51
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Komatsu Y, Nogami A, Shinoda Y, Masuda K, Machino T, Kuroki K, Yamasaki H, Sekiguchi Y, Aonuma K. Idiopathic Ventricular Arrhythmias Originating From the Vicinity of the Communicating Vein of Cardiac Venous Systems at the Left Ventricular Summit. Circ Arrhythm Electrophysiol 2018; 11:e005386. [DOI: 10.1161/circep.117.005386] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 11/28/2017] [Indexed: 11/16/2022]
Abstract
Background
The communicating vein (CV) between the great cardiac vein and small cardiac venous systems passes between the aortic and pulmonary annulus and is located in close association with the left ventricular summit (summit CV).
Methods and Results
Thirty-one patients with idiopathic ventricular arrhythmias (VAs) underwent mapping of the left ventricular summit by using a 2F microcatheter introduced into the summit CV with coronary sinus venographic guidance. Of these, 14 patients were found to have summit-CV VAs. The remaining 17 patients (control group) had VAs originating from the right ventricular outflow tract and the aortic cusps. In patients with summit-CV VAs, the earliest activation during VAs in the summit CV preceded QRS onset by 34.1±5.3 ms. The summit-CV VAs exhibited inferior axis, negative polarity in lead I, deeper QS wave in lead aVL than aVR, and nonspecific bundle branch block morphology with an R/S ratio in lead V
1
of 0.67±0.33, which could be distinguishable from VAs originating from the right ventricular outflow tract and the right coronary cusp. Because of the inaccessibility of the summit CV to ablation catheter, ablation of summit-CV VAs was attempted at adjacent structures where an excellent pacemap was rarely obtained. Overall ablation success was achieved in 10 (71%) patients with summit VAs and 15 (88%) patients in control group (
P
=0.24).
Conclusions
The myocardium near the summit CV can be the source of idiopathic VAs. Direct monitoring of the summit CV is helpful for identifying the site of origin and provides a landmark of the ablation target, which may facilitate ablation through adjacent structures.
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Affiliation(s)
- Yuki Komatsu
- From the Department of Cardiology, University of Tsukuba, Japan
| | - Akihiko Nogami
- From the Department of Cardiology, University of Tsukuba, Japan
| | | | - Keita Masuda
- From the Department of Cardiology, University of Tsukuba, Japan
| | - Takeshi Machino
- From the Department of Cardiology, University of Tsukuba, Japan
| | - Kenji Kuroki
- From the Department of Cardiology, University of Tsukuba, Japan
| | - Hiro Yamasaki
- From the Department of Cardiology, University of Tsukuba, Japan
| | - Yukio Sekiguchi
- From the Department of Cardiology, University of Tsukuba, Japan
| | - Kazutaka Aonuma
- From the Department of Cardiology, University of Tsukuba, Japan
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53
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Lin CY, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Liao JN, Tuan TC, Chao TF, Chang YT, Chen YY, Te ALD, Yamada S, Kuo L, Vicera JJB, Chang TY, Minh HQ, Salim S, Huang TC, Chen SA. Novel electrophysiological criteria for septal ventricular outflow tract tachycardias requiring a sequential bilateral ablation. J Cardiovasc Electrophysiol 2017; 29:298-307. [PMID: 29071756 DOI: 10.1111/jce.13376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Septal ventricular outflow tract ventricular arrhythmias (OT-VAs) are defined as septal origin VAs from the right ventricular or left ventricular OT. Patients with septal OT-VAs may require a sequential bilateral OT ablation. This study aimed to evaluate the electrophysiological characteristics and ablation outcome in patients with septal OT-VAs. METHODS We retrospectively analyzed the electrocardiography and electrophysiological parameters in 96 patients (mean age 49 ± 15 years, 49 male) undergoing bilateral activation mapping before catheter ablation of idiopathic septal OT-VAs. The patients were categorized into three groups based on the successful ablation sites, including the right ventricular outflow tract (RVOT), RVOT/left ventricular outflow tract (LVOT), and LVOT. RESULTS Mapping in the three groups demonstrated a gradually decreasing and increasing trend in the earliest activation time obtained from the RVOT and LVOT, respectively. The absolute earliest activation time discrepancy (AEAD) of ≤18 milliseconds could predict the requirement for a sequential bilateral ablation with a sensitivity and specificity of 100.0% and 93.7%, respectively. The small AEAD (≤21 milliseconds) was associated with a higher recurrence rate in patients receiving a successful unilateral ablation, while patients with a longer distance between the bilateral OT earliest activation sites (DEA > 26 mm) increased future recurrences after an initially successful sequential bilateral ablation. CONCLUSIONS The application of bilateral OT-VA activation mapping and the measurement of the AEAD and DEA provided not only pivotal information for the ablation strategy, but also prognostic implications for recurrences in patients with septal OT-VAs.
