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Stevenson WG, Richardson TD, Kanagasundram AN, Tandri H. State of the Art: Mapping Strategies to Guide Ablation in Ischemic Heart Disease. JACC Clin Electrophysiol 2024:S2405-500X(24)00787-4. [PMID: 39520431 DOI: 10.1016/j.jacep.2024.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 09/06/2024] [Accepted: 09/12/2024] [Indexed: 11/16/2024]
Abstract
Catheter ablation to prevent ventricular tachycardia (VT) that emerges late after a myocardial infarction aims to interrupt the re-entry substrate. Interruption of potential channels and regions of slow conduction that can be identified during stable sinus or paced rhythm is often effective and a number of substrate markers for guiding this approach have been described. While there is substantial agreement with different markers in some patients, the different markers select different regions for ablation in others. Mapping during VT to identify critical re-entry circuit isthmuses is likely more specific, and most useful when VT is incessant or frequent during the procedure or when sinus rhythm substrate ablation fails. Both approaches are often combined. These methods for identifying and characterizing post-infarct-related arrhythmia substrate and the re-entry circuits are reviewed.
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Affiliation(s)
- William G Stevenson
- Cardiac Electrophysiology Section, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Travis D Richardson
- Cardiac Electrophysiology Section, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arvindh N Kanagasundram
- Cardiac Electrophysiology Section, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Harikrishna Tandri
- Cardiac Electrophysiology Section, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Miller JM, Tanawuttiwat T, Vasilottos N. Tachycardia Termination Without Global Propagation: A Stimulating Experience. JACC Clin Electrophysiol 2024:S2405-500X(24)00784-9. [PMID: 39520429 DOI: 10.1016/j.jacep.2024.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 09/04/2024] [Indexed: 11/16/2024]
Affiliation(s)
- John M Miller
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| | - Tanyanan Tanawuttiwat
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nektarios Vasilottos
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Moriwaki K, Doi A, Nishigaki K, Tsukamoto T, Tanaka S, Yamasaki R, Fukuda K, Yoshiyama T, Kawarabayashi T, Fukuda D. Entrainment response during ventricular tachycardia originating from the para-Hisian region: What is the mechanism? J Cardiovasc Electrophysiol 2024; 35:1696-1700. [PMID: 38802978 DOI: 10.1111/jce.16329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Kazuki Moriwaki
- Department of Cardiovascular Medicine, Tane General Hospital, Osaka, Japan
| | - Atsushi Doi
- Department of Cardiovascular Medicine, Tane General Hospital, Osaka, Japan
| | - Keisuke Nishigaki
- Department of Cardiovascular Medicine, Tane General Hospital, Osaka, Japan
| | - Takuya Tsukamoto
- Department of Cardiovascular Medicine, Tane General Hospital, Osaka, Japan
| | - Sawa Tanaka
- Department of Cardiovascular Medicine, Tane General Hospital, Osaka, Japan
| | - Reiko Yamasaki
- Department of Cardiovascular Medicine, Tane General Hospital, Osaka, Japan
| | - Keisuke Fukuda
- Department of Cardiovascular Medicine, Tane General Hospital, Osaka, Japan
| | - Tomotaka Yoshiyama
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | | | - Daiju Fukuda
- Department of Cardiovascular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Arceluz MR, Thind M, Hambach B, Garcia FC, Callans DJ, Guandalini GS, Frankel DS, Supple GE, Hyman M, Schaller RD, Nazarian S, Dixit S, Lin D, Marchlinski FE, Santangeli P. Septal Substrate Ablation Guided by Delayed Transmural Conduction Times: A Novel Ablation Approach to Target Intramural Substrates. JACC Clin Electrophysiol 2023; 9:1903-1913. [PMID: 37480866 DOI: 10.1016/j.jacep.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/03/2023] [Accepted: 05/15/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Intraprocedural identification of intramural septal substrate for ventricular tachycardia (ISS-VT) in nonischemic cardiomyopathy (NICM) is challenging. Delayed (>40 ms) transmural conduction time (DCT) with right ventricular basal septal pacing has been previously shown to identify ISS-VT. OBJECTIVES This study sought to determine whether substrate catheter ablation incorporating areas of DCT may improve acute and long-term outcomes. METHODS We included patients with NICM and ISS-VT referred for catheter ablation between 2016 and 2020. ISS-VT was defined by the following: 1) confluent septal areas of low unipolar voltage (<8.3 mV) in the presence of normal or minimal bipolar abnormalities; and 2) presence of abnormal electrograms in the septum. Substrate ablation was guided by the following: 1) activation and/or entrainment mapping for tolerated VT and pace mapping with ablation of abnormal septal electrograms for unmappable VTs (n = 57, Group 1); and 2) empirically extended to target areas of DCT during right ventricular basal septal pacing regardless of their participation in inducible VT(s) but sparing the conduction system when possible (n = 24, Group 2). RESULTS There were no significant baseline differences between Groups 1 and 2. Noninducibility of any VT programmed stimulation at the end of ablation was higher in Group 2 compared with Group 1 (80% vs 53%; P = 0.03). At 12-month follow-up, single-procedure VT-free survival was significantly higher (79% vs 46%; P = 0.006) and the time to VT recurrence was longer (mean 10 ± 3 months vs 7 ± 4 months; P = 0.02) in Group 2 compared with Group 1. CONCLUSIONS In patients with NICM and ISS-VT, a substrate ablation strategy that incorporates areas of DCT appears to improve freedom from recurrent VT.
