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Qiu S, Sun Z, Li X, Li J, Huang X, Liu M, Bin J, Liao Y, Xiu J, Zha D, Xue Y, Wang L, Wang Y. A novel and effective ECG method to differentiate right from left ventricular outflow tract arrhythmias: Angle-corrected V2S. Front Cardiovasc Med 2022; 9:868634. [PMID: 36312235 PMCID: PMC9606339 DOI: 10.3389/fcvm.2022.868634] [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: 02/03/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background and aims Standard 12-lead electrocardiogram (ECG) patterns combined with the anatomical cardiac long-axis angle revealed by chest X-ray can prevent the influence of cardiac rotation, physical shape, and lead position, so it may be an ideal means to predict the origin of the outflow tract (OT) ventricular arrhythmias (OTVAs) for ablation procedures. The study explores the value of this strategy in identifying the origin of OTVA. Methods This study was conducted using a retrospective cohort and a prospective cohort of consecutive patients at two centers. The anatomical cardiac long-axis angle was calculated by measuring the angle between the cardiac long-axis (a line joining the apex to the midpoint of the mitral annulus) and the horizontal plane on a chest X-ray. The V2S angle was calculated as the V2S amplitude times the angle. We ultimately enrolled 147 patients with symptomatic OTVAs who underwent successful radiofrequency catheter ablation (RFCA) (98 women (66.7%); mean age 46.9 ± 14.7 years; 126 right ventricular OT (RVOT) origins, 21 left ventricular OT (LVOT) origins) as a development cohort. The new algorithm was validated in 48 prospective patients (12 men (25.0%); mean age 48.0 ± 15.8 years; 36 RVOT, 12 LVOT origins). Results Patients with RVOT VAs had greater V2S, long-axis angle, and V2S angle than patients with LVOT VA (all P < 0.001). The cut-off V2S angle obtained by receiver operating characteristic (ROC) curve analysis was 58.28 mV° for the prediction of RVOT origin (sensitivity: 85.7%; specificity: 95.2%; positive predictive value: 99.1%; negative predictive value: 52.6%). The AUC achieved using the V2S angle was 0.888 (P < 0.001), which was the highest among all indexes (V2S/V3R: 0.887 (P < 0.016); TZ index: 0.858 (P < 0.001); V1-2 SRd: 0.876 (P < 0.001); V3 transition: 0.651 (P < 0.001)). In the prospective cohort, the V2S angle had a high overall accuracy of 93.8% and decreased the procedure time (P = 0.002). Conclusion V2S angle can be a novel measure that can be used to accurately differentiate RVOT from LVOT origins. It could help decrease ablation duration and radiation exposure.
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Affiliation(s)
- Shifeng Qiu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhuhua Sun
- Department of Health Management, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Xinzhong Li
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianyong Li
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaobo Huang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Menghui Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Jianping Bin
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yulin Liao
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiancheng Xiu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Daogang Zha
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yumei Xue
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Yumei Xue,
| | - Lichun Wang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China,Lichun Wang,
| | - Yuegang Wang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China,*Correspondence: Yuegang Wang,
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Electrocardiogram Parameters That Affect the Success Rate of Radiofrequency Ablation in Patients with Outflow Tract Ventricular Premature Complexes. Cardiovasc Ther 2022; 2022:8160144. [PMID: 35936796 PMCID: PMC9337924 DOI: 10.1155/2022/8160144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/14/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives. The objectives of this study are to assess the efficacy of radiofrequency catheter ablation (RFCA) in patients with outflow tract (OT) ventricular premature complexes (VPCs) and to explore the electrocardiographic (ECG) features of initially successful procedures. Methods. Based on the outcome of ablation, 154 consecutive patients with OT-VPCs who underwent RFCA from January 2017 to December 2019 were divided into two groups. The rate of successful procedures and the ECG features were analyzed and compared between the two groups. Results. The highest success rate was found in patients with VPCs from the right ventricular outflow tract (RVOT), and the lowest success rate was evident among patients with complexes from both the RVOT and the left ventricular OT (LVOT). The patients with successful procedures (136) reflected a lower pseudo delta wave ratio (16.2% vs. 44.4%,
), a smaller R-wave amplitude in lead V1 (V1) (
mV vs.
mV,
), shorter intrinsicoid deflection time in lead V2 (V2) (
ms vs.
ms,
), a shorter RS duration in V2 (
ms vs.
ms,
), and smaller R/S-waveratios in V2. Furthermore, multivariate analysis demonstrated that RS duration in V2 was above 109.17 ms and R/S ratio in V2 was above 0.28, forecasting a failed procedure. Conclusions. The ECG predictors of failed ablation were characterized by RS duration and R/S ratio in V2.
