Prospects for the Treatment of Patients With Atrial Fibrillation

Sulimov, V. A.; Лишута, А. С.

doi:10.20996/1819-6446-2011-7-3-323-333

Cited by 8 publications

(4 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Трофимов Николай Александрович. E-mail: nikolai.trofimov@mail.ru Ф ибрилляция предсердий (ФП) -одно из наиболее распространенных нарушений ритма сердца, его частота достигает 2 % случаев в популяции и за последнее десятилетие имеет тенденцию к увеличению [1,2]. Данная аритмия выявляется у 30-84 % пациентов с патологией клапанного аппарата сердца, при этом ФП снижает эффективность хирургического лечения и качество жизни больных данной категории, а также повышает риск развития тромбоэмболических осложнений, способствует нарастанию сердечной недостаточности и в конечном итоге увеличивает смертность [2][3][4][5].…”

Section: автор для перепискиunclassified

Circular Sympathetic Pulmonary Artery Denervation in Cardiac Surgery Patients With Mitral Valve Defect, Atrial Fibrillation and High Pulmonary Hypertension

et al. 2020

View full text Add to dashboard Cite

Objective Investigate the influence of the sympathetic denervation of the pulmonary trunk and the orifices of the pulmonary arteries on the degree of pulmonary hypertension (PH) and outcomes of the surgical treatment of atrial fibrillation (AF) in patients with mitral valve defects, complicated AF, and high PH.Material and methods We analyzed the surgical treatment of 140 patients with mitral valve defect, concomitant AF, and high PH – pulmonary artery systolic pressure (PASP) gradient more than 40 mm Hg. The group of interest included 51 patients (46 patients with severe mitral stenosis and five patients with grade 4 mitral valve regurgitation). All patients underwent mitral valve correction (47 valve replacement surgeries and 4 valve-sparing interventions), biatrial Maze IV procedure, and additionally, denervation of the pulmonary trunk and the orifices of the pulmonary arteries. The control group included 89 patients diagnosed with mitral valve defect, AF, and PH with PASP > 40 mm Hg. However, unlike in patients of interest, denervation of the pulmonary arteries was not performed.Results Circular radiofrequency denervation of the pulmonary trunk and the orifices of the pulmonary arteries using a clamp-destructor is an effective and safe method, significantly reduces secondary PH (p=0.018), promotes reverse remodeling of the heart chambers, left atrium in particular (p=0.01), and improves outcomes of the Maze IV procedure (p=0.022) by restoring sinus rhythm in patients with mitral valve defects, complicated AF, and high PH.Conclusion This technique must be studied further involving a more significant number of patients, analyzing long-term results, and using this technique in patients with non-valvular causes of secondary PH.

show abstract

Section: автор для перепискиunclassified

Circular Sympathetic Pulmonary Artery Denervation in Cardiac Surgery Patients With Mitral Valve Defect, Atrial Fibrillation and High Pulmonary Hypertension

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The classification (2018) describes 5 cases of PH: pulmonary arterial hypertension (PAH); pulmonary hypertension connected with the pathology of heart left chambers; pulmonary hypertension associated with respiratory system diseases and/or hypoxemia; chronic thromboembolic pulmonary hypertension and other types of obstruction of pulmonary arteries; pulmonary hypertension with unclear or multiple mechanisms [3,9,10].…”

Section: Introductionmentioning

confidence: 99%

IMMUNOHISTOCHEMICAL CRITERIA OF PULMONARY ARTERY CIRCULAR DENERVATION EFFICIENCY IN EXPERIMENT (animals, pigs)

2022

pnr

View full text Add to dashboard Cite

Research objective. Evaluation of the influence of various modes of radiofrequency circular exposure on immunohistochemical parameters of pulmonary trunk tissues in the experiment on animals (pigs).Materials and methods. The experiments were made on outbred pigs -12 animals. During the experiment 3 groups were formed, 4 animals in each. The first experimental group comprised 188 histological samples of pulmonary artery (PA) after circular radiofrequency exposure on PA using an ablator clamp. Two lines of ablation impact on the pulmonary trunk and two lines of impact on each mouth of PA were performed with the formation of 6 ablation lines. The ablation was performed until the target level of tissue impedance between the ablator jaws corresponding to the values for transmural damage was reached. The second experimental group comprised 162 histological samples of PA after circular denervation of the pulmonary trunk and mouths of both PAs according to the described method. The ablation was completed upon reaching 50% of the impedance level relative to the impedance values for transmural damage. The third groupcontrol, without circular radiofrequency exposure (55 histological samples). The obtained material was studied by light microscopy, typical general pathological processes were recorded with the help of staining with hematoxylin and eosin. The changes in the connective tissue (fibrous, muscle) were found with the help of Van Gieson staining. The thermoablative effect degree was assessed using semi-quantitative analysis of pathological processes (Olpred stain intensity assessment). In order to assess the degree of impact on the nerve fibers of different layers of PA, an immunohistochemical study (IHC) of the samples was carried out in all three groups. The expression of S-100 protein and synaptophysin was evaluated.Conclusion. Average optic density of the samples of the ablation groups was significantly lower than in the control group (p <0.001). When calculating the specific area of the connective tissue disconnection, its greater value was determined in "the edge zones" of the sections in both experimental groups, which is due to mechanical compression of tissues, compaction of their structure and, as a result, an increase in capacitive characteristics as a current collector and conductor for radio frequency rate ( p = 0.056). IHC analysis of preparations made it possible to qualitatively assess the damage to the trunks and endings of peripheral nerve fibers in the adventitial and intimal layers of PA section after radiofrequency exposure in the experimental groups.In the first experimental group the active expression of synaptophysin and protein S-100 of sympathetic nerve fibers was absent in the adventitial and, as a rule, in the intimal layers. In the preparations obtained from PA of animals of the second experimental group, the activity of synaptophysin in synaptic fibers and expression of protein S-100 of endothelium vasa vasorum were also not determined in the adventitial layer. At the same time, the posi...

