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Fred Morady - One of the best experts on this subject based on the ideXlab platform.

  • a quantitative fluoroscopic comparison of the coronary Sinus Ostium in patients with and without av nodal reentrant tachycardia
    Journal of Cardiovascular Electrophysiology, 1995
    Co-Authors: John D Hummel, Adam S Strickberger, Ching K Man, Emile G Daoud, Mark Niebauer, Fred Morady
    Abstract:

    Coronary Sinus Ostium. Introdttctlon: Tbe purpose of tbis study was to perform a quantitative fluoroscopic analysis of the coronary Sinus Ostium and its relationship to the His bundle in patients witb and without AV nodal reentrant tacbycardia. Sites of slow patbway ablation are often near the coronary Sinus Ostium, which can be located witbin a few millimeters of tbe His bundle. Wbetber such close proximity of the coronary Sinus Ostium to tbe His bundle is unique to patients with AV nodal reentrant tachycardia is unknown. Methods and Results: Fifty consecutive patients (mean age 39 ± 14 years) with no structural heart disease underwent electropbysiologic testing and radiofrequency ablation. Tbe study group consisted of 28 patients witb inducible AV nodal reentrant tachycardia or dual AV nodal physiology and 22 patients in tbe control group. A coronary Sinus venogram was performed in each patient. The coronary Sinus Ostium was similar in size in tbe study group (II.4 ± 4.5 mm) and in the control group (10.5 ± 3.6 mm, P = 0.2). The coronary Sinus Ostium was funnel shaped in balf of the study patients and in half of the control patients {P = LO). Tbe mean distance from the upper lip of tbe coronary Sinus Ostium to tbe tip of tbe His bundle catheter was 9.7 ± 5.5 mm in the study group and 10.4 ± 5.1 mm in the control group (P = 0.7). The mean distance from tbe lower lip of tbe coronary Sinus Ostium to tbe tip of the His-bundle catheter in tbe study group was 20.1 ± 6.1 mm and 19.5 ± 5.6 mm in tbe control group {P = 0.7). Conclusion: This study demonstrates a wide range of normal coronary Sinus Ostium diameters, morphology, and anatomic relationships witb surrounding structures, with no demonstrable correlation to the presence or absence of dual AV node pbysiology or AV nodal reentrant

  • randomized comparison of anatomic and electrogram mapping approaches to ablation of the slow pathway of atrioventricular node reentrant tachycardia
    Journal of the American College of Cardiology, 1994
    Co-Authors: Steven J Kalbfleisch, John D Hummel, Adam S Strickberger, Brian D Williamson, Vicken R Vorperian, Ching Man, Jonathan J Langberg, Fred Morady
    Abstract:

    Abstract Objectives . The purpose of this study was to prospectively compare in random fashion an anatomic and an electrogram mapping approach for ablation of the slow pathway of atrioventricular (AV) node reentrant tachycardia. Background . Ablation of the slow pathway in patients with AV node reentrant tachycardia can be performed by using either an anatomic or an electrogram mapping approach to identify target sites for ablation. These two approaches have never been compared prospectively. Methods . Fifty consecutive patients with typical AV node reentrant tachycardia were randomly assigned to undergo either an anatomic or an electrogram mapping approach for ablation of the slow AV node pathway. In 25 patients randomly assigned to the anatomic approach, sequential radiofrequency energy applications were delivered along the tricuspid annulus from the level of the coronary Sinus Ostium to the His bundle position. In 25 patients assigned to the electrogram mapping approach, target sites along the posteromedial tricuspid annulus near the coronary Sinus Ostium were sought where there was a multicomponent atrial electrogram or evidence of a possible slow pathway potential. If the initial approach was ineffective after 12 radiofrequency energy applications, the alternative approach was then used. Results . The anatomic approach was effective in 21 (84%) of 25 patients, and the electrogram mapping approach was effective in all 25 patients (100%) randomly assigned to this technique (p = 0.1). The four patients with an ineffective anatomic approach had a successful outcome with the electrogram mapping approach. On the basis of intention to treat analysis, there were no significant differences between the electrogram mapping approach and the anatomic approach with respect to the time required for ablation (28 ± 21 and 31 ± 31 min, respectively, mean ± SD, p = 0.7) duration of fluoroscopic exposure (27 ± 20 and 27 ±18 min, respectively, p = 0.9) or mean number of radiofrequency applications delivered (6.3 ± 3.9 vs. 7.2 ± 8.0, p s 0.6). With both the anatomic and electrogram mapping approaches, the atrial electrogram duration and number of peaks in the atrial electrogram were significantly greater at successful target sites than at unsuccessful target sites. Conclusions . The anatomic and electrogram mapping approaches for ablation of the slow AV nodal pathway are comparable in efficacy and duration. If the anatomic approach is initially attempted and fails, the electrogram mapping approach may be successful at sites outside the areas targeted in the anatomic approach. With both the anatomic and electrogram mapping approaches, there are significant differences in the atrial electrogram configuration between successful and unsuccessful target sites.

