1
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Kao PH, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Lin CY, Chang TY, Kuo L, Wu CI, Liu CM, Liu SH, Cheng WH, Lin L, Ton AKN, Hsu CY, Chhay C, Chen SA. Application of Ensite TM LiveView Function for Identification of Scar-related Ventricular Tachycardia Isthmus. J Cardiovasc Electrophysiol 2022; 33:1223-1233. [PMID: 35304796 DOI: 10.1111/jce.15455] [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: 01/10/2022] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Dynamic display of real-time wavefront activation pattern may facilitate the recognition of reentrant circuits, particularly the diastolic path of ventricular tachycardia (VT). OBJECTIVE We aimed to evaluate the feasibility of LiveView Dynamic Display for mapping the critical isthmus of scar-related reentrant VT. METHODS Patients with mappable scar-related reentrant VT were selected. The characteristics of the underlying substrates and VT circuits were assessed using HD grid multi-electrode catheter. The VT isthmuses were identified based on the activation map, entrainment, and ablation results. The accuracy of the LiveView findings in detecting potential VT isthmus was assessed. RESULTS We studied 18 scar-related reentrant VTs in 10 patients (median age: 59.5 years, 100% male) including 6 and 4 patients with ischemic and non-ischemic cardiomyopathy, respectively. The median VT cycle length was 426 ms (interquartile range: 386-466 ms). Among 590 regional mapping displays, 92.0% of the VT isthmus sites were identified by LiveView Dynamic Display. The accuracy of LiveView for isthmus identification was 84%, with positive and negative predictive values of 54.8% and 97.8%, respectively. The area with abnormal electrograms was negatively correlated with the accuracy of LiveView Dynamic Display (r = -0.506, p = 0.027). The median time interval to identify a VT isthmus using LiveView was significantly shorter than that using conventional activation maps (50.5 [29.8-120] vs. 219 [157.5-400.8] s, p = 0.015). CONCLUSION This study demonstrated the feasibility of LiveView Dynamic Display in identifying the critical isthmus of scar-related VT with modest accuracy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Pei-Heng Kao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ting-Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ling Kuo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-I Wu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shin-Huei Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Han Cheng
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Linda Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - An Khanh-Nu Ton
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chu-Yu Hsu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chheng Chhay
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular center, Taichung Veterans General Hospital, Taichung, Taiwan
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: executive summary. Europace 2021; 22:450-495. [PMID: 31995197 DOI: 10.1093/europace/euz332] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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3
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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4
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: Executive summary. J Interv Card Electrophysiol 2020; 59:81-133. [PMID: 31960344 PMCID: PMC7508755 DOI: 10.1007/s10840-019-00664-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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5
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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6
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Kim Y, Chen S, Ernst S, Guzman CE, Han S, Kalarus Z, Labadet C, Lin Y, Lo L, Nogami A, Saad EB, Sapp J, Sticherling C, Tilz R, Tung R, Kim YG, Stiles MK. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J Arrhythm 2020; 36:215-270. [PMID: 32256872 PMCID: PMC7132207 DOI: 10.1002/joa3.12308] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Young‐Hoon Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
| | - Shih‐Ann Chen
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Sabine Ernst
- Department of CardiologyRoyal Brompton and Harefield HospitalImperial College LondonLondonUK
| | | | - Seongwook Han
- Division of CardiologyDepartment of Internal MedicineKeimyung University School of MedicineDaeguRepublic of Korea
| | - Zbigniew Kalarus
- Department of CardiologyMedical University of SilesiaKatowicePoland
| | - Carlos Labadet
- Cardiology DepartmentArrhythmias and Electrophysiology ServiceClinica y Maternidad Suizo ArgentinaBuenos AiresArgentina
| | - Yenn‐Jian Lin
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Li‐Wei Lo
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Eduardo B. Saad
- Center for Atrial FibrillationHospital Pro‐CardiacoRio de JaneiroBrazil
| | - John Sapp
- Division of CardiologyDepartment of MedicineQEII Health Sciences CentreDalhousie UniversityHalifaxNSCanada
| | | | - Roland Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine)University Hospital Schleswig‐Holstein (UKSH) – Campus LuebeckLuebeckGermany
| | - Roderick Tung
- Center for Arrhythmia CarePritzker School of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Yun Gi Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
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7
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Stevenson WG, Kanagasundram A. VT Ablation. JACC Clin Electrophysiol 2020; 6:241-243. [DOI: 10.1016/j.jacep.2019.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
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8
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Aziz Z, Shatz D, Raiman M, Upadhyay GA, Beaser AD, Besser SA, Shatz NA, Fu Z, Jiang R, Nishimura T, Liao H, Nayak HM, Tung R. Targeted Ablation of Ventricular Tachycardia Guided by Wavefront Discontinuities During Sinus Rhythm. Circulation 2019; 140:1383-1397. [DOI: 10.1161/circulationaha.119.042423] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Accurate and expedited identification of scar regions most prone to reentry is needed to guide ventricular tachycardia (VT) ablation. We aimed to prospectively assess outcomes of VT ablation guided primarily by the targeting of deceleration zones (DZ) identified by propagational analysis of ventricular activation during sinus rhythm.