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Affiliation(s)
- Chin-Yu Lin
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Taipei Veterans General Hospital, YuanShan Branch, Yi-Lan, Taiwan
| | - Fa-Po Chung
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Lin Chang
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Wei Lo
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Feng Hu
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jo-Nan Liao
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tze-Fan Chao
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yao-Ting Chang
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yun-Yu Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Abigail Louise D Te
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shinya Yamada
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ling Kuo
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jennifer Jeanne B Vicera
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ting-Yung Chang
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hoang Quang Minh
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Simon Salim
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ting-Chung Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Multiform premature ventricular contractions: A reason not to ablate? Heart Rhythm 2017; 14:1629-1630. [PMID: 28797679 DOI: 10.1016/j.hrthm.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 11/20/2022]
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55
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Yamada T, Doppalapudi H, Litovsky SH, McElderry HT, Kay GN. Challenging Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Summit Near the Left Main Coronary Artery. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004202. [DOI: 10.1161/circep.116.004202] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 08/25/2016] [Indexed: 11/16/2022]
Abstract
Background—
Radiofrequency catheter ablation (RFCA) of idiopathic ventricular arrhythmias (VAs) originating from the basal portion of the left ventricular (LV) summit, which is divided from the apical LV (A-LV) summit by the great cardiac vein (GCV), is challenging. This study investigated the efficacy of RFCA and electrocardiographic and electrophysiological characteristics of these VAs.
Methods and Results—
Forty-five consecutive patients with symptomatic idiopathic LV summit VAs were studied. RFCA was successful within the main trunk of the GCV in 16 patients and within a branch of the GCV traversing the basal LV (B-LV) summit in 7. Transpericardial RFCA was successful on the epicardial surface in the A-LV summit in 6 patients and was abandoned in 14 with the B-LV summit VAs because of the close proximity to the coronary arteries and thick fat pads. RFCA was successful at the aortomitral continuity in 3 patients (2 with a failed transpericardial RFCA), and left coronary cusp in 1. The RFCA success rate of the A-LV summit VAs including the GCV VAs was 100% (22/22), whereas that of the B-LV summit VAs was 48% (11/23). The B-LV summit VAs could be differentiated from the A-LV summit VAs by left bundle branch block pattern, QRS duration ≤175 ms, precordial transition ≥V1, and maximum deflection index of ≥0.55.
Conclusions—
This study revealed that ≈50% of the B-LV summit VAs could be eliminated by a direct approach through a GCV branch running below the proximal left coronary arteries and a remote approach from the adjacent endocardial sites.
