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Biomedical subjects

Daniel L Lustgarten

Publications and source records attributed to Daniel L Lustgarten.

7 recordsLinked to original sources
PubMed2006

Multidetector computed tomography guidance in complex cardiac ablations.

Radiofrequency ablation of complex cardiac arrhythmias has undergone significant evolution in the past decade, with the development of technology enabling better anatomic and electrophysiologic mapping of abnormal cardiac tissue. In this paper, we will discuss the role of pre-procedural and post-procedural multidetector computed tomography, with specific focus on the anatomic assessment of pulmonary vein and left atrial anatomy in the ablation of atrial fibrillation. We will also consider how the integration of both multidetector computed tomography and electroanatomic computer-based imaging may contribute more broadly to the management of a variety of complex ablation procedures.

Aortography↗
PubMed2006

Coronary venous capture of contrast during angiography.

Contrast-induced nephropathy (CIN) after angiographic procedures results in significant morbidity, mortality, and costs. Given the limitations of current prophylactic measures, we have tested the hypothesis that the majority of the contrast injected into a coronary artery can be captured from the coronary sinus before it enters the systemic circulation. The current study involves coronary venous capture after coronary angiography in dogs with determination of contrast capture using quantitative fluoroscopy. Venous contrast capture (VCC) was achieved with a balloon tipped through lumen catheter introduced into the coronary sinus via the superior vena cava. After selective injection of iohexol contrast into the left main coronary artery, the coronary sinus was balloon occluded in order to capture all contrast. The venous blood was subsequently withdrawn from the coronary sinus catheter, and then the balloon was deflated. By quantitative fluoroscopy we could demonstrate that an average 70 +/- 6% of the injected contrast could be captured without complications. Coronary sinus VCC is a novel approach to remove the majority of contrast selectively injected into coronary arteries. As an adjunct procedure in coronary angiography, VCC has the potential to significantly reduce the risk of CIN in patients at risk.

Animals↗
PubMed2005

Safety and efficacy of epicardial cryoablation in a canine model.

OBJECTIVES: The purpose of this study was to evaluate the safety and efficacy of cryoablation in a closed chest canine epicardial ablation model. BACKGROUND: Limitations of radiofrequency energy in the epicardial space warrants investigation of alternative energy sources. METHODS: A linear-tip catheter with a 3-cm freezing element and a 6-mm-tip catheter were used to create epicardial atrial and ventricular cryolesions. Epicardial coronary arteries were targeted to evaluate the effects of cryoablation on epicardial vessels. Cryoablation was performed at -90 degrees C for 4 minutes per lesion. Pathologic examination of the hearts was performed. Lesions were stained with tetrazolium chloride, analyzed grossly, and examined histologically. RESULTS: Ten of 11 linear catheter atrial lesions were transmural (average depth 1.5 +/- 1.3 mm). Only three of 13 6-mm-tip atrial lesions were transmural (average depth 1.1 +/- 1.2 mm). Ventricular lesions were continuous and not transmural (average depth of lesion for the linear and 6-mm-tip catheters: 2.7 +/- 1.3 mm and 1.6 +/- 0.7 mm, respectively). Angiographic stenosis (20-100%) during freezing was detected in 9 of 28 lesions, with TIMI III flow present in all vessels 5 minutes following thaw. Neointimal proliferation was present in 13 vessels, with no evidence of damage in vessels with internal diameters greater than 0.7 mm. Occlusive injury was identified in one small branch vessel. CONCLUSIONS: Creation of transmural lesions was possible in the atria but not in the ventricles. Cryothermal ablation can cause neointimal proliferation, with the probability that damage will be directly proportional to lesion depth and inversely proportional to vessel diameter.

Animals↗
PubMed2004

Relation between pulmonary vein firing and extent of left atrial-pulmonary vein connection in patients with atrial fibrillation.