Methods:
Patients with scar-related VT were prospectively enrolled in the University of Chicago VT Ablation Registry between 2016 and 2018. Isochronal late activation maps annotated to the latest local electrogram deflection were created with high-density multielectrode mapping catheters. Targeted ablation of DZ (>3 isochrones within 1cm radius) was performed, prioritizing later activated regions with maximal isochronal crowding. When possible, activation mapping of VT was performed, and successful ablation sites were compared with DZ locations for mechanistic correlation. Patients were prospectively followed for VT recurrence and mortality.
Results:
One hundred twenty patients (median age 65 years [59-71], 15% female, 50% nonischemic, median ejection fraction 31%) underwent 144 ablation procedures for scar-related VT. 57% of patients had previous ablation and epicardial access was employed in 59% of cases. High-density mapping during baseline rhythm was performed (2518 points [1615-3752] endocardial, 5049±2580 points epicardial) and identified an average of 2±1 DZ, which colocalized to successful termination sites in 95% of cases. The median total radiofrequency application duration was 29 min (21-38 min) to target DZ, representing ablation of 18% of the low-voltage area. At 12±10 months, 70% freedom from VT recurrence (80% in ischemic cardiomyopathy and 63% in nonischemic cardiomyopathy) was achieved. The overall survival rate was 87%.
Conclusions:
A novel voltage-independent high-density mapping display can identify the functional substrate for VT during sinus rhythm and guide targeted ablation, obviating the need for extensive radiofrequency delivery. Regions with isochronal crowding during the baseline rhythm were predictive of VT termination sites, providing mechanistic evidence that deceleration zones are highly arrhythmogenic, functioning as niduses for reentry.
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Affiliation(s)
- Zaid Aziz
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Dalise Shatz
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Michael Raiman
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
- Abbott, Abbott Park, IL (M.R., N.A.S.)
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Andrew D. Beaser
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Stephanie A. Besser
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | | | - Zihuan Fu
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Ruhong Jiang
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Takuro Nishimura
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Hongtao Liao
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Hemal M. Nayak
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
| | - Roderick Tung
- Center for Arrhythmia Care, Pritzker School of Medicine, Department of Medicine, Division of Cardiology, University of Chicago, IL (Z.A., D.S., M.R., G.A.U., A.B., S.A.B., Z.F., R.J., T.N., H.L, H.M.N., R.T.)
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9
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: Executive summary. Heart Rhythm 2019; 17:e155-e205. [PMID: 31102616 PMCID: PMC8459311 DOI: 10.1016/j.hrthm.2019.03.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Indexed: 12/16/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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10
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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11
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Abstract
Diagnostic and interventional cardiac catheterization is routinely used in the diagnosis and treatment of congenital heart disease. There are well-established concerns regarding the risk of radiation exposure to patients and staff, particularly in children given the cumulative effects of repeat exposure. Magnetic resonance imaging (MRI) offers the advantage of being able to provide better soft tissue visualization, tissue characterization, and quantification of ventricular volumes and vascular flow. Initial work using MRI catheterization employed fusion of x-ray and MRI techniques, with x-ray fluoroscopy to guide catheter placement and subsequent MRI assessment for anatomical and hemodynamic assessment. Image overlay of 3D previously acquired MRI datasets with live fluoroscopic imaging has also been used to guide catheter procedures.Hybrid x-ray and MRI-guided catheterization paved the way for clinical application and validation of this technique in the assessment of pulmonary vascular resistance and pharmacological stress studies. Purely MRI-guided catheterization also proved possible with passive catheter tracking. First-in-man MRI-guided cardiac catheter interventions were possible due to the development of MRI-compatible guidewires, but halted due to guidewire limitations.More recent developments in passive and active catheter tracking have led to improved visualization of catheters for MRI-guided catheterization. Improvements in hardware and software have also increased image quality and scanning times with better interactive tools for the operator in the MRI catheter suite to navigate through the anatomy as required in real time. This has expanded to MRI-guided electrophysiology studies and radiofrequency ablation in humans. Animal studies show promise for the utility of MRI-guided interventional catheterization. Ongoing investment and development of MRI-compatible guidewires will pave the way for MRI-guided diagnostic and interventional catheterization coming into the mainstream.