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Affiliation(s)
- Martín R Arceluz
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Munveer Thind
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bryce Hambach
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fermin C Garcia
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Callans
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gustavo S Guandalini
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David S Frankel
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory E Supple
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew Hyman
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert D Schaller
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saman Nazarian
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay Dixit
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Lin
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Termination of Macroreentrant Atrial Arrhythmias by Pacing Stimuli without Global Propagation. Heart Rhythm 2022; 19:1084-1096. [PMID: 35341994 DOI: 10.1016/j.hrthm.2022.03.1220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Electrical stimulation during ventricular tachycardia resulting in tachycardia termination without global propagation (TWGP) is a well-recognized phenomenon. However, there is a paucity of literature showing a similar phenomenon in atrial arrhythmias. OBJECTIVE The purpose of the study was to evaluate the significance of TWGP in atrial arrhythmias. METHODS Electrophysiology (EP) studies performed during 2000-2019 at Methodist Hospital, Indiana University were reviewed retrospectively. Thirty-four patients were identified in whom stimulation during atrial tachycardia/flutter resulted in TWGP. RESULTS Of the 34 patients, 12 (29%) had cavotricuspid isthmus (CTI) dependent atrial flutter and 22 (71%) had other atrial arrhythmias during which TWGP was seen. The mean age of the population was 53 ± 13 years; 68% were male. Prior catheter ablation either for atrial fibrillation, atrial flutter or other atrial tachyarrhythmias had been performed in 70.5%, and 44% had previously undergone cardiac surgery involving the atria. Congenital heart disease was present in 20.5%; 3 patients were post lung transplant. The mean cycle length of atrial arrhythmia in which TWGP was seen was 317 ± 76 ms. The sites at which TWGP was seen reproducibly were highly specific for successful termination of the arrhythmias with radiofrequency energy. The arrhythmia circuits were 12 CTI dependent atrial flutter, 11 left atrial macroreentrant AT (MRAT), 1 involving both left and right atrium, and 8 were other right atrial MRAT. CONCLUSION Termination of macroreentrant atrial arrhythmias by pacing stimuli without global propagation identifies a narrow diastolic isthmus at which catheter ablation is highly effective.
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Itoh T, Kimura M, Ishida Y, Tomita H. Multiple exit sites identification by pace mapping with a grid catheter: Which bipolar pairs are in the critical ventricular tachycardia isthmus? HeartRhythm Case Rep 2021; 7:776-779. [PMID: 34820279 PMCID: PMC8602121 DOI: 10.1016/j.hrcr.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Taihei Itoh
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masaomi Kimura
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Ishida
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Kotake Y, Nalliah CJ, Campbell T, Trivic I, Ross N, Bennett RG, Turnbull S, Kumar S. Epicardial-Endocardial Reentry in Ischemic Cardiomyopathy. J Innov Card Rhythm Manag 2021; 12:4467-4472. [PMID: 33936862 PMCID: PMC8081459 DOI: 10.19102/icrm.2021.120402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/28/2020] [Indexed: 11/06/2022] Open
Abstract
In ischemic cardiomyopathy, endocardial reentry has traditionally been the mechanistic paradigm for understanding ventricular tachycardia (VT). However, recognition is growing that epicardial myocardium is a critical component for VT substrate, even in patients with ischemic cardiomyopathy. In this report, we present a novel case of a three-dimensional VT reentry involving epicardial components and an endocardial exit.