Amin R Javer - One of the best experts on this subject based on the ideXlab platform.

  • frontal Ostium grade fog a new computer tomography grading system for endoscopic frontal Sinus surgery
    Otolaryngology-Head and Neck Surgery, 2020
    Co-Authors: Heitham Gheriani, Alrahim R Habib, Rami Alsalman, Amin R Javer
    Abstract:

    ObjectiveThe location and size of the frontal Sinus Ostium are critical in determining surgical difficulty. The more anterior the Ostium, the more difficult is the surgical access. We propose a nov...

  • the safety and performance of a maxillary Sinus Ostium self dilation device a pilot study
    International Forum of Allergy & Rhinology, 2014
    Co-Authors: Iain Hathorn, Alrahim R Habib, Rachelle Dar Santos, Amin R Javer
    Abstract:

    Background Balloon dilation is now commonly used to open Sinus ostia while preserving mucosa and minimizing trauma. A new maxillary Sinus Ostium (MSO) self-dilation device that functions on the principle of osmosis, absorbing a small amount of fluid from the surrounding tissues, can be placed into the MSO under endoscopic visualization and slowly enlarge its outer diameter. The slower dilation may further minimize tissue damage and scarring compared to the currently available balloon dilation systems. The MSO self-dilating expansion device has never been studied before in clinical trials; the purpose of this pilot study is to determine the safety and performance of the device in human subjects. Methods Twelve chronic rhinoSinusitis (CRS) patients presenting with maxillary Sinus inflammation requiring FESS were enrolled. The device was inserted into the MSO at the start of surgery and removed after 60 minutes. Endoscopic evaluation for patency was performed immediately after removal, and at 1 week, 1 month, and 3 months. Adverse events were recorded intraoperatively and at each subsequent visit. Results The device was successfully inserted in 100% of cases attempted (19/19 MSOs, 12 patients). Seventeen (89%) devices remained in the MSO for 60 minutes and dilated to a mean diameter of 4.8 ± 0.5 mm. One patient was withdrawn from the study. No adverse events occurred during insertion or removal of the device. At 3 months postinsertion 14 of 15 MSO dilated (93%) were confirmed patent. Conclusion Placement of an osmotic self-dilating expansion device in human MSO is safe, achievable and effective at dilating the ostia.

Herve Poty - One of the best experts on this subject based on the ideXlab platform.

  • radiofrequency catheter ablation of type 1 atrial flutter prediction of late success by electrophysiological criteria
    Circulation, 1995
    Co-Authors: Herve Poty, Nadir Saoudi, Ahmed Aziz, Mohan Nair, B Letac
    Abstract:

    Background Radiofrequency energy has demonstrated its efficacy in catheter ablation of atrial flutter (AFl). However, long-term recurrences of AFl have been reported frequently after initial, apparently successful ablation. To date, criteria for prediction of late recurrences are lacking. Methods and Results Twelve patients (10 men; mean age, 53.6 years; range, 26 to 69 years) were referred for AFl ablation. Duodecapolar and decapolar catheters were used for detailed mapping of the tricuspid ring, the inferior vena cava–tricuspid annulus (IVC-TA) isthmus, and the coronary Sinus Ostium (CSOs) area. Additional multipolar catheters were used for recording activation of the coronary Sinus and the CSOs-TA isthmus. AFl was present at baseline in 9 patients and was induced by proximal coronary Sinus (PCS) pacing in 3. Counterclockwise right atrial activation was recorded in all patients. Primary success of ablation was defined as when AFl was no longer inducible even during isoproterenol infusion. AFl was succes...

  • 943 11 endocardial activation mapping of the area posterior to the coronary Sinus Ostium in type 1 atrial flutter
    Journal of the American College of Cardiology, 1995
    Co-Authors: Nadir Saoudi, Frederic Anselme, Herve Poty, Brice Letac
    Abstract:

