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Radiofrequency catheter ablation in patients with symptomatic atrial flutter/tachycardia after orthotopic heart transplantation

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Chinese Medical Journal 2006年第24期119卷 2036-2041页

作者： LI Yi-gang Gerian Gronefeld carsten israel LU Shang-biao WANG Qun-shan Stefan H Hohnloser Department of Cardiology Xinhua Hospital Shanghai Jiaotong University Shanghai 200092 China Department of Medicine Division of Cardiology J.-W.Goethe-University Frankfurt Germany

Background Atrial tachycardia or flutter is common in patients after orthotopic heart transplantation. Radiofrequency catheter ablation to treat this arrhythmia has not been well defined in this setting. This study was conducted to assess the incidence of various symptomatic atrial arrhythmias and the efficacy and safety of radiofrequency catheter ablation in these patients. Methods Electrophysiological study and catheter ablation were performed in patients with symptomatic tachyarrhythmia. One Halo catheter with 20 poles was positioned around the tricuspid annulus of the donor right atrium, or positioned around the surgical anastomosis when it is necessary. Three quadripolar electrode catheters were inserted via the right or left femoral vein and positioned in the recipient atrium, the bundle of His position, the coronary sinus. Programmed atrial stimulation and burst pacing were performed to prove electrical conduction between the recipient and the donor atria and to induce atrial arrhythmias. Results Out of 55 consecutive heart transplantation patients, 6 males [（58±12） years] developed symptomatic tachycardias at a mean of （5±4） years after heart transplantation. Electrical propagation through the suture line between the recipient and the donor atrium was demonstrated during atrial flutter or during recipient atrium and donor atrium pacing in 2 patients. By mapping around the suture line, the earliest fragmented electrogram of donor atrium was assessed. This electrical connection was successfully ablated in the anterior lateral atrium in both patients. There was no electrical propagation through the suture line in the other 4 patients. Two had typical atrial flutter in the donor atrium which was successfully ablated by completing a linear ablation between the tricuspid annulus and the inferior vena cava. Two patients had atrial tachycardia which was ablated in the anterior septal and lateral donor atrium. There were no procedure-related complications. Patients w

关键词： atrial flutter atrial tachycardia heart transplantation ablation

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Stepwise approach to substrate modification of ventricular tachycardia after myocardial infarction

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Chinese Medical Journal 2006年第14期119卷 1182-1189页

作者： LI Yi-gang Gerian Groenefeld carsten israel LU Shang-biao WANG Qun-shan MENG Shu Stefan H Hohnloser Department of Cardiology Xinhua Hospital Shanghai Jiao Tong University Shanghai 200092 China Department of Medicine Division of Cardiology J. W. Goethe- University Frankfurt Germany

Background Recently, substrate mapping （SM） has been described to facilitate catheter ablation of stable and unstable ventricular tachycardia （VT） after myocardial infarction. However, SM is time consuming with potential disadvantages of multiple ablation lines such as impairment of ventricular function or proarrhythmia. The aim of the present study was to delineate a stepwise approach to SM to shorten procedure time and limit the possibility of complications. Methods SM was performed in 14 infarct survivors referred for VT ablation using an electroanatomical mapping system （CARTO） to define infarct regions. A new stepwise approach for SM was designed as follows. The initial ablation site was identified by pace- and entrainment mapping in case of stable VT and by pace mapping only in case of unstable VT. Based on the CARTO voltage mapping, linear ablation was done from this site to the center of the scar and perpendicular to the boundary of the scar or to the mitral annulus. Additional lines were performed only when VT remained inducible. A maximum of 3 ablation lines were created during one procedure. Results A total of 57 VTs （21 stable, 36 unstable） were induced during the procedures. VT was no longer inducible after the first linear ablation in 2 patients, after the second linear ablation in 6 patients and after the third linear ablation in 3 patients. Either VT or ventricular fibrillation was still inducible at the end of the procedure in 3 patients. Procedure time averaged （291 ±85） minutes, fluoroscopy time （10±7） minutes. VT recurred in 3 patients. Following a second procedure in 2 patients, there were no further VT recurrences. Overall, there was a significant reduction in VT episodes 3 months after [median： 0, interquartile ranges （IQR）： 0-1] compared with 3 months before ablation （median： 25, IQR： 16-105, P〈0.01）. Conclusions This stepwise approach to SM is effective in facilitating ablation of stable and unstable VT. It reduces procedure and fluoro