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Affiliation(s)
- Yasuhito Kotake
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Chrishan J Nalliah
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Ivana Trivic
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Neil Ross
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
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Muser D, Santangeli P, Castro SA, Liang JJ, Enriquez A, Liuba I, Magnani S, Garcia FC, Arkles J, Supple GG, Lin D, Schaller RD, Kumareswaran R, Zado E, Tschabrunn CM, Dixit S, Frankel DS, Callans DJ, Marchlinski FE. Collateral injury of the conduction system during catheter ablation of septal substrate in nonischemic cardiomyopathy. J Cardiovasc Electrophysiol 2020; 31:1726-1739. [PMID: 32298038 DOI: 10.1111/jce.14498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/07/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In patients with nonischemic cardiomyopathy (NICM) little is known about the clinical impact of catheter ablation (CA) of septal ventricular tachycardia (VT) resulting in the collateral injury of the conduction system (CICS). METHODS AND RESULTS Ninety-five consecutive patients with NICM underwent CA of septal VT. Outcomes in patients with no baseline conduction abnormalities who developed CICS (group 1, n = 28 [29%]) were compared to patients with no CICS (group 2, n = 17 [18%]) and to patients with preexisting conduction abnormalities or biventricular pacing (group 3, n = 50 [53%]). Group-1 patients were younger, had a higher left ventricular ejection fraction and a lower prevalence of New York Heart Association III/IV class compared to group 3 while no significant differences were observed with group 2. After a median follow-up of 15 months, VT recurred in 14% of patients in group 1, 12% in group 2 (P = .94) and 32% in group 3 (P = .08) while death/transplant occurred in 14% of patients in group 1, 18% in group 2 (P = .69) and 28% in group 3 (P = .15). A worsening of left ventricular ejection fraction (LVEF) (median LVEF variation, -5%) was observed in group 1 compared to group 2 (median LVEF variation, 0%; P < .01) but not group-3 patients (median LVEF variation, -4%; P = .08) with a consequent higher need for new biventricular pacing in group 1 (43%) compared to group 2 (12%; P = .03) and group 3 (16%; P < .01). CONCLUSIONS In patients with NICM and septal substrate, sparing the abnormal substrate harboring the conduction system provides acceptable VT control while preventing a worsening of the systolic function.
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Affiliation(s)
- Daniele Muser
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pasquale Santangeli
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Simon A Castro
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jackson J Liang
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andres Enriquez
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ioan Liuba
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Silvia Magnani
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fermin C Garcia
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey Arkles
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory G Supple
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Lin
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert D Schaller
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ramanan Kumareswaran
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica Zado
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cory M Tschabrunn
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sanjay Dixit
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Callans
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Department of Medicine, Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Yokokawa M, Kim HM, Sharaf Dabbagh G, Siontis KC, Lathkar-Pradhan S, Jongnarangsin K, Latchamsetty R, Morady F, Bogun F. Targeting Noninducible Clinical Ventricular Tachycardias in Patients With Prior Myocardial Infarctions Based on Stored Electrograms. Circ Arrhythm Electrophysiol 2019; 12:e006978. [PMID: 31216885 DOI: 10.1161/circep.118.006978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ablation of postinfarction ventricular tachycardia (VT) has been shown to reduce VT recurrence and decrease mortality. However, VT recurrence can occur despite extensive ablation procedures. The lack of inducibility of clinical VTs during ablation procedures remains problematic and may be in part responsible for VT recurrences. In this prospective study, we targeted documented but noninducible clinical VTs based on stored implantable cardioverter-defibrillator (ICD) electrograms. METHODS Radiofrequency ablation was performed in a consecutive group of 66 postinfarction patients (mean age, 67.5±9.2 years; men, 61; mean left ventricular ejection fraction, 25.1±10.8%) in whom clinical VTs were not inducible during an ablation procedure. In the first 33 patients (control group), only inducible VTs were targeted, and in the second 33 patients, noninducible clinical VTs were also targeted by pace-mapping based on stored ICD-electrograms (ICD-electrogram-guided ablation group). Procedural and clinical outcomes were compared at 24 months post-ablation. RESULTS VT recurred in 5 patients (15%) in whom the ICD-electrogram-guided approach was performed and in 13 patients (39%) in the control group. Freedom from recurrent VT was higher (log-rank P=0.04) in the ICD-electrogram-guided group, but there was no difference in ventricular fibrillation or in total mortality between both groups. CONCLUSIONS Ablation guided by pace-mapping of noninducible postinfarction clinical VTs based on ICD-electrograms is feasible and reduces the risk of recurrent VT.