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12
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Sapp JL, Deyell MW. Ventricular Tachycardia Ablation: Should We Be Impelled to Do More? JACC Clin Electrophysiol 2017; 3:1544-1546. [PMID: 29759836 DOI: 10.1016/j.jacep.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/03/2017] [Indexed: 10/18/2022]
Affiliation(s)
- John L Sapp
- Division of Cardiology, Department of Medicine, QEII Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Marc W Deyell
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada
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13
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Chubb H, Williams SE, Whitaker J, Harrison JL, Razavi R, O'Neill M. Cardiac Electrophysiology Under MRI Guidance: an Emerging Technology. Arrhythm Electrophysiol Rev 2017; 6:85-93. [PMID: 28845235 DOI: 10.15420/aer.2017.1.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
MR-guidance of electrophysiological (EP) procedures offers the potential for enhanced arrhythmia substrate assessment, improved procedural guidance and real-time assessment of ablation lesion formation. Accurate device tracking techniques, using both active and passive methods, have been developed to offer an interface similar to electroanatomic mapping platforms, and MR-compatible EP equipment continues to be developed. Progress to clinical implementation of these technically complex fields has been relatively slow over the last 10 years, but recent developments have led to successful clinical experience. However, further advances, particularly in harnessing the full imaging potential of CMR, are required to realise the mainstream adoption of this powerful guidance modality.
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Affiliation(s)
| | - Steven E Williams
- King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - James L Harrison
- King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Mark O'Neill
- King's College London, London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
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14
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Tedrow UB, Stevenson WG. Arrhythmia Substrate Ablation for Nonischemic Cardiomyopathy: All or Some? J Am Coll Cardiol 2016; 68:1999-2001. [PMID: 27788855 DOI: 10.1016/j.jacc.2016.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/16/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Usha B Tedrow
- Arrhythmia Unit, Brigham and Women's Hospital, Boston, Massachusetts
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15
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Recent advances in ablation of ventricular tachycardia associated with structural heart disease: overcoming the challenges of functional and fixed barriers. Curr Opin Cardiol 2016; 31:64-71. [PMID: 26627313 DOI: 10.1097/hco.0000000000000242] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Ablation of ventricular tachycardia in structural heart disease has evolved to include techniques to ablate the myocardial substrate in sinus rhythm for ventricular tachycardias that are noninducible or hemodynamically unstable. The intricacies of the complex functional and fixed components of the myocardial scar involved in the arrhythmic mechanisms require careful consideration in identifying targets for substrate ablation identified in sinus rhythm. RECENT FINDINGS The substrate ablation approach referred to as 'scar homogenization' aims to thoroughly abolish any abnormal electrical activity inside the scar. However, this extensive approach may target bystander abnormal activity that is not necessarily related to arrhythmias. Recently, different substrate ablation strategies have been developed to more selectively target areas of the scar responsible for ventricular tachycardia. New technologies have also been introduced to provide offline analysis of the electroanatomical substrate, and to improve high-density mapping of the myocardial scar. SUMMARY Recent advances have improved the ability to ablate ventricular tachycardia using techniques that allow targeting the responsible myocardial substrate while in sinus rhythm. Further research using higher-density mapping with more sophisticated online and offline analysis will aid in the assessment of the complex arrhythmogenicity of the scar and improve efficacy of ventricular tachycardia ablation.
