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Results for “Patient pathway”

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At least 19 recordsLinked to original sources

PubMed1991

Phase image triangulation of accessory pathways in patients undergoing catheter ablation of posteroseptal pathways.

The outcome of posteroseptal accessory pathway ablation by direct current (DC) shocks delivered just outside the os of the coronary sinus was studied in 21 patients. Electrocardiographic and electrophysiological parameters as well as phase image patterns of equilibrium multiple-gated blood-pool scintigrams were studied to determine their usefulness in predicting the success of ablation. A second free-wall pathway was documented by electrophysiological or surgical findings in six patients, and the value of phase images in detecting this second pathway was studied as well. Ablation was successful in 57%. The cumulative mean energy of DC shocks amounted to 524 +/- 170 joules and was not predictive of ablation outcome, neither was the mean ventriculoatrial (VA) conduction time. The predictive value of the 12-lead maximally preexcited electrocardiogram was poor in the 15 patients with a single posteroseptal bypass tract. A new method to triangulate the site of the earliest phase angle on the atrioventricular (AV) valve plane successfully localized the bypass pathway in 14 of those patients. No specific phase pattern predicted successful ablation except for a symmetrical, concentric peripheral phase progression found to be predictive of ablation success in the four patients who showed this pattern. Phase analysis was able to localize the second, nonposteroseptal pathway in four of six patients. This study showed that a concentric peripheral phase progression in the gated blood-pool scintigrams is predictive for ablation success in patients with posteroseptal pathways. A free-wall localization of the earliest phase angle is suggestive of a second bypass tract in this area.

Adolescent↗

PubMed1986

Catheter atrioventricular junctional ablation in patients with accessory pathways.

Seven patients with accessory pathway and symptomatic atrioventricular reciprocating tachycardia underwent catheter ablation of the atrioventricular junction (AVJ). Four patients had the Wolff-Parkinson-White syndrome, two had concealed left free-wall accessory pathways, and one patient had a nodoventricular connection. All patients failed multiple antiarrhythmic drugs and one failed attempted surgical ablation of a posteroseptal accessory pathway. Chronic interruption of atrioventricular node-His conduction was achieved in all patients. Over a mean follow-up period of 21 +/- 14 months, four patients remained asymptomatic without antiarrhythmic therapy. One patient developed atrial fibrillation after magnet application to her VVI pacemaker, another developed atrial flutter, and a third had nonparoxysmal sinus or atrial tachycardia. Two patients required chronic quinidine therapy. Two patients with concealed accessory pathways had pacemaker-mediated tachycardia which was controlled by pacemaker reprogramming. Atrioventricular junctional ablation in patients with accessory pathways proved effective in that all are currently controlled without need for surgical intervention. On follow-up, a relatively high incidence of atrial arrhythmias requiring antiarrhythmic therapy was found.

Adult↗

PubMed1978

Effect of catheter position on the initiation of atrial echoes with atrial pacing and premature stimulation in patients with accessory pathways.

Eleven patients with an accessory pathway and reciprocating tachycardia were studied using both fixed rate atrial pacing and the atrial extrastimulus technique. Six of the patients had an accessory pathway that conducted in both the anterograde and retrograde direction; but the effective refractory period of their accessory pathway in the anterograde direction was relatively long and was greater than the longest coupling intervals that initiated atrial echoes. Five patients had an accessory pathway that conducted only in the retrograde direction. The extrastimulus technique could be used with stimulation sites near to and remote from the accessory pathway in 10 of the 11 patients. Atrial echoes were initiated by a single atrial extrastimulus at both sites in 7 of the 10 patients, and in each patient the upper limit of the echo zone was longer with stimulation at the site near the accessory pathway. In the other three patients atrial echoes were initiated only during stimulation at the site near the accessory pathway because either atrial refractoriness or atrioventricular nodal refractoriness was encountered before the echo zone was entered during stimulation at the site remote from the accessory pathway. Differences in the longest cycle length that initiated an atrial echo during fixed rate atrial pacing were similarly demonstrated in three patients. In these three patients, pacing at the site near the accessory pathway initiated echoes at a longer cycle length than pacing at the site remote from the accessory pathway. In three other patients the electrophysiologic characteristics of atrioventricular conduction prevented a demonstration of these differences. Catheter position is an important variable in the initiation of atrial echoes in patients with accessory pathways.