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Affiliation(s)
- Takumi Yamada
- From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Harish Doppalapudi
- From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - Silvio H. Litovsky
- From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
| | - G. Neal Kay
- From the Division of Cardiovascular Disease (T.Y., H.D., H.T.M., G.N.K.) and Department of Pathology (S.H.L.), University of Alabama at Birmingham
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Santangeli P, Callans DJ. Idiopathic Outflow Tract Ventricular Arrhythmia Ablation. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004537. [DOI: 10.1161/circep.116.004537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pasquale Santangeli
- From the Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
| | - David J. Callans
- From the Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
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Yamada T, Doppalapudi H, Maddox WR, McElderry HT, Plumb VJ, Kay GN. Prevalence and Electrocardiographic and Electrophysiological Characteristics of Idiopathic Ventricular Arrhythmias Originating From Intramural Foci in the Left Ventricular Outflow Tract. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004079. [DOI: 10.1161/circep.116.004079] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 07/19/2016] [Indexed: 11/16/2022]
Abstract
Backgrounds—
Idiopathic ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT) sometimes require catheter ablation from both the endocardial and epicardial sides for their elimination, suggesting the presence of intramural VA foci. This study investigated the prevalence and electrocardiographic and electrophysiological characteristics of these idiopathic intramural LVOT VAs when compared with the idiopathic endocardial and epicardial LVOT VAs.
Methods and Results—
We studied 82 consecutive VAs with origins in the aortomitral continuity (n=30), LV summit (n=34), and intramural site (n=18). The maximum deflection index (the time to the maximum deflection in the precordial leads/QRS duration) was the largest in LV summit VAs (0.52±0.07), smallest in aortomitral continuity VAs (0.45±0.06), and midrange in intramural VAs (0.49±0.05). The electrocardiographic and electrophysiological characteristics of the intramural LVOT VAs were similar to those of the aortomitral continuity VAs. The intramural LVOT VAs exhibited a significantly smaller R-wave amplitude ratio in leads III to II, and ratio of the Q-wave amplitude in leads aVL to aVR, and a significantly earlier and later local ventricular activation time relative to the QRS onset at the His bundle and successful ablation sites than the LV summit VAs, respectively.
Conclusions—
Intramural sites account for a significant proportion of LVOT VAs. The electrocardiographic and electrophysiological characteristics of the idiopathic intramural LVOT VAs were midrange between those of the idiopathic endocardial and epicardial LVOT VAs, and more similar to those of the idiopathic endocardial LVOT VAs than those of the idiopathic epicardial LVOT VAs.
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Affiliation(s)
- Takumi Yamada
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - Harish Doppalapudi
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - William R. Maddox
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - Vance J. Plumb
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - G. Neal Kay
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
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Heeger CH, Hayashi K, Kuck KH, Ouyang F. Catheter Ablation of Idiopathic Ventricular Arrhythmias Arising From the Cardiac Outflow Tracts - Recent Insights and Techniques for the Successful Treatment of Common and Challenging Cases. Circ J 2016; 80:1073-86. [PMID: 27074752 DOI: 10.1253/circj.cj-16-0293] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Ventricular arrhythmias (VA), like premature ventricular contractions (PVC) and ventricular tachycardia (VT) in patients without structural heart disease (idiopathic VA), mainly arise from the right and left ventricular outflow tracts (RVOT/LVOT). The prognosis for OT VA is generally good in the majority of patients, but there is potential for developing dilated cardiomyopathies from the high burden of VA, as well as a certain risk for sudden cardiac death because of fast monomorphic VT or polymorphic VT triggered by short-coupling PVC. Radiofrequency catheter ablation (RFCA) has evolved into a widely accepted treatment strategy for patients suffering from VAs. A detailed knowledge of surface ECGs and complex cardiac anatomy, especially within the ventricular OTs, is essential for the understanding of cardiac OT-VAs and highly related to safe and successful RFCA procedures. This review article focuses on RFCA of idiopathic VA arising from the cardiac OT as well as adjacent regions and will illustrate recent insights and technical issues. (Circ J 2016; 80: 1073-1086).
