151
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Koutalas E, Rolf S, Dinov B, Richter S, Arya A, Bollmann A, Hindricks G, Sommer P. Contemporary Mapping Techniques of Complex Cardiac Arrhythmias - Identifying and Modifying the Arrhythmogenic Substrate. Arrhythm Electrophysiol Rev 2015; 4:19-27. [PMID: 26835095 PMCID: PMC4711490 DOI: 10.15420/aer.2015.4.1.19] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 01/12/2015] [Indexed: 12/16/2022] Open
Abstract
Cardiac electrophysiology has moved a long way forward during recent decades in the comprehension and treatment of complex cardiac arrhythmias. Contemporary electroanatomical mapping systems, along with state-of-the-art technology in the manufacture of electrophysiology catheters and cardiac imaging modalities, have significantly enriched our armamentarium, enabling the implementation of various mapping strategies and techniques in electrophysiology procedures. Beyond conventional mapping strategies, ablation of complex fractionated electrograms and rotor ablation in atrial fibrillation ablation procedures, the identification and modification of the underlying arrhythmogenic substrate has emerged as a strategy that leads to improved outcomes. Arrhythmogenic substrate modification also has a major role in ventricular tachycardia ablation procedures. Optimisation of contact between tissue and catheter and image integration are a further step forward to augment our precision and effectiveness. Hybridisation of existing technologies with a reasonable cost should be our goal over the next few years.
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Affiliation(s)
- Emmanuel Koutalas
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Sascha Rolf
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
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152
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Kumar S, Barbhaiya CR, Sobieszczyk P, Eisenhauer AC, Couper GS, Nagashima K, Mahida S, Baldinger SH, Choi EK, Epstein LM, Koplan BA, John RM, Michaud GF, Stevenson WG, Tedrow UB. Role of alternative interventional procedures when endo- and epicardial catheter ablation attempts for ventricular arrhythmias fail. Circ Arrhythm Electrophysiol 2015; 8:606-15. [PMID: 25925229 DOI: 10.1161/circep.114.002522] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 04/21/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Ventricular tachycardia (VT) refractory to antiarrhythmic drugs and standard percutaneous catheter ablation techniques portends a poor prognosis. We characterized the reasons for ablation failure and describe alternative interventional procedures in this high-risk group. METHODS AND RESULTS Sixty-seven patients with VT refractory to 4±2 antiarrhythmic drugs and 2±1 previous endocardial/epicardial catheter ablation attempts underwent transcoronary ethanol ablation, surgical epicardial window (Epi-window), or surgical cryoablation (OR-Cryo; age, 62±11 years; VT storm in 52%). Failure of endo/epicardial ablation attempts was because of VT of intramural origin (35 patients), nonendocardial origin with prohibitive epicardial access because of pericardial adhesions (16), and anatomic barriers to ablation (8). In 8 patients, VT was of nonendocardial origin with a coexisting condition also requiring cardiac surgery. Transcoronary ethanol ablation alone was attempted in 37 patients, OR-Cryo alone in 21 patients, and a combination of transcoronary ethanol ablation and OR-Cryo (5 patients), or transcoronary ethanol ablation and Epi-window (4 patients), in the remainder. Overall, alternative interventional procedures abolished ≥1 inducible VT and terminated storm in 69% and 74% of patients, respectively, although 25% of patients had at least 1 complication. By 6 months post procedures, there was a significant reduction in defibrillator shocks (from a median of 8 per month to 1; P<0.001) and antiarrhythmic drug requirement although 55% of patients had at least 1 VT recurrence, and mortality was 17%. CONCLUSIONS A collaborative strategy of alternative interventional procedures offers the possibility of achieving arrhythmia control in high-risk patients with VT that is otherwise uncontrollable with antiarrhythmic drugs and standard percutaneous catheter ablation techniques.
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Affiliation(s)
- Saurabh Kumar
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA.
| | - Chirag R Barbhaiya
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Piotr Sobieszczyk
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Andrew C Eisenhauer
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Gregory S Couper
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Koichi Nagashima
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Saagar Mahida
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Samuel H Baldinger
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Eue-Keun Choi
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Laurence M Epstein
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Bruce A Koplan
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Roy M John
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Gregory F Michaud
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - William G Stevenson
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Usha B Tedrow
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA.
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153
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Schade A, Nentwich K, Müller P, Krug J, Kerber S, Deneke T. [Electrical storm in the emergency room: clinical pathways]. Herzschrittmacherther Elektrophysiol 2015; 25:73-81. [PMID: 24898990 DOI: 10.1007/s00399-014-0312-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In patients with structural heart disease, occurrence of an electrical storm (ES) is associated with increased mortality acutely and during medium term follow-up. Depending on the underlying heart disease and baseline type of arrhythmia, different clinical pathways have to be followed to reach sustained freedom from ventricular arrhythmia recurrences. Trigger elimination, sympathetic blockade (initially using betablockers and sedation), antiarrhythmic therapy with amiodarone and catheter ablation, treatment of heart failure and invasive hemodynamic support are cornerstones of the treatment. We present an algorithm which may help to organize an optimized treatment for each ES patient, implementing invasive treatment options like coronary angioplasty, catheter ablation and invasive circulatory support. Further studies are necessary to evaluate medium term outcome of such a structured therapy.
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Affiliation(s)
- Anja Schade
- Klinik für Kardiologie II (Interventionelle Elektrophysiologie), Herz-und Gefäßklinik Bad Neustadt, Bad Neustadt a.d. Saale, Deutschland,
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154
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Choi EK, Kumar S, Nagashima K, Lin KY, Barbhaiya CR, Chinitz JS, Enriquez AD, Helmbold AF, Baldinger SH, Tedrow UB, Koplan BA, Michaud GF, John RM, Epstein LM, Stevenson WG. Better outcome of ablation for sustained outflow-tract ventricular tachycardia when tachycardia is inducible. Europace 2015; 17:1571-9. [DOI: 10.1093/europace/euv064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 02/23/2015] [Indexed: 11/13/2022] Open
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155
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Berte B, Yamashita S, Sacher F, Cochet H, Hooks D, Aljefairi N, Amraoui S, Denis A, Derval N, Hocini M, Haïssaguerre M, Jaïs P. Epicardial only mapping and ablation of ventricular tachycardia: a case series. Europace 2015; 18:267-73. [DOI: 10.1093/europace/euv072] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 03/03/2015] [Indexed: 01/10/2023] Open
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156
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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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157
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Sultan A, Lüker J, Hoffmann B, Servatius H, Aydin A, Nührich J, Akbulak Ö, Schreiber D, Schäffer B, Rostock T, Willems S, Steven D. Necessity of epicardial ablation for ventricular tachycardia after sequential endocardial approach. Int J Cardiol 2015; 182:56-61. [DOI: 10.1016/j.ijcard.2014.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/17/2014] [Accepted: 12/01/2014] [Indexed: 11/25/2022]
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158
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Moubarak G, Anselme F. Indications des ablations dans le traitement des arythmies cardiaques. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1040-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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159
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Leong KMW, Lim PB, Kanagaratnam P. Comparative analysis of diagnostic 12-lead electrocardiography and 3-dimensional noninvasive mapping. Card Electrophysiol Clin 2015; 7:71-78. [PMID: 25784023 DOI: 10.1016/j.ccep.2014.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The clinical utility of noninvasive electrocardiographic imaging has been demonstrated in a variety of conditions. It has recently been shown to have superior predictive accuracy and higher clinical value than validated 12-lead electrogram algorithms in the localization of arrhythmias arising from the ventricular outflow tract, and displays similar potential in other conditions.