Arrhythmias, Cardiac↗

PubMed1990

Retrograde dual atrioventricular nodal pathway in patients with atrioventricular reciprocating tachycardia using concealed accessory pathways.

We present electrophysiological studies in two patients with atrioventricular reciprocating tachycardias. The first patient had anterograde dual atrioventricular nodal pathways with a right-sided concealed accessory pathway. The retrograde atrioventricular nodal pathway showed evidence suggestive of slow pathway properties. After block was induced with ajmaline in the accessory pathway, a typical pattern of discontinuous retrograde atrioventricular nodal conduction curves was recognized. We then observed three types of induced atrioventricular reentry. The other patient had continuous anterograde atrioventricular nodal conduction, a fast-conducting retrograde atrioventricular nodal pathway and a left-sided concealed accessory pathway. After refractoriness had been induced in the accessory pathway with ajmaline, a typical pattern of retrograde dual atrioventricular nodal pathways was recognized, and it proved impossible to induce atrioventricular nodal echoes. Induction of block or impairment of conduction with ajmaline in the concealed accessory pathway proved helpful in the disclosure of retrograde dual atrioventricular nodal pathways by means of the ventricular extrastimulus method.

Adolescent↗

PubMed1990

Correction of reentrant atrioventricular tachycardia by surgical ablation of accessory pathways.

Patients with reentrant atrioventricular (AV) tachycardia have an accessory connection in addition to the normal conduction pathway, AV node and His-Purkinje system. This pathway predisposes some patients to recurrent, disabling supraventricular tachyarrhythmias. Although it is found with other associated cardiac conditions, most patients are healthy with no underlying structural heart disease. Interest has developed in surgically dividing the accessory pathway in patients with arrhythmias poorly controlled with medications or at risk for potentially fatal tachyarrhythmias. Surgery is safe and effective and should be considered for patients with rapid AV conduction during atrial fibrillation, those refractory to pharmacologic therapy, and young patients who otherwise would require lifelong antiarrhythmic therapy. This report describes surgical correction of reentrant AV tachycardia in five patients ranging in age from six months to 23 years.

Adolescent↗

PubMed1989

Cryoablation of septal pathways in patients with supraventricular tachyarrhythmias.

Eighteen patients with supraventricular tachycardia refractory to medical therapy underwent preoperative electrophysiological study and subsequent operation. There were 6 female and 12 male patients ranging in age from 1.5 to 31.6 years (mean age, 11.9 +/- 7.8 years). Eleven had classic Wolff-Parkinson-White syndrome with intermittent tachycardia, and 7 had a form of permanent junctional reciprocating tachycardia. Five had impaired left ventricular function preoperatively. The location of the accessory conduction pathway was anteroseptal in 3, posteroseptal in 12, and both anteroseptal and posteroseptal in 3 patients. Pathway location was confirmed by intraoperative mapping in all patients. The pathways were ablated utilizing a cryoprobe at -70 degrees C. All patients survived the operation, had immediate abolishment of delta waves and tachycardia, and were considered cured at the time of hospital discharge. Sixteen (89%) remain cured at a mean follow-up of 16.9 months. One patient with a posteroseptal pathway no longer has a delta wave but has had poorly documented episodes of tachycardia and is taking medication. One other patient with both anteroseptal and posteroseptal pathways had a recurrent delta wave 6 months postoperatively but has had no tachycardia and is asymptomatic without medication. No patient experienced heart block. Ventricular function has returned to normal in all 5 patients with impaired function preoperatively. Cryoablation is an effective method of abolishing accessory conduction pathways located in the anteroseptal or posteroseptal region. The method is easy, and results are comparable with those of other techniques previously described.

Adolescent↗

PubMed1991

Central motor pathways in patients with mirror movements.