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16
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Ávila P, Pérez-David E, Izquierdo M, Rojas-González A, Sánchez-Gómez JM, Ledesma-Carbayo MJ, López-Lereu MP, Loughlin G, Monmeneu JV, González-Torrecilla E, Atienza F, Datino T, Bravo L, Bermejo J, Fernández-Avilés F, Ruíz-Granel R, Arenal Á. Scar Extension Measured by Magnetic Resonance–Based Signal Intensity Mapping Predicts Ventricular Tachycardia Recurrence After Substrate Ablation in Patients With Previous Myocardial Infarction. JACC Clin Electrophysiol 2015; 1:353-365. [DOI: 10.1016/j.jacep.2015.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/20/2015] [Accepted: 07/30/2015] [Indexed: 11/29/2022]
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17
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Conti S, Pala S, Biagioli V, Del Giorno G, Zucchetti M, Russo E, Marino V, Dello Russo A, Casella M, Pizzamiglio F, Catto V, Tondo C, Carbucicchio C. Electrical storm: A clinical and electrophysiological overview. World J Cardiol 2015; 7:555-61. [PMID: 26413232 PMCID: PMC4577682 DOI: 10.4330/wjc.v7.i9.555] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/04/2015] [Accepted: 07/29/2015] [Indexed: 02/06/2023] Open
Abstract
Electrical storm (ES) is a clinical condition characterized by three or more ventricular arrhythmia episodes leading to appropriate implantable cardioverter-defibrillator (ICD) therapies in a 24 h period. Mostly, arrhythmias responsible of ES are multiple morphologies of monomorphic ventricular tachycardia (VT), but polymorphic VT and ventricular fibrillation can also result in ES. Clinical presentation is very dramatic in most cases, strictly related to the cardiac disease that may worsen electrical and hemodynamic decompensation. Therefore ES management is challenging in the majority of cases and a high mortality is the rule both in the acute and in the long-term phases. Different underlying cardiomyopathies provide significant clues into the mechanism of ES, which can arise in the setting of structural arrhythmogenic cardiomyopathies or rarely in patients with inherited arrhythmic syndrome, impacting on pharmacological treatment, on ICD programming, and on the opportunity to apply strategies of catheter ablation. This latter has become a pivotal form of treatment due to its high efficacy in modifying the arrhythmogenic substrate and in achieving rhythm stability, aiming at reducing recurrences of ventricular arrhythmia and at improving overall survival. In this review, the most relevant epidemiological and clinical aspects of ES, with regard to the acute and long-term follow-up implications, were evaluated, focusing on these novel therapeutic strategies of treatment.
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Affiliation(s)
- Sergio Conti
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Salvatore Pala
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Viviana Biagioli
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Giuseppe Del Giorno
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Martina Zucchetti
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Eleonora Russo
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Vittoria Marino
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Antonio Dello Russo
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Michela Casella
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Francesca Pizzamiglio
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Valentina Catto
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Claudio Tondo
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Corrado Carbucicchio
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
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18
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Impact of general anesthesia on initiation and stability of VT during catheter ablation. Heart Rhythm 2015; 12:2213-20. [PMID: 26072026 DOI: 10.1016/j.hrthm.2015.06.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Radiofrequency ablation of ventricular tachycardia (VT) may be performed with general anesthesia (GA) or conscious sedation; however, comparative data are limited. OBJECTIVE The purpose of the study was to assess the effects of GA on VT inducibility and stability. METHODS A retrospective comparison of 226 patients undergoing radiofrequency ablation for scar-related VT under GA or intravenous conscious sedation was performed. Data were then prospectively collected in 73 patients undergoing noninvasive programmed stimulation (NIPS) while awake, followed by GA and invasive programmed stimulation for VT induction. RESULTS In the retrospective study, groups did not differ in VT inducibility, complications, or abolition of clinical VT. Intravenous hemodynamic support was used more often in the GA group. In the prospective group, 12 patients (16%) were noninducible with NIPS. Of the 61 patients with inducible VT with NIPS, 5 (8%) were noninducible with GA, 25 (41%) were inducible with more aggressive simulation, and 31 (51%) were inducible with the same or less aggressive stimulation. Of the 56 patients who were inducible with NIPS and under GA, 28 (50%) had the same induced VTs and 28 (50%) had different induced VTs. In 23 of 56 patients, the clinical VT morphology was known. The clinical VT was reproduced with NIPS in 17 of 23 patients (74%) and under GA in 13 of 23 patients (59%). Under GA, nonclinical VTs were more often induced in patients with a lower ejection fraction and nonischemic cardiomyopathy. CONCLUSION GA does not prevent inducible VT in the majority of patients. GA is associated with an increased use of hemodynamic support, but this did not adversely affect VT stability or procedure outcomes.
