The Experts below are selected from a list of 273 Experts worldwide ranked by ideXlab platform
David O Martin - One of the best experts on this subject based on the ideXlab platform.
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electrical isolation of the superior vena cava an adjunctive strategy to pulmonary vein antrum isolation improving the outcome of af ablation
Journal of Cardiovascular Electrophysiology, 2007Co-Authors: Mauricio Arruda, Hanka Mlcochova, Subramanya Prasad, Fethi Kilicaslan, Walid Saliba, Dimpi Patel, Tamer S Fahmy, Luis Saenz C Morales, Robert A Schweikert, David O MartinAbstract:PV isolation at the antrum (PVAI) has improved safety and efficacy of ablation Procedures for atrial fibrillation (AF). AF triggers from the superior vena cava (SVC) may compromise the outcome of PVAI. Purpose: We evaluated the (1) incidence of SVC triggers, (2) feasibility of empiric SVC electrical isolation (SVCI) as an adjunct to PVAI, and (3) SVCI safety. Methods and Results: Of 190 patients (group I), 24 (12%) showed SVC triggers. Following PVAI, seven patients had AT originating from the SVC and three had AF. After SVCI, all 24 patients were arrhythmia-free 450 ± 180 days post Procedure. In the subsequent 217 patients (group II), empirical SVCI was performed following PVAI. Sixty-six of all 407 patients (16%) experienced recurrence of AF. A Repeat Procedure in 25 of the 66 patients showed that five (20%) had AF recurrence initiated by SVC triggers, of whom four were among group I patients (4/190; 2%) and one was from group II (1/217; 0.4%), (P < 0.05). Transient diaphragmatic paralysis can be avoided by pacing at the lateral aspect of the SVC using high output (30 mA). There was no SVC stenosis on CT scans before or 3 months after the Procedure. There was no sinus node injury. Conclusions: The SVC harbors the majority of non-PV triggers of AF. SVCI is feasible, safe, and may be considered as an adjunctive strategy to PVAI for ablation of AF. The long-term favorable outcome of this hybrid approach remains to be evaluated in a larger series of patients.
Dade L Lunsford - One of the best experts on this subject based on the ideXlab platform.
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the clinical significance of persistent trigeminal nerve contrast enhancement in patients who undergo Repeat radiosurgery
Journal of Neurosurgery, 2017Co-Authors: Seyed H Mousavi, Douglas Kondziolka, Ajay Niranjan, John C Flickinger, Berkcan Akpinar, Vikas Agarwal, Jonathan Cohen, Dade L LunsfordAbstract:OBJECTIVE Contrast enhancement of the retrogasserian trigeminal nerve on MRI scans frequently develops after radiosurgical ablation for the management of medically refractory trigeminal neuralgia (TN). The authors sought to evaluate the clinical significance of this imaging finding in patients who underwent a second radiosurgical Procedure for recurrent TN. METHODS During a 22-year period, 360 patients underwent Gamma Knife stereotactic radiosurgery (SRS) as their first surgical Procedure for TN at the authors' center. The authors retrospectively analyzed the data from 59 patients (mean age 72 years, range 33-89 years) who underwent Repeat SRS for recurrent pain at a median of 30 months (range 6-146 months) after the first SRS. The isocenter was 4 mm, and the median maximum doses for the first and second Procedures were 80 Gy and 70 Gy, respectively. A neuroradiologist and a neurosurgeon blinded to the treated side evaluated the presence of nerve contrast enhancement on MRI series at the time of the Repeat Procedure. The authors correlated the presence of this imaging change with clinical outcomes. Pain outcomes and development of trigeminal sensory dysfunction were evaluated with the Barrow Neurological Institute (BNI) Pain Scale and BNI Numbness Scale, respectively. The mean length of follow-up after the second SRS was 58 months (95% CI 49-68 months). RESULTS At the time of the Repeat SRS, contrast enhancement of the trigeminal nerve on MRI scans was observed in 31 patients (53%). Five years after the SRS, patients with this enhancement had lower actuarial rates of complete pain relief after the Repeat SRS (27% [95% CI 7%-47%]) than patients without the enhancement (76% [95% CI 58%-94%]) (p < 0.001). At the 5-year follow-up, patients with the contrast enhancement also had a higher risk for trigeminal sensory loss after Repeat SRS (75% [95% CI 59%-91%]) than patients without contrast enhancement (26% [95% CI 10%-42%]) (p = 0.001). Dysesthetic pain after Repeat SRS was observed for 8 patients with and for 2 patients without contrast enhancement. CONCLUSIONS Trigeminal nerve contrast enhancement on MRI scans observed at the time of a Repeat SRS for TN was associated with less satisfactory pain control and more frequently detected facial sensory loss. Residual contrast enhancement at the time of a Repeat SRS may warrant consideration of dose reduction or further separation of the radiosurgical targets.