Central motor pathways were investigated in three patients with congenital mirror movements using magnetic motor cortex stimulation. Response thresholds, amplitudes and latencies were normal. The projection of the corticomotoneuronal pathways was assessed by placing the coil over the vertex and comparing the size of responses in the first dorsal interosseous (FDI) muscles evoked by anticlockwise and clockwise [corrected] coil currents. In normal subjects, right FDI responses are larger with anticlockwise currents than with clockwise [corrected] currents at the same stimulation strength and vice versa. In two out of three patients with congenital mirror movements, this sensitivity of response amplitude to coil current direction was reversed. The third patient with congenital mirror movements and a fourth patient with acquired mirror movements had responses which were normally sensitive to current direction. These findings support the hypothesis that some cases of congenital mirror movements may be due to abnormal projection of corticomotoneuronal pathways.

Adult↗

PubMed1991

[Electrophysiologic characteristics of multiple atrioventricular accessory pathways in patients with pre-excitation syndrome].

The electrophysiologic studies in 4 patients with multiple accessory pathways (AP) were reported. The results showed that in these patients, the electrophysiologic characteristics were diversified: The VA intervals often changed abruptly during ventricular pacing at a set rate; and during ventricular pacing with incremental rate or a single premature stimulus scanning, the VA intervals revealed several different constant values. At the onset of AV reentrant SVT with wide QRS complex, the HBE showed VA-VA sequence and no H wave could be found; when orthodromic reentrant SVT, the VA interval and SVT cycle length were various, especially at the beginning of the onset. It was found that when the multiple APs located at both the right and left side and the septum of the heart, the variation of the VA interval would follow the variation of the atrial excitation sequence; when the multiple APs located at the same side of the heart, the atrial excitation sequence was unchanged. Of the 4 cases, 3 received epicardial mapping and surgical treatment. All the existence and locations of the APs suggested by the electrophysiologic studies were confirmed during the operation except one AP in which the location was slightly deviated from the pre-estimation.

Adult↗

PubMed1992

Catheter ablation of accessory pathways in patients with Wolff-Parkinson-White syndrome.

PATIENTS: Fifty-two patients with Wolff-Parkinson-White syndrome underwent transcatheter ablation. All patients were symptomatic. Eighteen had documented episodes of atrial fibrillation, 14 of which also had reentrant tachycardias; the remaining 34 had only episodes of reentrant tachycardias. Forty-nine patients had both anterograde and retrograde conduction through the accessory pathway; 3 had retrograde conduction alone; 2 patients had 2 accessory pathways and 1 had 3. All patients were resistant or intolerant to at least 2 antiarrhythmic drugs. METHODS: All patients were treated with radiofrequency current. Ablation was considered successful if the anterograde and retrograde conduction were completely abolished. Ablation was considered unsuccessful if ablation of only 1 pathway in patients with 2 or more accessory pathways and/or modification of the accessory pathway conduction without interruption was achieved. RESULTS: Accessory pathway ablation was successfully performed in 46 out of 52 patients (88%). Fifty out of 56 accessory pathways were effectively ablated (89%). Thirty-eight required a single session of ablation and 8 additional patients were successfully ablated during a second session. The number of radiofrequency current applications ranged from 2 to 13 (mean 4.1 +/- 2.5). The mean duration of the sessions was 4.30 +/- 1.50 hours (range 2.30 to 9). The mean radiation exposure for session was 55 +/- 25 minutes (range 20 minutes to 2.30 hours). Complications were observed in 2 out of 52 patients. One patient had a transient II degree type 1 atrioventricular block; another patient with severe arterial hypertension had a mild hemorrhagic stroke with complete neurological remission. FOLLOW-UP. Forty-five out of the 46 patients in whom ablation was successful were asymptomatic for arrhythmias during a mean follow-up of 8 months (range 4 to 16), without antiarrhythmic treatment, and without reappearance of preexcitation. One patient showed reappearance of preexcitation at electrocardiogram one month after the ablation, followed by an episode of reentrant tachycardia; this patient underwent a second successful ablation session. CONCLUSIONS: Our results show that ablation techniques have high success rates with no serious complications.