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Affiliation(s)
- Miki Yokokawa
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor
| | - Hyungjin Myra Kim
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor
| | - Ghaith Sharaf Dabbagh
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor
| | - Konstantinos C Siontis
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor
| | - Sangeeta Lathkar-Pradhan
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor
| | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor
| | - Fred Morady
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor
| | - Frank Bogun
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor
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Noninvasive Programmed Ventricular Stimulation-Guided Management Following Ventricular Tachycardia Ablation. JACC Clin Electrophysiol 2019; 5:719-727. [PMID: 31221360 DOI: 10.1016/j.jacep.2019.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/07/2019] [Accepted: 03/14/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study sought to determine the impact of repeat catheter ablation (CA) prior to hospital discharge based on inducibility of clinical ventricular tachycardia (VT) during noninvasive programmed ventricular stimulation (NIPS). BACKGROUND Inducibility of clinical VT during NIPS performed several days after CA identifies patients at high risk of recurrence. The impact of NIPS-guided repeat CA has not been reported. METHODS Consecutive patients with structural heart disease undergoing CA of VT followed by NIPS were studied. Clinical VT was defined by comparison with 12-lead electrocardiograms and stored implantable cardioverter-defibrillator electrograms from spontaneous VT episodes. Among those with inducible clinical VT at NIPS, VT-free survival was compared between those in whom ablation was repeated (group 1) versus those in whom ablation was not repeated (group 2) prior to hospital discharge. RESULTS Among 469 patients (64 ± 12 years of age; 85% males; 60% ischemic), 216 patients (46%) underwent NIPS 3 days (interquartile range: 2 to 4 days) after CA. Clinical VT was induced in 45 patients (21%). Among those 45, CA was repeated in 11 patients (24%). There were no significant differences in baseline clinical or index CA characteristics between groups 1 and 2. Over a median 36-month follow-up, only 1 patient (9%) in group 1 experienced VT recurrence compared to 24 patients (71%) in group 2 (p < 0.01). In univariate Cox regression, repeat CA guided by NIPS (hazard ratio: 0.07; 95% confidence interval: 0.01 to 0.58; p = 0.01) was the only predictor of VT-free survival. CONCLUSIONS In patients with inducible clinical VT during post-ablation NIPS, repeat CA was associated with significantly lower risk of subsequent recurrence.
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11
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Santangeli P, Tung R, Xue Y, Chung FP, Lin YJ, Di Biase L, Zhan X, Lin CY, Wei W, Mohanty S, Burkhardt DJ, Zado ES, Callans DJ, Marchlinski FE, Wu S, Chen SA, Natale A. Outcomes of Catheter Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy Without Background Implantable Cardioverter Defibrillator Therapy. JACC Clin Electrophysiol 2019; 5:55-65. [DOI: 10.1016/j.jacep.2018.09.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/18/2018] [Accepted: 09/28/2018] [Indexed: 10/27/2022]
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Logue JP, Greenspon AJ, Ho RT. Termination of a narrow complex tachycardia by a single extrastimulus: What is the mechanism? Heart Rhythm 2018; 15:1889-1890. [PMID: 30502773 DOI: 10.1016/j.hrthm.2018.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Jonathan P Logue
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Arnold J Greenspon
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Reginald T Ho
- Department of Medicine, Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
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13
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Hayashi T, Liang JJ, Muser D, Shirai Y, Enriquez A, Garcia FC, Supple GE, Schaller RD, Frankel DS, Lin D, Nazarian S, Zado ES, Arkles JS, Dixit S, Callans DJ, Marchlinski FE, Santangeli P. Epicardial ventricular tachycardia in ischemic cardiomyopathy: Prevalence, electrophysiological characteristics, and long-term ablation outcomes. J Cardiovasc Electrophysiol 2018; 29:1530-1539. [PMID: 30230120 DOI: 10.1111/jce.13739] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 07/29/2018] [Accepted: 08/03/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The characteristics of the epicardial (EPI) substrate responsible for ventricular tachycardia (VT) in ischemic cardiomyopathy (ICM) are undefined, and data on the long-term outcomes of EPI catheter ablation limited. We evaluated the prevalence, electrophysiologic features, and outcomes of catheter ablation of EPI VT in ICM. METHODS AND RESULTS From December 2010 to June 2013, a total of 13 of 93 (14%) patients with ICM underwent catheter ablation at our institution and had conclusive evidence of critical EPI substrate demonstrated to participate in VT with activation, entrainment and/or pace mapping during sinus rhythm (two other patients underwent EPI mapping but had no optimal ablation targets). The electrophysiologic substrate characteristics and activation/entrainment mapping data were compared with a reference group of ICM patients without evidence of critical EPI substrate (N = 44), defined as a complete procedural success (noninducibility of any VT at programmed stimulation) after endocardial (ENDO)-only ablation. Patients with failed EPI access (N = 2) or history of cardiac surgery (N = 92) were excluded from the study. All 13 patients had evidence of abnormal EPI substrate with fractionated/late/split electrograms and low-bipolar voltage areas. The critical VT ablation sites were all located within the EPI bipolar "dense" scar (<1.0 mV) opposite the ENDO bipolar scar in 77% of cases and extending beyond the ENDO bipolar scar (within the ENDO unipolar low-voltage area) in the remaining patients. Compared with the reference ENDO-only group, patients with EPI VT had a smaller ENDO bipolar scar area, 54.0 (37.1-84) vs 86.7 (55.6-112) cm2 ; P = 0.0159, with a similar extent of ENDO unipolar low voltage. No other substrate characteristics or location differed between the two groups. After 35.2 ± 24.2 months of follow-up, VT-free survival was 73% in patients with EPI VT compared with 66% in the ENDO-only group (log-rank P = 0.56). CONCLUSIONS The presence of the critical EPI substrate responsible for VT can be demonstrated in at least 14% of patients with ICM. The majority of EPI critical ablation sites are distributed opposite the ENDO bipolar scar area and catheter ablation is effective in achieving long-term arrhythmia control.