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Repeat gamma knife radiosurgery for trigeminal neuralgia
Neurosurgery, 2012Co-Authors: Kyungjae Park, Douglas Kondziolka, Oren Berkowitz, Hideyuki Kano, Josef Novotny, Ajay Niranjan, John C Flickinger, Dade L LunsfordAbstract:Background Trigeminal neuralgia (TN) may recur after treatment by gamma knife stereotactic radiosurgery (GKSR). Objective To evaluate management outcomes in patients who underwent Repeat GKSR for TN. Methods The authors reviewed their experience with Repeat GKSR in 119 patients with recurrent TN. The median patient age was 74 years (range, 34-96 years). The median interval between Procedures was 26 months. The median target dose for Repeat GKSR was 70 Gy (range, 50-90 Gy) and the median cumulative dose was 145 Gy (range, 120-170 Gy). The median follow-up was 48 months (range, 6-187 months) after Repeat GKSR. Results After Repeat GKSR, 87% of patients achieved initial pain relief (Barrow Neurological Institute pain score I-IIIb). Pain relief was maintained in 87.8% at 1 year, 69.8% at 3 years, and 44.2% at 5 years. Facial sensory dysfunction occurred in 21% of patients within 18 months after GKSR. Longer pain relief was observed in patients who had recurrent pain in a reduced pain distribution of the face compared with the pain distribution at the time of their initial GKSR, and in those who developed additional trigeminal sensory loss after a Repeat Procedure. A cumulative edge of brainstem dose ≥ 44 Gy was more likely to be associated with the development of sensory loss. Conclusion Repeat GKSR provides a similar rate of pain relief as the first Procedure. The best responses were observed in patients who had good pain control after the first Procedure and those who developed new sensory dysfunction in the affected trigeminal distribution.
Alexander Y Shin - One of the best experts on this subject based on the ideXlab platform.
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comparison of arthroscopic and open treatment of septic arthritis of the wrist surgical technique
Journal of Bone and Joint Surgery American Volume, 2010Co-Authors: Douglas M Sammer, Alexander Y ShinAbstract:BACKGROUND: Open irrigation and debridement is the standard of treatment for septic arthritis of the wrist. Although isolated cases of arthroscopic irrigation and debridement have been reported, a comparison of arthroscopic and open techniques has not been performed, to our knowledge. The purpose of this study was to compare the two methods of management. METHODS: A retrospective comparison of patients with septic arthritis of the wrist initially treated, over an eleven-year period, with open or arthroscopic irrigation and debridement was undertaken at a single institution. The clinical presentation, laboratory and microbiological findings, hospital course, complications, and outcomes were compared between the two groups. RESULTS: Between 1997 and 2007, thirty-six patients with septic arthritis involving a total of forty wrists were identified. Nineteen wrists (seventeen patients) were initially treated with open irrigation and debridement, and twenty-one wrists (nineteen patients) were initially treated arthroscopically. Eleven wrists in the open-treatment cohort required Repeat irrigation and debridement, and eight wrists in the arthroscopy cohort required a Repeat Procedure. If a Repeat irrigation and debridement was required, it was performed in an open fashion in all but two cases. When the comparison included all of the patients in the series, no difference between the two cohorts was found with regard to the number of irrigation and debridement Procedures required or the length of the hospital stay. However, when the comparison was limited to the patients with isolated septic arthritis of the wrist, it was found that only one of seven wrists in the open-treatment cohort but all eight wrists in the arthroscopy cohort had been successfully managed with a single irrigation and debridement Procedure (p = 0.001). No patient in whom isolated septic arthritis of the wrist had been treated with arthroscopic irrigation and debridement required a second operation. The patients in whom isolated septic arthritis of the wrist was treated with the open method stayed in the hospital for an average of sixteen days compared with a six-day stay for those in whom isolated septic arthritis of the wrist was treated with the arthroscopic method (p = 0.04). The ninety-day perioperative mortality rate in the series was substantial (18% [three patients] in the open-treatment cohort and 21% [four patients] in the arthroscopy cohort). CONCLUSIONS: Arthroscopic irrigation and debridement is an effective treatment for patients with isolated septic arthritis of the wrist; these patients had fewer operations and a shorter hospital stay than did patients who had received open treatment. However, these benefits were not seen in patients with multiple sites of infection. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Comparison of Arthroscopic and Open Treatment of Septic Arthritis of the Wrist” (2009;91:1387-93).