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Chang TY, Chen KW, Liu CM, Chang SL, Lin YJ, Lo LW, Hu YF, Chung FP, Lin CY, Kuo L, Chen SA. A High-Precision Deep Learning Algorithm to Localize Idiopathic Ventricular Arrhythmias. J Pers Med 2022; 12:jpm12050764. [PMID: 35629186 PMCID: PMC9145898 DOI: 10.3390/jpm12050764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/30/2022] [Accepted: 05/06/2022] [Indexed: 12/04/2022] Open
Abstract
Background: An accurate prediction of ventricular arrhythmia (VA) origins can optimize the strategy of ablation, and facilitate the procedure. Objective: This study aimed to develop a machine learning model from surface ECG to predict VA origins. Methods: We obtained 3628 waves of ventricular premature complex (VPC) from 731 patients. We chose to include all signal information from 12 ECG leads for model input. A model is composed of two groups of convolutional neural network (CNN) layers. We chose around 13% of all the data for model testing and 10% for validation. Results: In the first step, we trained a model for binary classification of VA source from the left or right side of the chamber with an area under the curve (AUC) of 0.963. With a threshold of 0.739, the sensitivity and specification are 90.7% and 92.3% for identifying left side VA. Then, we obtained the second model for predicting VA from the LV summit with AUC is 0.998. With a threshold of 0.739, the sensitivity and specificity are 100% and 98% for the LV summit. Conclusions: Our machine learning algorithm of surface ECG facilitates the localization of VPC, especially for the LV summit, which might optimize the ablation strategy.
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Affiliation(s)
- Ting-Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan
| | - Ke-Wei Chen
- Department of BioMedical Engineering, National Cheng Kung University, Tainan City 701401, Taiwan;
| | - Chih-Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Correspondence: ; Tel.: +886-2-7735-3832; Fax: +886-2-2872-4082
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Ling Kuo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan
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Zheng L, Sun W, Qiao Y, Hou B, Guo J, Killu A, Yao Y. Symptomatic Premature Ventricular Contractions in Vasovagal Syncope Patients: Autonomic Modulation and Catheter Ablation. Front Physiol 2021; 12:653225. [PMID: 34012407 PMCID: PMC8126685 DOI: 10.3389/fphys.2021.653225] [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: 01/14/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction There has been limited reports about the comorbid premature ventricular contractions (PVCs) and vasovagal syncope (VVS). Deceleration capacity (DC) was demonstrated to be a quantitative evaluation to assess the cardiac vagal activity. This study sought to report the impact of autonomic modulation on symptomatic PVCs in VVS patients. Methods and Results Twenty-six VVS patients with symptomatic idiopathic PVCs were consecutively enrolled. Identification and catheter ablation of left atrial ganglionated plexi (GP) and PVCs were performed in 26 and 20 patients, respectively. Holter 24 h-electrocardiograms were performed before and after the procedure to evaluate DC and PVCs occurrence. Eighteen patients were subtyped as DC-dependent PVCs (D-PVCs) and eight as DC-independent PVCs groups (I-PVCs). In D-PVCs group, circadian rhythm of hourly PVCs was positively correlated with hourly DC (P < 0.05) while there was no correlation in I-PVCs group (P > 0.05). Fifty-three GPs with positive vagal response were successfully elicited (2.0 ± 0.8 per patient). PVCs failed to occur spontaneously nor to be induced in six patients. In the remaining 20 patients, PVCs foci identified were all located in the ventricular outflow tract region. Post-ablation DC decreased significantly from baseline (P < 0.05). During mean follow-up of 10.64 ± 6.84 months, syncope recurred in one patient and PVCs recurred in another. PVCs burden of the six patients in whom neither catheter ablation nor antiarrhythmic drugs were applied demonstrated a significant decrease during follow-up (P = 0.037). Conclusion Autonomic activities were involved in the occurrence of symptomatic idiopathic PVCs in some VVS patients. D-PVCs might be facilitated by increased vagal activities. Catheter ablation of GP and PVCs foci may be an effective, safe treatment in patients with concomitant VVS and idiopathic PVCs.