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19
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Carbucicchio C, Al Mohani G, Casella M, Pizzamiglio F, Catto V, Pontone G, Tondo C. Uncommon ventricular tachycardia originating from an interventricular septal aneurism: Mapping and ablation guided by real-time image integration. Int J Cardiol 2015; 185:103-5. [PMID: 25791102 DOI: 10.1016/j.ijcard.2015.03.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Corrado Carbucicchio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino - IRCCS, Milan, Italy.
| | - Ghaliah Al Mohani
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino - IRCCS, Milan, Italy
| | - Michela Casella
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino - IRCCS, Milan, Italy
| | - Francesca Pizzamiglio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino - IRCCS, Milan, Italy
| | - Valentina Catto
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino - IRCCS, Milan, Italy
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino - IRCCS, Milan, Italy
| | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino - IRCCS, Milan, Italy
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20
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Berruezo A, Fernández-Armenta J, Andreu D, Penela D, Herczku C, Evertz R, Cipolletta L, Acosta J, Borràs R, Arbelo E, Tolosana JM, Brugada J, Mont L. Scar Dechanneling. Circ Arrhythm Electrophysiol 2015; 8:326-36. [DOI: 10.1161/circep.114.002386] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 12/23/2014] [Indexed: 11/16/2022]
Abstract
Background—
Ventricular tachycardia (VT) substrate ablation usually requires extensive ablation. Scar dechanneling technique may limit the extent of ablation needed.
Methods and Results—
The study included 101 consecutive patients with left ventricular scar–related VT (75 ischemic patients; left ventricular ejection fraction, 36±13%). Procedural end point was the elimination of all identified conducting channels (CCs) by ablation at the CC entrance followed by abolition of residual inducible VTs. By itself, scar dechanneling rendered noninducibility in 54.5% of patients; ablation of residual inducible VT increased noninducibility to 78.2%. Patients needing only scar dechanneling had a shorter procedure (213±64 versus 244±71 minutes;
P
=0.027), fewer radiofrequency applications (19±11% versus 27±18%;
P
=0.01), and external cardioversion/defibrillation shocks (20% versus 65.2%;
P
<0.001). At 2 years, patients needing scar dechanneling alone had better event-free survival (80% versus 62%) and lower mortality (5% versus 11%). Incomplete CC-electrogram elimination was the only independent predictor (hazard ratio, 2.54 [1.06–6.10]) for the primary end point. Higher end point-free survival rates were observed in patients noninducible after scar dechanneling (log-rank
P
=0.013) and those with complete CC-electrogram elimination (log-rank
P
=0.013). The complications rate was 6.9%, with no deaths.
Conclusions—
Scar dechanneling alone results in low recurrence and mortality rates in more than half of patients despite the limited ablation extent required. Residual inducible VT ablation improves acute results, but patients who require it have worse outcomes. Recurrences are mainly related to incomplete CC-electrogram elimination.