关键词： ventricular tachycardia mapping ablation substrate modification

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Refinement of CARTO-guided substrate modification in patients with ventricular tachycardia after myocardial infarction

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Chinese Medical Journal 2008年第2期121卷 122-127页

作者： LI Yi-gang WANG Qun-shan Gerian Gronefeld carsten israel LU Shang-biao SHAO Yun Joachim R. Ehrlich Stefan H. Hohnloser Department of Cardiology Xinhua Hospital School of Medicine Shanghai Jiaotong University Shanghai 200092 China Department of Medicine Division of Cardiology J. W. Goethe-University Frankfurt Germany

Background Substrate modification guided by CARTO system has been introduced to facilitate linear ablation of ventricular tachycardia （VT） after myocardial infarction （MI）. However, there is no commonly accepted standard approach available for drawing these ablation lines. Therefore, the aim of the present study was to practically refine this time consuming procedure.Methods Substrate modification was performed in 23 consecutive patients with frequent VTs after MI using the CARTO system. The initial target site （ITS） for ablation was identified by pace mapping （PM） during sinus rhythm and/or entrainment pacing （EM） during VT. According to the initial target site, two approaches were used. The initial target site in approach one has a similar QRS morphology as VT and an interval from the stimulus to the onset of QRS cmplex （S-QRS） of ≥50 ms during PM in sinus rhythm or a difference of the post pacing interval and VT cycle length ≤30 ms during concealed entrainment pacing of VT; The initial target site in approach two has an similar QRS morphology as VT and an S-QRS of 〈50 ms during PM in sinus rhythm.Results Overall, 50 lines were performed with a length of （35±11） mm. Procedure time averaged （232±56） minutes, fluoroscopy time （10±8） minutes. Sixteen patients were initially involved into approach one. After completion of 3±1 ablation lines, no further VT was inducible in 13 patients. The remaining 3 patients were switched to use the alternative approach. However, in none of them the alternative approaches were successful. Approach two was initially used in 7 patients. After completion of 3±1 ablation lines, no further VT was inducible in only 2 patients. The remaining 5 patients were switched to approach one, which resulted in noninducibility of VT in 4 of them. The initial successful rate was significantly higher in the group of approach one compared to that in the group of approach two （13/16 patients vs 2/7 patients, P=-0.026）.Conclusions The approach for su

关键词： ventricular tachycardia mapping ablation substrate modification

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心肌梗死后室性心动过速的消融治疗

心肌梗死后室性心动过速的消融治疗

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中华医学会心血管病学分会第八次全国心血管病学术会议

作者：李毅刚 Gerian Grnefeld carsten israel 陆尚彪王群山孟舒 Stefan H．Hohnloser 上海交通大学医学院附属新华医院心内科德国Frankfurt J．W．Goethe大学

目的探讨一种心室基质改良的新方法,以缩短心肌梗死后室性心动过速(室速)消融的手术时间,减少可能的并发症。方法对21例心肌梗死后室速并进行导管消融的患者进行了研究。先用电解剖标测系统(CARTO)确定梗死区,然后进行基质改良。基质改...

目的探讨一种心室基质改良的新方法,以缩短心肌梗死后室性心动过速(室速)消融的手术时间,减少可能的并发症。方法对21例心肌梗死后室速并进行导管消融的患者进行了研究。先用电解剖标测系统(CARTO)确定梗死区,然后进行基质改良。基质改良采用的是一种顺序法,设计如下:首先确定起始消融靶点。对稳定性室速通过起搏标测和拖带标测识别始消融靶点,而对不稳定性室速则只通过起搏标测识别。根据CARTO电压标测,从该起始消融靶点一边向瘢痕中心消融,一边垂直于瘢痕边缘或二尖瓣环进行

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器质性心脏病室性心动过速的消融

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上海医学 2007年第S1期30卷 25-25页

作者：李毅刚王群山陆尚彪邵芸 Stefan H.Hohnloser carsten W.israel Gerian Grnefeld 俞洁霏谢起裕舒红上海交通大学医学院附属新华医院心内科 200092 Department of Medicine Division of CardiologyJ.W.Goethe-UniversityFrankfurtGermany

目的探讨器质性心脏病室性心动过速的发病谱、发生机制和导管消融的方法学,使器质性心脏病室性心动过速得到更有效的控制。方法106例器质性心脏病室性心动过速进行电生理检查和消融治疗的患者,男72例,女34例,平均年龄为(61±13)岁。冠心... 详细信息

