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Futyma P, Gupta D. Open surgery for ventricular tachycardia following failed stereotactic radiation treatment: A bailout when a parachute hasn't helped. HeartRhythm Case Rep 2022; 8:77-78. [PMID: 35242542 PMCID: PMC8858732 DOI: 10.1016/j.hrcr.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Piotr Futyma
- Medical College, University of Rzeszów and St. Joseph’s Heart Rhythm Center, Rzeszów, Poland
| | - Dhiraj Gupta
- Department of Electrophysiology, Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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Zhang PP, Heeger CH, Mathew S, Fink T, Reissmann B, Lemeš C, Maurer T, Santoro F, Huang Y, Riedl J, Schmoeckel M, Rillig A, Metzner A, Kuck KH, Ouyang F. Left-lateral thoracotomy for catheter ablation of scar-related ventricular tachycardia in patients with inaccessible pericardial access. Clin Res Cardiol 2020; 110:801-809. [PMID: 32458110 PMCID: PMC8166673 DOI: 10.1007/s00392-020-01670-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 04/29/2020] [Indexed: 12/02/2022]
Abstract
Objectives We aimed to describe the feasibility of a surgical left thoracotomy for catheter ablation of scar-related ventricular tachycardia (VT) in patients with inaccessible pericardial access. Background Pericardial adhesion due to prior cardiac surgery or previous epicardial ablation procedures limits epicardial access in patients with drug-refractory VT originated from the epicardium. Methods Six patients who underwent a surgical left lateral thoracotomy epicardial access for catheter ablation of VT after failed subxiphoid percutaneous epicardial access were reviewed. Patients’ baseline characteristics and procedural characteristics including epicardial access, mapping, and ablation were described. Epicardial access was successfully obtained in all patients by a surgical left lateral thoracotomy. Results The reasons of pericardial adhesion were prior cardiac surgery (n = 3, 50%) and previous epicardial ablation procedures (n = 3, 50%). Epicardial mapping of the lateral and inferior left ventricle was acquired, and a total of 15 different VTs originated from those regions were abolished. Unless one patient with ST elevation myocardial infarction due to periprocedural occlusion of the posterior descending artery no further complications occurred. All patients were discharged 10.2 ± 4 days after the procedure. VT recurred in 1 patient (17%) and was controlled with oral amiodarone therapy during follow-up (median follow-up: 479 days). Conclusions A surgical left lateral thoracotomy is feasible and safe for selected patients. This approach provides epicardial ablation in patients with VT located at the infero-lateral left ventricle and pericardial adhesions due to previous cardiac surgery or previous ablation procedures. Graphic abstract ![]()
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Affiliation(s)
- Peng-Pai Zhang
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Department of Cardiology, Shanghai Xinhua Hospital Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, China
| | - Christian-Hendrik Heeger
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Shibu Mathew
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Thomas Fink
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Bruno Reissmann
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christine Lemeš
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Tilman Maurer
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Francesco Santoro
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - YingHao Huang
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Johannes Riedl
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Michael Schmoeckel
- Department of Cardiovascular Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Andreas Rillig
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Andreas Metzner
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
- Fuwai Hospital/National Center of Cardiovascular Diseases, 167 North Lishi Road, Xicheng District, Beijing, 10037, China.
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Heeger CH, Metzner A, Schlüter M, Rillig A, Mathew S, Tilz RR, Wohlmuth P, Romero ME, Virmani R, Fink T, Reissmann B, Lemes C, Maurer T, Santoro F, Schmidt T, Ghanem A, Frerker C, Kuck KH, Ouyang F. Cerebral Protection During Catheter Ablation of Ventricular Tachycardia in Patients With Ischemic Heart Disease. J Am Heart Assoc 2018; 7:JAHA.118.009005. [PMID: 29960991 PMCID: PMC6064920 DOI: 10.1161/jaha.118.009005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Catheter ablation of ventricular tachycardia (VT) is associated with the risk of cerebral embolism. The origin of periprocedural brain embolism in the setting of VT ablation is often unknown and strategies to avoid it are sparse. The aim of this study was to assess the safety and feasibility of an endovascular 2‐filter‐based cerebral protection system (CPS) in left ventricular VT ablation procedures in patients with ischemic heart disease. Furthermore, histopathological correlates of periprocedural embolization were investigated. Methods and Results In this pilot study, 11 patients with ischemic heart disease and sustained VT underwent left ventricular catheter ablation under CPS surveillance. The placement of the CPS was conducted before the ablation procedure via the right radial artery. The VT ablation procedure was performed via a combined transaortic and transseptal approach. All VTs were successfully ablated. Placement and retrieval of the CPS was successful and safe in all cases. No periprocedural complications related to the CPS were observed and no periprocedural transient ischemic attack or stroke occurred. Debris captured by the CPS was detected in all patients. Histology revealed that acute thrombus was the most common type of debris (91%), followed by arterial wall tissue (73%) and foreign material (55%). Less frequently found were myocardium (27%), calcification (9%), necrotic core (9%), and valve tissue (9%). Conclusions Cerebral protection during VT ablation seems to be safe and feasible. Ablation procedures of VT are associated with embolization of embolic debris, which was found in every patient.