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Yokokawa M, Jung DY, Hero III AO, Baser K, Morady F, Bogun F. Single- and dual-site pace mapping of idiopathic septal intramural ventricular arrhythmias. Heart Rhythm 2016; 13:72-7. [DOI: 10.1016/j.hrthm.2015.08.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Indexed: 10/23/2022]
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Yokokawa M, Morady F, Bogun F. Injection of cold saline for diagnosis of intramural ventricular arrhythmias. Heart Rhythm 2016; 13:78-82. [DOI: 10.1016/j.hrthm.2015.08.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Indexed: 11/28/2022]
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Njeim M, Bogun F. Selecting the Appropriate Ablation Strategy: the Role of Endocardial and/or Epicardial Access. Arrhythm Electrophysiol Rev 2015; 4:184-8. [PMID: 26835123 DOI: 10.15420/aer.2015.4.3.184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 10/27/2015] [Indexed: 11/04/2022] Open
Abstract
Percutaneous catheter ablation has emerged as an effective treatment modality for the management of ventricular tachycardia. Despite years of progress in this field, the role of epicardial mapping and ablation needs to be further refined. In this review, we discuss the relationship between the type of underlying heart disease and the location of the arrythmogenic substrate as it pertains to a procedural approach. We describe the contribution of preprocedural and intraprocedural diagnostic tools for the localisation of the arrhythmogenic substrate, with a special emphasis on cardiac MRI and electrophysiological mapping. In our opinion, the preferred approach to target ventricular tachycardia should depend on the patient's underlying heart disease and the location of scar tissue, which can be best visualised using cardiac MRI.
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Yamada T, Maddox WR, McElderry HT, Doppalapudi H, Plumb VJ, Kay GN. Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From Intramural Foci in the Left Ventricular Outflow Tract. Circ Arrhythm Electrophysiol 2015; 8:344-52. [PMID: 25637597 DOI: 10.1161/circep.114.002259] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 01/18/2015] [Indexed: 11/16/2022]
Abstract
Backgrounds—
Idiopathic ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT) sometimes require catheter ablation from the endocardial and epicardial sides for their elimination, suggesting the presence of intramural VA foci. This study investigated the efficacy of sequential and simultaneous unipolar radiofrequency catheter ablation from the endocardial and epicardial sides in treating intramural LVOT VAs.
Methods and Results—
Fourteen consecutive LVOT VAs, which required sequential or simultaneous irrigated unipolar radiofrequency ablation from the endocardial and epicardial sides for their elimination, were studied. The first ablation was performed at the site with the earliest local ventricular activation and best pace map on the endocardial or epicardial side. When the first ablation was unsuccessful, the second ablation was delivered on the other surface. If this sequential unipolar ablation failed, simultaneous unipolar ablation from both sides was performed. The first ablation was performed on the epicardial side in 9 VAs and endocardial side in 5 VAs. The intramural LVOT VAs were successfully eliminated by the sequential (n=9) or simultaneous (n=5) unipolar catheter ablation. Simultaneous ablation was most likely to be required for the elimination of the VAs when the distance between the endocardial and epicardial ablation sites was >8 mm and the earliest local ventricular activation time relative to the QRS onset during the VAs of <–30 ms was recorded at those ablation sites.
Conclusions—
LVOT VAs originating from intramural foci could usually be eliminated by sequential unipolar radiofrequency ablation and sometimes required simultaneous ablation from both the endocardial and epicardial sides.
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Affiliation(s)
- Takumi Yamada
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
| | - William R. Maddox
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
| | - Harish Doppalapudi
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
| | - Vance J. Plumb
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
| | - G. Neal Kay
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham (T.Y., H.T.M., H.D., V.J.P., G.N.K.); and Clinical Cardiac Electrophysiology, Department of Medicine, Georgia Regents University, Augusta (W.R.M.)
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Kusa S, Hachiya H, Iwasawa J, Ichihara N, Komatsu Y, Taniguchi H, Miyazaki S, Nakamura H, Iesaka Y. Ventricular arrhythmias with superior axis originating from the left ventricular septum: electrocardiographic characteristics predicting successful ablation and insights into their mechanism-observations from a small series of patients. Europace 2015; 17:1587-95. [DOI: 10.1093/europace/euu396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 12/15/2014] [Indexed: 11/13/2022] Open
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Asirvatham SJ, Stevenson WG. In the middle. Circ Arrhythm Electrophysiol 2014; 7:982-3. [PMID: 25336369 DOI: 10.1161/circep.114.002202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Samuel J Asirvatham
- From the Division of Cardiovascular Diseases, Department of Medicine, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.G.S.).
| | - William G Stevenson
- From the Division of Cardiovascular Diseases, Department of Medicine, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN (S.J.A.); and Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.G.S.)
