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Toba M, Nasu T, Nekomiya N, Makino T, Yokoshiki H. Bipolar radiofrequency ablation for re-entrant ventricular tachycardia of right bundle branch block and left bundle branch block morphologies with the common slow conduction zone at the left ventricular summit: a case report. Eur Heart J Case Rep 2024; 8:ytae191. [PMID: 38690559 PMCID: PMC11060111 DOI: 10.1093/ehjcr/ytae191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024]
Abstract
Background The left ventricular (LV) summit has anatomical limitations, so the detailed mapping is difficult. Therefore, the mechanism of ventricular tachycardia (VT) originating from the LV summit is not well understood. Case summary A 70-year-old man had VTs with right bundle branch block (VT1 and VT3) and left bundle branch block (VT2) morphologies originating from the left ventricular summit (LV summit). During the VT2 and VT3, fragmented potentials, which occurred earlier than the QRS onset, were recorded from bipolar electrodes of a catheter at the anterior intraventricular vein (AIV). By pacing from right ventricular apex, constant and progressive fusion were observed. During the entrainment pacing, the fragmented potentials in the AIV catheter were activated orthodromically and those in the His bundle were activated antidromically. In addition, there were two components of the ventricular electrogram at the LV summit area with the interval of more than 100 ms during the VTs. We performed bipolar radiofrequency ablation between the LV endocardium and AIV, and the VTs became non-inducible. Discussion Non-sustained VT/premature ventricular contraction originating from LV summit is generally considered to occur due to abnormal automaticity or triggered activity. In contrast, using entrainment technique, we demonstrated that the VTs with multiple morphologies were sustained with a re-entrant mechanism. Fragmentated potentials recorded in the AIV catheter were activated orthodromically with the entrainment pacing, indicating the slowly conducting isthmus. The intramural VT substrate was also suggested with a prolonged conduction time between the two ventricular components during the VTs.
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Affiliation(s)
- Masahiro Toba
- Department of Cardiovascular Medicine, Sapporo City General Hospital, Kita-11, Nishi-13, Chuo-ku, Sapporo 060-8604, Japan
| | - Toshihiro Nasu
- Division of Medical Engineering Center, Sapporo City General Hospital, Sapporo, Japan
| | - Nobuyoshi Nekomiya
- Division of Medical Engineering Center, Sapporo City General Hospital, Sapporo, Japan
| | - Takao Makino
- Department of Cardiovascular Medicine, Sapporo City General Hospital, Kita-11, Nishi-13, Chuo-ku, Sapporo 060-8604, Japan
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Sapporo City General Hospital, Kita-11, Nishi-13, Chuo-ku, Sapporo 060-8604, Japan
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2
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Futyma P, Chen S, Enriquez A, Pürerfellner H, Santangeli P. Bipolar ablation of ventricular arrhythmias: Step-by-step. J Cardiovasc Electrophysiol 2023; 34:2599-2606. [PMID: 37968834 DOI: 10.1111/jce.16131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023]
Abstract
Radiofrequency (RF) ablation of intramural ventricular arrhythmias (VAs) may require advanced ablation techniques to achieve effective energy transfer to the targeted tissue. As an alternative to standard RF ablation, catheter ablation can also be conducted in bipolar configuration when two ablation catheters participate in the RF circuit. This strategy has proved to result in deeper lesion formation and may be effective for eliminating arrhythmias that have been refractory to standard ablation. In this article, we provide a step-by-step guide on when and how to perform bipolar ablation of VAs.