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Affiliation(s)
- Antonio Berruezo
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Juan Fernández-Armenta
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - David Andreu
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Diego Penela
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Csaba Herczku
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Reinder Evertz
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Laura Cipolletta
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Juan Acosta
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Roger Borràs
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Elena Arbelo
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Jose María Tolosana
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Josep Brugada
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
| | - Lluis Mont
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut d’Investigació Agustí Pi i Sunyer), Barcelona, Spain
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21
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Hooks DA, Berte B, Yamashita S, Mahida S, Sellal JM, Aljefairi N, Frontera A, Derval N, Denis A, Hocini M, Haïssaguerre M, Jaïs P, Sacher F. New strategies for ventricular tachycardia and ventricular fibrillation ablation. Expert Rev Cardiovasc Ther 2015; 13:263-76. [DOI: 10.1586/14779072.2015.1009039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Jamil-Copley S, Vergara P, Carbucicchio C, Linton N, Koa-Wing M, Luther V, Francis DP, Peters NS, Davies DW, Tondo C, Della Bella P, Kanagaratnam P. Application of ripple mapping to visualize slow conduction channels within the infarct-related left ventricular scar. Circ Arrhythm Electrophysiol 2014; 8:76-86. [PMID: 25527678 DOI: 10.1161/circep.114.001827] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Ripple mapping (RM) displays each electrogram at its 3-dimensional coordinate as a bar changing in length according to its voltage-time relationship with a fiduciary reference. We applied RM to left ventricular ischemic scar for evidence of slow-conducting channels that may act as ventricular tachycardia (VT) substrate. METHODS AND RESULTS CARTO-3© (Biosense Webster Inc, Diamond Bar, CA) maps in patient undergoing VT ablation were analyzed on an offline MatLab RM system. Scar was assessed for sequential movement of ripple bars, during sinus rhythm or pacing, which were distinct from surrounding tissue and termed RM conduction channels (RMCC). Conduction velocity was measured within RMCCs and compared with the healthy myocardium (>1.5 mV). In 21 maps, 77 RMCCs were identified. Conduction velocity in RMCCs was slower when compared with normal left ventricular myocardium (median, 54 [interquartile range, 40-86] versus 150 [interquartile range, 120-160] cm/s; P<0.001). All 7 sites meeting conventional criteria for diastolic pathways coincided with an RMCC. Seven patients had ablation colocating to all identified RMCCs with no VT recurrence during follow-up (median, 480 [interquartile range, 438-841] days). Fourteen patients had ≥1 RMCC with no ablation lesions. Five had recurrence during follow-up (median, 466 [interquartile range, 395-694] days). One of the 2 patients with no RMCC locations ablated had VT recurrence at 605 days post procedure. RMCCs were sensitive (100%; negative predictive value, 100%) for VT recurrence but the specificity (43%; positive predictive value, 35.7%) may be limited by blind alleys channels. CONCLUSIONS RM identifies slow conduction channels within ischemic scar and needs further prospective investigation to understand the role of RMCCs in determining the VT substrate.
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Affiliation(s)
- Shahnaz Jamil-Copley
- From the Department of Cardiac Electrophysiology, Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom (S.J.-C., N.L., M.K.-W., V.L., D.P.F., N.S.P., D.W.D., P.K.); Arrhythmology and Cardiac Electrophysiology Division, San Raffaele Hospital, University of Milan, Milan, Italy (P.V., P.D.B.); and Department of Arrhythmology and Electrophysiology, Centro Cardiologico Monzino, Milan, Italy (C.C., C.T.)
| | - Pasquale Vergara
- From the Department of Cardiac Electrophysiology, Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom (S.J.-C., N.L., M.K.-W., V.L., D.P.F., N.S.P., D.W.D., P.K.); Arrhythmology and Cardiac Electrophysiology Division, San Raffaele Hospital, University of Milan, Milan, Italy (P.V., P.D.B.); and Department of Arrhythmology and Electrophysiology, Centro Cardiologico Monzino, Milan, Italy (C.C., C.T.)
| | - Corrado Carbucicchio
- From the Department of Cardiac Electrophysiology, Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom (S.J.-C., N.L., M.K.-W., V.L., D.P.F., N.S.P., D.W.D., P.K.); Arrhythmology and Cardiac Electrophysiology Division, San Raffaele Hospital, University of Milan, Milan, Italy (P.V., P.D.B.); and Department of Arrhythmology and Electrophysiology, Centro Cardiologico Monzino, Milan, Italy (C.C., C.T.)
| | - Nick Linton
- From the Department of Cardiac Electrophysiology, Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom (S.J.-C., N.L., M.K.-W., V.L., D.P.F., N.S.P., D.W.D., P.K.); Arrhythmology and Cardiac Electrophysiology Division, San Raffaele Hospital, University of Milan, Milan, Italy (P.V., P.D.B.); and Department of Arrhythmology and Electrophysiology, Centro Cardiologico Monzino, Milan, Italy (C.C., C.T.)