BACKGROUND: The purpose of this study was to measure the extent of left atrial-pulmonary vein (LA-PV) connections and determine the relation to PV firing in patients with atrial fibrillation (AF). METHODS AND RESULTS: Ten close-bipolar (1 mm-spacing) Lasso electrograms were recorded circumferentially around 210 PVs (excluding 2 right middle PVs and 4 left common trunks) in 62 patients with AF. PV firing was provoked by isoproterenol (4 microg/min) and cardioversion of pacing-induced AF. The width of each LA-PV connection was measured in tenths of PV circumference, based on number of continuous close-bipolar Lasso electrode sites required for ablation (10% for each close-bipolar electrode site). One, 2, or 3 to 4 discrete LA-PV connections (discrete connection defined by ablation along 10% to 30% of PV circumference) were present in 18 (9%), 31 (14%), and 32 (15%) of 210 PVs, respectively: 1 broad connection (ablation along continuous 40% to 80% circumference) in 46 (22%) PVs; 1 broad plus other broad or discrete connections in 54 (26%) PVs; and a circumferential connection (ablation along 90% to 100%) in 29 (14%) PVs. Circumferential LA-PV connections were more common in superior than in inferior PVs (20% versus 7%, P<0.01). There was no major difference in distribution of the other types of LA-PV connections between the four PVs. PV firing occurred in 27%, 47%, and 72% of PVs with discrete only, broad and circumferential connections, respectively (P<0.01). Dissociated PV potentials after isolation were more common in arrhythmogenic (firing) PVs (32% versus 8%, P<0.01). CONCLUSIONS: The extent of LA-PV connections corresponds with arrhythmognesis. The incidence of PV firing increases with progressively wider LA-PV connections (discrete versus broad versus circumferential).

Action Potentials↗
PubMed2004

Treatment of Arrhythmias in Patients with Congestive Heart Failure.

Both ventricular and atrial arrhythmias are commonly encountered in patients with ventricular dysfunction. In fact, roughly half of the deaths occurring in patients with ventricular dysfunction are caused by ventricular arrhythmias. Atrial arrhythmias in this patient population compromise left ventricular filling and if uncontrolled can exacerbate (and in some cases cause) the underlying myopathic process. Consequently, the diagnosis and treatment of these complex, and often life-threatening, arrhythmias is a critical component in the management of congestive heart failure (CHF). As the complexity of pharmacologic and nonpharmacologic antiarrhythmic therapy evolves, it has become increasingly important to understand the potential benefits and limitations of the various treatment modalities in the setting of patients with CHF. The management of arrhythmias in patients with CHF includes conventional drug therapies, as well as therapies directed specifically at treating the arrhythmias that are encountered. The treatment of atrial arrhythmias may include anticoagulation, drugs for rate control, rhythm control, or radiofrequency ablation. The treatment of ventricular arrhythmias, conversely, uses the implantable cardioverter-defibrillator to prevent sudden death, with adjuvant drug therapy or ablation for refractory ventricular tachycardia. This article provides an overview of the current state-of-the-art arrhythmia management in patients with CHF.

Journal Article↗
PubMed2002

Effects of radiofrequency pulses delivered in the vicinity of the coronary arteries: implications for nonsurgical transthoracic epicardial catheter ablation to treat ventricular tachycardia.

This study evaluates the effects of epicardial RF ablation on the coronary vessels in a canine model. Nonsurgical epicardial catheter ablation is a minimally invasive procedure that has proven to be efficacious for the treatment of VT. This approach is limited by concern regarding the potential adverse effects of RF ablation on the epicardial coronary arteries. After lateral thoracotomy, a multipolar linear ablation catheter was sewn adjacent to or crossing the LAD in nine mongrel dogs. Five of these dogs also had a standard 4-mm tip ablation catheter sewn adjacent to the LAD. RF pulses were delivered using temperature control. Animals were sacrificed 14 days after ablation for histological analyses. Using the 4-mm tip catheter, 22 consecutive single lesions of 2.67 +/- 0.35 mm depth were studied. The only coronary arterial change seen was replacement of the media with extracellular matrix. Using the linear ablation catheter, 117 pulses were applied to generate 24 linear lesions (3.8 +/- 1 mm depth). Replacement of the coronary arterial media with extracellular matrix proliferation was commonly seen, and severe hyperplasia occurred in one artery. Intravascular thrombosis occurred in six arteries. The internal perimeter of the vessel (0.78 +/- 0.49 mm vs 1.79 +/- 0.83 mm) was the only variable associated with severe arterial damage. The effects of RF ablation delivered adjacent to the LAD were limited to the media but when delivered above the artery, severe intimal hyperplasia and intravascular thrombosis may occur. Susceptibility to damage is inversely proportional to the vessel size.

Animals↗