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Enriquez A, Muser D, Markman TM, Garcia F. Mapping and Ablation of Premature Ventricular Complexes: State of the Art. JACC Clin Electrophysiol 2024; 10:1206-1222. [PMID: 38639702 DOI: 10.1016/j.jacep.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/20/2024]
Abstract
Premature ventricular complexes (PVCs) are common arrhythmias in clinical practice. Although benign and asymptomatic in most cases, PVCs may result in disabling symptoms, left ventricular systolic dysfunction, or PVC-induced ventricular fibrillation. Catheter ablation has emerged as a first-line therapy in such cases, with high rates of efficacy and low risk of complications. Significant progress in mapping and ablation technology has been made in the past 2 decades, along with the development of a growing body of knowledge and accumulated experience regarding PVC sites of origin, anatomical relationships, electrocardiographic characterization, and mapping/ablation strategies. This paper provides an overview of the main indications for catheter ablation of PVCs, electrocardiographic features, PVC mapping techniques, and contemporary ablation approaches. The authors also review the most common sites of PVC origin and the main considerations and challenges with ablation in each location.
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Affiliation(s)
- Andres Enriquez
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Daniele Muser
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Timothy M Markman
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fermin Garcia
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Okada M, Tanaka K, Mizutani A, Ikada Y, Tanaka N. Successful catheter ablation of intraseptal ventricular tachycardia from the entrance side of the slow conduction zone. HeartRhythm Case Rep 2023; 9:524-528. [PMID: 37614399 PMCID: PMC10444554 DOI: 10.1016/j.hrcr.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Affiliation(s)
- Masato Okada
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Koji Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Akinobu Mizutani
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yusuke Ikada
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
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Chatterjee NA. Septal Substrate in Ventricular Tachycardia Storm: Bellwether of Risk. JACC Clin Electrophysiol 2023:S2405-500X(23)00211-6. [PMID: 37227352 DOI: 10.1016/j.jacep.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Neal A Chatterjee
- Electrophysiology Section, Cardiology Division, University of Washington Medicine Heart Institute, University of Washington, Seattle, Washington, USA.
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4
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Roca-Luque I, Quinto L, Sanchez-Somonte P, Garre P, Alarcón F, Zaraket F, Vazquez S, Prat-Gonzalez S, Ortiz-Perez JT, Guasch E, Tolosana JM, Arbelo E, Berruezo A, Sitges M, Brugada J, Mont L. Late Potential Abolition in Ventricular Tachycardia Ablation. Am J Cardiol 2022; 174:53-60. [PMID: 35437160 DOI: 10.1016/j.amjcard.2022.02.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/12/2022] [Accepted: 02/18/2022] [Indexed: 11/01/2022]
Abstract
Ventricular tachycardia (VT) substrate-based ablation has become the gold standard treatment for patients with structural heart disease-related VT. VT is linked to re-entry in relation to myocardial scarring, with areas of conduction block (core scar) and of slow conduction (border zone). Slow conduction areas can be detected in sinus rhythm as late potentials (LPs). LP abolition has been shown to be the best end point to avoid long-term recurrences. Our study aimed to analyze the challenges of LP abolition and the predictors of failure. We analyzed 169 consecutive patients with structural heart disease (61% ischemic cardiomyopathy, left ventricular ejection fraction: 37 ± 13%) who underwent VT ablation between 2013 and 2018. A preprocedural clinical evaluation, including cardiac magnetic resonance, was done in 66% of patients. Electroanatomical mapping with the identification of LPs was performed in all patients. Noninducibility was achieved in 71% (119), and complete LP abolition was achieved in 61% (103) of patients. Incomplete LP abolition was a powerful predictor of VT recurrence (67% vs 33%, hazard ratio 3.19 [2.1 to 4.7]; p <0.001). Lack of use of a high-density mapping catheter (odds ratio 6.2, 1.2 to 38.1; p = 0.028), the septal substrate (odds ratio 9.34, 2.27 to 38.4; p = 0.002), and larger left ventricular mass (190 ± 58 g vs 156 ± 46 g, p = 0.002) were predictors of incomplete LP abolition. The main reasons that contributed to unsuccessful LP abolition were anatomic obstacles (such as the conduction system) and large extension of the LP area. In conclusion, incomplete LP abolition is related to VT recurrence. Lack of use of a high-density mapping catheter, the septal substrate, and larger left ventricular mass are related to incomplete LP abolition.