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Affiliation(s)
- Kevin Ming Wei Leong
- Department of Cardiology, International Centre for Circulatory Health, St Mary's Hospital, Praed Street, Paddington, London W2 1NY, UK
| | - Phang Boon Lim
- Department of Cardiology, International Centre for Circulatory Health, St Mary's Hospital, Praed Street, Paddington, London W2 1NY, UK
| | - Prapa Kanagaratnam
- Department of Cardiology, International Centre for Circulatory Health, St Mary's Hospital, Praed Street, Paddington, London W2 1NY, UK.
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160
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Berte B, Derval N, Sacher F, Yamashita S, Haïssaguerre M, Jaïs P. A case of incessant VT from an intramural septal focus: Ethanol or bipolar ablation? HeartRhythm Case Rep 2015; 1:89-94. [PMID: 28491520 PMCID: PMC5418617 DOI: 10.1016/j.hrcr.2015.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | | | | | | | - Pïerre Jaïs
- Address reprint requests and correspondence: Dr Pierre Jaïs, Hôpital Cardiologique du Haut-Lévêque, Université de Bordeaux, LIRYC Institute, Bordeaux-Pessac 33604, France
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161
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Incidence and relevance of nonreentrant monomorphic ventricular tachycardia in patients with frequent implantable cardioverter defibrillator interventions. J Interv Card Electrophysiol 2015; 42:151-60. [DOI: 10.1007/s10840-015-9973-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 01/13/2015] [Indexed: 11/27/2022]
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162
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Killu AM, Wan SH, Munger TM, Hodge DO, Mulpuru S, Packer DL, Asirvatham SJ, Friedman PA. Pericardial effusion following drain removal after percutaneous epicardial access for an electrophysiology procedure. Pacing Clin Electrophysiol 2015; 38:383-90. [PMID: 25583074 DOI: 10.1111/pace.12565] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/10/2014] [Accepted: 11/16/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the frequency and predictors of pericardial effusion following epicardial sheath removal. BACKGROUND Pericardial effusion can occur following cardiac surgical or interventional procedures including percutaneous epicardial access (EpiAcc), which is increasingly used as part of electrophysiology ablation procedures. METHODS A retrospective analysis of the Mayo Clinic comprehensive electronic medical record was performed from all patients who underwent planned EpiAcc as part of an electrophysiology ablation procedure between January 1, 2004 and June 30, 2013. RESULTS Of 144 patients (mean age 51.3 ± 15.5 years, 68% male) who underwent planned EpiAcc as part of an electrophysiology ablation (95.8% pericardial access success rate), seven (4.9%) developed a postoperative pericardial effusion requiring repeat EpiAcc. Inferior access was utilized in 74 (51.4%) patients. Patients with pericardial effusion tended to be younger (41.1 years vs 51.8 years, P = 0.08) and were more likely to have undergone inferior approach access (85.7% vs 49.6%, P = 0.06) than those who did not develop postoperative pericardial effusion. Seventy-one percent of patients with postoperative pericardial effusion versus 32.1% of patients without postoperative pericardial effusion had a preprocedure ejection fraction ≥55% (P = 0.03). There were no procedural-related deaths, and no difference in mortality between groups. CONCLUSIONS Postoperative pericardial effusion requiring repeat access/drainage was relatively infrequent, occurring in 4.9% of patients shortly after epicardial procedures. While the majority occur early and therefore require close observation, some patients may present in a delayed manner.
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Affiliation(s)
- Ammar M Killu
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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163
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Lin T, Conti S, Cipolletta L, Marino V, Zucchetti M, Russo E, Pizzamiglio F, AlMohani G, Pala S, Catto V, Biase LD, Natale A, Tondo C, Carbucicchio C. Right Ventricular Outflow Tract Arrhythmias: Benign Or Early Stage Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia? J Atr Fibrillation 2014; 7:1161. [PMID: 27957137 DOI: 10.4022/jafib.1161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 10/24/2014] [Accepted: 10/24/2014] [Indexed: 01/01/2023]
Abstract
Ventricular arrhythmias (VAs) arising from the right ventricular outflow tract (RVOT) are a common and heterogeneous entity. Idiopathic right ventricular arrhythmias (IdioVAs) are generally benign, with excellent ablation outcomes and long-term arrhythmia-free survival, and must be distinguished from other conditions associated with VAs arising from the right ventricle: the differential diagnosis with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is therefore crucial because VAs are one of the most important causes of sudden cardiac death (SCD) in young individuals even with early stage of the disease. Radiofrequency catheter ablation (RFCA) is a current option for the treatment of VAs but important differences must be considered in terms of indication, purposes and procedural strategies in the treatment of the two conditions. In this review, we comprehensively discuss clinical and electrophysiological features, diagnostic and therapeutic techniques in a compared analysis of these two entities.
