Interatrial pressure gradients during simulated obstructive sleep apnea: A catheter‐based study

Konečný, Tomáš; Khanna, Amber; Novák, Jan; Jama, Abdi A.; Zawadowski, George; Orban, Marek; Pressman, Gregg S.; Bukartyk, Jan; Kára, Tomáš; Cetta, Frank; Borlaug, Barry A.; Somers, Virend K.; Reeder, Guy S.

doi:10.1002/ccd.25433

Cited by 24 publications

(22 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a simulated obstructive sleep apnea study, Konecny, et al [4] showed that right atrial pressure transiently and consistently exceeded left atrial pressure in response to the steep decline in intrathoracic pressure during a Mueller maneuver. There have been no studies to show the effect of upright position on intrathoracic pressure, thus a potential relationship with POS.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2023

Int J Clin Cardiol

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Untitled

2023

Int J Clin Cardiol

View full text Add to dashboard Cite

“…It is known that the pressure in the left atrium (LA) is usually positive. However, in the case of sedation, the LA pressure becomes negative (−3.1 ± 9.3 mm Hg); in patients with obstructive sleep apnea syndrome (OSA), the LA pressure drops from a maximum of −20 mm Hg to almost −40 mm Hg . Patients with atrial fibrillation (AF) have a high prevalence rate (49%) of OSA, and long apnea episodes have been reported to cause massive air embolism during AF ablation .…”

Section: Introductionmentioning

confidence: 99%

Prevention of serious air embolism during cryoballoon ablation; risk assessment of air intrusion into the sheath by catheter selection and change in intrathoracic pressure: An ex vivo study

Tsukahara

Oginosawa

Fujino

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction One cause of cerebral infarction during cryoballoon ablation is the entry of air into a sheath due to the use of inappropriate catheters. It is known that the left atrial pressure of patients with obstructive sleep apnea syndrome can be negative. However, the effects of catheter selection and negative pressure changes in the sheath on air intrusion are not yet well understood. The aim of this study was to evaluate how catheter selection and negative pressure changes affect air intrusion and to perform countermeasures for air intrusion. Methods and Results This experiment used siphon principle to create negative pressure in the sheath. Noncryoablation catheters (not designed exclusively for cryoballoon ablation) and cryoballoon catheters were investigated. Catheters were inserted into the sheath and then removed. Thereafter, the amount of air in the sheath was measured. For catheters producing significantly larger amounts of air intrusion, the catheters were inserted via a long sheath in the sheath (sheath‐in‐sheath technique) and the same procedures were repeated. We found that the amount of air intrusion through most of the noncryoablation catheters was significantly larger than that through cryoablation catheters. An increase in the magnitude of negative pressure in the sheath resulted in a proportional increase in air intrusion, but the sheath‐in‐sheath technique significantly reduced air intrusion. Conclusion The amount of air intrusion increased when using catheters with complicated tip shapes and thin outer diameters and when the magnitude of negative pressure in the sheath increased. The sheath‐in‐sheath technique may be an effective countermeasure.

show abstract

“…3 This could be related, at least in part, to right to left shunting across a PFO, as evidenced by invasive hemodynamic measurements in healthy humans, demonstrating that during the onset of simulated OSA, the right atrial pressure exceeds left atrial pressure in response to the steep decline in intrathoracic pressure. 4 Improvement of arterial oxygen saturation by PFO closure may prevent this problem.…”

mentioning

confidence: 99%

Patent Foramen Ovale Closure in Obstructive Sleep Apnea Improves Blood Pressure and Cardiovascular Function

et al. 2015

View full text Add to dashboard Cite

O bstructive sleep apnea (OSA) is characterized by intermittent hypoxemia and associated with increased prevalence of vascular dysfunction and arterial hypertension, but the underlying mechanisms are incompletely understood.1 In OSA, apneas are related to excessive throat muscle relaxation with consequent inspiratory efforts against the closed glottis, finally resulting in the patient's arousal associated with sympathetic activation and hyperventilation. The hyperventilation, in turn, contributes to the next apnea by reducing the arterial partial pressure of CO 2 toward the apnea threshold. In this scenario, arterial oxygen desaturation plays a pivotal role by narrowing the gap between the eupneic and apneic CO 2 pressure level, thereby rendering the CO 2 -controlled breathing regulation more unstable and, thus, prone to periodic breathing. 2In patients with OSA, the presence of patent foramen ovale (PFO) is associated with a marked increase in the frequency and severity of nocturnal oxygen desaturations.3 This could be related, at least in part, to right to left shunting across a PFO, as evidenced by invasive hemodynamic measurements in healthy humans, demonstrating that during the onset of simulated OSA, the right atrial pressure exceeds left atrial pressure in response to the steep decline in intrathoracic pressure. 4 Improvement of arterial oxygen saturation by PFO closure may prevent this problem.We recently reported preliminary findings showing that PFO closure in patients with newly diagnosed OSA was associated with a reduction of nocturnal apnea-hypopnea events and oxygen desaturations and decreased pulmonary artery pressure.5 Moreover, circumstantial evidence shows that intermittent hypoxia is associated with systemic endothelial dysfunction and arterial hypertension. 6,7 In line with these observations, systemic endothelial function is impaired in OSA patients without any traditional cardiovascular risk factors.8 Systemic endothelial dysfunction precedes the development of arteriosclerosis and contributes to the pathogenesis of arterial hypertension.9 Accordingly, the prevalence of arterial Abstract-Obstructive sleep apnea (OSA) is a frequent syndrome characterized by intermittent hypoxemia and increased prevalence of arterial hypertension and cardiovascular morbidity. In OSA, the presence of patent foramen ovale (PFO) is associated with increased number of apneas and more severe oxygen desaturation. We hypothesized that PFO closure improves sleep-disordered breathing and, in turn, has favorable effects on vascular function and arterial blood pressure. In 40 consecutive patients with newly diagnosed OSA, we searched for PFO. After initial cardiovascular assessment, the 14 patients with PFO underwent initial device closure and the 26 without PFO served as control group. Conventional treatment for OSA was postponed for 3 months in both groups, and polysomnographic and cardiovascular examinations were repeated at the end of the follow-up period. PFO closure significantly improved the apnea-hypopnea index ...

show abstract

Interatrial pressure gradients during simulated obstructive sleep apnea: A catheter‐based study

Cited by 24 publications

References 16 publications

Untitled

Untitled

Prevention of serious air embolism during cryoballoon ablation; risk assessment of air intrusion into the sheath by catheter selection and change in intrathoracic pressure: An ex vivo study

Patent Foramen Ovale Closure in Obstructive Sleep Apnea Improves Blood Pressure and Cardiovascular Function

Contact Info

Product

Resources

About