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Chaldoupi SM, Nissen SD, Vriesendorp PA, Farnir FIP, Jerltorp K, Linz B, Johannessen A, Haugdal MA, Luermans JGLM, Saljic A, Jespersen T, Hansen J, Linz D. Focal monopolar pulsed field ablation from within the great cardiac vein for idiopathic premature ventricular contractions after failed radiofrequency ablation. Heart Rhythm 2024:S1547-5271(24)02873-X. [PMID: 38971417 DOI: 10.1016/j.hrthm.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/22/2024] [Accepted: 07/01/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Idiopathic epicardial premature ventricular contractions (PVCs) originating from the left ventricular summit are difficult to eliminate. OBJECTIVE To describe feasibility and procedural safety of focal monopolar biphasic pulsed field ablation (F-PFA) from within the great cardiac vein (GCV) for the treatment of idiopathic epicardial PVCs. METHODS In 4 pigs, F-PFA (CENTAURI, Cardiofocus) was applied from within the GCV followed by macroscopic gross analysis. In 4 patients with previously failed radiofrequency ablation, electroanatomic mapping was used to guide F-PFA from within the GCV and the ventricular outflow tracts. Coronary angiography and optical coherence tomography (OCT) were performed in 2 patients. RESULTS In pigs, F-PFA from within the GCV (5mm away from the coronary arteries) resulted in myocardial lesions with a maximal depth of 4mm which was associated with non-obstructive transient coronary spasms. In patients, sequential delivery of F-PFA in the ventricular outflow tracts and from within the GCV eliminated the PVCs. During F-PFA delivery from within the GCV with prophylactic nitroglycerin application, coronary angiography showed no coronary spasm when F-PFA was delivered >5mm away from the coronary artery and a transient coronary spasm without changes in a subsequent OCT, when F-PFA was delivered directly on the coronary artery. Intracardiac echo and computer tomography integration was used to monitor F-PFA delivery from within the GCV. There were no immediate or short-term complications. CONCLUSION Sequential mapping-guided F-PFA from endocardial ventricular outflow tracts and from within the GCV is feasible with a favourable procedural safety profile for the treatment of epicardial PVC.
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Affiliation(s)
- Sevasti-Maria Chaldoupi
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Sarah Dalgas Nissen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pieter A Vriesendorp
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Florent I P Farnir
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Kezia Jerltorp
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Benedikt Linz
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Arne Johannessen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Martin Aar Haugdal
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Justin G L M Luermans
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Arnela Saljic
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jim Hansen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
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Könemann H, Güler-Eren S, Ellermann C, Frommeyer G, Eckardt L. Antiarrhythmic Treatment in Heart Failure. Curr Heart Fail Rep 2024; 21:22-32. [PMID: 38224446 PMCID: PMC10828006 DOI: 10.1007/s11897-023-00642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE OF REVIEW Arrhythmias are common in patients with heart failure (HF) and are associated with a significant risk of mortality and morbidity. Optimal antiarrhythmic treatment is therefore essential. Here, we review current approaches to antiarrhythmic treatment in patients with HF. RECENT FINDINGS In atrial fibrillation, rhythm control and ventricular rate control are accepted therapeutic strategies. In recent years, clinical trials have demonstrated a prognostic benefit of early rhythm control strategies and AF catheter ablation, especially in patients with HF with reduced ejection fraction. Prevention of sudden cardiac death with ICD therapy is essential, but optimal risk stratification is challenging. For ventricular tachycardias, recent data support early consideration of catheter ablation. Antiarrhythmic drug therapy is an adjunctive therapy in symptomatic patients but has no prognostic benefit and well-recognized (proarrhythmic) adverse effects. Antiarrhythmic therapy in HF requires a systematic, multimodal approach, starting with guideline-directed medical therapy for HF and integrating pharmacological, device, and interventional therapy.
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Affiliation(s)
- Hilke Könemann
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany.
| | - Sati Güler-Eren
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Christian Ellermann
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
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3
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Könemann H, Dagres N, Merino JL, Sticherling C, Zeppenfeld K, Tfelt-Hansen J, Eckardt L. Spotlight on the 2022 ESC guideline management of ventricular arrhythmias and prevention of sudden cardiac death: 10 novel key aspects. Europace 2023; 25:euad091. [PMID: 37102266 PMCID: PMC10228619 DOI: 10.1093/europace/euad091] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 04/28/2023] Open
Abstract
Sudden cardiac death and ventricular arrhythmias are a global health issue. Recently, a new guideline for the management of ventricular arrhythmias and prevention of sudden cardiac death has been published by the European Society of Cardiology that serves as an update to the 2015 guideline on this topic. This review focuses on 10 novel key aspects of the current guideline: As new aspects, public basic life support and access to defibrillators are guideline topics. Recommendations for the diagnostic evaluation of patients with ventricular arrhythmias are structured according to frequently encountered clinical scenarios. Management of electrical storm has become a new focus. In addition, genetic testing and cardiac magnetic resonance imaging significantly gained relevance for both diagnostic evaluation and risk stratification. New algorithms for antiarrhythmic drug therapy aim at improving safe drug use. The new recommendations reflect increasing relevance of catheter ablation of ventricular arrhythmias, especially in patients without structural heart disease or stable coronary artery disease with only mildly impaired ejection fraction and haemodynamically tolerated ventricular tachycardias. Regarding sudden cardiac death risk stratification, risk calculators for laminopathies, and long QT syndrome are now considered besides the already established risk calculator for hypertrophic cardiomyopathy. Generally, 'new' risk markers beyond left ventricular ejection fraction are increasingly considered for recommendations on primary preventive implantable cardioverter defibrillator therapy. Furthermore, new recommendations for diagnosis of Brugada syndrome and management of primary electrical disease have been included. With many comprehensive flowcharts and practical algorithms, the new guideline takes a step towards a user-oriented reference book.