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Affiliation(s)
- Tina Lin
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Sergio Conti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Cipolletta
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Vittoria Marino
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Martina Zucchetti
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Eleonora Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Ghaliah AlMohani
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Salvatore Pala
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Valentina Catto
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Luigi Di Biase
- Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA; Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA; Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA; Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA
| | - Andrea Natale
- Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA; Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA; Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA; Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA; Texas Cardiac Arrhytmia Institute at St David's Medical Centre, Austin , TX, USA
| | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Corrado Carbucicchio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
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164
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Rillig A, Lin T, Ouyang F, Kuck KH, Tilz RR. Which Is The Appropriate Arrhythmia Burden To Offer RF Ablation For RVOT Tachycardias? J Atr Fibrillation 2014; 7:1157. [PMID: 27957135 DOI: 10.4022/jafib.1157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 12/14/2022]
Abstract
Premature ventricular complexes (PVCs) and ventricular tachycardia (VT) in patients with structurally normal hearts originate from the right ventricular outflow tract (RVOT) in the majority of cases. In the last few decades catheter ablation of these arrhythmias has been proven to be effective. RVOT VT/PVCs may cause disabling symptoms or arrhythmia induced cardiomyopathy. However, the PVC burden at which catheter ablation should be recommended is still controversial. What adds to the controversy is why some patients with only a low number of PVCs can be highly symptomatic and may even develop arrhythmia induced cardiomyopathy, whilst others may have a higher PVC/VT burden and remain asymptomatic and do not develop cardiomyopathy for a long period of time. Therefore, although catheter ablation of RVOT PVCs has high success and low complication rates, the time point of when ablation should be recommended is currently still under debate. This review discusses the treatment strategies and prognosis for RVOT tachycardias and focuses on the question of which arrhythmia burden is appropriate to offer RF ablation.
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Affiliation(s)
- Andreas Rillig
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Tina Lin
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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165
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Proietti R, Essebag V, Beardsall J, Hache P, Pantano A, Wulffhart Z, Juta R, Tsang B, Joza J, Nascimento T, Pegoraro V, Khaykin Y, Verma A. Substrate-guided ablation of haemodynamically tolerated and untolerated ventricular tachycardia in patients with structural heart disease: effect of cardiomyopathy type and acute success on long-term outcome. Europace 2014; 17:461-7. [DOI: 10.1093/europace/euu326] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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166
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Sacher F, Lim HS, Derval N, Denis A, Berte B, Yamashita S, Hocini M, Haissaguerre M, Jaïs P. Substrate mapping and ablation for ventricular tachycardia: the LAVA approach. J Cardiovasc Electrophysiol 2014; 26:464-471. [PMID: 25328104 DOI: 10.1111/jce.12565] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 09/28/2014] [Accepted: 10/08/2014] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Catheter ablation of ventricular tachycardia (VT) is proven effective therapy particularly in patients with frequent defibrillator shocks. However, the optimal endpoint for VT ablation has been debated and additional endpoints have been proposed. At the same time, ablation strategies aiming at homogenizing the substrate of scar-related VT have been reported. METHODS AND RESULTS Our method to homogenize the substrate consists of local abnormal ventricular activity (LAVA) elimination. LAVA are high-frequency sharp signals that represent near-field signals of slowly conducting tissue and hence potential VT isthmuses. Pacing maneuvers are sometimes required to differentiate them from far-field signals. Delayed enhancement on cardiac MRI and/or wall thinning on multidetector computed tomography are also extremely helpful to identify the areas of interest during ablation. A strategy aiming at careful LAVA mapping, ablation, and elimination is feasible and can be achieved in about 70% of patients with scar-related VT. Complete LAVA elimination is associated with a better outcome when compared to LAVA persistence even when VT is rendered noninducible. CONCLUSION This is a simple approach, with a clear endpoint and the ability to ablate in sinus rhythm. This strategy significantly benefits from high-definition imaging, mapping, and epicardial access.
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Affiliation(s)
- Frederic Sacher
- Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France
| | - Han S Lim
- Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France
| | - Arnaud Denis
- Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France
| | - Benjamin Berte
- Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France
| | - Seigo Yamashita
- Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France
| | - Michel Haissaguerre
- Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, Bordeaux University, INSERM 1045, Bordeaux-Pessac, France
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Nicoara A, Holmquist F, Raggains C, Mathew JP. Anesthesia for Catheter Ablation Procedures. J Cardiothorac Vasc Anesth 2014; 28:1589-603. [DOI: 10.1053/j.jvca.2014.05.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Indexed: 11/11/2022]
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Basiouny T, Kholeif HAEL, El-Tahan MH, Karim M, Attia W, El-Din MMMM. Radiofrequency catheter ablation of premature ventricular complexes from right ventricular outflow tract in patients with left ventricular dilation and/or dysfunction. Egypt Heart J 2014. [DOI: 10.1016/j.ehj.2014.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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169
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Alcaine A, Soto-Iglesias D, Calvo M, Guiu E, Andreu D, Fernandez-Armenta J, Berruezo A, Laguna P, Camara O, Martinez JP. A Wavelet-Based Electrogram Onset Delineator for Automatic Ventricular Activation Mapping. IEEE Trans Biomed Eng 2014; 61:2830-9. [DOI: 10.1109/tbme.2014.2330847] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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170
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Ferrero JM, Trenor B, Romero L. Multiscale computational analysis of the bioelectric consequences of myocardial ischaemia and infarction. Europace 2014; 16:405-15. [PMID: 24569895 DOI: 10.1093/europace/eut405] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Ischaemic heart disease is considered as the single most frequent cause of death, provoking more than 7 000 000 deaths every year worldwide. A high percentage of patients experience sudden cardiac death, caused in most cases by tachyarrhythmic mechanisms associated to myocardial ischaemia and infarction. These diseases are difficult to study using solely experimental means due to their complex dynamics and unstable nature. In the past decades, integrative computational simulation techniques have become a powerful tool to complement experimental and clinical research when trying to elucidate the intimate mechanisms of ischaemic electrophysiological processes and to aid the clinician in the improvement and optimization of therapeutic procedures. The purpose of this paper is to briefly review some of the multiscale computational models of myocardial ischaemia and infarction developed in the past 20 years, ranging from the cellular level to whole-heart simulations.