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Affiliation(s)
- Lihui Zheng
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Sun
- Department of General Medicine, Monash Health, Melbourne, VIC, Australia
| | - Yu Qiao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bingbo Hou
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinrui Guo
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ammar Killu
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, United States
| | - Yan Yao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Li J, Zheng C, Liu ZR, Ma J, Jin G, Lin WQ, Wang YY, Lin JF. Radiofrequency catheter ablation of ventricular arrhythmias arising from the region above pulmonary valve. BMC Cardiovasc Disord 2019; 19:233. [PMID: 31640555 PMCID: PMC6805441 DOI: 10.1186/s12872-019-1220-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 10/04/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Ventricular arrhythmias (VAs) arising from the origin above pulmonary valve lack comprehensive investigation. This study aimed to disclose the characteristics and radiofrequency catheter ablation (RFCA) outcomes for those VAs. METHODS One hundred six VAs arising from the region above pulmonary valve treated with RFCA were included in this study. RESULTS Seventy-five cases were identified in the pulmonary sinus cusps (PSCs, 32 in left sinus cusp (PLC), 15 in right (PRC), 28 in anterior (PAC)) and 31 cases were in the main stem of pulmonary artery (MSPA, 18 above PLC (LMSPA), 3 above PRC (RMSPA), 10 above PAC (AMSPA)). Compared with PSCs VAs, MSPA VAs exhibited a higher R wave amplitude in the inferior leads, a total inferior R amplitude > 5.1 mV predicting MSPA origins. LMSPA, RMSPA and AMSPA VAs resembled PLC, PRC and PAC VAs in electrocardiographic characteristics respectively. No electrophysiological differences were found between PSCs and MSPA VAs. The irrigated-up catheter and R0 Swartz long sheath were more utilized for ablation of PSCs VAs than for MSPA VAs. All these VAs were successfully eliminated by RFCA. CONCLUSION VAs arising from the origin above pulmonary valve were common. Based on certain electrocardiographic characteristics, they could be roughly located, which contributed to an effective RFCA.
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Affiliation(s)
- Jin Li
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Road, Wenzhou, 325000, Zhejiang, China
| | - Cheng Zheng
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Road, Wenzhou, 325000, Zhejiang, China
| | - Zhi-Rui Liu
- Department of Cardiology, Ruian People's Hospital and the Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jun Ma
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Road, Wenzhou, 325000, Zhejiang, China
| | - Ge Jin
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Road, Wenzhou, 325000, Zhejiang, China
| | - Wei-Qian Lin
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Road, Wenzhou, 325000, Zhejiang, China
| | - Yao-Yao Wang
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Road, Wenzhou, 325000, Zhejiang, China
| | - Jia-Feng Lin
- Department of Cardiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan Road, Wenzhou, 325000, Zhejiang, China.
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Walia R, Chang S, Lin Y, Lo L, Hu YF, Chao T, Chung F, Liao J, Lin C, Chang Y, Lin C, Te ALD, Yamada S, Chen S, Tsao H. Early detection of electromechanical dysfunction in patients with idiopathic premature ventricular contractions. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:637-645. [DOI: 10.1111/pace.13650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/15/2018] [Accepted: 02/11/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Rohit Walia
- Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
| | - Shih‐Lin Chang
- Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Department of MedicineNational Yang‐Ming University School of Medicine Taipei Taiwan
| | - Yenn‐Jiang Lin
- Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Department of MedicineNational Yang‐Ming University School of Medicine Taipei Taiwan
| | - Li‐Wei Lo
- Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Department of MedicineNational Yang‐Ming University School of Medicine Taipei Taiwan
| | - Yu Feng Hu
- Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Department of MedicineNational Yang‐Ming University School of Medicine Taipei Taiwan
| | - Tze‐Fan Chao
- Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Department of MedicineNational Yang‐Ming University School of Medicine Taipei Taiwan
| | - Fa‐Po Chung
- Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Department of MedicineNational Yang‐Ming University School of Medicine Taipei Taiwan
| | - Jo‐Nan Liao
- Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Department of MedicineNational Yang‐Ming University School of Medicine Taipei Taiwan
| | - Chin‐Yu Lin
- Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Department of MedicineNational Yang‐Ming University School of Medicine Taipei Taiwan
| | - Yao‐Ting Chang
- Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Department of MedicineNational Yang‐Ming University School of Medicine Taipei Taiwan
| | - Chung‐Hsing Lin
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of MedicineTaipei Medical University Taipei Taiwan
- Division of Cardiology, Department of MedicineTaipei Medical University, Shuang Ho Hospital Taipei Taiwan
| | - Abigail Louise D. Te
- Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
| | - Shinya Yamada
- Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
| | - Shih‐Ann Chen
- Division of Cardiology, Department of MedicineTaipei Veterans General Hospital Taipei Taiwan