Adolescent↗

PubMed2026

Comprehensive Genomic Profiling Timeliness Beyond Laboratory Turnaround Time: A Patient-Facing Pathway Analysis.

AIM: We evaluated the timeliness of the patient-facing comprehensive genomic profiling (CGP) pathway by separating laboratory and post-laboratory intervals within an expert panel-mediated process, using direct disclosure of results to patients as the endpoint. METHODS: This single-center retrospective study included adult CGP test episodes performed under government-funded cancer genomic medicine at a Japanese university hospital between October 2019 and November 2025. The primary outcome was patient-centered turnaround time (TAT), defined as the interval from informed consent to direct disclosure of the CGP result to the patient. Laboratory TAT and pathway intervals were summarized descriptively, and laboratory TAT was compared across assays. RESULTS: Among 882 CGP test episodes, median laboratory TAT was 14 days (interquartile range [IQR], 12-16) among 871 evaluable episodes. Among 828 evaluable episodes, median patient-centered TAT was 41 days (IQR 35-45). The laboratory analysis retained observed long intervals, including a maximum of 72 days; no episode was excluded solely because laboratory TAT exceeded 56 days. These findings indicate that laboratory TAT was only one component of the longer consent-to-disclosure pathway. CONCLUSION: In this routine-care CGP pathway, patient-facing timeliness depended on the full process from consent to direct patient disclosure. Patient-centered TAT should be monitored alongside laboratory TAT as a care-delivery measure.

comprehensive genomic profiling↗

PubMed1992

[Local features of electrophysiologic and epicardial mapping of posterior septal accessory pathways in patients with surgically corrected preexcitation syndrome].

Posterior septal accessory pathways were documented in 6 patients with preexcitation syndrome who underwent detailed electrophysiologic evaluation and epicardial mapping. All 6 patients were cured by surgical ablation of accessory atrioventricular pathway. After follow-up of 9 months on average, 6 patients remain cured. No patient had recurrent supraventricular tachycardia and none had persistent atrioventricular conduction disturbance. The results of electrophysiologic study and epicardial mapping showed local characteristics of posterior septal accessory pathways. Accurate localization of posterior septal accessory pathways is very important in raising the rate of success in operation.

Adolescent↗

PubMed1975

Evidence suggesting dual A-V nodal pathways in patients without supraventricular tachycardias.

Electrophysiologic evidence for dual pathways of conduction through the A-V node is presented in three patients without history of supraventricular tachycardia. In case 1, abrupt spontaneous changes in the PR interval from 0.17 to 0.42 second were seen. His bundle electrographic studies showed two sets of A-H intervals during sinus rhythm and at several atrial pacing rates, although at rates over 100 per minute only the slow pathway conducted. Using the extrastimulus method, different refractory periods for the fast and slow pathways were documented. Cases 2 and 3 underwent His bundle electrography studies to evaluate intraventricular conduction defects. During atrial pacing studies abrupt changes in the A-H interval, from 220 to 470 msec and from 220 to 370 msec, were observed on increasing the pacing rate from 90 to 95 per minute in case 2 and from 120 to 130 per minute in case 3. In these two patients, dual A-V nodal pathways were suggested by the sudden changes in the A-H -interval at critical pacing rates. These findings indicate that evidence suggesting dual pathways of conduction through the A-V node may not be an uncommon finding and may be present without the manifestation of recurrent supraventricular tachycardias.

Atrioventricular Node↗

PubMed1992

Tryptophan metabolism via the kynurenine pathway in patients with the eosinophilia-myalgia syndrome.