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Affiliation(s)
- Jose M Ferrero
- Departamento de Ingeniería Electrónica, Instituto I3BH, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
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171
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Ranjan R, McGann CJ, Jeong EK, Hong K, Kholmovski EG, Blauer J, Wilson BD, Marrouche NF, Kim D. Wideband late gadolinium enhanced magnetic resonance imaging for imaging myocardial scar without image artefacts induced by implantable cardioverter-defibrillator: a feasibility study at 3 T. Europace 2014; 17:483-8. [PMID: 25336666 DOI: 10.1093/europace/euu263] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM Late gadolinium enhanced (LGE) magnetic resonance imaging (MRI) is a useful tool for facilitating ventricular tachycardia (VT) ablation. Unfortunately, most VT ablation candidates often have prophylactic implantable cardioverter-defibrillator (ICD) and do not undergo cardiac MRI largely due to image artefacts generated by ICD. A prior study has reported success of 'wideband' LGE MRI for imaging myocardial scar without image artefacts induced by ICD at 1.5T. The purpose of this study was to widen the availability of wideband LGE MRI to 3T, since it has the potential to achieve higher spatial resolution than 1.5T. METHODS AND RESULTS We compared the performance of standard and wideband LGE MRI pulse sequences in phantoms and canines with myocardial lesions created by radiofrequency ablation. Standard LGE MRI produced image artefacts induced by ICD and 49% accuracy in detecting 97 myocardial scars examined in this study, whereas wideband LGE MRI produced artefact-free images and 94% accuracy in detecting scars. The mean image quality score (1 = nondiagnostic, 2 = poor, 3 = adequate, 4 = good, 5 = excellent) was significantly (P < 0.001) higher for wideband (3.7 ± 0.8) than for standard LGE MRI (2.1 ± 0.7). The mean artefact level score (1 = minimal, 2 = mild, 3 = moderate, 4 = severe, 5 = nondiagnostic) was significantly (P < 0.001) lower for wideband (2.1 ± 0.8) than for standard LGE MRI (4.0 ± 0.6). Wideband LGE MRI agreed better with gross pathology than standard LGE MRI. CONCLUSION This study demonstrates the feasibility of wideband LGE MRI for suppression of image artefacts induced by ICD at 3T.
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Affiliation(s)
- Ravi Ranjan
- CARMA Center, Division of Cardiology, Internal Medicine, University of Utah, 30 North 1900 East, Rm 4A100, Salt Lake City, UT 84132, USA
| | - Christopher J McGann
- CARMA Center, Division of Cardiology, Internal Medicine, University of Utah, 30 North 1900 East, Rm 4A100, Salt Lake City, UT 84132, USA
| | - Eun-Kee Jeong
- UCAIR, Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - KyungPyo Hong
- UCAIR, Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Eugene G Kholmovski
- CARMA Center, Division of Cardiology, Internal Medicine, University of Utah, 30 North 1900 East, Rm 4A100, Salt Lake City, UT 84132, USA UCAIR, Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Josh Blauer
- CARMA Center, Division of Cardiology, Internal Medicine, University of Utah, 30 North 1900 East, Rm 4A100, Salt Lake City, UT 84132, USA
| | - Brent D Wilson
- CARMA Center, Division of Cardiology, Internal Medicine, University of Utah, 30 North 1900 East, Rm 4A100, Salt Lake City, UT 84132, USA
| | - Nassir F Marrouche
- CARMA Center, Division of Cardiology, Internal Medicine, University of Utah, 30 North 1900 East, Rm 4A100, Salt Lake City, UT 84132, USA
| | - Daniel Kim
- UCAIR, Department of Radiology, University of Utah, Salt Lake City, UT, USA
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Yu R, Ma S, Tung R, Stevens S, Macias C, Bradfield J, Buch E, Vaseghi M, Fujimura O, Gornbein J, Mandapati R, Shivkumar K, Boyle NG. Catheter ablation of scar-based ventricular tachycardia: Relationship of procedure duration to outcomes and hospital mortality. Heart Rhythm 2014; 12:86-94. [PMID: 25285644 DOI: 10.1016/j.hrthm.2014.10.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Ablation has become an important option for treatment of ventricular tachycardia (VT). The influence of procedure duration on outcomes remains unexamined. OBJECTIVE The purpose of this study was to determine the influence of procedure duration on outcomes and complications over an 8-year period METHODS Patients referred for scar-mediated VT ablation from 2004 to 2011 were retrospectively analyzed. Procedure duration was defined as the time from the insertion of catheters through the femoral vein to the time of their withdrawal. Procedure duration was analyzed in relationship with baseline and intraoperative covariates, acute procedural outcomes, complications, and 6-month clinical outcomes. RESULTS One hundred forty-eight patients underwent VT ablation with mean procedure duration of 5.7 ± 1.8 hours. VT recurrence and survival at 6 months were 46% and 82%, respectively, and were not associated with procedure duration. Hospital mortality increased with intraoperative intraaortic balloon pump insertion (adjusted odds ratio [OR] 13.7, 95% confidence interval [CI] 2.35-79.94, P = .004) and was improved with successful ablation of the clinical VT as a procedural end-point (adjusted OR 0.13, 95% Cl 0.03-0.54, P = .005). The association between procedure duration and hospital mortality remained after adjusting for significant baseline variables (adjusted OR 1.75, 95% CI 1.14-2.68, P = .0098) and intraoperative variables (adjusted OR 1.6, 95% CI 1.12-2.29, P = .0104). CONCLUSION Hospital mortality was significantly increased by unsuccessful clinical VT ablation as a procedural end-point and intraoperative intraaortic balloon pump insertion. However, after adjusting for significant baseline and intraoperative covariates, procedure duration still was associated with increased hospital mortality. Procedure duration had no impact on VT recurrence and survival at 6 months.
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Affiliation(s)
- Ricky Yu
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Sootkeng Ma
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Roderick Tung
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Steven Stevens
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Carlos Macias
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jason Bradfield
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Eric Buch
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Osama Fujimura
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jeffrey Gornbein
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ravi Mandapati
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California.
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Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GY, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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174
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Neven K, van Driel V, van Wessel H, van Es R, du Pré B, Doevendans PA, Wittkampf F. Safety and Feasibility of Closed Chest Epicardial Catheter Ablation Using Electroporation. Circ Arrhythm Electrophysiol 2014; 7:913-9. [DOI: 10.1161/circep.114.001607] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kars Neven
- From the Departments of Cardiology (K.N., V.v.D., H.v.W., R.v.E., B.d.P., P.A.D., F.W.) and Medical Physiology (B.d.P.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen, Germany (K.N.); St Jude Medical, Veenendaal, The Netherlands (H.v.W.); and ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D.)
| | - Vincent van Driel
- From the Departments of Cardiology (K.N., V.v.D., H.v.W., R.v.E., B.d.P., P.A.D., F.W.) and Medical Physiology (B.d.P.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen, Germany (K.N.); St Jude Medical, Veenendaal, The Netherlands (H.v.W.); and ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D.)
| | - Harry van Wessel
- From the Departments of Cardiology (K.N., V.v.D., H.v.W., R.v.E., B.d.P., P.A.D., F.W.) and Medical Physiology (B.d.P.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen, Germany (K.N.); St Jude Medical, Veenendaal, The Netherlands (H.v.W.); and ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D.)
