FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W4386770108> ?p ?o ?g. }

• W4386770108 abstract "We presented a detailed time course of RFCA-associated PV calcification process. Because RFCA-associated PV calcification may progress over time even with a single ablation, long-term caution should be paid in cases of especially extensive ablation and/or patients with stiff LA syndrome A 52-year-old Japanese man was admitted to our center for a fourth PV isolation for recurrence of symptomatic paroxysmal atrial fibrillation (AF). His medical history included hypertension, left nephrectomy for renal cancer, and hemodialysis for chronic glomerulonephritis since the age of 27 years. The patient underwent cavotricuspid isthmus (CTI) ablation without warfarinization 16 years prior. PV isolation was performed under the guidance of three-dimensional (3D) electroanatomic mapping (CARTO 3; Biosense Webster Inc.). The patient was administered warfarin during the perioperative period of PV isolation. The radiofrequency (RF) energy was applied using a quadripolar 3.5-mm-tip irrigation catheter (Thermocool, Biosense Webster, Diamond Bar, CA, USA). Basically, the RF energy was 25–30 W in the right PVs, anterior of the left PVs, and carina line and 20–25 W at the posterior of the left PVs (near the esophagus). In the first session, we achieved right PV isolation; however, left PV isolation was abandoned because of ridge connection, despite linear ablation of the left PV carina. In the second session 12 months after the first session, we confirmed reconnection of the right PV. Re-isolation of the right PV, including linear ablation of the right PV carina and left PV isolation was performed, and all four PVs were isolated. In the third session 44 months after the first session, we solely confirmed the reconnection of the right inferior PV, while the right inferior PV could not be isolated, even with a maximum of 35 W. Since the area of ablation was extensive, we decided to abandon isolating the right inferior PV in consideration of the risk of PV stenosis. Preoperative computed tomography (CT) for the third session showed PV calcification for the first time in the right PV carina (Figure 1-RA). Fifty-six months after the first session, a CT scan for follow-up of renal cancer showed calcifications in the roof of the left superior PV and the bottom of the left inferior PV (Figure 1-LAr, LAb). In the fourth session 101 months after the first session, preoperative CT showed that the bilateral PV calcification had obviously progressed (Figure 1-RDs, RDi, LCr, LC, LCb). The preoperative 3D CT showed a calcified area around the left PV and in the right PV carina (Figure 2A'–C′; white part). All calcification sites were located along past ablation lines. However, no calcification was observed in the previous CTI ablation line. We solely confirmed the reconnection of the right inferior PV and successfully isolated it by ablating the posterior wall of the right inferior PV with 30 W (non-calcified lesions). Since AF initiation was reproducibly observed from the posterior left atrium (LA), LA posterior wall isolation was additionally performed. No other non-PV foci were observed with drug or pacing. There was neither recurrence of AF nor heart failure at 4 months after discharge. Reports of RFCA-associated PV calcifications were limited1 and the detailed time course of calcification process has not been determined. It took a relatively long time (44 months) from the initial PV isolation to the first finding of PV calcification (Figure 3). During the observation period, the total amount of calcification increased over time, whereas echocardiography showed no consistent changes in E/e’, which is an indicator of LA diastolic dysfunction, or in systolic pulmonary artery pressure (Figure S1). We have shown that RFCA-associated PV calcification was not fully explained by the time since the initial ablation, the frequency of ablations, or the ablation energy (Figure 2D). A recent paper reported that multiple ablation procedures were independent risk factors for calcification.1 Unlike previous studies, we analyzed the relationship between the ablation site of multiple sessions and the site of calcification over time and semiquantitatively. Although the overall calcification increased with each session after the second procedure, the number of ablation sessions per site did not correlate with calcification. Hence calcification may progress over time even with a single ablation. These results, which cannot be explained by ablation factors, suggest that RFCA-associated calcification may also be influenced by factors on the myocardial side. A recent paper speculated that the presence of consistently high wall stresses cause calcification at the site, and wall stresses in PV ostia is high.1 However, it has also been reported that the distribution of high wall stresses in the LA varies among subjects, hence there was a possibility that wall stresses was low in some areas of the LA, which are non-calcified in this case. Moreover, there have been no reports of RFCA-associated CTI calcification including in our case. One speculation is that in addition to the differences in wall stresses associated with structural differences between PV ostia and CTI, wall stresses is known to correlate with intracardiac pressure, so calcification may not have appeared in CTI in the right atrium, where pressure is lower than in the LA. There are several possible mechanisms underlying calcification. Ectopic calcification deposits because of disturbances in calcium and phosphorus metabolism caused by chronic renal disease or hyperparathyroidism, and calcification deposits on necrotic tissues are thought to be responsible.2 In patients with rheumatism, chronic inflammation is thought to cause calcification of the LA.2 Oral vitamin K antagonists (VKA), such as warfarin, have the potential to decrease the activity of matrix-γ-carboxyglutamic acid protein, a strong inhibitor of soft tissue calcification.3 Although this patient was on dialysis, the serum calcium and phosphorus levels were only mildly elevated, at 10.5 and 4.9 mg/dL, respectively. An animal study demonstrated that RF energy causes inflammation, coagulation necrosis, and edema in the acute phase, and fibrosis, fatty degeneration, and sometimes calcification in the chronic phase.4 This has the potential to explain the relatively long time required for calcification after RFCA. It has been reported that the longer the VKA is used, the higher the coronary calcium scores.3 However, the period of warfarin use in the present case was only the perioperative period of PV isolation (1 month before and 3 months after RFCA, Figure 3), and furthermore, the site of PV calcification was clearly along the previous ablation line. Hence, calcification could not be explained by metabolic disorders alone. These results suggested that the main mechanism of PV calcification in this case was calcification deposits in catheter ablation-associated necrotic tissues. Here, we present a detailed time course of RFCA-associated PV calcification process for the first time. It is known that progressive calcification has the potential to reduce the function of the LA as a reservoir or booster pump.5 Because RFCA-associated PV calcification may progress over time even with a single ablation, long-term caution should be paid in cases of especially extensive ablation and/or patients with stiff LA syndrome. Authors declare no conflict of interests for this article. Informed consent was obtained from the patient. Figure S1 Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article." @default.