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Affiliation(s)
- Hilke Könemann
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - José Luis Merino
- Cardiology Department, La Paz University Hospital, Madrid, Spain
| | | | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jacob Tfelt-Hansen
- Section of Genetics, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Eckardt
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149 Münster, Germany
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4
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Qiu J, Dai M, Bai Y, Chen G. Potential Application of Pulsed Field Ablation in Ventricular Arrhythmias. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040723. [PMID: 37109681 PMCID: PMC10143478 DOI: 10.3390/medicina59040723] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 03/20/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023]
Abstract
Pulsed field ablation (PFA) is a new ablative method for the therapy of arrhythmia. Recent preclinical and clinical studies have already demonstrated the feasibility and safety of PFA for the treatment of atrial fibrillation (AF). However, the application of PFA may not be limited to the above fields. There are some data on the application of PFA on ventricular arrhythmias (VAs), such as ventricular fibrillation (VF) and ventricular tachycardia (VT). Further, a case report about PFA has been published recently, in which PFA was successfully applied to the ablation of premature ventricular contractions (PVCs) from the right ventricular outflow tract. Thus, we aimed to review recent research findings of PFA in ventricular ablation and evaluate the possibility of its application in VAs.
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Affiliation(s)
- Jie Qiu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Meiyan Dai
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Yang Bai
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Guangzhi Chen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan 430030, China
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Restrepo AJ, Saenz Morales LC. Preventing Complications During Mapping and Ablation of Left Ventricular Summit Arrhythmias. Card Electrophysiol Clin 2023; 15:93-109. [PMID: 36774142 DOI: 10.1016/j.ccep.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The left ventricular summit is a site of origin for idiopathic ventricular arrhythmias. With advancements in mapping and ablation techniques, sites previously considered inaccessible can now be approached. Anatomical knowledge of the 3-dimensional landmarks of this space is important, as critical structures reside within its boundaries and are potentially liable to collateral injury during ablation. This article reviews reported complications from ablation of ventricular arrhythmias arising from the left ventricular summit and its vicinity and discusses the pros and cons of different ablation technique and the role of an individualized anatomical approach to reduce procedural related complications and improve outcomes.
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Affiliation(s)
- Alejandro Jimenez Restrepo
- Marshfield Clinic Health System, 1000 North Oak Avenue, Marshfield, WI 54449, USA; University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Luis Carlos Saenz Morales
- International Arrhythmia Center, Fundacion CardioInfantil, Bogota, Colombia; Fundacion CardioInfantil, Instituto de Cardiologia, Calle 163 #13b-60, Bogota, Colombia
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Könemann H, Frommeyer G, Zeppenfeld K, Eckardt L. [The new ESC guidelines on the management of ventricular tachyarrhythmias : Implications for daily practice]. Herz 2023; 48:3-14. [PMID: 36441174 DOI: 10.1007/s00059-022-05148-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/29/2022]
Abstract
The recently published guidelines of the European Society of Cardiology (ESC) on the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death is an update of the 2015 guideline. For the first time a new section is dedicated to public basic life support. In the acute treatment of ventricular arrhythmias electrical cardioversion is upgraded, and there is a new focus on the management of electrical storm. Recommendations for the comprehensive diagnostic evaluation of patients with first manifestations of ventricular arrhythmias structured according to common clinical scenarios are also new. Both genetic testing and cardiac magnetic resonance imaging are upgraded, not only for diagnostic evaluation but also for risk stratification. In the long-term management, recommendations for pharmacotherapy are aligned with current heart failure guidelines. Catheter ablation has gained relevance not only for recurrent ventricular tachycardia under amiodarone treatment and as an alternative to implantable cardioverter defibrillation (ICD) implantation in selected patients with coronary artery disease but also particularly in the treatment of idiopathic ventricular extrasystoles and tachycardia. The ICD treatment remains an essential component of primary and secondary prevention of sudden cardiac death. Of note, the recommendation on primary preventive ICD treatment for patients with dilated cardiomyopathy and left ventricular ejection fraction (LVEF) ≤ 35% has been downgraded. In addition to LVEF a combination of risk factors and risk calculators is included in the recommendations on primary prophylactic ICD implantation. Overall, due to numerous tables and practical algorithms, the guidelines have become a user-oriented reference book.