| | - René van Es
- From the Departments of Cardiology (K.N., V.v.D., H.v.W., R.v.E., B.d.P., P.A.D., F.W.) and Medical Physiology (B.d.P.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen, Germany (K.N.); St Jude Medical, Veenendaal, The Netherlands (H.v.W.); and ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D.)
| | - Bastiaan du Pré
- From the Departments of Cardiology (K.N., V.v.D., H.v.W., R.v.E., B.d.P., P.A.D., F.W.) and Medical Physiology (B.d.P.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen, Germany (K.N.); St Jude Medical, Veenendaal, The Netherlands (H.v.W.); and ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D.)
| | - Pieter A. Doevendans
- From the Departments of Cardiology (K.N., V.v.D., H.v.W., R.v.E., B.d.P., P.A.D., F.W.) and Medical Physiology (B.d.P.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen, Germany (K.N.); St Jude Medical, Veenendaal, The Netherlands (H.v.W.); and ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D.)
| | - Fred Wittkampf
- From the Departments of Cardiology (K.N., V.v.D., H.v.W., R.v.E., B.d.P., P.A.D., F.W.) and Medical Physiology (B.d.P.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen, Germany (K.N.); St Jude Medical, Veenendaal, The Netherlands (H.v.W.); and ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (P.A.D.)
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EBRILLE ELISA, KILLU AMMARM, ANAVEKAR NANDANS, PACKER DOUGLASL, MUNGER THOMASM, MCLEOD CHRISTOPHERJ, ASIRVATHAM SAMUELJ, FRIEDMAN PAULA. Successful Percutaneous Epicardial Access in Challenging Scenarios. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:84-90. [DOI: 10.1111/pace.12503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/30/2014] [Accepted: 08/01/2014] [Indexed: 12/19/2022]
Affiliation(s)
- ELISA EBRILLE
- Division of Cardiovascular Diseases; Department of Medicine; Mayo Clinic; Rochester Minnesota
| | - AMMAR M. KILLU
- Division of Cardiovascular Diseases; Department of Medicine; Mayo Clinic; Rochester Minnesota
| | - NANDAN S. ANAVEKAR
- Division of Cardiovascular Diseases; Department of Medicine; Mayo Clinic; Rochester Minnesota
| | - DOUGLAS L. PACKER
- Division of Cardiovascular Diseases; Department of Medicine; Mayo Clinic; Rochester Minnesota
| | - THOMAS M. MUNGER
- Division of Cardiovascular Diseases; Department of Medicine; Mayo Clinic; Rochester Minnesota
| | - CHRISTOPHER J. MCLEOD
- Division of Cardiovascular Diseases; Department of Medicine; Mayo Clinic; Rochester Minnesota
| | - SAMUEL J. ASIRVATHAM
- Division of Cardiovascular Diseases; Department of Medicine; Mayo Clinic; Rochester Minnesota
- Department of Pediatrics and Adolescent Medicine; Mayo Clinic; Rochester Minnesota
| | - PAUL A. FRIEDMAN
- Division of Cardiovascular Diseases; Department of Medicine; Mayo Clinic; Rochester Minnesota
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177
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Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GYH, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Europace 2014; 16:1257-83. [PMID: 25172618 DOI: 10.1093/europace/euu194] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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178
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Gorenek B, Blomström Lundqvist C, Brugada Terradellas J, Camm AJ, Hindricks G, Huber K, Kirchhof P, Kuck KH, Kudaiberdieva G, Lin T, Raviele A, Santini M, Tilz RR, Valgimigli M, Vos MA, Vrints C, Zeymer U, Kristiansen SB, Lip GY, Potpara T, Fauchier L, Sticherling C, Roffi M, Widimsky P, Mehilli J, Lettino M, Schiele F, Sinnaeve P, Boriani G, Lane D, Savelieva I. Cardiac arrhythmias in acute coronary syndromes: position paper from the joint EHRA, ACCA, and EAPCI task force. Europace 2014; 16:1655-73. [DOI: 10.1093/europace/euu208] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Bulent Gorenek
- Department of Cardiology, Aarhus University Hospital, Denmark
| | | | | | - A. John Camm
- Department of Cardiology, Aarhus University Hospital, Denmark
| | | | - Kurt Huber
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Paulus Kirchhof
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Karl-Heinz Kuck
- Department of Cardiology, Aarhus University Hospital, Denmark
| | | | - Tina Lin
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Antonio Raviele
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Massimo Santini
- Department of Cardiology, Aarhus University Hospital, Denmark
| | | | | | - Marc A. Vos
- Department of Cardiology, Aarhus University Hospital, Denmark
| | | | - Uwe Zeymer
- Department of Cardiology, Aarhus University Hospital, Denmark
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Zeppenfeld K. The ideal end point for ablation in postinfarction ventricular tachycardia: one may not fit all. Circ Arrhythm Electrophysiol 2014; 7:567-9. [PMID: 25140016 DOI: 10.1161/circep.114.001925] [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)
- Katja Zeppenfeld
- From the Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
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180
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Neven K, van Driel V, van Wessel H, van Es R, Doevendans PA, Wittkampf F. Epicardial linear electroporation ablation and lesion size. Heart Rhythm 2014; 11:1465-70. [DOI: 10.1016/j.hrthm.2014.04.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Indexed: 10/25/2022]
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181
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Mahida S, Berte B, Yamashita S, Derval N, Denis A, Shah A, Amraoui S, Hocini M, Haissaguerre M, Jais P, Sacher F. New Ablation Technologies and Techniques. Arrhythm Electrophysiol Rev 2014; 3:107-12. [PMID: 26835075 PMCID: PMC4711538 DOI: 10.15420/aer.2014.3.2.107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/28/2014] [Indexed: 11/04/2022] Open
Abstract
Catheter ablation is an established treatment strategy for a range of different cardiac arrhythmias. Over the past decade two major areas of expansion have been ablation of atrial fibrillation (AF) and ventricular tachycardia (VT) in the context of structurally abnormal hearts. In parallel with the expanding role of catheter ablation for AF and VT, multiple novel technologies have been developed which aim to increase safety and procedural success. Areas of development include novel catheter designs, novel navigation technologies and higher resolution imaging techniques. The aim of the present review is to provide an overview of novel developments in AF ablation and VT ablation in patients with of structural cardiac diseases.