OBJECTIVE: To investigate the metabolism of L-tryptophan (LT) via the kynurenine pathway in patients with the eosinophilia-myalgia syndrome (EMS). METHODS: Measurement of LT, L-kynurenine, and quinolinic acid in plasma and cerebrospinal fluid (CSF) from subjects with EMS, from asymptomatic users of LT, and from normal subjects. RESULTS: Plasma LT concentrations were lower in untreated EMS patients (n = 5) than in corticosteroid-treated EMS patients (n = 5; P less than 0.05) and in asymptomatic users of LT (n = 5; P less than 0.05). Untreated EMS patients, who had discontinued LT weeks to months prior to study, had significantly higher plasma levels of L-kynurenine and quinolinic acid than did corticosteroid-treated EMS patients (P less than 0.05), normal subjects (P less than 0.02), and asymptomatic users of LT (P less than 0.05). EMS patients also had significantly elevated levels of L-kynurenine (P less than 0.05) and quinolinic acid (P less than 0.001) in CSF compared with normal subjects. After a 1-gm oral dose of LT, untreated EMS patients (n = 4) showed lower peak levels of LT and accentuated synthesis of L-kynurenine and quinolinic acid, compared with these values in corticosteroid-treated EMS patients (n = 2), who responded like normal subjects (n = 5). CONCLUSION: These data demonstrate that during the active phase of EMS, LT metabolism via the kynurenine pathway was accentuated, probably secondary to induction of the enzyme indoleamine-2,3-dioxygenase. Ingestion of large amounts of LT (median daily dose 1.5 gm) resulted in high concentrations of kynurenine-pathway metabolites in blood and extrahepatic tissues, which was accentuated in EMS patients and which may have played a significant role in the pathogenesis of the disease.

Adrenal Cortex Hormones↗

PubMed1978

[Determination of the alternative complement pathway in patients with amebic liver abscess].

The activation of the alternative pathway of complement in the sera of patients with amebic liver abscess was studied. Of 11 sera examined, only six showed an activation of the alternative pathway. However, all sera showed diminished levels of complement (CH50) and C3, in spite of normal levels of C1q. The results suggest that the sera of patients with invasive amebiasis have a substance capable of activating the properdin pathway. The significance of these observations is not completely clear at the present time.

Complement Activation↗

PubMed1991

Single-catheter approach to radiofrequency current ablation of left-sided accessory pathways in patients with Wolff-Parkinson-White syndrome.

BACKGROUND: Catheter ablation with the use of radiofrequency current has been introduced as a therapeutic option for patients with tachyarrhythmias mediated by an accessory atrioventricular pathway. The technique conventionally implies the introduction of several catheters into the heart for assessment of electrophysiological parameters as well as for localization of the accessory pathway and may last for several hours. METHODS AND RESULTS: Thirty-four patients with Wolff-Parkinson-White syndrome and a delta wave pattern indicative of an overt (i.e., capable of consistent antegrade conduction) left-sided free-wall accessory pathway underwent attempts at radiofrequency current ablation of the pathway with the use of just one catheter. No patient had a previous electrophysiological study. The catheter was introduced into the left ventricle close to the mitral annulus and was used for pathway localization as well as for ablation. The approach was completely successful in 30 patients (88%). In the remaining four patients, ablation of the pathway was achieved by using the multiple-catheter approach. Overall procedure duration was 2.0 +/- 1.1 hours; radiation exposure time was 22.8 +/- 20.4 minutes (median, 17.3 minutes). There were no acute complications. CONCLUSIONS: The single-catheter approach to radiofrequency current ablation of overt left-sided free-wall accessory pathways is feasible, safe, and effective in the majority of patients. The approach requires considerable investigator experience but significantly reduces procedure duration and radiation exposure time.

Adolescent↗

PubMed1990

Histopathology of anterior parts of the optic pathway in patients with multiple sclerose.

Multiple sclerosis involves the anterior part of the optic pathway of 5 patients with clinically definite multiple sclerosis. No pathological changes were found in the retina. Plaques were found in all optic nerves, in two of three chiasms and in the optic track from one patient. Periphlebitis was found in three optic nerves, and in one chiasm. One patient had plaques as well as periphlebitis in the optic nerves and chiasm but did not show any changes in the brain or the spinal cord.

Adult↗

PubMed1991

Epicardial mapping in patients with "nodoventricular" accessory pathways.