目的探讨器质性心脏病室性心动过速的发病谱、发生机制和导管消融的方法学,使器质性心脏病室性心动过速得到更有效的控制。方法106例器质性心脏病室性心动过速进行电生理检查和消融治疗的患者,男72例,女34例,平均年龄为(61±13)岁。冠心病72例(包括心肌梗死后患者67例和冠状动脉外科搭桥术后16例),扩张性心肌病17例,右室发育不良性心肌病室性心动过速4例,心肌炎后3例,高血压性心脏病6例,除冠状动脉搭桥术外其他心脏外科术后4例。常规植入3根标测导管,分别放置在高右房、希氏束和右心室。行常规电生理检查,包括心室程序刺激。所有患者均有自发或诱发的持续性室性心动过速。然后行右心室和(或)左心室标测,必要时行冠状动脉窦标测．理想消融耙点确定后,行消融治疗。结果67例心肌梗死后室性心动过速患者,除2例成功的消融靶点在右心室近原起搏器植入部位和右心室心尖部外,其余瘢痕相关的折返性室性心动过速成功消融部位均在左心室。接受常规方法消融42例,消融成功率为86％(36例,以不能诱发临床室性心动过速为终点);接受心室三维基质标测和线性消融25例,消融成功率为84％(20例,以不能诱发任何室性心动过速为终点)。5例冠心病无心肌梗死史的室性心动过速患者,2例患者的发生机制为折返,3例为触发机制,均消融成功。17例扩张性心肌病室性心动过速的发生机制均为折返,其中2例消融成功的部位在冠状动脉窦; 9例束支折返性心动过速,右束支消融成功;其余6例中4例常规和(或)三维标测、消融后不能诱发室性心动过速。4例右室发育不良性心肌病室性心动过速、4例心脏外科术后室性心动过速和3例心肌炎后室性心动过速的发生机制均为折返,分别有2例、3例和2例消融成功。6例高血压性心脏病室性心动过速,1例的发生机制为折返,5例为触发机制,均消融成功。结论折返是器质性心脏病室性心动过速的主要发生机制,触发激动也是其发生机制之一。常规标测方法是器质性心脏病室性心动过速消融的基础,三维基质标测和线性消融有利于该类室性心动过速消融成功。

关键词：标测右心室心尖部线性消融电生理检查右束支触发激动消融靶点希氏束右室发育不良导管消融

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Pyrolysis-induced shrinking of threedimensional structures fabricated by twophoton polymerization:experiment and theoretical model

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Microsystems & Nanoengineering 2019年第1期5卷 303-315页

作者： Braulio Cardenas-Benitez carsten Eschenbaum Dario Mager Jan G.Korvink Marc JMadou Uli Lemmer israel De Leon Sergio O.Martinez-Chapa School of Engineering and Sciences Tecnologico de MonterreyAv.Eugenio Garza Sada 2501 Sur64849 MonterreyNLMexico Light Technology Institute Karlsruhe Institute of Technology(KIT)Engesserstraße 1376131 KarlsruheGermany Institute of Microstructure Technology Karlsruhe Institute of Technology(KIT)Hermann-von-Helmholtz-Platz 176344 Eggenstein-LeopoldshafenGermany Department of Mechanical and Aerospace Engineering University of CaliforniaIrvine4200 Engineering GatewayIrvineCA 92697USA

The introduction of two-photon polymerization(TPP)into the area of Carbon Micro Electromechanical Systems(CMEMS)has enabled the fabrication of three-dimensional glassy carbon nanostructures with geometries previously unattainable through conventional UV *** of TPP structures conveys a characteristic reduction of feature size—one that should be properly estimated in order to produce carbon microdevices with *** this work,we studied the volumetric shrinkage of TPP-derived microwires upon pyrolysis at 900℃.Through this process,photoresist microwires thermally decompose and shrink by as much as 75%,resulting in glassy carbon nanowires with linewidths between 300 and 550 *** after the thermal decomposition induced by the pyrolysis step,the linewidth of the carbon nanowires was found to be dependent on the TPP exposure *** have also found that the thermal stress induced during the pyrolysis step not only results in axial elongation of the nanowires,but also in buckling in the case of slender carbon nanowires(for aspect ratios greater than 30).Furthermore,we show that the calculated residual mass fraction that remains after pyrolysis depends on the characteristic dimensions of the photoresist microwires,a trend that is consistent with several works found in the *** phenomenon is explained through a semi-empirical model that estimates the feature size of the carbon structures,serving as a simple guideline for shrinkage evaluation in other designs.

关键词： lithography pyrolysis structures

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