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Affiliation(s)
- Saagar Mahida
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Benjamin Berte
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Seigo Yamashita
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Arnaud Denis
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Ashok Shah
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Sana Amraoui
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Meleze Hocini
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Michel Haissaguerre
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Frederic Sacher
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
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Peichl P, Wichterle D, Pavlu L, Cihak R, Aldhoon B, Kautzner J. Complications of Catheter Ablation of Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2014; 7:684-90. [DOI: 10.1161/circep.114.001530] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Petr Peichl
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Dan Wichterle
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ludek Pavlu
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Robert Cihak
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Bashar Aldhoon
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Kautzner
- From the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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183
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Kumar S, Stevenson WG, John RM. Catheter ablation for premature ventricular contractions and ventricular tachycardia in patients with heart failure. Curr Cardiol Rep 2014; 16:522. [PMID: 25059465 DOI: 10.1007/s11886-014-0522-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ventricular arrhythmias (VA) are a significant contributor to morbidity and mortality in patients with heart failure (HF). Implantable cardioverter defibrillators are effective in reducing mortality, but do not prevent arrhythmia recurrence. There is increasing recognition that frequent premature ventricular contractions or repetitive ventricular tachycardia may also lead to new onset ventricular dysfunction or deterioration of ventricular function in patients with pre-existing HF. Suppression of the arrhythmia may lead to recovery of ventricular function. Catheter ablation has emerged as a safe and effective treatment option for reducing arrhythmia recurrence and for suppression of PVCs but its efficacy is governed by the nature of the arrhythmias, the underlying HF substrate and the accessibility of the arrhythmia substrates to ablation.
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Affiliation(s)
- Saurabh Kumar
- Cardiac Arrhythmia Service, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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184
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Grazioli G, Fernández-Armenta J, Prat S, Berruezo A, Brugada J, Sitges M. Ablation of frequent premature ventricular complex in an athlete. Scand J Med Sci Sports 2014; 25:876-9. [PMID: 25048763 DOI: 10.1111/sms.12299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 11/28/2022]
Abstract
Premature ventricular complex are common findings in the exam of many athletes. There is no extensive scientific evidence in the management of this situation particularly when associated with borderline contractile function of the left ventricle. In this case report, we present a 35-year-old asymptomatic healthy athlete with high incidence (over 10,000 beats in 24 h) of premature ventricular complex and left ventricular dilatation with dysfunction, which persisted after a resting period of 6 months without training. We performed radiofrequency ablation of the premature ventricular complex focus. After 1-year follow-up, he was asymptomatic without arrhythmia and the left ventricle normalized its size and function as shown by echocardiogram and cardiac magnetic resonance.
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Affiliation(s)
- G Grazioli
- Group of Sports Cardiology, Arrhythmia Section and Cardiac Imaging Section, Hospital Clinic, Thorax Institute, Barcelona, Catalonia, Spain
| | - J Fernández-Armenta
- Group of Sports Cardiology, Arrhythmia Section and Cardiac Imaging Section, Hospital Clinic, Thorax Institute, Barcelona, Catalonia, Spain
| | - S Prat
- Group of Sports Cardiology, Arrhythmia Section and Cardiac Imaging Section, Hospital Clinic, Thorax Institute, Barcelona, Catalonia, Spain
| | - A Berruezo
- Group of Sports Cardiology, Arrhythmia Section and Cardiac Imaging Section, Hospital Clinic, Thorax Institute, Barcelona, Catalonia, Spain
| | - J Brugada
- Group of Sports Cardiology, Arrhythmia Section and Cardiac Imaging Section, Hospital Clinic, Thorax Institute, Barcelona, Catalonia, Spain
| | - M Sitges
- Group of Sports Cardiology, Arrhythmia Section and Cardiac Imaging Section, Hospital Clinic, Thorax Institute, Barcelona, Catalonia, Spain
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185
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Slack J, Boston RC, Soma LR, Reef VB. Occurrence of cardiac arrhythmias in Standardbred racehorses. Equine Vet J 2014; 47:398-404. [DOI: 10.1111/evj.12299] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 05/01/2014] [Indexed: 12/22/2022]
Affiliation(s)
- J. Slack
- Department of Clinical Studies; New Bolton Center; University of Pennsylvania; USA
| | - R. C. Boston
- Department of Clinical Studies; New Bolton Center; University of Pennsylvania; USA
| | - L. R. Soma
- Department of Clinical Studies; New Bolton Center; University of Pennsylvania; USA
| | - V. B. Reef
- Department of Clinical Studies; New Bolton Center; University of Pennsylvania; USA
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186
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Kim J, Lee M, Rhim JS, Wang P, Lu N, Kim DH. Next-generation flexible neural and cardiac electrode arrays. Biomed Eng Lett 2014. [DOI: 10.1007/s13534-014-0132-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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187
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Nazer B, Gerstenfeld EP. Catheter ablation of ventricular tachycardia in patients with post-infarction cardiomyopathy. Korean Circ J 2014; 44:210-7. [PMID: 25089131 PMCID: PMC4117840 DOI: 10.4070/kcj.2014.44.4.210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Monomorphic ventricular tachycardia (VT) in patients with post-infarction cardiomyopathy (CMP) is caused by reentry through slowly conducting tissue with in areas of myocardial scar. The use of implantable cardioverter-defibrillators (ICDs) has helped to decrease the risk of arrhythmic death in patients with post-infarction CMP, but the symptomatic and psychological burden of ICD shocks remains significant. Experience with catheter ablation has progressed substantially in the past 20 years, and is now routinely used to treat patients with post-infarction CMP who experience VT or receive ICD therapy. Depending on the hemodynamic tolerance of VT, a variety of mapping techniques may be used to identify sites for catheter ablation, including activation and entrainment mapping for mappable VTs, or substrate mapping for unmappable VTs. In this review, we discuss the pathophysiology of VT in post-infarction CMP patients, and the contemporary practice of catheter ablation.
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Affiliation(s)
- Babak Nazer
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Edward P Gerstenfeld
- Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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188
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Trevisi N, Silberbauer J, Radinovic A, Bavila R, Sala S, Vergara P, Bella PD. New diagnostic criteria for identifying left-sided ventricular ectopy using non-contact mapping and virtual unipolar electrogram analysis. Europace 2014; 17:108-16. [DOI: 10.1093/europace/euu145] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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189
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Wißner E, Reißmann B. [Catheter ablation for the treatment of electrical storm: methods and outcome]. Herzschrittmacherther Elektrophysiol 2014; 25:82-7. [PMID: 24898991 DOI: 10.1007/s00399-014-0313-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 03/20/2014] [Indexed: 10/25/2022]
Abstract
Electrical storm imposes a negative effect on quality of life and increases patient mortality. Once antiarrhythmic drug therapy proves ineffective, catheter ablation becomes the therapy of choice. The preferred procedural endpoint following catheter ablation of ES is defined as lack of inducibility of any clinical or non-clinical ventricular arrhythmia. If successful, catheter ablation of ES can significantly lower patient mortality.
