ORCID Profile
0000-0002-8267-1769
Current Organisations
Royal Australasian College of Physicians
,
University of Melbourne
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Publisher: Oxford University Press (OUP)
Date: 04-07-2012
Publisher: Wiley
Date: 23-02-2014
DOI: 10.1111/PACE.12349
Abstract: Radiation exposure is a major concern in cardiac device implantation, especially cardiac resynchronization therapy (CRT) procedures. The RadPad™ (Worldwide Innovations & Technologies, Inc., Kansas City, MO, USA), a radiation-attenuating adhesive drape, has been shown to be beneficial in several clinical settings involving fluoroscopy, but less is known about the actual benefits in CRT procedures. Consecutive CRT implants performed with and without a RadPad™ drape over a 10-month period were analyzed. Two thermoluminescent dosimeters (TLDs) were attached to each implanting physician at several locations (adjacent to eyes, center abdomen [outside lead apron], left and right index fingers, and dorsum of the right foot). Results were corrected for background using control TLDs, and normalized to dose-area product (DAP). Thirty-six patients (31 male), 16 with and 20 without the RadPad™, were included in the study. No technical problems were caused by the presence of the radiation-absorbing drape. Time required to position the drape never exceeded 30 seconds, no acute skin reactions were noted, and no radiation-absorbing drape became displaced. Despite a trend toward longer fluoroscopy times and higher DAPs in the radiation-absorbing drape group, radiation exposure was significantly reduced: 65% in the case of the hands and body (P < 0.001), and 40% the eyes (P < 0.01). The use of a radiation-absorbing drape results in a significant reduction in radiation dose to the implanting physician during CRT procedures. Not only is the dose to the hands reduced, but also the eye and body doses are significantly reduced. The routine use of radiation-absorbing drapes should be considered for all CRT implant procedures in the light of these findings.
Publisher: Bentham Science Publishers Ltd.
Date: 08-2013
DOI: 10.2174/15748901113089990019
Abstract: The assessment of tissue contact is an area undergoing much research as a means of improving the outcomes of cardiac radiofrequency ablation. This review provides an overview of RF ablation with specific reference to the relevance of good tissue contact to adequate RF lesion formation. An up-to-date review of the clinical evidence is provided, and recent patents of novel contact-sensing technologies in the field of cardiac RF ablation are presented.
Publisher: Wiley
Date: 15-06-2012
DOI: 10.1111/J.1540-8167.2012.02380.X
Abstract: Mitral isthmus ablation is challenging. The use of steerable sheath and high ablation power may improve success rate. This single-center, prospective study enrolled 200 patients who underwent ablation for atrial fibrillation (AF), including mitral isthmus ablation. Mitral isthmus ablation was performed using an irrigated ablation catheter via a steerable sheath (endocardium: maximum power: 40/50 W limited to annular end, maximum temperature: 48 °C coronary sinus [CS]: maximum power: 25/30 W, maximum temperature: 48 °C). Endpoint was bidirectional mitral isthmus block. Mitral isthmus block was acutely achieved in 182/200 patients (91%). Sixty-nine percent of patients required CS ablation. Mean total ablation time was 13 ± 6 minutes. There was 1 case of acute circumflex artery occlusion. Mean left atrium (LA) diameter was significantly bigger in patients with unsuccessful mitral isthmus ablation (49 ± 4 mm vs. 43 ± 6 mm P = 0.0007). In redo procedures, the incidence of reconduction at the mitral isthmus, roof and cavotricuspid isthmus was 44%, 37%, and 29%, respectively. Overall incidence of perimitral flutter was 9%. Prior complex fractionated atrial electrogram ablation was a predictor for microreentrant atrial tachycardia (AT) whereas gaps in linear lesions predicted macroreentrant flutters. After a mean follow-up of 20 ± 9 months, 73% of patients remained free from AF or AT. We reported on a series of mitral isthmus ablation using steerable sheath and high ablation power (50 W). Larger LA diameter was a predictor of failure to achieve mitral isthmus block. The mitral isthmus had a moderately high incidence of re-conduction but was only associated with a relatively low incidence of perimitral flutter.
Publisher: Wiley
Date: 10-06-2013
DOI: 10.1111/PACE.12201
Abstract: There are limited data on the use of a remote robotic catheter system (RCS) for mitral isthmus (MI) ablation. This single-center, prospective, matched control study included 45 patients who underwent atrial fibrillation ablation using a remote RCS compared to 45 patients who underwent conventional ablation. All patients had circumferential pulmonary vein isolation (PVI), roof, and MI ablation. There were no significant differences in baseline clinical characteristics. There were no significant differences in MI block (RCS: 44/45 [98%] vs 43/45 [96%], P = 1.0), roof block (RCS: 45/45 [100%] vs 44/45 [98%], P = 1.0), and PVI (RCS: 45/45 [100%] vs 45/45 [100%], P = 1.0). Ablation and procedural times were similar in both arms. Using RCS, mean total MI ablation and procedure times were 13 ± 6 minutes and 23 ± 15 minutes, respectively. Coronary sinus (CS) ablation was significantly less in the RCS arm (48% vs 72%, P = 0.03). It was possible to "drive" the ablation catheter into the distal CS using the RCS in 19/22 (86%) patients. There was a significant trend of reduction in mean MI ablation (P = 0.008) and procedural times (P = 0.004) over the course of the study period. There was a significant reduction in fluoroscopy time in the RNS arm (33 ± 17 minutes vs 49 ± 20 minutes, P = 0.0004). It is feasible and safe to use a remote RCS for MI ablation, including "driving into the CS." MI block was achieved in 98% with a significant reduction in the need for CS ablation (48%). There is a short learning curve.
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