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comparison of arthroscopic and open treatment of septic arthritis of the wrist
Journal of Bone and Joint Surgery American Volume, 2009Co-Authors: Douglas M Sammer, Alexander Y ShinAbstract:BACKGROUND: Open irrigation and debridement is the standard of treatment for septic arthritis of the wrist. Although isolated cases of arthroscopic irrigation and debridement have been reported, a comparison of arthroscopic and open techniques has not been performed, to our knowledge. The purpose of this study was to compare the two methods of management. METHODS: A retrospective comparison of patients with septic arthritis of the wrist initially treated, over an eleven-year period, with open or arthroscopic irrigation and debridement was undertaken at a single institution. The clinical presentation, laboratory and microbiological findings, hospital course, complications, and outcomes were compared between the two groups. RESULTS: Between 1997 and 2007, thirty-six patients with septic arthritis involving a total of forty wrists were identified. Nineteen wrists (seventeen patients) were initially treated with open irrigation and debridement, and twenty-one wrists (nineteen patients) were initially treated arthroscopically. Eleven wrists in the open-treatment cohort required Repeat irrigation and debridement, and eight wrists in the arthroscopy cohort required a Repeat Procedure. If a Repeat irrigation and debridement was required, it was performed in an open fashion in all but two cases. When the comparison included all of the patients in the series, no difference between the two cohorts was found with regard to the number of irrigation and debridement Procedures required or the length of the hospital stay. However, when the comparison was limited to the patients with isolated septic arthritis of the wrist, it was found that only one of seven wrists in the open-treatment cohort but all eight wrists in the arthroscopy cohort had been successfully managed with a single irrigation and debridement Procedure (p = 0.001). No patient in whom isolated septic arthritis of the wrist had been treated with arthroscopic irrigation and debridement required a second operation. The patients in whom isolated septic arthritis of the wrist was treated with the open method stayed in the hospital for an average of sixteen days compared with a six-day stay for those in whom isolated septic arthritis of the wrist was treated with the arthroscopic method (p = 0.04). The ninety-day perioperative mortality rate in the series was substantial (18% [three patients] in the open-treatment cohort and 21% [four patients] in the arthroscopy cohort). CONCLUSIONS: Arthroscopic irrigation and debridement is an effective treatment for patients with isolated septic arthritis of the wrist; these patients had fewer operations and a shorter hospital stay than did patients who had received open treatment. However, these benefits were not seen in patients with multiple sites of infection. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “Comparison of Arthroscopic and Open Treatment of Septic Arthritis of the Wrist” (2009;91:1387-93).
Heidi Estner - One of the best experts on this subject based on the ideXlab platform.
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arrhythmia type after persistent atrial fibrillation ablation predicts success of the Repeat Procedure
Circulation-arrhythmia and Electrophysiology, 2011Co-Authors: Sonia Ammar, Gabriele Hessling, Tilko Reents, Stephanie Fichtner, Pinjun Zhu, Susanne Kathan, Heidi Estner, Clemens Jilek, Christof Kolb, Bernhard HallerAbstract:Background— The aim of the study was to investigate whether the type of arrhythmia recurrence after ablation of persistent atrial fibrillation (AF) has an impact on the maintenance of sinus rhythm after the Repeat ablation Procedure. Methods and Results— Included were 78 consecutive patients (82% men; mean age, 61±10 years; mean left atrial diameter, 47±4 mm) with persistent AF who underwent ≥1 Repeat ablation. The initial ablation Procedure had consisted of pulmonary vein isolation with additional substrate modification (ablation of complex fractionated atrial electrograms [n=63] or linear lesions [n=15]). Patients presented for reablation either with persistent atrial tachycardia (AT) (group 1, n=36), persistent AF (group 2, n=37), or paroxysmal AF (group 3, n=5). The primary end point was freedom from any arrhythmia off antiarrhythmic drugs 6 and 9 months after the reablation Procedure. Estimated proportions of patients reaching the primary end point were 59% for group 1, 28% for group 2, and 100% for group 3 at 6 months and 51%, 23%, and 100%, for groups 1, 2, and 3, respectively, at 9 months ( P =0.002). Conclusions— In patients presenting for a Repeat Procedure after ablation of persistent AF, the occurrence of AT is associated with a significantly better outcome compared with recurrent persistent AF. These results suggest that AT might be considered as a step toward sinus rhythm.