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Affiliation(s)
- Erik Wißner
- II. Medizinische Abteilung, Asklepios Klinik St. Georg, Lohmühlenstrasse 5, 20099, Hamburg, Deutschland,
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190
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Ito Y, Shiga K, Yoshida K, Ogata K, Kandori A, Inaba T, Nakazawa Y, Sekiguchi Y, Tada H, Sekihara K, Aonuma K. Development of a magnetocardiography-based algorithm for discrimination between ventricular arrhythmias originating from the right ventricular outflow tract and those originating from the aortic sinus cusp: a pilot study. Heart Rhythm 2014; 11:1605-12. [PMID: 24887136 DOI: 10.1016/j.hrthm.2014.05.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although several reports address characteristic 12-lead electrocardiographic findings of outflow tract ventricular arrhythmias (OT-VAs), the accuracy of electrocardiogram-based algorithms to predict the OT-VA origin is sometimes limited. OBJECTIVE This study aimed to develop a magnetocardiography (MCG)-based algorithm using a novel adaptive spatial filter to differentiate between VAs originating from the aortic sinus cusp (ASC-VAs) and those originating from the right ventricular outflow tract (RVOT-VAs). METHODS This study comprised 51 patients with an OT-VA as the target of catheter ablation. An algorithm was developed by correlating MCG findings with the successful ablation site. The arrhythmias were classified as RVOT-VAs or ASC-VAs. Three parameters were obtained from 3-dimensional MCG imaging: depth of the origin of the OT-VA in the anteroposterior direction; distance between the earliest atrial activation site, that is, sinus node, and the origin of the OT-VA; and orientation of the arrhythmia propagation at the QRS peak. The distance was indexed to the patient's body surface area (in mm/m2). RESULTS Origins of ASC-VAs were significantly deeper (81 ± 6 mm/m(2) vs. 68 ± 8 mm/m(2); P < .01) and farther from the sinus node (55 ± 9 mm/m2 vs. 41 ± 9 mm/m(2); P < .01) than those of RVOT-VAs. ASC-VA propagation had a tendency toward rightward axis. Receiver operating characteristic analyses determined that the depth of the origin was the most powerful predictor, with a sensitivity of 90% and a specificity of 73% (area under the curve = 0.90; P < .01). Discriminant analysis combining all 3 parameters revealed the accuracy of the localization to be 94%. CONCLUSION This MCG-based algorithm appeared to precisely discriminate ASC-VAs from RVOT-VAs. Further investigation is required to validate the clinical value of this technique.
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Affiliation(s)
- Yoko Ito
- Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Keisuke Shiga
- Department of Systems Design & Engineering, Tokyo Metropolitan University, Hachioji, Japan
| | - Kentaro Yoshida
- Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Kuniomi Ogata
- Central Research Laboratory, Hitachi Ltd, Kokubunji, Japan
| | | | - Takeshi Inaba
- Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoko Nakazawa
- Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukio Sekiguchi
- Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroshi Tada
- Cardiovascular Division, Institute of Clinical Medicine, University of Fukui, Yoshida-gun, Japan
| | - Kensuke Sekihara
- Department of Systems Design & Engineering, Tokyo Metropolitan University, Hachioji, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
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191
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Schade A, Nentwich K, Deneke T. Catheter ablation of electrical storm in a patient with left ventricular assist device. Herzschrittmacherther Elektrophysiol 2014; 25:102-104. [PMID: 24853788 DOI: 10.1007/s00399-014-0311-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Catheter ablation is an effective treatment for ventricular tachycardia (VT) in structural heart disease to reduce VT recurrence and implantable cardioverter defibrillator shocks.Current guidelines recommend ablation in patients with recurrent or incessant VT. In patients with left ventricular assist device (LVAD), VTs may be well tolerated hemodynamically and catheter ablation has been performed rarely, until now. We present a case of successful VT ablation in a patient with LVAD and electrical storm. Effective ablation after a transseptal LV access was achieved using electroanatomic mapping and a substrate-based approach. On the basis of this case, we discuss the pros and cons of VT ablation in these patients.
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Affiliation(s)
- Anja Schade
- Klinik für Kardiologie II (Interventionelle Elektrophysiologie), Herz-und Gefäßklinik Bad Neustadt, Salzburger Leite 1, 97616, Bad Neustadt a.d. Saale, Germany,
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192
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Al Mohani G, Israel C, Casella M, Carbucicchio C. Epicardial ablation as a bailout in electrical storm? Herzschrittmacherther Elektrophysiol 2014; 25:93-101. [PMID: 24942696 DOI: 10.1007/s00399-014-0308-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 03/28/2014] [Indexed: 06/03/2023]
Abstract
Electrical storm (ES) is one of the most challenging clinical scenarios facing electrophysiologists, and in certain settings emergency ablation should be performed. The majority of ES occurs in patients with structural heart disease, predominantly coronary heart disease and nonischemic heart disease like right ventricular arrhythmogenic dysplasia and previous myocarditis as well as other cardiomyopathies. Implantable cardioverter-defibrillators (ICDs) are the first-line therapy in patients with ventricular tachycardia (VT) and structural heart disease. Recurrent VT episodes or ES are major problems in patients who receive an ICD after a spontaneous sustained VT. In addition, in patients with an ICD implanted for primary prevention of sudden cardiac death, 20 % will experience at least one VT episode within 3-5 years after ICD implantation. Catheter ablation has a high success rate in the acute setting in eliminating clinical VT. However, several factors make enodocardial catheter ablation of VT more difficult especially in advanced ischemic heart disease with heart failure and aneurysm. Frequently in nonischemic cardiomyopathies (NICM) there tends to be an epicardial and intramyocardial substrate where the critical VT zone can occasionally be epicardial or intramural in location. In some patients, an epicardial approach should be warranted first together with an endocardial approach or after failure of enodocardial ablation. Currently, the success rates of endocardial ablation in the acute setting are acceptable, but in the long term they are still not well defined. The purpose of this article is to highlight the importance of epicardial ablation as an alternative approach in controlling ES and to confirm the need for highly qualified centers to manage such challenging cases.