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Affiliation(s)
- Piotr Futyma
- St. Joseph's Heart Rhythm Center, Rzeszów, Poland
- Medical College, University of Rzeszów, Rzeszów, Poland
| | - Shaojie Chen
- Department Kardiologe, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
| | - Andres Enriquez
- Kingston Health Science Centre, Queen's University, Kingston, Ontario, Canada
| | | | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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3
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Hoskins MH, Lisko JC, Greenbaum AB, Ueyama HA, Merchant FM, Lloyd MS, Gleason PT, El-Chami MF, Byku I, Block PC, Lederman RJ, Babaliaros VC, Westerman SB. Septal Bipolar Ablation to Prevent Left Ventricular Outflow Tract Obstruction After Transcatheter Mitral Valve Implantation. Circ Cardiovasc Interv 2023; 16:e013333. [PMID: 37712286 PMCID: PMC10592079 DOI: 10.1161/circinterventions.123.013333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Affiliation(s)
- Michael H. Hoskins
- Department of Medicine, Division of Cardiology, Section of Electrophysiology and Pacing, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Cardiology, New Mexico Heart Institute, Albuquerque, New Mexico, USA
| | - John C. Lisko
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Adam B. Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Hiroki A. Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Faisal M. Merchant
- Department of Medicine, Division of Cardiology, Section of Electrophysiology and Pacing, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael S. Lloyd
- Department of Medicine, Division of Cardiology, Section of Electrophysiology and Pacing, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patrick T. Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Mikhael F. El-Chami
- Department of Medicine, Division of Cardiology, Section of Electrophysiology and Pacing, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Peter C. Block
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Vasilis C. Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Stacy B. Westerman
- Department of Medicine, Division of Cardiology, Section of Electrophysiology and Pacing, Emory University School of Medicine, Atlanta, Georgia, USA
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Futyma P, Sauer WH. Bipolar Radiofrequency Catheter Ablation of Left Ventricular Summit Arrhythmias. Card Electrophysiol Clin 2023; 15:57-62. [PMID: 36774137 DOI: 10.1016/j.ccep.2022.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Challenging anatomic and morphologic conditions of the left ventricular (LV) summit architecture and its surrounding sites may prevent sufficient heating of the targeted area during standard radiofrequency catheter ablation. Bipolar ablation can result in higher likelihood of efficacy for ablation of LV summit arrhythmias from inaccessible regions and increase the chance of achieving a transmural lesion. In this review, the authors describe the present approaches for bipolar ablation of the LV summit arrhythmias refractory to standard approaches.
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Affiliation(s)
- Piotr Futyma
- Medical College, University of Rzeszów and St. Joseph's Heart Rhythm Center, Anny Jagiellonki 17, Rzeszów 35-623, Poland.
| | - William H Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Ravi V, Winterfield J, Liang J, Larsen T, Dye C, Sanders D, Skeete J, Payne J, Trohman RG, Aksu T, Sharma PS, Huang HD. Solving the Reach Problem: A Review of Present and Future Approaches for Addressing Ventricular Arrhythmias Arising from Deep Substrate. Arrhythm Electrophysiol Rev 2023; 12:e04. [PMID: 37600155 PMCID: PMC10433105 DOI: 10.15420/aer.2022.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/26/2022] [Indexed: 08/22/2023] Open
Abstract
Ventricular tachycardia (VT) is a significant cause of morbidity and mortality in patients with ischaemic and non-ischaemic cardiomyopathies. In most patients, the primary strategy of VT catheter ablation is based on the identification of critical components of reentry circuits and modification of abnormal substrate which can initiate reentry. Despite technological advancements in catheter design and improved ability to localise abnormal substrates, putative circuits and site of origins of ventricular arrhythmias (VAs), current technologies remain inadequate and durable success may be elusive when the critical substrate is deep or near to critical structures that are at risk of collateral damage. In this article, we review the available and potential future non-surgical investigational approaches for treatment of VAs and discuss the viability of these modalities.