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Affiliation(s)
- Tatsuya Hayashi
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jackson J Liang
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniele Muser
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yasuhiro Shirai
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andres Enriquez
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fermin C Garcia
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Supple
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert D Schaller
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Lin
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saman Nazarian
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica S Zado
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey S Arkles
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sanjay Dixit
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Callans
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pasquale Santangeli
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Schaeffer B, Stevenson WG. Entrainment mapping: Theoretical considerations and practical implementation. J Cardiovasc Electrophysiol 2017; 29:204-213. [DOI: 10.1111/jce.13348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Benjamin Schaeffer
- Cardiovascular Division, Department of Medicine; Brigham and Women's Hospital; Boston MA USA
| | - William G. Stevenson
- Cardiovascular Division, Department of Medicine; Brigham and Women's Hospital; Boston MA USA
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Muser D, Liang JJ, Pathak RK, Magnani S, Castro SA, Hayashi T, Garcia FC, Supple GE, Riley MP, Lin D, Dixit S, Zado ES, Frankel DS, Callans DJ, Marchlinski FE, Santangeli P. Long-Term Outcomes of Catheter Ablation of Electrical Storm in Nonischemic Dilated Cardiomyopathy Compared With Ischemic Cardiomyopathy. JACC Clin Electrophysiol 2017; 3:767-778. [DOI: 10.1016/j.jacep.2017.01.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/09/2017] [Accepted: 01/12/2017] [Indexed: 12/26/2022]
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16
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Muser D, Santangeli P, Pathak RK, Castro SA, Liang JJ, Magnani S, Hayashi T, Garcia FC, Hutchinson MD, Supple GE, Frankel DS, Riley MP, Lin D, Schaller RD, Desjardins B, Dixit S, Callans DJ, Zado ES, Marchlinski FE. Long-Term Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients With Cardiac Sarcoidosis. Circ Arrhythm Electrophysiol 2017; 9:CIRCEP.116.004333. [PMID: 27516457 DOI: 10.1161/circep.116.004333] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/08/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Catheter ablation (CA) of ventricular tachycardia (VT) in patients with cardiac sarcoidosis can be challenging because of the complex underlying substrate. We sought to determine the long-term outcome of CA of VT in patients with cardiac sarcoidosis. METHODS AND RESULTS We enrolled 31 patients (age, 55±10 years) with diagnosis of cardiac sarcoidosis based on Heart Rhythm Society criteria and VT who underwent CA. In 23 (74%) patients, preprocedure cardiac magnetic resonance imaging and positron emission tomographic (PET) evaluation were performed. Preprocedure magnetic resonance imaging was positive for late gadolinium enhancement in 21 of 23 (91%) patients, whereas abnormal 18-fluorodeoxyglucose uptake was found in 15 of 23 (65%) cases. In 14 of 15 patients with positive PET at baseline, PET was repeated after 6.1±3.7-month follow-up. After a median follow-up of 2.5 (range, 0-10.5) years, 1 (3%) patient died and 4 (13%) underwent heart transplant. Overall VT-free survival was 55% at 2-year follow-up. Among the 16 (52%) patients with VT recurrences, CA resulted in a significant reduction of VT burden, with 8 (50%) having only isolated (1-3) VT episodes and only 1 patient with recurrent VT storm. The presence of late gadolinium enhancement at magnetic resonance imaging, a positive PET at baseline, and lack of PET improvement over follow-up were associated with increased risk of recurrent VT. CONCLUSIONS In patients with cardiac sarcoidosis and VT, CA is effective in achieving long-term freedom from VT or improvement in VT burden in the majority of patients. The presence of late gadolinium enhancement at magnetic resonance imaging, a positive PET scan at baseline, or lack of improvement at repeat PET over follow-up predict worse arrhythmia-free survival.
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Affiliation(s)
- Daniele Muser
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Pasquale Santangeli
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Rajeev K Pathak
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Simon A Castro
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Jackson J Liang
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Silvia Magnani
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Tatsuya Hayashi
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Fermin C Garcia
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Mathew D Hutchinson
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Gregory E Supple
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - David S Frankel
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Michael P Riley
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - David Lin
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Robert D Schaller
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Benoit Desjardins
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Sanjay Dixit
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - David J Callans
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Erica S Zado
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Francis E Marchlinski
- From the Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia.