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Affiliation(s)
- Ghaliah Al Mohani
- Arrhythmology and Electrophysiology, Centro Cardiologico Monzino, IRCCS, Via C Parea n. 4, 20138, Milan, Italy,
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193
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Dechering DG, Frommeyer G, Kochhäuser S, Eckardt L. [Catheter ablation of electrical storm: ready for prime time?]. Herzschrittmacherther Elektrophysiol 2014; 25:88-92. [PMID: 24821527 DOI: 10.1007/s00399-014-0309-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
Electrical storm is an increasingly recognized clinical entity. It is generally defined as the occurrence of ≥ 3 episodes of potentially life-threatening ventricular arrhythmias during a time span of 24 h. Apart from pharmacological treatment options, catheter ablation remains a relatively novel, promising addition to the armamentarium of the cardiologist. Here, we will review the study data on ablation of patients with electrical storm.
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Affiliation(s)
- D G Dechering
- Abteilung für Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland,
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194
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Jared Bunch T, Peter Weiss J, Crandall BG, Day JD, May HT, Bair TL, Osborn JS, Mallender C, Fischer A, Brunner KJ, Mahapatra S. Patients treated with catheter ablation for ventricular tachycardia after an ICD shock have lower long-term rates of death and heart failure hospitalization than do patients treated with medical management only. Heart Rhythm 2014; 11:533-40. [DOI: 10.1016/j.hrthm.2013.12.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Indexed: 11/25/2022]
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195
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Wutzler A, Mueller A, Loehr L, Huemer M, Parwani AS, Attanasio P, Blaschke F, Storm C, Boldt LH, Haverkamp W. Minimal and deep sedation during ablation of ventricular tachycardia. Int J Cardiol 2014; 172:161-4. [DOI: 10.1016/j.ijcard.2013.12.175] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/17/2013] [Accepted: 12/31/2013] [Indexed: 01/17/2023]
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196
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Gangadharan V, Sharma D, Ramu V, Paul T. Too much exercise: right ventricular outflow tract tachycardia. Am J Med 2014; 127:205-8. [PMID: 24321412 DOI: 10.1016/j.amjmed.2013.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 11/26/2013] [Accepted: 11/26/2013] [Indexed: 11/16/2022]
Affiliation(s)
| | - Dinesh Sharma
- Department of Cardiology, Quillen College of Medicine, East Tennessee State University, Johnson City
| | - Vijay Ramu
- Department of Cardiology, Quillen College of Medicine, East Tennessee State University, Johnson City
| | - Timir Paul
- Department of Cardiology, Quillen College of Medicine, East Tennessee State University, Johnson City
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197
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Relevance of guideline-based ICD indications to clinical practice. Indian Heart J 2014; 66 Suppl 1:S82-7. [PMID: 24568834 DOI: 10.1016/j.ihj.2013.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 11/22/2013] [Indexed: 11/21/2022] Open
Abstract
The implantable cardioverter-defibrillator (ICD) has established itself as life-saving therapy in patients at risk for sudden cardiac death. Remarkable technological advances have made ICDs easier and safer to implant, with improved therapeutic and diagnostic functions and reduced morbidity. Guidelines on ICD indications have been proposed by American and European scientific societies since a number of years, based upon trials and expert opinion. In the context of variable economic and political constraints, it is questionable whether these guidelines may be applied to all settings. This review discusses the guideline-based indications, critically examines their applicability to clinical practice, and discusses alternatives to ICD therapy.
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198
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Maccabelli G, Tsiachris D, Silberbauer J, Esposito A, Bisceglia C, Baratto F, Colantoni C, Trevisi N, Palmisano A, Vergara P, De Cobelli F, Del Maschio A, Della Bella P. Imaging and epicardial substrate ablation of ventricular tachycardia in patients late after myocarditis. Europace 2014; 16:1363-72. [DOI: 10.1093/europace/euu017] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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199
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McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, McDonagh T, Sechtem U, Bonet LA, Avraamides P, Ben Lamin HA, Brignole M, Coca A, Cowburn P, Dargie H, Elliott P, Flachskampf FA, Guida GF, Hardman S, Iung B, Merkely B, Mueller C, Nanas JN, Nielsen OW, Ørn S, Parissis JT, Ponikowski P. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur J Heart Fail 2014; 14:803-69. [PMID: 22828712 DOI: 10.1093/eurjhf/hfs105] [Citation(s) in RCA: 1818] [Impact Index Per Article: 181.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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200
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Noninvasive electrocardiographic mapping to guide ablation of outflow tract ventricular arrhythmias. Heart Rhythm 2014; 11:587-94. [PMID: 24440381 PMCID: PMC4067940 DOI: 10.1016/j.hrthm.2014.01.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Indexed: 11/30/2022]
Abstract
Background Localizing the origin of outflow tract ventricular tachycardias (OTVT) is hindered by lack of accuracy of electrocardiographic (ECG) algorithms and infrequent spontaneous premature ventricular complexes (PVCs) during electrophysiological studies. Objectives To prospectively assess the performance of noninvasive electrocardiographic mapping (ECM) in the pre-/periprocedural localization of OTVT origin to guide ablation and to compare the accuracy of ECM with that of published ECG algorithms. Methods Patients with symptomatic OTVT/PVCs undergoing clinically indicated ablation were recruited. The OTVT/PVC origin was mapped preprocedurally by using ECM, and 3 published ECG algorithms were applied to the 12-lead ECG by 3 blinded electrophysiologists. Ablation was guided by using ECM. The OTVT/PVC origin was defined as the site where ablation caused arrhythmia suppression. Acute success was defined as abolition of ectopy after ablation. Medium-term success was defined as the abolition of symptoms and reduction of PVC to less than 1000 per day documented on Holter monitoring within 6 months. Results In 24 patients (mean age 50 ± 18 years) recruited ECM successfully identified OTVT/PVC origin in 23/24 (96%) (right ventricular outflow tract, 18; left ventricular outflow tract, 6), sublocalizing correctly in 100% of this cohort. Acute ablation success was achieved in 100% of the cases with medium-term success in 22 of 24 patients. PVC burden reduced from 21,837 ± 23,241 to 1143 ± 4039 (P < .0001). ECG algorithms identified the correct chamber of origin in 50%–88% of the patients and sublocalized within the right ventricular outflow tract (septum vs free-wall) in 37%–58%. Conclusions ECM can accurately identify OTVT/PVC origin in the left and the right ventricle pre- and periprocedurally to guide catheter ablation with an accuracy superior to that of published ECG algorithms.
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