequency ablation at a particular location was limited by the position of the Esophagus, safe ablation at that site is unlikely to be feasible during a repeat procedure.
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computed tomographic analysis of the anatomy of the left atrium and the Esophagus implications for left atrial catheter ablation
Circulation, 2004Co-Authors: Kristina Lemola, Eric Good, Aman Chugh, Michael Sneider, Benoit Desjardins, Ian Case, Jihn Han, Kamala Tamirisa, Ariane Tsemo, Frank BogunAbstract:Background— During left atrial (LA) catheter ablation, an atrioesophageal fistula can develop as a result of thermal injury of the Esophagus during ablation along the posterior LA. No in vivo studies have examined the relationship of the Esophagus to the LA. The purpose of this study was to describe the topographic anatomy of the Esophagus and the posterior LA by use of CT. Methods and Results— A helical CT scan of the chest with 3D reconstruction was performed in 50 patients (mean age, 54±11 years) with atrial fibrillation before an ablation procedure. Consecutive axial and sagittal sections of the CT scan were examined to determine the relationship, size, and thickness of the tissue layers between the LA and the Esophagus. The mean length and width of the Esophagus in contact with the posterior LA were 58±14 and 13±6 mm, respectively. The Esophagus had a variable course along the posterior LA. The Esophagus was close (10±6 mm from the ostia) and parallel to the left-sided pulmonary veins (PVs) in 56% of...
Peter S Rabinovitch - One of the best experts on this subject based on the ideXlab platform.
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ral ssBioMed CentMolecular Cancer Open AcceResearch Expression of the bile acid receptor FXR in Barrett's Esophagus and enhancement of apoptosis by guggulsterone in vitro
2016Co-Authors: Andrea De Gottardi, Jean-marc Dumonceau, Fabien Bruttin, Alain Vonlaufen, Isabelle Morard, Laurent Spahr, Laura Rubbia-br, Jean-louis Frossard, Nm Dinjens, Peter S RabinovitchAbstract:Background: Barrett's Esophagus, a risk factor for esophageal adenocarcinoma, is associated with reflux disease. The aim of this study was to assess the expression of bile acid receptors in the Esophagus (normal, esophagitis, Barrett's Esophagus and adenocarcinoma) and to investigate their possible function. Results: the expression of the bile acid receptors FXR and VDR in esophageal biopsies from patients with a normal mucosa, esophagitis, Barrett's Esophagus or adenocarcinoma (n = 6 per group) and in cell lines derived from Barrett's Esophagus and esophageal adenocarcinoma, was assessed by real time Q-PCR and immunohistochemistry. The effect of guggulsterone, an antagonist of bile acid receptors, on apoptosis of Barrett's Esophagus-derived cells was assessed morphologically, by flow cytometry and by measuring caspase 3 activity. The expression of FXR was increased in esophagitis, Barrett's Esophagus and adenocarcinoma compared to normal mucosa by a mean of 44, 84 and 16, respectively. Immunohistochemistry showed a weak expression i
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expression of the bile acid receptor fxr in barrett s Esophagus and enhancement of apoptosis by guggulsterone in vitro
Molecular Cancer, 2006Co-Authors: Andrea De Gottardi, Jean-marc Dumonceau, Fabien Bruttin, Alain Vonlaufen, Isabelle Morard, Laurent Spahr, Jean-louis Frossard, Laura Rubbiabrandt, Winand N M Dinjens, Peter S RabinovitchAbstract:Background Barrett's Esophagus, a risk factor for esophageal adenocarcinoma, is associated with reflux disease. The aim of this study was to assess the expression of bile acid receptors in the Esophagus (normal, esophagitis, Barrett's Esophagus and adenocarcinoma) and to investigate their possible function.
Eric Good - One of the best experts on this subject based on the ideXlab platform.