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Affiliation(s)
- Venkatesh Ravi
- Saint Francis Heart and Vascular Institute, Tulsa, OK, US
| | - Jeffrey Winterfield
- Department of Cardiology, Medical University of South Carolina, Charleston, SC, US
| | - Jackson Liang
- Department of Cardiology, University of Michigan, Ann Arbor, MI, US
| | - Timothy Larsen
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - Cicely Dye
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - David Sanders
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - Jamario Skeete
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - Josh Payne
- Department of Cardiology, University of Michigan, Ann Arbor, MI, US
| | - Richard G Trohman
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Parikshit S Sharma
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
| | - Henry D Huang
- Department of Cardiology, Rush University Medical Center, Chicago, IL, US
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Stevenson WG, Sapp JL. Newer Methods for VT Ablation and When to Use Them. Can J Cardiol 2021; 38:502-514. [PMID: 34942300 DOI: 10.1016/j.cjca.2021.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/03/2021] [Accepted: 12/11/2021] [Indexed: 02/07/2023] Open
Abstract
Radiofrequency (RF) catheter ablation has long been an important therapy for ventricular tachycardia and frequent symptomatic premature ventricular beats and nonsustained arrhythmias when antiarrhythmic drugs fail to suppress the arrhythmias. It is increasingly used in preference to antiarrhythmic drugs, sparing the patient drug adverse effects. Ablation success varies with the underlying heart disease and type of arrhythmia, being very effective for patients without structural heart disease, less in structural heart disease. Failure occurs when a target for ablation cannot be identified, or ablation lesions fail to reach and abolish the arrhythmia substrate that may be extensive, intramural or subepicardial in location. Approaches to improving ablation lesion creation are modifications to RF ablation and emerging investigational techniques. Easily implemented modifications to RF methods include manipulating the size and location of the cutaneous dispersive electrode, increasing RF delivery duration, and use of lower tonicity catheter irrigation (usually 0.45% saline). When catheters can be placed on either side of culprit substrate RF can be delivered in a bipolar or simultaneous unipolar configuration that can be successful. Catheters with extendable/retractable irrigated needles for RF delivery are under investigation in clinical trials. Cryoablation is potentially useful in specific situations when maintaining contact is difficult. Transvascular ethanol ablation and stereotactic radioablation have both shown promise for arrhythmias that fail other ablation strategies. Although substantial clinical progress has been achieved, further improvement is clearly needed. With ability to increase ablation lesion size, continued careful evaluation of safety, which has been excellent for standard RF ablation, remains important.
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Affiliation(s)
- William G Stevenson
- The Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; The Heart Rhythm Service, Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
| | - John L Sapp
- The Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; The Heart Rhythm Service, Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
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Garg L, Pothineni NVK, Arroyo A, Rodriguez D, Garcia FC, Hyman MC, Kumareswaran R, Arkles JS, Schaller RD, Supple GE, Frankel DS, Riley MP, Nazarian S, Lin D, Dixit S, Callans DJ, Zado ES, Marchlinski FE, Saenz LC, Santangeli P. Interatrial septal tachycardias following atrial fibrillation ablation or cardiac surgery: Electrophysiological features and ablation outcomes. Heart Rhythm 2021; 18:1491-1499. [PMID: 33984525 DOI: 10.1016/j.hrthm.2021.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Interatrial septal tachycardias (IAS-ATs) following atrial fibrillation (AF) ablation or cardiac surgery are rare, and their management is challenging. OBJECTIVE The purpose of this study was to investigate the electrophysiological features and outcomes associated with catheter ablation of IAS-AT. METHODS We screened 338 patients undergoing catheter ablation of ATs following AF ablation or cardiac surgery. Diagnosis of IAS-AT was based on activation mapping and analysis of response to atrial overdrive pacing. RESULTS Twenty-nine patients (9%) had IAS-AT (cycle length [CL] 311 ± 104 ms); 16 (55%) had prior AF ablation procedures (median 3; range 1-5), 3 (10%) had prior surgical maze, and 12 (41%) had prior cardiac surgery (including atrial septal defect surgical repair in 5 and left atrial myxoma resection in 1). IAS substrate abnormalities were documented in all patients. Activation mapping always demonstrated a diffuse early IAS breakout with centrifugal biatrial activation, and atrial overdrive pacing showed a good postpacing interval (equal or within 25 ms of the AT CL) only at 1 or 2 anatomically opposite IAS sites in all cases. Ablation was acutely successful in 27 patients (93%) (from only the right IAS in 2, only the left IAS in 9, both IAS sides with sequential ablation in 13, and both IAS sides with bipolar ablation in 3). After median follow-up of 15 (6-52) months, 17 patients (59%) remained free from recurrent arrhythmias. CONCLUSION IAS-ATs are rare and typically occur in patients with evidence of IAS substrate abnormalities and prior cardiac surgery. Catheter ablation can be challenging and may require sequential unipolar ablation or bipolar ablation.