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Affiliation(s)
- Hilke Könemann
- Klinik für Kardiologie - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.
| | - Gerrit Frommeyer
- Klinik für Kardiologie - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - Katja Zeppenfeld
- Department für Kardiologie, Universitätsklinikum Leiden, Leiden, Niederlande
| | - Lars Eckardt
- Klinik für Kardiologie - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
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Könemann H, Eckardt L. [From premature ventricular complexes to sustained ventricular tachycardia : An overview of innovations in the 2022 ESC Guideline on the therapy of ventricular arrhythmias]. Herzschrittmacherther Elektrophysiol 2022; 33:450-457. [PMID: 36385401 PMCID: PMC9691474 DOI: 10.1007/s00399-022-00908-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
The recent 2022 European Society of Cardiology Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death are an update of the former 2015 European guidelines. With multiple tables, algorithms, and comprehensive integration of underlying study data, the new guideline is a user-oriented reference book for clinical practice that also covers special clinical situations such as cardiac arrhythmias in pregnancy or in the context of sports. Regarding the acute treatment of ventricular arrhythmias, cardioversion is now recommended in case of hemodynamically tolerated arrhythmias. Beyond that, the guideline places special emphasis on the management of the electrical storm. In long-term therapy, recommendations for drug therapy have been aligned with current heart failure guidelines. Catheter ablation of ventricular arrhythmias has gained importance not only for recurrent ventricular tachycardia under chronic amiodarone therapy and as an alternative to implantable cardioverter-defibrillators (ICDs) in selected patients with coronary artery disease, but especially for the treatment of idiopathic premature ventricular contractions and tachycardias. Risk stratification and criteria for primary preventive ICDs are still controversial topics, which are discussed in detail based on the specific disease entities.
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Affiliation(s)
- Hilke Könemann
- Klinik für Kardiologie - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.
| | - Lars Eckardt
- Klinik für Kardiologie - Rhythmologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
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8
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Idiopathic Ventricular Arrhythmias Originating from Different Portions of the Coronary Venous System: Prevalence, Electrocardiographic Characteristics, Catheter Ablation, and Complications. J Cardiovasc Dev Dis 2022; 9:jcdd9030078. [PMID: 35323626 PMCID: PMC8955335 DOI: 10.3390/jcdd9030078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/14/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: To determine the prevalence, electrocardiographic characteristics, mapping, and ablation of IVAs arising from the CVS. (2) Methods: Detailed activation and pace mapping of the CVS IVAs was performed before attempted radiofrequency ablation (RFCA). (3) Results: The IVAs originating from the vicinity of the CVS represented approximately 5.27% (164/3113) of all IVAs; 94.51% (155/164) cases were accessed at the earliest identified site and 83.54% (137/164) IVAs were successfully ablated. The main coronary vein group had a relatively short procedure time, short fluoroscopy time, fewer radiofrequency lesions prior to success, and less Swartz sheath support. IVAs originating from the CVS had distinct ECG characteristics: Rs, RS or rS (with s or S) wave in lead V1 indicate the Vas arising from the proximal portion of the anterior interventricular vein (AIV) and summit-CV; Rs (with s or S) wave in leads V5−V6 indicate the Vas arising from the adjacent regions of the distal great cardiac vein 1 (DGCV1); positive wave (R, Rs or r) In lead I indicate the VAs ori”inat’ng from Summit-CV and posterior wall subgroup (including middle cardiac vein [MCV], posterior lateral vein [PLV], coronary sinus [CS]). Compared with the IVAs originating from the endocardial mitral annulus, a PdW > 45 ms, an IDT > 74 ms, and an MDI > 0.50 indicate a CVS origin of the IVAs. The common peri-procedure complications were CV dissection (6.45%, 10/155), CV rupture (1.29%, 2/155), coronary artery spasm (1.29%, 2/155), coronary artery stenosis (0.65%, 1/155), pericardial effusion (0.65%, 1/155) and tamponade (1.29%, 2/155). Stenosis of coronary arteries was not observed at the adjacent ablation site in the CVS during follow-up. (4) Conclusions: vAs arising from the CVS are not a rare phenomenon. Several ECG and procedure characteristics could help regionalize, map, and ablate the origin of IVAs from different portions of the CVS. RFCA within the CVS was relatively effective and safe.
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9
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Xuan F, Liang M, Li S, Zuo Z, Han Y, Wang Z. Guidewire ablation of epicardial ventricular arrhythmia within the coronary venous system: A case report. HeartRhythm Case Rep 2021; 8:195-199. [PMID: 35492837 PMCID: PMC9039544 DOI: 10.1016/j.hrcr.2021.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Fengqi Xuan
- Department of Cardiology, General Hospital of Northern Theater Command of China Medical University, Shenyang, China
| | - Ming Liang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Sainan Li
- Department of Cardiology, General Hospital of Northern Theater Command of China Medical University, Shenyang, China
| | - Zhongyin Zuo
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zulu Wang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- Address reprint requests and correspondence: Dr Zulu Wang, Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China.