- Department of MedicineNational Yang‐Ming University School of Medicine Taipei Taiwan
| | - Hsuan‐Ming Tsao
- Department of MedicineNational Yang‐Ming University School of Medicine Taipei Taiwan
- Division of CardiologyNational Yang ‐ Ming University Hospital Yilan Taiwan
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7
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Yamada S, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Chao TF, Liao JN, Lin CH, Lin CY, Chang YT, Te ALD, Liao YC, Chi PC, Chen SA. Electrocardiographic characteristics for predicting idiopathic right ventricular outflow tract premature ventricular complex-induced cardiomyopathy. J Interv Card Electrophysiol 2018; 53:175-185. [PMID: 29948583 DOI: 10.1007/s10840-018-0384-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/15/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE In spite of several proposed predictors for premature ventricular complex (PVC)-induced cardiomyopathy (PVC-CMP), the specific ECG features of idiopathic right ventricular outflow tract (RVOT) PVC-CMP remain unknown. METHODS A total of 130 patients (49 males, mean age 44 years) with symptomatic and drug-refractory idiopathic RVOT PVCs undergoing radiofrequency catheter ablation (RFCA) were enrolled. The patients were categorized into two groups, including those with and without RVOT PVC-CMP (left ventricular ejection fraction (LVEF) < 50%, n = 25 and LVEF ≥ 50%, n = 105, respectively). The 12-lead PVC morphologies were assessed. RESULTS Patients with RVOT PVC-CMP had a lower LVEF (42 ± 5% vs. 60 ± 7%, P < 0.01) and higher PVC burden (24 ± 14% vs. 15 ± 11%, P = 0.02) when compared to patients without RVOT PVC-CMP. The PVC features in those with PVC-CMP displayed a significantly wider QRS duration (143 ± 14 ms vs. 132 ± 17 ms, P < 0.01) and higher peak deflection index (PDI; 0.60 ± 0.07 vs. 0.55 ± 0.08, P < 0.01). A multivariate analysis demonstrated that the QRS duration (odds ratio (OR) 1.130, 95% confidence interval (CI) 1.020-1.253, P = 0.02) and PDI (OR 1.240, 95% CI 1.004-1.532, P = 0.04) were independently associated with RVOT PVC-CMP. Based on the receiver-operating characteristic analysis, a QRS duration > 139 ms and PDI > 0.57 could predict RVOT PVC-CMP (area under the curve (AUC) 0.710 and AUC 0.690, respectively). The elimination and suppression of PVCs by RFCA resulted in the recovery of the LVEF in RVOT PVC-CMP. CONCLUSIONS The ECG parameters, including a wider QRS duration and higher PDI, could predict the development of RVOT PVC-CMP, which could be effectively treated by RFCA.
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Affiliation(s)
- Shinya Yamada
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Fa-Po Chung
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chung-Hsing Lin
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan.,Department of Internal Medicine, Division of Cardiology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Yao-Ting Chang
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Abigail Louise D Te
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Ying-Chieh Liao
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Po-Ching Chi
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center and Department of Medicine, Division of Cardiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Road, Taipei, Taiwan. .,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
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8
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Yamada S, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Lin CH, Lin CY, Chang YT, Chang TY, Te ALD, Chen SA. Electrocardiographic features of failed and recurrent right ventricular outflow tract catheter ablation of idiopathic ventricular arrhythmias. J Cardiovasc Electrophysiol 2017; 29:127-137. [PMID: 28988456 DOI: 10.1111/jce.13359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/16/2017] [Accepted: 09/29/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Various ECG algorithms have been proposed to identify the origin of idiopathic outflow tract (OT)-ventricular arrhythmia (VA). However, electrocardiographic features of failed and recurrent right ventricular outflow tract (RVOT) ablation of idiopathic OT-VAs have not been clearly elucidated. METHODS AND RESULTS A total of 264 consecutive patients (mean age: 44.0 ± 13.0 years, 96 male) undergoing RVOT ablation for OT-VAs with a transition ≥V3 , including 241 patients (91.6%) with initially successful procedures and 23 patients (8.4%) with failed ablation. Detailed clinical characteristics and ECG features were analyzed and compared between the two groups. VAs with failed RVOT ablation had larger peak deflection index (PDI), longer V2 R wave duration (V2 Rd), smaller V2 S wave amplitude, higher R/S ratio in V2 , higher V3 R wave amplitude, and larger V2 transition ratio than those with successful ablation. Multivariate analysis demonstrated that PDI, V2 Rd, V2 transition ratio, and pacemapping score acquired during mapping independently predicted failed ablation (P = 0.01, P = 0.01, P = 0.01, and P < 0.001, respectively). In 31 recurrent cases (12.8%) after initially successful ablation, multivariate Cox regression analysis showed that only the earliest activation time acquired during mapping predicted the recurrences after successful ablation (P = 0.001). The recurrent cases displayed different ECG features comparing with those with failed ablation. CONCLUSION The electrocardiographic features of failed RVOT ablation of idiopathic OT-VAs with a transition ≥V3 were characterized by PDI, V2 Rd, V2 transition ratio, and pacemapping score acquired during mapping, unlike the recurrent RVOT ablation.