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Affiliation(s)
- Lohit Garg
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Naga Venkata K Pothineni
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alonso Arroyo
- Electrophysiology Section, Fundación Cardio Infantil, Bogota, Colombia
| | - Diego Rodriguez
- Electrophysiology Section, Fundación Cardio Infantil, Bogota, Colombia
| | - Fermin C Garcia
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew C Hyman
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ramanan Kumareswaran
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey S Arkles
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert D Schaller
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Supple
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael P Riley
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saman Nazarian
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Lin
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sanjay Dixit
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Callans
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica S Zado
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Luis C Saenz
- Electrophysiology Section, Fundación Cardio Infantil, Bogota, Colombia
| | - Pasquale Santangeli
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Della Bella P, Peretto G, Paglino G, Bisceglia C, Radinovic A, Sala S, Baratto F, Limite LR, Cireddu M, Marzi A, D’Angelo G, Vergara P, Gulletta S, Mazzone P, Frontera A. Bipolar radiofrequency ablation for ventricular tachycardias originating from the interventricular septum: Safety and efficacy in a pilot cohort study. Heart Rhythm 2020; 17:2111-2118. [DOI: 10.1016/j.hrthm.2020.06.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/03/2020] [Accepted: 06/12/2020] [Indexed: 12/21/2022]
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9
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Ablation strategies for intramural ventricular arrhythmias. Heart Rhythm 2020; 17:1176-1184. [DOI: 10.1016/j.hrthm.2020.02.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/07/2020] [Indexed: 11/23/2022]
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10
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John M, Rook A, Post A, Mersman A, Allen W, Schramm C, Razavi M. Bipolar ablation's unique paradigm: Duration and power as respectively distinct primary determinants of transmurality and steam pop formation. Heart Rhythm O2 2020; 1:290-296. [PMID: 34113883 PMCID: PMC8183883 DOI: 10.1016/j.hroo.2020.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/16/2020] [Indexed: 01/24/2023] Open
Abstract
Background Bipolar radiofrequency (RF) ablation strategies are increasingly used, mainly to target deep myocardial reentrant circuits responsible for ventricular tachycardia that cannot be extinguished with traditional unipolar RF ablation. Because this strategy is novel, factors that affect lesion geometry and steam pop formation require further investigation. Objective To assess the effect of contact force, power, and time on the resulting lesion geometry and the risk of steam pop formation during bipolar RF ablation of thick myocardial tissue. Methods A custom ex vivo bipolar ablation model was used to assess lesion formation. A combination of parallel and perpendicular configurations of ablation catheters was used to create lesions by varying force (20g, 30g, or 40g), power (30 or 40 W), and time (20, 30, 45, or 60 seconds). Lesion dimensions and the incidence of steam pops were recorded and then analyzed with binary logistic regression and multiple linear regression. Results In bipolar ablation, lesion transmurality was most affected by the amount of time RF energy was applied. Durations longer than 20 seconds resulted in lesions deeper than half the tissue thickness. Steam pop formation was more frequent in thinner tissue, at longer ablation times, and at higher powers. Conclusion The parameters assessed in this ex vivo model could be used as guidelines for future in vivo work and clinical evaluation of interventricular septal bipolar ablation.