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Mathew S, Schmitt J, Bogossian H. [Prognostic significance of premature ventricular contractions : Harmless or life-threatening?]. Herzschrittmacherther Elektrophysiol 2021; 32:14-20. [PMID: 33523285 DOI: 10.1007/s00399-021-00741-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Abstract
Premature ventricular contractions (PVC) are very common arrhythmias in cardiology. In structural normal hearts they usually represent a benign entity. If the ECG morphology is not consistent with idiopathic PVC, further diagnostic workup should be performed. They can occur due to structural heart disease and may be associated with sudden cardiac death. Polymorphic PVC or a high PVC burden should also always lead to further diagnostics and an individual risk-stratification. Therapeutic options include drug therapy and invasive catheter ablation.
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Affiliation(s)
- Shibu Mathew
- I. Med. Klinik, Kardiologie, Universitätsklinik Giessen, Klinikstr. 34, 35390, Gießen, Deutschland.
| | - Jörn Schmitt
- I. Med. Klinik, Kardiologie, Universitätsklinik Giessen, Klinikstr. 34, 35390, Gießen, Deutschland
| | - Harilaos Bogossian
- Abteilung für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen-Haspe und Universität Witten-Herdecke, Hagen, Deutschland
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11
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Aksan G. Catheter Ablation of Left Ventricular Summit Arrhythmia in a Patient with Critical Coronary Artery Stenosis: A Sequential Approach. J Innov Card Rhythm Manag 2020; 11:4266-4271. [PMID: 33123415 PMCID: PMC7588238 DOI: 10.19102/icrm.2020.111004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022] Open
Abstract
The left ventricular (LV) summit is the usual source of epicardial idiopathic premature ventricular contractions (PVCs). A 56-year-old male patient presented to the cardiology outpatient clinic with palpitations and dyspnea. Twelve-lead electrocardiography performed on admission revealed monomorphic PVCs with precordial QRS transition in the V1 derivation and an rS pattern in the D1 derivation and inferior axis. An electrophysiology study and ablation procedure were planned. Activation mapping guided by a three-dimensional electroanatomic system was conducted to identify the earliest site of ventricular activation of the PVCs. During the PVCs, the earliest ventricular activation was observed within the great cardiac vein (GCV) and preceded the QRS onset by 37 ms. Coronary angiography was performed before ablation in the coronary venous system (CVS) to assess the distance from the coronary artery, which showed severe stenosis in the left circumflex artery. Then, percutaneous coronary intervention was performed to address the left circumflex artery stenosis. Anatomic catheter ablation was performed in the aortic cusp and endocardial LV outflow tract, the sites adjacent to the LV-summit PVC origin. However, successful ablation could not be achieved. Subsequently, an irrigated radiofrequency current was delivered in the GCV for 60 seconds, with the power being gradually increased to 30 W and with an irrigation flow rate of 30 mL/min. After ablation, under isoproterenol infusion and burst pacing from the right ventricle, no PVC or ventricular tachycardia was observed. Special precautions should be taken to avoid coronary artery damage during ablation from distal CVS. This approach may increase the success of ablation and avoid potential complications.
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Affiliation(s)
- Gökhan Aksan
- Department of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey
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12
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Muser D, Santangeli P. Epicardial Ablation of Idiopathic Ventricular Tachycardia. Card Electrophysiol Clin 2020; 12:295-312. [PMID: 32771184 DOI: 10.1016/j.ccep.2020.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Ventricular arrhythmias (VAs) occurring in the absence of structural heart disease or ion channelopathies are referred to as idiopathic. They can clinically present with frequent monomorphic premature ventricular contractions, nonsustained ventricular tachycardia (VT), or sustained VT, and generally share a benign prognosis. Approximately 4% to 10% of idiopathic VAs have an epicardial site of origin, represented in most cases by the left ventricular summit and, less frequently, by the cardiac crux. Epicardial foci can be addressed by catheter ablation via the coronary venous system tributaries. In rarer instances, a direct epicardial access from a subxiphoid approach is needed.
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Affiliation(s)
- Daniele Muser
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Pasquale Santangeli
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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Unique features of epicardial ventricular arrhythmias/premature ventricular complexes ablated from coronary venous system in veteran population. Indian Pacing Electrophysiol J 2020; 20:97-104. [PMID: 32081685 PMCID: PMC7244881 DOI: 10.1016/j.ipej.2020.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/13/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Ventricular arrhythmias/premature ventricular complexes (VA/PVCs) that can be ablated from within the coronary venous system (CVS) have not been described in the United States Veterans Health Administration (VHA) population. We retrospectively studied the VA/PVCs ablations that were performed in the VHA population. Methods Data from 42 consecutive patients who underwent VA/PVCs ablation at Veterans Affairs Hospital, Indianapolis, IN, with 44 VA/PVCs was included in the study. Patients were divided into two groups (CVS group [n = 10], and non-CVS group [n = 32]) based on where the earliest pre-systolic activation was seen with >95% pacematch. Results The mean age in CVS group was 65 ± 8 years versus 64 ± 12 years (p = 0.69) in non-CVS group. Overall there was a statistically significant reduction in PVC burden post ablation (27.7% (pre-ablation) versus 4.7% (post-ablation). In the 10 patients in the CVS group, either ablation or catheter-related mechanical trauma resulted in complete (n = 6 [60%]) or partial (n = 4 [40%]) long-term suppression of VA/PVCs. Right bundle branch block-type VA/PVC (9/11: 82%) was the most common morphology in the CVS group, whereas in the non-CVS group, this type was seen in only 3/33 (9%). The CVS group (25% of total VA/PVCs) had shorter activation time compared to non CVS group. Conclusion In our experience VA/PVCs with electrocardiograms suggestive of epicardial origin can often be safely and successfully ablated within the coronary venous system. These arrhythmias have unique features in Veterans patient population.