    The most frequently proposed targets for catheter ablation of atrial flutter (AFI) have been (1) the Inferior Vena Cava (IVC)-Tricuspid Ring (TR), (2) the Coronary Sinus Ostium (CSOs)-TR and (3) the IVC-CSOs Isthmuses. (2) would imply that no essential wavefront crosses (3) during AFI. To investigate this point, a special steerable decapolar catheter (Ca) for precise (1 mm interelectrode spacing) mapping of this area was inserted during the mapping procedure in 7 patients (Pts) referred for radiofrequency (RF) ablation of type I AFI. Ca was manipulated in order to record the IVC-CSOs isthmus. This was divided in postero (P)superior, P.medial and P.inferior region of CSOs. These were 6 males and 1 female (mean age = 46 yr) with a mean AF cycle length of 274 ms. In five cases, counterclockwise (CCW) endocardial activation was recorded whereas in two cases, impulse was reversed and proceeded inferiorly in the septum and superiorly in the lateral wall (Clockwise = CW). In CCW AF two patterns of activation were encountered: Ascending (n = 2) or widely spaced double spikes (DS) Pinferior to CSOs with progressive narrowing when proceeding upward with Psuperior OS fusion (n = 3): RF pulses delivered at the CSOs-TR isthmus failed to terminate AFI in the first pattern whereas RF (delivered in 2/3 cases) terminated AF in the other. In both CW AF activation proceeded inferiorly in this area. In these and in the 2 Pts with a unique ascending wavefront during CCW AF, the line of DS was further posterior in the right atrial wall. RF pulses delivered in the IVC-TR Isthmus terminated AFI in 4/4 Pts. Conclusion An ascending wavefront may cross the IVC-CSOs isthmus and therefore suggests a more lateral target for successful RF ablation of type I AF in this subgroup of Pts. In the other cases there seem to exist a line of block between IVC and CSOs and ablation of the CSOs-TR isthmus should be successful.

Sriram Shankar - One of the best experts on this subject based on the ideXlab platform.

  • atresia of coronary Sinus Ostium with retrograde drainage via persistent left superior vena cava
    The Annals of Thoracic Surgery, 2003
    Co-Authors: Apoorva Gogna, Keng Y Wong, Sriram Shankar
    Abstract:

    Atesia of the coronary Sinus Ostium (ACSO) with retrograde drainage of cardiac veins via the left superior vena cava (LSVC) is a very rare abnormality. This condition is usually asymptomatic during life and a majority of the cases were reported as incidental postmortem findings. If there is retrograde venous drainage via persistent LSVC, this communication cannot be ligated irrespective of its size or the presence of a communicating vein because of resultant cardiac congestion and edema. We report herein a 9-month-old Chinese female who underwent repair of a perimembranous ventricular septal defect, patent ductus arteriosus and secundum atrial septal defect. During the operation, ligation of LSVC resulted in myocardial congestion and distension of the heart. The release of ligature decompressed the heart immediately.

Osamu Fujimura - One of the best experts on this subject based on the ideXlab platform.

  • endoscopy assisted radiofrequency ablation around the coronary Sinus Ostium in dogs its effects on atrioventricular nodal properties and ventricular response during atrial fibrillation
    Journal of Cardiovascular Electrophysiology, 1996
    Co-Authors: Kazushi Tanaka, Yong Mei Cha, Osamu Fujimura
    Abstract:

    Endoscopy for Ablation Around the CS Ostium. Introduction: Radiofrequency ablation of the slow pathway can prolong atrioventricular (AV) nodal properties and RR intervals during atrial fibrillation (AF) in many patients with AV nodal reentrant tachycardia. However, it is not well elucidated whether these changes are related to the presence of dual AV nodal pathway physiology. The aim of this study was to evaluate changes of AV nodal properties and RR intervals during AF caused by ablation of two specific areas in dogs. Methods and Results: Assisted by fiberoptic endoscopy, linear lesions were created between the coronary Sinus Ostium and tricuspid valve annulus (area 1) or posterior to the Ostium (area 2) in 15 dogs. Three additional dogs served as controls. The measurements were made under autonomic blockade. Catheter ablation could be assisted in all dogs by means of endoscopy. Linear lesions were confirmed at autopsy. AV nodal parameters and RR intervals showed no overall changes. Individual data showed that ablation of area I resulted in modification of AV nodal properties in 54.5% (facilitation in 363% and inhibition in 18.2%), whereas ablation of area 2 induced changes in 50% (facilitation in 10% and inhibition in 40%). The RR intervals were shortened in 33.3% and 20% and prolonged in 44.5% and 40% after ablation of areas 1 and 2, respectively. The RR intervals during AF correlated well with the Wenckebach cycle length and the AV node functional refractory period before and after ablation (r = 0.78 to 0.94, P < 0.01 for each). Conclusions: Ablation of the two specific areas around the coronary Sinus Ostium was equally effective in modifying AV nodal properties and the ventricular response during AF without dual AV nodal pathway physiology. The ventricular rate to AF after ablation correlated well with the residual AV nodal properties.