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17
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Muser D, Santangeli P, Castro SA, Pathak RK, Liang JJ, Hayashi T, Magnani S, Garcia FC, Hutchinson MD, Supple GG, Frankel DS, Riley MP, Lin D, Schaller RD, Dixit S, Zado ES, Callans DJ, Marchlinski FE. Long-Term Outcome After Catheter Ablation of Ventricular Tachycardia in Patients With Nonischemic Dilated Cardiomyopathy. Circ Arrhythm Electrophysiol 2017; 9:CIRCEP.116.004328. [PMID: 27733494 DOI: 10.1161/circep.116.004328] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/25/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Catheter ablation (CA) of ventricular tachycardia (VT) in patients with nonischemic dilated cardiomyopathy can be challenging because of the complexity of underlying substrates. We sought to determine the long-term outcomes of endocardial and adjuvant epicardial CA in nonischemic dilated cardiomyopathy. METHODS AND RESULTS We examined 282 consecutive patients (aged 59±15 years, 80% males) with nonischemic dilated cardiomyopathy who underwent CA. Ablation was guided by activation/entrainment mapping for tolerated VT and pacemapping/targeting of abnormal electrograms for unmappable VT. Adjuvant epicardial ablation was performed for recurrent VT or persistent inducibility after endocardial-only ablation. Epicardial ablation was performed in 90 (32%) patients. Before ablation, patients failed a median of 2 antiarrhythmic drugs), including amiodarone, in 166 (59%) patients. The median follow-up after the last procedure was 48 (19-67) months. Overall, VT-free survival was 69% at 60-month follow-up. Transplant-free survival was 76% and 68% at 60- and 120-month follow-up, respectively. Among the 58 (21%) patients with VT recurrence, CA still resulted in a significant reduction of VT burden, with 31 (53%) patients having only isolated (1-3) VT episodes in 12 (4-35) months after the procedure. At the last follow-up, 128 (45%) patients were only on β-blockers or no treatment, 41 (15%) were on sotalol or class I antiarrhythmic drugs, and 62 (22%) were on amiodarone. CONCLUSIONS In patients with nonischemic dilated cardiomyopathy and VT, endocardial and adjuvant epicardial CA is effective in achieving long-term VT freedom in 69% of cases, with a substantial improvement in VT burden in many of the remaining patients.
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Affiliation(s)
- Daniele Muser
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Pasquale Santangeli
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Simon A Castro
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Rajeev K Pathak
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Jackson J Liang
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Tatsuya Hayashi
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Silvia Magnani
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Fermin C Garcia
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Mathew D Hutchinson
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Gregory G Supple
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - David S Frankel
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Michael P Riley
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - David Lin
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Robert D Schaller
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Sanjay Dixit
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Erica S Zado
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - David J Callans
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia
| | - Francis E Marchlinski
- From the Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia.
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Santangeli P, Frankel DS, Tung R, Vaseghi M, Sauer WH, Tzou WS, Mathuria N, Nakahara S, Dickfeldt TM, Lakkireddy D, Bunch TJ, Di Biase L, Natale A, Tholakanahalli V, Tedrow UB, Kumar S, Stevenson WG, Della Bella P, Shivkumar K, Marchlinski FE, Callans DJ. Early Mortality After Catheter Ablation of Ventricular Tachycardia in Patients With Structural Heart Disease. J Am Coll Cardiol 2017; 69:2105-2115. [DOI: 10.1016/j.jacc.2017.02.044] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/26/2017] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
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Lee A, Kite J, Davison O, Haqqani HM. Localized atrial reentrant tachycardia in tetralogy of Fallot: Ultra-high-resolution mapping and termination by nonpropagated atrial pacing stimulus. Heart Rhythm 2017; 14:1102-1103. [PMID: 28323170 DOI: 10.1016/j.hrthm.2017.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Adam Lee
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Joel Kite
- Boston Scientific Corp, Sydney, NSW, Australia
| | - Oscar Davison
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
| | - Haris M Haqqani
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia.