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Busch S, Eckardt L, Sommer P, Meyer C, Bonnemeier H, Thomas D, Neuberger HR, Tilz RR, Steven D, von Bary C, Kuniss M, Voss F, Estner HL. [Premature ventricular contractions and tachycardia in a structurally normal heart : Idiopathic PVC and VT]. Herzschrittmacherther Elektrophysiol 2019; 30:212-224. [PMID: 30767064 DOI: 10.1007/s00399-019-0607-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Abstract
Premature ventricular contractions (PVC) are a common, often incidental and mostly benign finding. Treatment is indicated in frequent and symptomatic PVC or in cases of worsening of left ventricular function. Idiopathic ventricular tachycardia (VT) is mostly found in patients with a structurally healthy heart. These PVC/VT usually have a focal origin. The most likely mechanism is delayed post-depolarization. Localization of the origin is based on the creation of an activation map with or without combination of pace mapping. Idiopathic PVC/VT are most frequently located on the outflow tracts of the right and left ventricles, including the aortic root. Other typical locations include the annulus of the tricuspid or mitral valve, papillary muscles and Purkinje fibers. Catheter ablation is an alternative to antiarrhythmic medication in symptomatic monomorphic PVC/VT. The success rate is good whereby mapping and ablation can often represent a challenge. This article is the fifth part of a series dedicated to specific advanced training in the field of special rhythmology and invasive electrophysiology. It describes the pathophysiological principles, types and typical findings that can be obtained during an electrophysiological investigation.
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Affiliation(s)
- Sonia Busch
- II. Med. Klinik, Klinik für Kardiologie, Angiologie, Pneumologie, Klinikum Coburg, Ketschendorfer Str. 33, 96450, Coburg, Deutschland.
| | - Lars Eckardt
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Deutschland
| | - Christian Meyer
- Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herzzentrum Hamburg, Hamburg, Deutschland
| | - Hendrik Bonnemeier
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Dierk Thomas
- Department of Cardiology, Medical University Hospital, Heidelberg, Deutschland
- HCR (Heidelberg Center for Heart Rhythm Disorders), Heidelberg, Deutschland
- partner site Heidelberg/Mannheim, DZHK (German Center for Cardiovascular Research), Heidelberg, Deutschland
| | | | - Roland Richard Tilz
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin) - Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Daniel Steven
- Herzzentrum, Abteilung für Elektrophysiologie, Uniklinik Köln, Köln, Deutschland
| | - Christian von Bary
- Medizinische Klinik I, Rotkreuzklinikum München - Akademisches Lehrkrankenhaus der Technischen Universität München, München, Deutschland
| | - Malte Kuniss
- Abteilung für Kardiologie, Kerckhoff-Klinik GmbH, Bad Nauheim, Deutschland
| | - Frederic Voss
- Innere Medizin 3, Krankenhaus der Barmherzigen Brüder Trier, Trier, Deutschland
| | - Heidi L Estner
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität München (LMU München), München, Deutschland
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15
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Jularic M, Akbulak RÖ, Schäffer B, Moser J, Nuehrich J, Meyer C, Eickholt C, Willems S, Hoffmann BA. Image integration into 3-dimensional-electro-anatomical mapping system facilitates safe ablation of ventricular arrhythmias originating from the aortic root and its vicinity. Europace 2018; 20:520-527. [PMID: 28340078 DOI: 10.1093/europace/euw399] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/17/2016] [Indexed: 11/12/2022] Open
Abstract
Aims During ablation in the vicinity of the coronary arteries establishing a safe distance from the catheter tip to the relevant vessels is mandatory and usually assessed by fluoroscopy alone. The aim of the study was to investigate the feasibility of an image integration module (IIM) for continuous monitoring of the distance of the ablation catheter tip to the main coronary arteries during ablation of ventricular arrhythmias (VA) originating in the sinus of valsalva (SOV) and the left ventricular summit part of which can be reached via the great cardiac vein (GCV). Methods and results Of 129 patients undergoing mapping for outflow tract arrhythmias from June 2014 till October 2015, a total of 39 patients (52.4 ± 18.1 years, 17 female) had a source of origin in the SOV or the left ventricular summit. Radiofrequency (RF) ablation was performed when a distance of at least 5 mm could be demonstrated with IIM. A safe distance in at least one angiographic plane could be demonstrated in all patients with a source of origin in the SOV, whereas this was not possible in 50% of patients with earliest activation in the summit area. However, using the IIM a safe position at an adjacent site within the GCV could be obtained in three of these cases and successful RF ablation performed safely without any complications. Ablation was successful in 100% of patients with an origin in the SOV, whereas VAs originating from the left ventricular summit could be abolished completely in only 60% of cases. Conclusion Image integration combining electroanatomical mapping and fluoroscopy allows assessment of the safety of a potential ablation site by continuous real-time monitoring of the spatial relations of the catheter tip to the coronary vessels prior to RF application. It aids ablation in anatomically complex regions like the SOV or the ventricular summit providing biplane angiograms merged into the three-dimensional electroanatomical map.