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Chen H, Shehata M, Swerdlow C, Ma W, Xu G, Yang B, Chen M, Wang X. Intramural Outflow Tract Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2014; 7:978-81. [DOI: 10.1161/circep.114.001744] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hongwu Chen
- From the Heart Rhythm Center, The Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., S.C., W.M., G.X., X.W.); and Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (H.C., B.Y., M.C.)
| | - Michael Shehata
- From the Heart Rhythm Center, The Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., S.C., W.M., G.X., X.W.); and Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (H.C., B.Y., M.C.)
| | - Charles Swerdlow
- From the Heart Rhythm Center, The Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., S.C., W.M., G.X., X.W.); and Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (H.C., B.Y., M.C.)
| | - Wei Ma
- From the Heart Rhythm Center, The Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., S.C., W.M., G.X., X.W.); and Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (H.C., B.Y., M.C.)
| | - Gang Xu
- From the Heart Rhythm Center, The Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., S.C., W.M., G.X., X.W.); and Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (H.C., B.Y., M.C.)
| | - Bing Yang
- From the Heart Rhythm Center, The Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., S.C., W.M., G.X., X.W.); and Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (H.C., B.Y., M.C.)
| | - Minglong Chen
- From the Heart Rhythm Center, The Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., S.C., W.M., G.X., X.W.); and Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (H.C., B.Y., M.C.)
| | - Xunzhang Wang
- From the Heart Rhythm Center, The Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.S., S.C., W.M., G.X., X.W.); and Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (H.C., B.Y., M.C.)
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Baser K, Bas HD, Yokokawa M, Latchamsetty R, Morady F, Bogun F. Infrequent intraprocedural premature ventricular complexes: implications for ablation outcome. J Cardiovasc Electrophysiol 2014; 25:1088-92. [PMID: 24841954 DOI: 10.1111/jce.12454] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/23/2014] [Accepted: 05/13/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Frequent premature ventricular complexes (PVCs) can be eliminated with an ablation procedure. Ablation success rates have been reported to be in the 80% range. Reasons for failure of ablation have not been described in detail. The purpose of this study was to determine whether the paucity of PVCs at the beginning of the ablation procedure affects the outcome. METHODS Catheter ablation was attempted in a consecutive series of 194 patients (age: 50 ± 14 years, 91 male, ejection fraction: 56.4 ± 8.4%) with frequent idiopathic PVCs. Based on receiver operator characteristics (ROC) analysis, patients were divided into 2 groups: Patients with frequent PVCs (≥32 PVCs within the first 30 minutes of the procedure: n = 135 [70%]); and patients with infrequent PVCs (<32 PVCs within the first 30 minutes of the procedure: n = 59 [30%]). Procedural outcomes were compared at 3 months postablation. A successful ablation was defined as a ≥80% reduction in the PVC burden compared to baseline. RESULTS A successful procedure was performed in 148 patients (76%) resulting in a decrease in the PVC burden from 19.1 ± 13.6% to 0.38 ± 0.98%(P < 0.0001). Patients with frequent intraprocedural PVCs had a higher success rate than patients with infrequent intraprocedural PVCs (85% vs. 56%, P = 0.0001). Administration of sedation was no different in the 2 groups. The paucity of PVCs was independent of the site of origin in predicting procedural failure (OR: 6.9, 95% CI: 3.0-16.2 P = 0.0001). CONCLUSION Paucity of PVCs at the beginning of an ablation procedure is associated with a lower ablation success rate independent of the site of origin.