show abstract

“…Correction of valvular disorders is necessary for the successful treatment of AF [ 1 ]. However, in most cases, this is not enough: surgical treatment of a mitral defect in patients with preoperative AF provides restoration of sinus rhythm only in 8.5–20.0% of cases, thereby, additional surgical intervention is required [ 5 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Histological Justification for the Need of Radiofrequency Ablation of Pulmonary Arteries in Patients with High-Grade Secondary Pulmonary Hypertension

Trofimov¹,

Rodionov²,

Egorov³

et al. 2021

Sovrem Tehnol Med

View full text Add to dashboard Cite

The aim of the study was to perform a histological assessment of the effectiveness of radiofrequency exposure for circular denervation of the pulmonary artery in patients with secondary high pulmonary hypertension.Materials and Methods. The study was carried out on the autopsy material derived from non-operated patients. Three groups were formed. The experimental group included the material (207 histological samples) from the patients with chronic high pulmonary hypertension arising on the background of mitral heart disease. The samples of this group were exposed to circular radiofrequency ablation. In the comparison group, we used autopsy material (24 samples) obtained from the patients with high pulmonary hypertension. The control group included material (35 samples) from the patients without pulmonary hypertension who died from causes not associated with cardiovascular diseases. The samples of the comparison and control groups were not exposed to radiofrequency.Visual evaluation of the damage to the vascular wall was performed after hematoxylin and eosin staining, according to Van Gieson. Damage to the nerve plexuses was evaluated after their impregnation by silver salts. To assess the degree of damage to the vascular wall on the stained sections, a scoring method of semi-quantitative analysis of the observed pathological processes (fibrinoid necrosis, metachromasia, karyorrhexis, karyolysis, fibrinoid and mucoid swelling, lipid presence) was used. Silver salt impregnation allowed visualizing damage to the reticular fibers, trunks and endings of peripheral nerve fibers.Results. The mean optical density of the ablation group was statistically significantly lower than in the comparison and control groups (p<0.001). The mean specific area of tissue dissociation was higher in the "marginal zones" of the ablated sections, under pronounced mechanical compression in these areas. The difference in the mean areas of the argentophilic samples of the ablation and comparison and control groups was expressed in a lower percentage of argentophilic fibrous structures (p<0.05). At the same time, the highest concentration of argentophilic structures was observed in the comparison group, which points to a bigger content of nerve fiber structures in the patients with high pulmonary hypertension. Conclusion.The results of the histological study demonstrated the feasibility of radiofrequency ablation of the pulmonary arteries in patients with high-grade secondary pulmonary hypertension. Radiofrequency denervation leads to the destruction of the sympathetic ganglia in the adventitial layer of the pulmonary arteries, which are responsible for the spasm of the precapillary bed of the pulmonary circulation, which promotes vasodilation, an increase in the vascular bed, and, as a result, a reduction in pulmonary hypertension.

show abstract

Prospects for the Treatment of Patients With Atrial Fibrillation

Cited by 8 publications

References 22 publications

Circular Sympathetic Pulmonary Artery Denervation in Cardiac Surgery Patients With Mitral Valve Defect, Atrial Fibrillation and High Pulmonary Hypertension

Circular Sympathetic Pulmonary Artery Denervation in Cardiac Surgery Patients With Mitral Valve Defect, Atrial Fibrillation and High Pulmonary Hypertension

IMMUNOHISTOCHEMICAL CRITERIA OF PULMONARY ARTERY CIRCULAR DENERVATION EFFICIENCY IN EXPERIMENT (animals, pigs)

Histological Justification for the Need of Radiofrequency Ablation of Pulmonary Arteries in Patients with High-Grade Secondary Pulmonary Hypertension

Contact Info

Product

Resources

About