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acute effects and long term outcome of pulmonary vein isolation in combination with electrogram guided substrate ablation for persistent atrial fibrillation
American Journal of Cardiology, 2008Co-Authors: Heidi Estner, Gabriele Hessling, Christof Kolb, Gjin Ndrepepa, Armin Luik, Claus Schmitt, Agathe Konietzko, Ekrem Ucer, Andreas Pflaumer, Bernhard ZrennerAbstract:Complex fractionated atrial electrographic (CFAE) catheter ablation is a new approach for the treatment of atrial fibrillation (AF). It is unclear if acute results of this approach correspond to long-term outcome. The purpose of this study was to prospectively assess acute and long-term successes of an ablation approach combining pulmonary vein isolation (PVI) and ablation of CFAE areas for treatment of persistent AF. PVI and ablation of CFAE areas were performed in 35 patients with persistent AF (30 men, 57 ± 9 years of age). At the end of the ablation Procedure AF had terminated in 23 of 35 patients (66%) by conversion to sinus rhythm (8 of 23 patients, 35%) or organization to atrial tachycardia (15 of 23 patients, 65%). AF persisted in 12 of 35 patients (34%). At the end of the follow-up period (19 ± 12 months), sinus rhythm was present in 26 of 35 patients (74%), including 9 patients with a Repeat Procedure. This group of 26 patients consisted of 7 of 8 patients (88%) with acute sinus rhythm after the first ablation, 11 of 15 patients (73%) with organization, and 8 of 12 patients (66%) with ongoing AF (p = 0.32). In conclusion, a combined approach of PVI and CFAE ablation in persistent AF leads to acute AF termination in 66% and long-term maintenance of sinus rhythm in 74% of cases. However, long-term outcome was not predictable by acute results of the ablation Procedure.
Mauricio Arruda - One of the best experts on this subject based on the ideXlab platform.
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electrical isolation of the superior vena cava an adjunctive strategy to pulmonary vein antrum isolation improving the outcome of af ablation
Journal of Cardiovascular Electrophysiology, 2007Co-Authors: Mauricio Arruda, Hanka Mlcochova, Subramanya Prasad, Fethi Kilicaslan, Walid Saliba, Dimpi Patel, Tamer S Fahmy, Luis Saenz C Morales, Robert A Schweikert, David O MartinAbstract:PV isolation at the antrum (PVAI) has improved safety and efficacy of ablation Procedures for atrial fibrillation (AF). AF triggers from the superior vena cava (SVC) may compromise the outcome of PVAI. Purpose: We evaluated the (1) incidence of SVC triggers, (2) feasibility of empiric SVC electrical isolation (SVCI) as an adjunct to PVAI, and (3) SVCI safety. Methods and Results: Of 190 patients (group I), 24 (12%) showed SVC triggers. Following PVAI, seven patients had AT originating from the SVC and three had AF. After SVCI, all 24 patients were arrhythmia-free 450 ± 180 days post Procedure. In the subsequent 217 patients (group II), empirical SVCI was performed following PVAI. Sixty-six of all 407 patients (16%) experienced recurrence of AF. A Repeat Procedure in 25 of the 66 patients showed that five (20%) had AF recurrence initiated by SVC triggers, of whom four were among group I patients (4/190; 2%) and one was from group II (1/217; 0.4%), (P < 0.05). Transient diaphragmatic paralysis can be avoided by pacing at the lateral aspect of the SVC using high output (30 mA). There was no SVC stenosis on CT scans before or 3 months after the Procedure. There was no sinus node injury. Conclusions: The SVC harbors the majority of non-PV triggers of AF. SVCI is feasible, safe, and may be considered as an adjunctive strategy to PVAI for ablation of AF. The long-term favorable outcome of this hybrid approach remains to be evaluated in a larger series of patients.