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Hayashi T, Mitsuhashi T, Sugawara Y, Momomura SI. Two mechanisms of termination of idiopathic reentrant ventricular tachycardia originating from the left coronary cusp/right coronary cusp commissure with nonglobal capture. HeartRhythm Case Rep 2015; 1:2-5. [PMID: 28491498 PMCID: PMC5420048 DOI: 10.1016/j.hrcr.2014.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Santangeli P, Muser D, Zado ES, Magnani S, Khetpal S, Hutchinson MD, Supple G, Frankel DS, Garcia FC, Bala R, Riley MP, Lin D, Rame JE, Schaller R, Dixit S, Marchlinski FE, Callans DJ. Acute hemodynamic decompensation during catheter ablation of scar-related ventricular tachycardia: incidence, predictors, and impact on mortality. Circ Arrhythm Electrophysiol 2014; 8:68-75. [PMID: 25491601 DOI: 10.1161/circep.114.002155] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The occurrence of periprocedural acute hemodynamic decompensation (AHD) in patients undergoing radiofrequency catheter ablation of scar-related ventricular tachycardia (VT) has not been previously investigated. METHODS AND RESULTS We identified univariate predictors of periprocedural AHD in 193 consecutive patients undergoing radiofrequency catheter ablation of scar-related VT. AHD was defined as persistent hypotension despite vasopressors and requiring mechanical support or procedure discontinuation. AHD occurred in 22 (11%) patients. Compared with the rest of the population, patients with AHD were older (68.5±10.7 versus 61.6±15.0 years; P=0.037); had a higher prevalence of diabetes mellitus (36% versus 18%; P=0.045), ischemic cardiomyopathy (86% versus 52%; P=0.002), chronic obstructive pulmonary disease (41% versus 13%; P=0.001), and VT storm (77% versus 43%; P=0.002); had more severe heart failure (New York Heart Association class III/IV: 55% versus 15%, P<0.001; left ventricular ejection fraction: 26±10% versus 36±16%, P=0.003); and more often received periprocedural general anesthesia (59% versus 29%; P=0.004). At 21±7 months follow-up, the mortality rate was higher in the AHD group compared with the rest of the population (50% versus 11%, log-rank P<0.001). CONCLUSIONS AHD occurs in 11% of patients undergoing radiofrequency catheter ablation of scar-related VT and is associated with increased risk of mortality over follow-up. AHD may be predicted by clinical factors, including advanced age, ischemic cardiomyopathy, more severe heart failure status (New York Heart Association class III/IV, lower ejection fraction), associated comorbidities (diabetes mellitus and chronic obstructive pulmonary disease), presentation with VT storm, and use of general anesthesia.
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Affiliation(s)
- Pasquale Santangeli
- From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Daniele Muser
- From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Erica S Zado
- From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Silvia Magnani
- From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Sumun Khetpal
- From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Mathew D Hutchinson
- From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Gregory Supple
- From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David S Frankel
- From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Fermin C Garcia
- From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Rupa Bala
- From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Michael P Riley
- From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David Lin
- From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - J Eduardo Rame
- From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Robert Schaller
- From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Sanjay Dixit
- From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Francis E Marchlinski
- From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David J Callans
- From the Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
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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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Sinno MC, Yokokawa M, Good E, Oral H, Pelosi F, Chugh A, Jongnarangsin K, Ghanbari H, Latchamsetty R, Morady F, Bogun F. Endocardial ablation of postinfarction ventricular tachycardia with nonendocardial exit sites. Heart Rhythm 2013; 10:794-9. [DOI: 10.1016/j.hrthm.2013.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Indexed: 11/16/2022]
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Yokokawa M, Desjardins B, Crawford T, Good E, Morady F, Bogun F. Reasons for Recurrent Ventricular Tachycardia After Catheter Ablation of Post-Infarction Ventricular Tachycardia. J Am Coll Cardiol 2013; 61:66-73. [PMID: 23122796 DOI: 10.1016/j.jacc.2012.07.059] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 07/11/2012] [Accepted: 07/16/2012] [Indexed: 11/25/2022]
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Wissner E, Stevenson WG, Kuck KH. Catheter ablation of ventricular tachycardia in ischaemic and non-ischaemic cardiomyopathy: where are we today? A clinical review. Eur Heart J 2012; 33:1440-50. [DOI: 10.1093/eurheartj/ehs007] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Yokokawa M, Good E, Crawford T, Chugh A, Pelosi F, Latchamsetty R, Oral H, Morady F, Bogun F. Value of right ventricular mapping in patients with postinfarction ventricular tachycardia. Heart Rhythm 2012; 9:938-42. [PMID: 22322328 DOI: 10.1016/j.hrthm.2012.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Postinfarction ventricular tachycardia (VT) typically involves the left ventricular endocardium. Right ventricular involvement in the arrhythmogenic substrate of postinfarction VT is considered unusual. OBJECTIVE To assess the role of right ventricular mapping and ablation in patients with prior septal myocardial infarction. METHODS From among 37 consecutive patients with recurrent postinfarction VT, 18 patients with evidence of left ventricular septal involvement of myocardial infarction were identified; these patients were the subjects of this report. In these 18 patients, 166 VTs (cycle length 372 ± 117 ms) were induced. Right ventricular voltage mapping was performed in all 18 patients with left ventricular septal myocardial infarction. RESULTS Right ventricular voltage mapping showed areas of low voltage in 11 patients; pace mapping from these areas revealed matching pace maps for 17 VTs, and radiofrequency ablation from the right ventricular endocardium but not the left ventricular endocardium eliminated 14 of 17 VTs. VTs with critical components in the right ventricle had a left bundle branch block morphology that had similar characteristics as left bundle branch block VTs with critical areas involving the left ventricular septum. Patients with right ventricular VT breakthrough sites had a lower ejection fraction than did patients without VT breaking out on the right ventricular septum (18% ± 5% vs 33% ± 15%; P = .01). CONCLUSIONS Right ventricular mapping and ablation may be necessary in order to eliminate all inducible VTs in patients with postinfarction VT. More than half the patients with septal myocardial infarction have right ventricular septal areas that are critical for postinfarction VT and that cannot be eliminated by left ventricular ablation alone.