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Affiliation(s)
- Shinya Yamada
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chung-Hsing Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Yu Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yao-Ting Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ting-Yung Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Abigail Louise D Te
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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9
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Te ALD, Higa S, Chung FP, Lin CY, Lo MT, Liu CA, Lin C, Chang YC, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao J, Chang YT, Lin CH, Hung Y, Yamada S, Pan KL, Lin YJ, Chen SA. The use of a novel signal analysis to identify the origin of idiopathic right ventricular outflow tract ventricular tachycardia during sinus rhythm: Simultaneous amplitude frequency electrogram transformation mapping. PLoS One 2017; 12:e0173189. [PMID: 28282453 PMCID: PMC5345764 DOI: 10.1371/journal.pone.0173189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 02/16/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The signal characteristics of intracardiac bipolar electrograms at the origin of idiopathic RVOT-VT during sinus rhythm remain unclear. OBJECTIVE The study sought to develop a novel real-time/online technique, simultaneous amplitude frequency electrogram transformation (SAFE-T), to quantify and localize the diseased ventricular substrate in idiopathic RVOT-VT. METHODS We retrospectively investigated the intracardiac bipolar recordings in 70 consecutive patients (26% male, mean age 42±12 years) who underwent successful radiofrequency catheter ablation of idiopathic RVOT-VT. We quantified the extent of the frequency fraction of ventricular potentials during sinus rhythm or ventricular pacing using a novel formula, the product of instantaneous amplitude and frequency, and showed that in a 3D geometry as an online SAFE-T map. RESULTS The characteristics of the HHT spectra of electrograms derived from VT origins demonstrated high frequency components (>70 Hz), which were independent of the rhythm. The density of the abnormal potentials at the VT origins were higher (VT origins, 7.5±2.3 sites/cm2 vs. surrounding myocardium, 1.5±1.3 sites/cm2, p<0.001), and were significantly decreased after ablation (0.7±0.6 sites/cm2, p<0.001). A small region of abnormal potentials were observed in the VT origins (mean area of 1.5±0.8 cm2). The SAFE-T maps predicted the VT origins with 92% sensitivity, 78% specificity with optimal cut-off value of >3.0 Hz·mV. CONCLUSION The online SAFE-T map was feasible for quantifying the diseased ventricular substrate, irrespective of the rhythm of activation, and can be used to identify the optimal ablation targets for idiopathic RVOT-VT. We found a limited region of abnormal potentials where the RVOT-VT origins were successfully ablated.