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Affiliation(s)
- Mathews John
- Department of Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - Ashley Rook
- Department of Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | - Allison Post
- Department of Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas
| | | | | | | | - Mehdi Razavi
- Department of Electrophysiology Clinical Research and Innovations, Texas Heart Institute, Houston, Texas.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
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12
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Sandhu A, Nguyen DT. Letter in reply: Forging ahead: Update on radiofrequency ablation technology and techniques. J Cardiovasc Electrophysiol 2020; 31:1240. [PMID: 32141661 DOI: 10.1111/jce.14412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Amneet Sandhu
- Division of Cardiology, Section of Cardiology, Section of Electrophysiology and Denver VA Medical Center, University of Colorado, Denver, Colorado
| | - Duy T Nguyen
- Division of Cardiology, Section of Electrophysiology, Stanford University, Stanford, California
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13
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Liu X, Chen Q, Fan B, Zhu W, Zhao H, Zhu Y, Zhao P, Zhang F, Kojodjojo P. Bipolar catheter ablation in ventricular myocardium. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 43:54-61. [PMID: 31721241 DOI: 10.1111/pace.13844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/17/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Xiaolin Liu
- Section of Pacing and Electrophysiology, Division of Cardiologythe First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Qiushi Chen
- Section of Pacing and Electrophysiology, Division of Cardiologythe First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Baohan Fan
- Section of Pacing and Electrophysiology, Division of Cardiologythe First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Wenwu Zhu
- Section of Pacing and Electrophysiology, Division of Cardiologythe First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Hongyan Zhao
- Section of Pacing and Electrophysiology, Division of Cardiologythe First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Yeqian Zhu
- Section of Pacing and Electrophysiology, Division of Cardiologythe First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Pengcheng Zhao
- Section of Pacing and Electrophysiology, Division of Cardiologythe First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Fengxiang Zhang
- Section of Pacing and Electrophysiology, Division of Cardiologythe First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Pipin Kojodjojo
- Department of CardiologyNational University Heart Centre Singapore
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14
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Sandhu A, Nguyen DT. Forging ahead: Update on radiofrequency ablation technology and techniques. J Cardiovasc Electrophysiol 2019; 31:360-369. [DOI: 10.1111/jce.14317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 11/19/2019] [Accepted: 12/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Amneet Sandhu
- Section of Cardiology, Division of Cardiology, Section of Electrophysiology and Denver VA Medical CenterUniversity of ColoradoAurora Colorado
| | - Duy T. Nguyen
- Section of Electrophysiology, Division of CardiologyStanford UniversityPalo Alto California
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15
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Chang S, Tzou WS. Advances in Technologies to Improve Ventricular Ablation Safety and Efficacy. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0628-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Hsia HH, Xiong N. Mapping and Ablation of Ventricular Arrhythmias in Cardiomyopathies. Card Electrophysiol Clin 2019; 11:635-655. [PMID: 31706471 DOI: 10.1016/j.ccep.2019.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Mapping and ablation of ventricular arrhythmias in patients with nonischemic cardiomyopathies remain a major challenge. The electroanatomic abnormalities are frequently inaccessible to conventional endocardial ablations. Diagnostic diligence with a thorough understanding of the potential mechanisms/substrate, coupled with detailed electroanatomic mapping, is essential. Careful procedural planning, advanced imaging, and unipolar recordings help to formulate ablation strategy, facilitate work flow, and improve outcomes. Inaccessibility of arrhythmogenic substrate and disease progression are important causes of ablation failure. Early intervention may help to improve outcome and minimize complications. Several novel adjunctive ablation techniques are capable of serving as alternative options in refractory cases.
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Affiliation(s)
- Henry H Hsia
- Cardiac Electrophysiology Service, University of California, San Francisco, MUE436, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Nanqing Xiong
- Department of Cardiology, Huashan Hospital Fudan University, No.12 Wulumuqizhong Road, Shanghai 200040, China
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Pandian J, Nandhakumar V, Saravanan S. Radiofrequency ablation of deep seated outflow tract ventricular tachycardia using custom modified bipolar irrigated radiofrequency ablation setup. Indian Pacing Electrophysiol J 2019; 19:197-201. [PMID: 31518691 PMCID: PMC6823727 DOI: 10.1016/j.ipej.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/11/2019] [Accepted: 09/10/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jayapandian Pandian
- Department of Cardiology, Meenakshi Mission Hospital & Research Centre, Madurai, Tamilnadu, India.
| | - Vasu Nandhakumar
- Institute of Cardio-Vascular Diseases, The Madras Medical Mission Hospital, Chennai, Tamilnadu, India
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18
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Enriquez A, Neira V, Bakker D, Baley J, Bisleri G, Baranchuk A, Redfearn D. Bipolar ablation with half normal saline for deep intramural outflow tract premature ventricular contraction. HeartRhythm Case Rep 2019; 5:436-439. [PMID: 31453098 PMCID: PMC6701005 DOI: 10.1016/j.hrcr.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Affiliation(s)
- Andres Enriquez
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Victor Neira
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | | | - Jason Baley
- Division of Surgery, Queen's University, Kingston, Ontario, Canada
| | | | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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