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Affiliation(s)
- Miki Yokokawa
- Division of Cardiovascular Medicine, Cardiovascular Center, University of Michigan, Ann Arbor, MI 48109-5853, USA
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Yoshida K, Yokokawa M, Desjardins B, Good E, Oral H, Chugh A, Pelosi F, Morady F, Bogun F. Septal involvement in patients with post-infarction ventricular tachycardia: implications for mapping and radiofrequency ablation. J Am Coll Cardiol 2012; 58:2491-500. [PMID: 22133849 DOI: 10.1016/j.jacc.2011.09.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Revised: 08/25/2011] [Accepted: 09/05/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the prevalence of the re-entry circuit within the interventricular septum in post-infarction patients referred for ventricular tachycardia (VT) ablation. BACKGROUND Post-infarction ventricular tachycardia can involve the endocardial myocardium, the intramural myocardium, the epicardium, or the His Purkinje system. METHODS Among 74 consecutive patients with recurrent post-infarction VT, 33 patients (45%) were identified in whom the critical part of the VT involved the interventricular septum. A total of 206 VTs were induced in these 33 patients. In 46 of the 206 VTs, a critical component was identified in the interventricular septum. The critical isthmus of the re-entry circuit was identified by entrainment mapping, activation mapping, or pace-mapping. RESULTS In 32 of 46 VTs (70%), the critical component of the re-entry circuit was confined to the endocardium. In 9 of 46 VTs (20%), the critical component involved the Purkinje system, and in 5 of 46 VTs (11%), an intramural area was critical. Entrainment and/or pace-mapping helped to identify critical areas of endocardial VTs as well as VTs involving the Purkinje fibers, but neither of these mapping techniques localized intramural VTs. Electrocardiographic characteristics were specific for each of the septal locations. All VTs mapped to the interventricular septum were acutely successfully ablated. VTs recurred in 9 of 33 patients with septal VTs during a mean follow-up period of 40 ± 20 months. CONCLUSIONS Post-infarction VT involving the interventricular septum can involve the endocardial muscle, Purkinje fibers, or intramural muscle fibers. Electrocardiographic characteristics differ depending on the type of tissue involved.
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Affiliation(s)
- Kentaro Yoshida
- University of Michigan Medical Center, Ann Arbor, MI 48109, USA
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MICHOWITZ YOAV, MATHURIA NILESH, SHIVKUMAR KALYANAM, MANDAPATI RAVI. Wide Complex Tachycardia with a Unique Mode of Termination: What Is the Mechanism? Pacing Clin Electrophysiol 2012; 35:97-9. [DOI: 10.1111/j.1540-8159.2011.03188.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Natale A, Raviele A, Al-Ahmad A, Alfieri O, Aliot E, Almendral J, Breithardt G, Brugada J, Calkins H, Callans D, Cappato R, Camm JA, Della Bella P, Guiraudon GM, Haïssaguerre M, Hindricks G, Ho SY, Kuck KH, Marchlinski F, Packer DL, Prystowsky EN, Reddy VY, Ruskin JN, Scanavacca M, Shivkumar K, Soejima K, Stevenson WJ, Themistoclakis S, Verma A, Wilber D. Venice Chart International Consensus document on ventricular tachycardia/ventricular fibrillation ablation. J Cardiovasc Electrophysiol 2010; 21:339-79. [PMID: 20082650 DOI: 10.1111/j.1540-8167.2009.01686.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
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Miller JM, Scherschel JA. Catheter ablation of ventricular tachycardia: Skill versus technology. Heart Rhythm 2009; 6:S86-90. [DOI: 10.1016/j.hrthm.2009.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Indexed: 10/21/2022]
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Lim KK, Knight BP. Pace termination of left atrial flutter after ablation for atrial fibrillation: what is the mechanism? Heart Rhythm 2008; 5:1619-20. [PMID: 18693075 DOI: 10.1016/j.hrthm.2007.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Kiam-Khiang Lim
- Section of Cardiology, Department of Internal Medicine, University of Chicago, Chicago, Illinois, USA.
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ZEPPENFELD KATJA, STEVENSON WILLIAMG. Ablation of Ventricular Tachycardia in Patients with Structural Heart Disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:358-74. [DOI: 10.1111/j.1540-8159.2008.00999.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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