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Affiliation(s)
- Abigail Louise D. Te
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Satoshi Higa
- Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Yu Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Men-Tzung Lo
- Research Center for Adaptive Data Analysis and Center for Dynamical Biomarkers and Translational Medicine, National Central University, Jhongli, Taiwan
| | - Che-An Liu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen Lin
- Research Center for Adaptive Data Analysis and Center for Dynamical Biomarkers and Translational Medicine, National Central University, Jhongli, Taiwan
| | - Yi-Chung Chang
- Research Center for Adaptive Data Analysis and Center for Dynamical Biomarkers and Translational Medicine, National Central University, Jhongli, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jonan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Ting Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Hsing Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuan Hung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shinya Yamada
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuo-Li Pan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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Chang YT, Lin YJ, Chung FP, Lo LW, Hu YF, Chang SL, Chao TF, Liao JN, Tuan TC, Lin CY, Wang HY, Jhuo SJ, Lin CH, Suresh A, Walia R, Te ALD, Yamada S, Chen SA. Ablation of ventricular arrhythmia originating at the papillary muscle using an automatic pacemapping module. Heart Rhythm 2016; 13:1431-40. [DOI: 10.1016/j.hrthm.2016.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Indexed: 11/16/2022]
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11
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Killu AM, Mulpuru SK, Asirvatham SJ. Mapping and ablation procedures for the treatment of ventricular tachycardia. Expert Rev Cardiovasc Ther 2016; 14:1071-87. [PMID: 27269734 DOI: 10.1080/14779072.2016.1186541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Ventricular tachycardia (VT) may occur in the presence or absence of structural heart disease. Given that the management of VT hinges on the presence of symptoms and risk of sudden cardiac death (SCD), the main treatment goals are elimination of symptoms (including frequent implantable cardioverter defibrillator [ICD] therapies) and prevention of SCD. Unfortunately, medical management is suboptimal in a significant proportion of patients. As such, ablative therapy plays a prominent role in the treatment of ventricular tachycardia. AREAS COVERED In this review, we will discuss various VT disorders that are encountered in patients with and without structural heart disease. Further, we will highlight salient features regarding mapping and ablation of the various VT syndromes. Finally, we will discuss what lies on the horizon for VT ablation. Expert commentary: Meticulous mapping should aim to find the region that is most likely to be successful and least likely to result in a complication. Although recognition of the various mechanisms of VT, familiarity with different methods to mapping and ablation, and awareness of potential limitations of current approaches is critical, a thorough understanding of the fundamental principles and nuances of each facet within EP is required to ensure optimal outcomes for our patients.
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Affiliation(s)
- Ammar M Killu
- a Department of Internal Medicine , Mayo Clinic , Rochester , MN , USA.,b Department of Cardiovascular Diseases , Mayo Clinic , Rochester , MN , USA
| | - Siva K Mulpuru
- a Department of Internal Medicine , Mayo Clinic , Rochester , MN , USA.,b Department of Cardiovascular Diseases , Mayo Clinic , Rochester , MN , USA
| | - Samuel J Asirvatham
- a Department of Internal Medicine , Mayo Clinic , Rochester , MN , USA.,b Department of Cardiovascular Diseases , Mayo Clinic , Rochester , MN , USA.,c Department of Pediatrics and Adolescent Medicine , Mayo Clinic , Rochester , MN , USA
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12
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Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Chen YY, Chiou CW, Chen SA. Long-Term Follow-Up of Catheter Ablation of Ventricular Arrhythmias: Experiences from a Tertiary Referral Center in Taiwan. ACTA CARDIOLOGICA SINICA 2016; 31:8-17. [PMID: 27122841 DOI: 10.6515/acs20140721a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Radiofrequency catheter ablation (RFCA) is an alternative therapeutic management for drug-refractory ventricular arrhythmias (VA). However, long-term follow-up of clinical outcome after RFCA for VAs in Taiwan remains unknown. METHODS From 1999 to 2013, patients undergoing RFCA for VAs from a single referral center were consecutively enrolled. The annual distribution of cases, clinical characteristics, etiology, disease entity and electrophysiological studies were investigated. The clinical outcomes and recurrences between distinct entities were compared. RESULTS A total of 502 patients receiving RFCA of VAs were eligible, including 388 patients for idiopathic VAs and 114 for substrate VAs. The annual distribution displayed a tendency towards a gradual increase in ablation cases within 2009-2013 compared with the prior decade (p < 0.001). Acute success was achieved in 453 patients (90.2%), partial success in 3 (0.6%), and failed ablation in 46 (9.2%). During a mean follow-up of 39.77 ± 48.75 months, 126 (25.1%) patients developed recurrences. Kaplan-Meier analysis demonstrated better prognosis after RFCA in patients with idiopathic fascicular VT and RVOT VAs (p < 0.001) and attenuation of the occurrences of sustained VT/VF, ICD therapies, and mortality in patients with BrS and ARVD/C (p = 0.036), as well as overall ICD interventions in substrate VAs (p < 0.001). CONCLUSIONS RFCA could be an effective and alternative strategy in the elimination of idiopathic VAs and prevention of malignant events in substrate VAs at an experienced referral center in Taiwan. Distinct location of arrhythmogenic trigger and disease entities may result in non-uniform recurrences and prognosis. KEY WORDS Idiopathic; Radiofrequency catheter ablation; Recurrence; Substrate; Ventricular arrhythmias.
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Affiliation(s)
- Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
| | - Yun-Yu Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chuen-Wang Chiou
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; ; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University
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