| | - Michael Koa-Wing
- From the Department of Cardiac Electrophysiology, Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom (S.J.-C., N.L., M.K.-W., V.L., D.P.F., N.S.P., D.W.D., P.K.); Arrhythmology and Cardiac Electrophysiology Division, San Raffaele Hospital, University of Milan, Milan, Italy (P.V., P.D.B.); and Department of Arrhythmology and Electrophysiology, Centro Cardiologico Monzino, Milan, Italy (C.C., C.T.)
| | - Vishal Luther
- From the Department of Cardiac Electrophysiology, Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom (S.J.-C., N.L., M.K.-W., V.L., D.P.F., N.S.P., D.W.D., P.K.); Arrhythmology and Cardiac Electrophysiology Division, San Raffaele Hospital, University of Milan, Milan, Italy (P.V., P.D.B.); and Department of Arrhythmology and Electrophysiology, Centro Cardiologico Monzino, Milan, Italy (C.C., C.T.)
| | - Darrel P Francis
- From the Department of Cardiac Electrophysiology, Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom (S.J.-C., N.L., M.K.-W., V.L., D.P.F., N.S.P., D.W.D., P.K.); Arrhythmology and Cardiac Electrophysiology Division, San Raffaele Hospital, University of Milan, Milan, Italy (P.V., P.D.B.); and Department of Arrhythmology and Electrophysiology, Centro Cardiologico Monzino, Milan, Italy (C.C., C.T.)
| | - Nicholas S Peters
- From the Department of Cardiac Electrophysiology, Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom (S.J.-C., N.L., M.K.-W., V.L., D.P.F., N.S.P., D.W.D., P.K.); Arrhythmology and Cardiac Electrophysiology Division, San Raffaele Hospital, University of Milan, Milan, Italy (P.V., P.D.B.); and Department of Arrhythmology and Electrophysiology, Centro Cardiologico Monzino, Milan, Italy (C.C., C.T.)
| | - David Wyn Davies
- From the Department of Cardiac Electrophysiology, Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom (S.J.-C., N.L., M.K.-W., V.L., D.P.F., N.S.P., D.W.D., P.K.); Arrhythmology and Cardiac Electrophysiology Division, San Raffaele Hospital, University of Milan, Milan, Italy (P.V., P.D.B.); and Department of Arrhythmology and Electrophysiology, Centro Cardiologico Monzino, Milan, Italy (C.C., C.T.)
| | - Claudio Tondo
- From the Department of Cardiac Electrophysiology, Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom (S.J.-C., N.L., M.K.-W., V.L., D.P.F., N.S.P., D.W.D., P.K.); Arrhythmology and Cardiac Electrophysiology Division, San Raffaele Hospital, University of Milan, Milan, Italy (P.V., P.D.B.); and Department of Arrhythmology and Electrophysiology, Centro Cardiologico Monzino, Milan, Italy (C.C., C.T.)
| | - Paolo Della Bella
- From the Department of Cardiac Electrophysiology, Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom (S.J.-C., N.L., M.K.-W., V.L., D.P.F., N.S.P., D.W.D., P.K.); Arrhythmology and Cardiac Electrophysiology Division, San Raffaele Hospital, University of Milan, Milan, Italy (P.V., P.D.B.); and Department of Arrhythmology and Electrophysiology, Centro Cardiologico Monzino, Milan, Italy (C.C., C.T.)
| | - Prapa Kanagaratnam
- From the Department of Cardiac Electrophysiology, Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom (S.J.-C., N.L., M.K.-W., V.L., D.P.F., N.S.P., D.W.D., P.K.); Arrhythmology and Cardiac Electrophysiology Division, San Raffaele Hospital, University of Milan, Milan, Italy (P.V., P.D.B.); and Department of Arrhythmology and Electrophysiology, Centro Cardiologico Monzino, Milan, Italy (C.C., C.T.).
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23
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Proietti R, Essebag V, Beardsall J, Hache P, Pantano A, Wulffhart Z, Juta R, Tsang B, Joza J, Nascimento T, Pegoraro V, Khaykin Y, Verma A. Substrate-guided ablation of haemodynamically tolerated and untolerated ventricular tachycardia in patients with structural heart disease: effect of cardiomyopathy type and acute success on long-term outcome. Europace 2014; 17:461-7. [DOI: 10.1093/europace/euu326] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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