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Affiliation(s)
- Mario Jularic
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Ruken Özge Akbulak
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Benjamin Schäffer
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Julia Moser
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Jana Nuehrich
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Christian Meyer
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Christian Eickholt
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Boris A Hoffmann
- Department of Cardiology-Electrophysiology, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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16
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Lv W, Zhou X, Yiming G, Zhang L, Zhou Q, Li Y, Xing Q, Zhang J, Lu Y, Wang H, Cao G, Tang B. Idiopathic premature ventricular complexes originating from the distal great cardiac vein: Clinical, cardiac and electrophysiological characteristics and catheter ablation outcome. Life Sci 2018; 202:61-69. [PMID: 29625195 DOI: 10.1016/j.lfs.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 03/07/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
AIMS Although catheter ablation for idiopathic ventricular arrhythmia (VA) has been generally well-established, VA originating from the great cardiac vein (GCV) may be clinically challenging due to its epicardial origin, proximity to coronary arteries and limited accessibility. The purpose of this study was to explore its electrophysiological characteristics and identify effective mapping/ablation strategies for idiopathic premature ventricular complexes (PVCs) originating from the GCV. MATERIALS AND METHODS Between January 2013 to January 2018, 12 patients (who were diagnosed with PVCs originating from the GCV) among the 305 patients with idiopathic left ventricular outflow tract tachycardia were included. The origin of the ectopy was localized by mapping, the characteristics of the electrocardiogram (ECG) were analyzed, and all the patients with PVCs originating from GCV were treated by radiofrequency catheter ablation (RFCA). The safety and efficacy of RFCA were evaluated. KEY FINDINGS The origin of the ectopy was successfully localized in GCV for all 12 patients by mapping, and access to GCV via the coronary sinus was feasible. Successful RFCA was achieved in 11 of 12 patients (91.67% acute procedural success) without perioperative complications. During a median follow-up of 12.6 ± 6.5 months, only one patient had recurrent VA (recurrence rate: 9.1%). SIGNIFICANCE ECG characteristics may be helpful for identifying patients with PVCs originating from the GCV. RFCA within the coronary venous system appears to be safe and effective for these patients, and should be considered when routine RFCA from the endocardium or aortic sinus of the Valsalva is not effective.
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Affiliation(s)
- Wenkui Lv
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Xianhui Zhou
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Gulinuer Yiming
- Department of Cardiac Function, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Ling Zhang
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Qina Zhou
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Yaodong Li
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Qiang Xing
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Jianghua Zhang
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Yanmei Lu
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Hongli Wang
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China
| | - Guiqiu Cao
- Department of Cardiology, Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China.
| | - Baopeng Tang
- Department of Pacing and Electrophysiological, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830011, PR China.
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17
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Muser D, Santangeli P. Ventricular Arrhythmias Linked to the Left Ventricular Summit Communicating Veins. Circ Arrhythm Electrophysiol 2018; 11:e006105. [DOI: 10.1161/circep.117.006105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniele Muser
- From the Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Pasquale Santangeli
- From the Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
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18
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Boulé S, Federspiel C, Verbrugge E, Klug D. Idiopathic epicardial ventricular tachycardia from the coronary venous system: From electrocardiographic recognition to appropriate therapy. Ann Noninvasive Electrocardiol 2017; 22. [PMID: 28188661 DOI: 10.1111/anec.12445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/20/2016] [Indexed: 11/30/2022] Open
Abstract
Idiopathic epicardial ventricular tachycardias (VTs) account for 9% of idiopathic VTs. The recognition of this entity is important, as a minimally invasive ablation procedure performed exclusively through the coronary sinus branches may be considered, avoiding the potential risks associated with access to the left ventricular endocardium, the aortic root, and the pericardial space. The electrocardiographic features and therapeutic management of this rare form of tachycardia are discussed.
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Affiliation(s)
- Stéphane Boulé
- Department of Cardiovascular Medicine, Department of Electrophysiology, Lille University Hospital, Lille, France
| | - Claire Federspiel
- Department of Cardiovascular Medicine, Department of Electrophysiology, Lille University Hospital, Lille, France.,Department of Cardiovascular Medicine, Vendée Hospital, Service de Cardiologie, La Roche-sur-Yon, France
| | - Eric Verbrugge
- Department of Cardiovascular Medicine, Department of Electrophysiology, Lille University Hospital, Lille, France.,Department of Cardiovascular Medicine, Duchenne Hospital, Boulogne sur Mer, France
| | - Didier Klug
- Department of Cardiovascular Medicine, Department of Electrophysiology, Lille University Hospital, Lille, France.,Faculty of Medicine, University of Lille 2, Lille, France
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19
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Aras D, Topaloglu S, Ozeke O, Cay S, Ozcan F, Baser K. Left coronary cusp cryoablation guided by electroanatomic mapping for outflow ventricular arrhythmias. Int J Cardiol 2016; 211:137-9. [PMID: 26961740 DOI: 10.1016/j.ijcard.2016.02.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 02/29/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Dursun Aras
- Turkiye Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey
| | - Serkan Topaloglu
- Turkiye Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey
| | - Ozcan Ozeke
- Turkiye Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey.