• W4386770108 created "2023-09-16" @default.
• W4386770108 creator A5000693907 @default.
• W4386770108 creator A5053082720 @default.
• W4386770108 creator A5058306123 @default.
• W4386770108 creator A5062175237 @default.
• W4386770108 creator A5087503433 @default.
• W4386770108 date "2023-09-15" @default.
• W4386770108 modified "2023-09-26" @default.
• W4386770108 title "Spatiotemporal incremental change of radiofrequency catheter ablation‐associated pulmonary vein calcifications" @default.
• W4386770108 cites W2082356430 @default.
• W4386770108 cites W2123959906 @default.
• W4386770108 cites W2973664944 @default.
• W4386770108 cites W4319460385 @default.
• W4386770108 doi "https://doi.org/10.1002/joa3.12925" @default.
• W4386770108 hasPublicationYear "2023" @default.
• W4386770108 type Work @default.
• W4386770108 citedByCount "0" @default.
• W4386770108 crossrefType "journal-article" @default.
• W4386770108 hasAuthorship W4386770108A5000693907 @default.
• W4386770108 hasAuthorship W4386770108A5053082720 @default.
• W4386770108 hasAuthorship W4386770108A5058306123 @default.
• W4386770108 hasAuthorship W4386770108A5062175237 @default.
• W4386770108 hasAuthorship W4386770108A5087503433 @default.
• W4386770108 hasBestOaLocation W43867701081 @default.
• W4386770108 hasConcept C126322002 @default.
• W4386770108 hasConcept C126838900 @default.
• W4386770108 hasConcept C164705383 @default.
• W4386770108 hasConcept C2776131983 @default.
• W4386770108 hasConcept C2777377203 @default.
• W4386770108 hasConcept C2778902805 @default.
• W4386770108 hasConcept C2780689522 @default.
• W4386770108 hasConcept C3018349756 @default.
• W4386770108 hasConcept C71924100 @default.
• W4386770108 hasConceptScore W4386770108C126322002 @default.
• W4386770108 hasConceptScore W4386770108C126838900 @default.
• W4386770108 hasConceptScore W4386770108C164705383 @default.
• W4386770108 hasConceptScore W4386770108C2776131983 @default.
• W4386770108 hasConceptScore W4386770108C2777377203 @default.
• W4386770108 hasConceptScore W4386770108C2778902805 @default.
• W4386770108 hasConceptScore W4386770108C2780689522 @default.
• W4386770108 hasConceptScore W4386770108C3018349756 @default.
• W4386770108 hasConceptScore W4386770108C71924100 @default.
• W4386770108 hasLocation W43867701081 @default.
• W4386770108 hasOpenAccess W4386770108 @default.
• W4386770108 hasPrimaryLocation W43867701081 @default.
• W4386770108 hasRelatedWork W1994675119 @default.
• W4386770108 hasRelatedWork W2057959040 @default.
• W4386770108 hasRelatedWork W2116263229 @default.
• W4386770108 hasRelatedWork W2116754947 @default.
• W4386770108 hasRelatedWork W2384582930 @default.
• W4386770108 hasRelatedWork W2770148134 @default.
• W4386770108 hasRelatedWork W2965366481 @default.
• W4386770108 hasRelatedWork W3021841437 @default.
• W4386770108 hasRelatedWork W3036776441 @default.
• W4386770108 hasRelatedWork W4377984292 @default.
• W4386770108 isParatext "false" @default.
• W4386770108 isRetracted "false" @default.
• W4386770108 workType "article" @default.