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temporal stability of the location of the Esophagus in patients undergoing a repeat left atrial ablation procedure for atrial fibrillation or flutter
Journal of Cardiovascular Electrophysiology, 2008Co-Authors: Robert T Kennedy, Eric Good, Hakan Oral, Elizabeth Huether, Frank Bogun, Frank Pelosi, Fred Morady, Aman ChughAbstract:Background: The Esophagus may be mobile during a left atrial (LA) ablation procedure for atrial fibrillation (AF). Objective: The goal of the study was to determine whether the location of the Esophagus is stable in patients undergoing a repeat LA ablation procedure. Methods: Forty-two patients underwent repeat LA ablation a mean of 7 ± 2 months after the initial procedure. Cinefluoroscopic images of the Esophagus during a barium swallow were recorded and the course of the Esophagus was tagged on the 3D map. The position of the Esophagus at the index and repeat procedure were compared. Results: At the index procedure, the Esophagus was located near the left pulmonary veins (PVs) in 20 (48%), right PVs in 13 (31%), and at the mid LA in 9 (21%) patients. During the repeat procedure, the Esophagus was found to be near the left PVs in 22 (52%), right PVs in 11 (26%), and at the mid LA in 9 patients (21%). In 35 of the 42 patients (83%), there was no change in the esophageal location, and in the remaining seven patients (17%), its position had shifted by ≥1 cm (range 1.0–4.0 cm). Conclusions: In more than 80% of patients presenting for a repeat LA ablation procedure, the Esophagus is in the same position relative to the PVs as during the initial procedure. Therefore, if radiofrequency ablation at a particular location was limited by the position of the Esophagus, safe ablation at that site is unlikely to be feasible during a repeat procedure.
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computed tomographic analysis of the anatomy of the left atrium and the Esophagus implications for left atrial catheter ablation
Circulation, 2004Co-Authors: Kristina Lemola, Eric Good, Aman Chugh, Michael Sneider, Benoit Desjardins, Ian Case, Jihn Han, Kamala Tamirisa, Ariane Tsemo, Frank BogunAbstract:Background— During left atrial (LA) catheter ablation, an atrioesophageal fistula can develop as a result of thermal injury of the Esophagus during ablation along the posterior LA. No in vivo studies have examined the relationship of the Esophagus to the LA. The purpose of this study was to describe the topographic anatomy of the Esophagus and the posterior LA by use of CT. Methods and Results— A helical CT scan of the chest with 3D reconstruction was performed in 50 patients (mean age, 54±11 years) with atrial fibrillation before an ablation procedure. Consecutive axial and sagittal sections of the CT scan were examined to determine the relationship, size, and thickness of the tissue layers between the LA and the Esophagus. The mean length and width of the Esophagus in contact with the posterior LA were 58±14 and 13±6 mm, respectively. The Esophagus had a variable course along the posterior LA. The Esophagus was close (10±6 mm from the ostia) and parallel to the left-sided pulmonary veins (PVs) in 56% of...
John D Ferguson - One of the best experts on this subject based on the ideXlab platform.
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real time rotational ice imaging of the relationship of the ablation catheter tip and the Esophagus during atrial fibrillation ablation
Journal of Cardiovascular Electrophysiology, 2009Co-Authors: Adam S Helms, Jason J West, Amit R Patel, Paul J Mounsey, John P Dimarco, Michael J Mangrum, John D FergusonAbstract:Introduction: Atrioesophageal fistula is a rare complication of atrial fibrillation (AF) ablation that should be avoided. We investigated whether rotational intracardiac echocardiography (ICE) can help to minimize ablation close to the Esophagus. Methods and Results: We studied 41 patients referred for catheter ablation of refractory AF. A rotational ICE catheter was inserted into the (LA) to determine the location of the Esophagus. The Esophagus was identified to be either adjacent to the pulmonary vein (PV) ostium or to a cuff 2 cm outside the ostium. Circumferential ablation was performed at the PV ostium, with the exact ablation location determined by ICE. The relationship of the catheter tip to the Esophagus was imaged during energy delivery, allowing interruption when respiration moved the tip closer to the Esophagus. Out of 41 patients, the Esophagus was seen near left-sided PVs in 32 and near right-sided PVs in three patients. The median distance from LA endocardium to Esophagus was 2.2 mm (range, 1.4–6 mm). In 21 of 35 patients with a closely related Esophagus, ablation over the Esophagus was avoided by ablating either lateral or medial to the Esophagus. In 14 patients, the Esophagus could not be avoided, and risk was minimized by limiting lesion size. Significant movement (>10 mm) of the Esophagus during the procedure occurred in 3/41 cases. Conclusion: Rotational ICE can accurately determine the distance of ablation sites from the Esophagus. Real-time imaging of the relationship of the ablation catheter tip to the Esophagus may reduce the incidence of esophageal injury.