| | - Serkan Cay
- Turkiye Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey
| | - Firat Ozcan
- Turkiye Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey
| | - Kazim Baser
- Turkiye Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey
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20
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Spot diagnosis of inferior axis and concordant R-pattern predicts left ventricular inflow tract tachycardia: Ablation from the great cardiac vein of an underdiagnosed entity. Int J Cardiol 2016; 214:175-9. [PMID: 27061655 DOI: 10.1016/j.ijcard.2016.03.183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/02/2016] [Accepted: 03/20/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The present literature holds an enormous variation concerning origin and ablation site of idiopathic ventricular arrhythmias (VA), ranging from 2.5 to 15% for the origin within the coronary venous system (CVS). The aim of the study was to detect positive predictive ECG morphology patterns to discriminate VA stemming from the CVS. METHODS 110 consecutive patients (P) with 111 premature ventricular capture beat (PVC) morphologies undergoing successful ablation for VA were retrospectively analyzed concerning their ECG patterns. RESULTS 20/110 P (18%) displayed their VA origin in the CVS with anterior/anterolateral left ventricular inflow tract (LVIT) (epicardial/GCV) in 16 P (14%), anterior/anterolateral LVIT (endo- and epicardial/GCV) in 3 P (3%), and anterior interventricular vein (AIV) 1 P (<1%). ECG morphology of all GCV cases demonstrated an inferior axis and concordant R-pattern in all precordial leads resulting in 100% sensitivity. One VA demonstrating this pattern was ablated outside at the LVOT resulting in 95% specificity for origin in the anterior/anterolateral LVIT. 3/20 P that were ablated in the CVS required additional endocardial ablation from the anterior/anterolateral LVIT resulting in 80% specificity for sole successful ablation in the CVS. CONCLUSION An inferior axis and concordant R-pattern in all precordial leads serve as diagnostic markers for an LVIT origin in the surface ECG and suggest a high primary ablation success via the GCV.
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21
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Ma J, Wu KX, Wang YB, Ma CS, Chu JM. Premature ventricular contractions with two QRS morphologies originate from one focus in great cardiac vein. HeartRhythm Case Rep 2016; 2:204-207. [PMID: 28491670 PMCID: PMC5419736 DOI: 10.1016/j.hrcr.2015.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Juan Ma
- Weifang Medical University, Weifang, China
| | | | - Yu-Bin Wang
- Weifang Medical University, Weifang, China
- Address reprints and correspondence: Dr Yu-Bin Wang, Weifang Medical University, Baotong Road, Weicheng Dictrict, 261042, Weifang, Shandong province, ChinaWeifang Medical University, Baotong Road, Weicheng DictrictWeifang261042China
| | - Chang-Sheng Ma
- National Clinical Research Center for Cardiovascular Diseases & Cardiology Department, Beijing An Zhen Hospital Capital Medical University, Beijing, China
| | - Jian-Min Chu
- FuWai Hospital, National Center For Cardiovascular Diseases of China, Beijing, China
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22
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Kumagai YU, Arimoto T, Iwayama T, Hashimoto N, Watanabe T, Kubota I. Contact Force-Guided Deep Engagement with a Steerable Sheath in the Distal Great Cardiac Vein: A Case Report. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:507-10. [PMID: 26854279 DOI: 10.1111/pace.12826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/08/2016] [Accepted: 01/19/2016] [Indexed: 11/26/2022]
Abstract
Ablation of ventricular tachycardia originating from the great cardiac vein involves the difficult step of deep engagement with an ablation catheter. The catheter and a steerable sheath (MobiCath, Biosense Webster, Diamond Bar, CA, USA) were advanced alternately only when the contact force vector was parallel to the coronary venous system. Deep engagement with a steerable sheath ensured a powerful backup force during ablation.
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Affiliation(s)
- Y U Kumagai
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Takanori Arimoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Tadateru Iwayama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Naoaki Hashimoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Isao Kubota
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
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23
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CHEN YIHE, LIN JIAFENG. Catheter Ablation of Idiopathic Epicardial Ventricular Arrhythmias Originating from the Vicinity of the Coronary Sinus System. J Cardiovasc Electrophysiol 2015; 26:1160-7. [PMID: 26175213 DOI: 10.1111/jce.12756] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 06/18/2015] [Accepted: 07/08/2015] [Indexed: 11/28/2022]
Affiliation(s)
- YI-HE CHEN
- Department of Cardiology; Second Affiliated Hospital of Wenzhou Medical College; Wenzhou Zhejiang China
| | - JIA-FENG LIN
- Department of Cardiology; Second Affiliated Hospital of Wenzhou Medical College; Wenzhou Zhejiang China
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24
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[Localization of the origin of idiopathic ventricular extrasystoles and tachycardia from the outflow tract]. Herzschrittmacherther Elektrophysiol 2015; 26:227-34. [PMID: 26272441 DOI: 10.1007/s00399-015-0384-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/15/2015] [Indexed: 10/23/2022]
Abstract
Premature ventricular contractions (PVC) are a common cause for complaints. As a rule PVCs are not life-threatening if no structural heart disease is present; however, due to the symptoms treatment is often required using either antiarrhythmic drugs or more commonly catheter ablation. The surface electrocardiogram (ECG) is very helpful in localizing the origin of the arrhythmia, in particular for differentiating right from left ventricular sources.