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Affiliation(s)
- Christian-Hendrik Heeger
- Department for Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany .,University Heart Center Luebeck, Luebeck, Germany
| | - Andreas Metzner
- Department for Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Andreas Rillig
- Department for Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Shibu Mathew
- Department for Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | | | | | | | - Thomas Fink
- Department for Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Bruno Reissmann
- Department for Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christine Lemes
- Department for Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Tilman Maurer
- Department for Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Francesco Santoro
- Department for Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Tobias Schmidt
- Department for Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Alexander Ghanem
- Department for Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.,University Heart Center Bonn, Bonn, Germany
| | - Christian Frerker
- Department for Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department for Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Feifan Ouyang
- Department for Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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Kitamura M, Schmidt T, Kuck KH, Frerker C. Heart Failure Interventions Targeting Impaired Left Ventricles in Structural Heart Disease. Curr Cardiol Rep 2018; 20:8. [PMID: 29435772 DOI: 10.1007/s11886-018-0950-6] [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] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW Interventional techniques have been developed for a wide spectrum of mechanisms of heart failure (HF), especially in valvular heart disease and cardiomyopathies (ischaemic cardiomyopathy and hypertrophic cardiomyopathy). In this article, we review recent reports on catheter interventions to treat patients with HF. RECENT FINDINGS Direct modification using the Parachute device and the REVIVENT-TC device for patients with impaired left ventricle with large infarct scars improves geometry and haemodynamic efficiency, resulting in a reduction of HF symptoms. Interatrial shunt therapy improves symptoms and quality of life in HF patients. Uniquely, left ventricular outflow tract obstruction has also been targeted in patients with transcatheter mitral valve implantation. For advanced stage HF patients with prohibitively high surgical risk, emerging transcatheter interventions make it possible to modify life-limiting symptoms. Further results on HF interventions are expected from ongoing clinical trials.
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Affiliation(s)
- Mitsunobu Kitamura
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | - Tobias Schmidt
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | - Christian Frerker
- Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany.
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Heeger C, Frerker C, Hayashi K, Schmidt T, Mathew S, Sohns C, Kaiser L, Metzner A, Kuck K, Ouyang F. Catheter ablation of frequent ventricular tachycardia after interventional left ventricular restoration with the Revivent-Transcatheter(™)-system. Clin Case Rep 2016; 4:339-43. [PMID: 27099723 PMCID: PMC4831379 DOI: 10.1002/ccr3.512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/01/2016] [Accepted: 01/27/2016] [Indexed: 11/29/2022] Open
Abstract
The Revivent-TC(™)-system is able to restore LV volumes in patients with severe ischemic cardiomyopathy. We are presenting a case report of successful implantation of the Revivent-TC(™)-system, but postprocedural development of sustained VT. This case report is presenting one way to successfully treat patients with postprocedural frequent VT.
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Affiliation(s)
| | | | - Kentaro Hayashi
- Department of CardiologyAsklepios Clinic St. GeorgHamburgGermany
| | - Tobias Schmidt
- Department of CardiologyAsklepios Clinic St. GeorgHamburgGermany
| | - Shibu Mathew
- Department of CardiologyAsklepios Clinic St. GeorgHamburgGermany
| | - Christian Sohns
- Department of CardiologyAsklepios Clinic St. GeorgHamburgGermany
| | - Lukas Kaiser
- Department of CardiologyAsklepios Clinic St. GeorgHamburgGermany
| | - Andreas Metzner
- Department of CardiologyAsklepios Clinic St. GeorgHamburgGermany
| | - Karl‐Heinz Kuck
- Department of CardiologyAsklepios Clinic St. GeorgHamburgGermany
| | - Feifan Ouyang
- Department of CardiologyAsklepios Clinic St. GeorgHamburgGermany
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