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Affiliation(s)
- Kazim Baser
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Tilz RR, Makimoto H, Lin T, Rillig A, Deiss S, Wissner E, Mathew S, Metzner A, Rausch P, Kuck KH, Ouyang F. Electrical isolation of a substrate after myocardial infarction: a novel ablation strategy for unmappable ventricular tachycardias--feasibility and clinical outcome. Europace 2014; 16:1040-52. [DOI: 10.1093/europace/eut419] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Ventricular arrhythmias may be benign, requiring only evaluation for associated risks and then reassurance, or associated with a risk of sudden death or significant morbidity. Therapies for these arrhythmias have evolved considerably over the past 20 years. For some, a definitive, curative therapy is available in the form of catheter ablation. Others are best managed with an implantable cardioverter-defibrillator that provides effective arrhythmia termination and protection from sudden death, with antiarrhythmic drugs or ablation to control recurrent arrhythmias. Although progress has been substantial, many challenges remain.
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Desjardins B, Yokokawa M, Good E, Crawford T, Latchamsetty R, Jongnarangsin K, Ghanbari H, Oral H, Pelosi F, Chugh A, Morady F, Bogun F. Characteristics of Intramural Scar in Patients With Nonischemic Cardiomyopathy and Relation to Intramural Ventricular Arrhythmias. Circ Arrhythm Electrophysiol 2013; 6:891-7. [DOI: 10.1161/circep.113.000073] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Benoit Desjardins
- From the Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI (M.Y., E.G., T.C., R.L., K.J., H.G., H.O., F.P., A.C., F.M.); and the Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA (B.D.)
| | - Miki Yokokawa
- From the Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI (M.Y., E.G., T.C., R.L., K.J., H.G., H.O., F.P., A.C., F.M.); and the Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA (B.D.)
| | - Eric Good
- From the Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI (M.Y., E.G., T.C., R.L., K.J., H.G., H.O., F.P., A.C., F.M.); and the Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA (B.D.)
| | - Thomas Crawford
- From the Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI (M.Y., E.G., T.C., R.L., K.J., H.G., H.O., F.P., A.C., F.M.); and the Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA (B.D.)
| | - Rakesh Latchamsetty
- From the Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI (M.Y., E.G., T.C., R.L., K.J., H.G., H.O., F.P., A.C., F.M.); and the Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA (B.D.)
| | - Krit Jongnarangsin
- From the Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI (M.Y., E.G., T.C., R.L., K.J., H.G., H.O., F.P., A.C., F.M.); and the Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA (B.D.)
| | - Hamid Ghanbari
- From the Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI (M.Y., E.G., T.C., R.L., K.J., H.G., H.O., F.P., A.C., F.M.); and the Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA (B.D.)
| | - Hakan Oral
- From the Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI (M.Y., E.G., T.C., R.L., K.J., H.G., H.O., F.P., A.C., F.M.); and the Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA (B.D.)
| | - Frank Pelosi
- From the Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI (M.Y., E.G., T.C., R.L., K.J., H.G., H.O., F.P., A.C., F.M.); and the Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA (B.D.)
| | - Aman Chugh
- From the Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI (M.Y., E.G., T.C., R.L., K.J., H.G., H.O., F.P., A.C., F.M.); and the Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA (B.D.)
| | - Fred Morady
- From the Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI (M.Y., E.G., T.C., R.L., K.J., H.G., H.O., F.P., A.C., F.M.); and the Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA (B.D.)
| | - Frank Bogun
- From the Division of Cardiology, University of Michigan Medical Center, Ann Arbor, MI (M.Y., E.G., T.C., R.L., K.J., H.G., H.O., F.P., A.C., F.M.); and the Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, PA (B.D.)
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Yokokawa M, Good E, Crawford T, Chugh A, Pelosi F, Latchamsetty R, Jongnarangsin K, Ghanbari H, Oral H, Morady F, Bogun F. Reasons for failed ablation for idiopathic right ventricular outflow tract-like ventricular arrhythmias. Heart Rhythm 2013; 10:1101-8. [DOI: 10.1016/j.hrthm.2013.05.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Indexed: 10/26/2022]
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Tholakanahalli VN, Bertog S, Roukoz H, Shivkumar K. Catheter ablation of ventricular tachycardia using intracoronary wire mapping and coil embolization: description of a new technique. Heart Rhythm 2012; 10:292-6. [PMID: 23089899 DOI: 10.1016/j.hrthm.2012.10.031] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Indexed: 12/26/2022]
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