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25
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WANG YUBIN, MA JUAN, DONG JIANZENG, BAI RONG, WANG JING, LI SONGNAN, YU RONGHUI, LONG DEYONG, MA CHANGSHENG, CHU JIANMIN. Catheter Ablation of Premature Ventricular Contractions Originating in the Aortic Sinus Cusp or Great Cardiac Vein: Two QRS Morphologies with One Origin. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1029-38. [PMID: 25953101 DOI: 10.1111/pace.12652] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 03/30/2015] [Accepted: 04/21/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - JUAN MA
- Weifang Medical University; Weifang China
| | - JIAN-ZENG DONG
- National Clinical Research Center for Cardiovascular Diseases & Cardiology Department, Beijing An Zhen Hospital, Capital Medical University; Beijing China
| | - RONG BAI
- National Clinical Research Center for Cardiovascular Diseases & Cardiology Department, Beijing An Zhen Hospital, Capital Medical University; Beijing China
| | - JING WANG
- FuWai Hospital, National Center for Cardiovascular Diseases of China; Beijing China
| | - SONG-NAN LI
- National Clinical Research Center for Cardiovascular Diseases & Cardiology Department, Beijing An Zhen Hospital, Capital Medical University; Beijing China
| | - RONG-HUI YU
- National Clinical Research Center for Cardiovascular Diseases & Cardiology Department, Beijing An Zhen Hospital, Capital Medical University; Beijing China
| | - DE-YONG LONG
- National Clinical Research Center for Cardiovascular Diseases & Cardiology Department, Beijing An Zhen Hospital, Capital Medical University; Beijing China
| | - CHANG-SHENG MA
- National Clinical Research Center for Cardiovascular Diseases & Cardiology Department, Beijing An Zhen Hospital, Capital Medical University; Beijing China
| | - JIAN-MIN CHU
- FuWai Hospital, National Center for Cardiovascular Diseases of China; Beijing China
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26
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Left anterior descending artery spasm after radiofrequency catheter ablation for ventricular premature contractions originating from the left ventricular outflow tract. HeartRhythm Case Rep 2015; 1:103-106. [PMID: 28491523 PMCID: PMC5418553 DOI: 10.1016/j.hrcr.2014.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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27
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Nagashima K, Choi EK, Lin KY, Kumar S, Tedrow UB, Koplan BA, Michaud GF, John RM, Epstein LM, Tokuda M, Inada K, Couper GS, Stevenson WG. Ventricular Arrhythmias Near the Distal Great Cardiac Vein. Circ Arrhythm Electrophysiol 2014; 7:906-12. [DOI: 10.1161/circep.114.001615] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Catheter ablation for ventricular arrhythmia (VA) near the distal great cardiac vein (GCV) is often challenging, and data are limited.
Methods and Results—
Analysis was performed in 30 patients (19 men; age, 52.8±15.5 years) who underwent catheter ablation for focal VA (11 ventricular tachycardia and 19 premature contractions) with early activation in the GCV (36.7±8.0 ms pre-QRS). Angiography in 27 patients showed earliest GCV site within 5 mm of a coronary artery in 20 (74%). Ablation was performed in the GCV in 15 patients and abolished VA in 8. Ablation was attempted at adjacent non-GCV sites in 19 patients and abolished VA in 5 patients (4 from the left ventricular endocardium and 1 from the left coronary cusp); all success had VA with an initial r wave in lead I and activation ≤7 ms after the GCV (GCV–non-GCV interval). In 13 patients, percutaneous epicardial mapping was performed, but because of adjacent coronaries only 2 received radiofrequency application with VA elimination in 1. Surgical cryoablation was performed in 3 patients and abolished VA in 2. Overall acute success was achieved in 16 (53%) patients. After a median of 2.8 months, 13 patients remained free of VA. Major complications occurred in 4 patients, including coronary injury requiring stenting.
Conclusions—
Ablation for this arrhythmia is challenging and often limited by the adjacent coronary vessels. Success of anatomically guided endocardial ablation may be identified by a short GCV–non-GCV interval and r wave in lead I.
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Affiliation(s)
- Koichi Nagashima
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Eue-Keun Choi
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Kaity Y. Lin
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Saurabh Kumar
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Usha B. Tedrow
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Bruce A. Koplan
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Gregory F. Michaud
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Roy M. John
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Laurence M. Epstein
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Michifumi Tokuda
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Keiichi Inada
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Gregory S. Couper
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - William G. Stevenson
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
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