Some patients with electrophysiologic features suggesting nodoventricular fibers have been shown to have right parietal atrioventricular (AV) accessory pathways with decremental conduction properties intraoperatively. The experience with 11 patients (7 women and 4 men, mean age +/- standard deviation 25 +/- 5 years) who had electrophysiologic features consistent with a nodoventricular pathway and who underwent operative correction was reviewed. At electrophysiologic study, all patients had absent or minimal preexcitation in sinus rhythm. During atrial pacing and extrastimulus testing, maximal preexcitation with left bundle branch block morphology developed and the AH and AV intervals progressively prolonged. Preexcited tachycardia was initiated in all patients (AV reentrant tachycardia in 10 patients and AV node reentrant tachycardia in 1 patient). At operation all patients had a right parietal accessory pathway demonstrated. Intraoperative mapping demonstrated the earliest site of ventricular activation during anterograde preexcitation to be at the midanterior right ventricle, consistent with insertion of these pathways into the right bundle branch system, in 7 patients. The ventricular insertion was at the AV groove in 4 patients, in keeping with the typical Wolff-Parkinson-White syndrome. Retrograde conduction over the pathway was not demonstrated in any patient. Two patients had evidence of a second accessory AV pathway in the left paraseptal region. Operative AV node ablation was electively performed in 2 patients without affecting preexcitation in either case. In 1 of these patients, accessory pathway conduction was temporarily abolished by ice mapping in the right anterolateral AV groove.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

Role of LFA-1 and VLA-4 in the adhesion of cloned normal and LFA-1 (CD11/CD18)-deficient T cells to cultured endothelial cells. Indication for a new adhesion pathway.

Patients with the leukocyte adhesion deficiency (LAD) syndrome have a genetic defect in the common beta 2-chain (CD18) of the leukocyte integrins. This defect can result in the absence of cell surface expression of all three members of the leukocyte integrins. We investigated the capacity of T cell clones obtained from the blood of an LAD patient and of normal T cell clones to adhere to human umbilical vein endothelial cells (EC). Adhesion of the number of LAD T cells to unstimulated EC was approximately half of that of leukocyte function-associated antigen (LFA)-1+ T cells. Stimulation of EC with human rTNF-alpha resulted in an average 2- and 2.5-fold increase in adhesion of LFA-1+ and LFA-1- cells, respectively. This effect was maximal after 24 h and lasted for 48 to 72 h. The involvement of surface structures known to participate in cell adhesion (integrins, CD44) was tested by blocking studies with mAb directed against these structures. Adhesion of LFA-1+ T cells to unstimulated EC was inhibited (average inhibition of 58%) with mAb to CD11a or CD18. Considerably less inhibition of adhesion occurred with mAb to CD11a or CD18 (average inhibition, 20%) when LFA-1+ T cells were incubated with rTNF-alpha-stimulated EC. The adhesion of LFA-1- T cells to EC stimulated with rTNF-alpha, but not to unstimulated EC, was inhibited (average inhibition, 56%) by incubation with a mAb directed to very late antigen (VLA)-4 (CDw49d). In contrast to LAD T cell clones and the LFA-1+ T cell line Jurkat, mAb to VLA-4 did not inhibit adhesion of normal LFA-1+ T cell clones to EC, whether or not the EC had been stimulated with rTNF-alpha. We conclude that the adhesion molecule pair LFA-1/intercellular adhesion molecule (ICAM)-1 plays a major role in the adhesion of LFA-1+ T cell clones derived from normal individuals to unstimulated EC. Adhesion of LFA-1-T cells to TNF-alpha-stimulated EC is mediated by VLA-4/vascular cell adhesion molecule (VCAM)-1 interactions. Since we were unable to reduce significantly the adhesion of cultured normal LFA-1+ T cells to 24 h with TNF-alpha-stimulated endothelium with antibodies that block LFA-1/ICAM-1 or VLA-4/VCAM-1 interactions, and lectin adhesion molecule-1 and endothelial leukocyte adhesion molecule-1 appeared not to be implicated, other as yet undefined cell surface structures are likely to participate in T cell/EC interactions.

Cell Adhesion↗