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"NO"Atp challenge markedly improves ablation outcome tokyo, japan. The average complete success rate (no af, no antiarrhythmics) for 729 initial ablation procedures evaluated in the 2008 ablation/maze survey was 50% for 15 top-ranked institutions and 21% of other institutions. After follow-up procedures the final complete success rates were 65% for top-ranked institutions (30% repeat rate) and 32% for other institutions (44% repeat rate). Now japanese researchers report that success rates can be markedly improved by attempting to induce atrial fibrillation 20 minutes after completing the initial procedure and then re-ablating in cases where afib recurs. It is common practice to pace the heart while infusing an isoproterenol solution when electrical isolation of the pulmonary veins from the left atrium has been achieved in order to attempt to induce af associated with acute electrical reconnection of the veins to the atrium. Isoproterenol is a beta adrenergic agonist which can induce tachycardia and other arrhythmias. The novelty in the approach used by the japanese researchers is that they also inject atp (adenosine-5’-triphosphate) while pacing the heart and infusing isoproterenol. Atp is a molecule which transports energy within cells to aid in metabolism. In the japanese study, the combination of pacing, isoproterenol, and atp revealed dormant reconnection in 225 pulmonary veins (24% of the 928 veins originally isolated). In comparison, pacing and isoproterenol alone only revealed dormant reconnection in 3 veins (0. 3% of originally isolated veins). Thus using a combination of isoproterenol and atp to check for acute (dormant) reconnections is substantially more effective than using isoproterenol alone. The study involved 144 patients with paroxysmal af, 43 with persistent af, and 46 with permanent af. The median age of the group was 55 years, 88% were men, and only 9% had underlying structural heart disease; so this study group consisted essentially of typical lone afibbers. All participants underwent a segmental pulmonary vein isolation procedure (pvi) using a lasso catheter for mapping. Patients with permanent (long-lasting persistent) af underwent additional ablation targeting complex fractionated electrograms and continuous electrical activity during ongoing afib. Those who had a history of right atrial flutter also underwent cavotricuspid isthmus ablation. Electrogram-based ablation was performed in all 46 patients with permanent af and a right atrial flutter ablation w. cheap viagra online cheap viagra viagra for sale buy generic viagra viagra online cheap viagra online generic viagra online buy cheap viagra buy generic viagra viagra without a doctor prescription Annual Fee
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