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Ueda A, Katsume Y, Miwa Y, Mohri T, Tashiro M, Nonoguchi N, Hoshida K, Togashi I, Sato T, Soejima K. Temporal and Spatial Pacemap Parameters for Identification of Cardiac Surfaces with Critical Sites for Ventricular Tachycardia. J Cardiovasc Electrophysiol 2022; 33:1791-1800. [PMID: 35748391 DOI: 10.1111/jce.15611] [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: 02/25/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Multi-surface pacemapping may help identify the surface of interest in scar-related ventricular tachycardia. This study aimed to investigate the performance of pacemap parameters for detecting critical sites through multi-surface mapping. METHODS AND RESULTS In 26 patients who underwent scar-related ventricular tachycardia ablation, pacemap parameters including a matching score, the difference between the longest and shortest stimulus-QRS intervals (Δs-QRS), and the distance between the good pacemap sites were measured. The parameters were compared between surfaces with and without critical sites and ablation outcomes. A total of 941 pacemaps at 56 surfaces targeting 35 ventricular tachycardias were analyzed. A greater Δs-QRS (40 vs. 8 ms, P<0.001) and longer distance between two good pacemap sites (24 vs. 13 mm, P<0.001) were observed on the surfaces with critical sites. A similar trend was seen in multi-surface pacemapping for the same ventricular tachycardias (52 vs 18 ms in Δs-QRS, P=0.021; 37 vs. 12 mm in distance, P=0.019), although the best pacemap scores were comparable (94 vs. 87, P=0.295). The Δs-QRS >20 ms and the distance >19 mm showed high positive likelihood ratios (19.8 and 6.1, respectively) for discriminating the surface harboring the critical site. Ablation of ventricular tachycardias fulfilling these parameters was successful on the surfaces, but without the required multi-surface ablation. CONCLUSION Temporal (Δs-QRS) and spatial (distance) parameters for good pacemap match sites were excellent markers for detecting the surface harboring critical sites in scar-related ventricular tachycardia. A multi-surface pacemapping can successfully identify the surface of interest. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Akiko Ueda
- Division of Advanced Arrhythmia Management, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Yumi Katsume
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Yosuke Miwa
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Takato Mohri
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Mika Tashiro
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Noriko Nonoguchi
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Kyoko Hoshida
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Ikuko Togashi
- Division of Advanced Arrhythmia Management, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Toshiaki Sato
- Division of Advanced Arrhythmia Management, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-0004, Japan
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The Interventricular Septum: Structure, Function, Dysfunction, and Diseases. J Clin Med 2022; 11:jcm11113227. [PMID: 35683618 PMCID: PMC9181036 DOI: 10.3390/jcm11113227] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/25/2022] [Accepted: 06/04/2022] [Indexed: 02/05/2023] Open
Abstract
Vertebrates developed pulmonary circulation and septated the heart into venous and arterial compartments, as the adaptation from aquatic to terrestrial life requires more oxygen and energy. The interventricular septum (IVS) accommodates the ventricular portion of the conduction system and contributes to the mechanical function of both ventricles. Conditions or diseases that affect IVS structure and function (e.g., hypertrophy, defects, other) may lead to ventricular pump failure and/or ventricular arrhythmias with grave consequences. IVS structure and function can be evaluated today using current imaging techniques. Effective therapies can be provided in most cases, although definitions of underlying etiologies may not always be easy, particularly in the elderly due to overlap between genetic and acquired causes of IVS hypertrophy, the most common being IVS abnormality. In this review, state-of-the-art information regarding IVS morphology, physiology, physiopathology, and disease is presented.
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John RM, Stevenson W. Interventricular septal substrates for scar-related monomorphic ventricular tachycardia. Indian Pacing Electrophysiol J 2022; 22:10-11. [PMID: 35101203 PMCID: PMC8811287 DOI: 10.1016/j.ipej.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Roy M John
- Stanford School of Medicine, Palo Alto, CA, USA.
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Kotake Y, Campbell T, Bennett RG, Turnbull S, Huang K, Ross N, Trivic I, De Silva K, Bhaskaran A, Kumar S. Clinical and Electrophysiological Characteristics of Ventricular Tachycardias From the Basal Septum in Structural Heart Disease. JACC Clin Electrophysiol 2021; 7:1274-1284. [PMID: 34454889 DOI: 10.1016/j.jacep.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study describes the clinical and electrophysiological characteristics of basal-septal ventricular tachycardias (VTs) in patients with structural heart disease (SHD). BACKGROUND The basal septum is a common source of VT in patients with SHD. METHODS Data from 312 consecutive patients with SHD undergoing catheter ablation of ventricular arrhythmias were reviewed. RESULTS Thirty-three basal-septal VTs in 31 patients (mean age 67.4 ± 14.2 years, mean left ventricular ejection fraction [LVEF] 42% ± 15%) were identified. Patients with VTs with left ventricular basal-septal breakthrough were more likely to have ischemic cardiomyopathy and lower LVEF; patients with right ventricular basal-septal VT were more likely to have sarcoidosis or right ventricular cardiomyopathy of unknown significance, with higher LVEF. Atrioventricular block was present in 45% of patients and intraventricular block including persistent biventricular pacing in 77%. Unipolar scar was larger than bipolar scar (area 18.8% ± 19.4% vs 12.7% ± 14.6%; P < 0.001). VTs with right bundle branch block configuration and S wave in lead V6 with positive V3/V4 polarity consistently indicated left ventricular basal-septal breakthrough. Inferior limb-lead discordance with right bundle branch block configuration and "reverse pattern break in lead V2" were identified in left ventricular basal inferior-septal origin in 3 patients. VT noninducibility was achieved in 55%, and VT recurred in 42% of patients after a single procedure, but VT burden was significantly reduced after ablation (59 episodes before vs 2 episodes after ablation; P = 0.02). CONCLUSIONS Basal-septal VTs in patients with SHD have a distinct clinical, electrocardiographic, and electrophysiological profile depending on the breakthrough site, accompanied by a deep intramural septal substrate that limits procedural success after catheter ablation.
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Affiliation(s)
- Yasuhito Kotake
- Department of Cardiology, Westmead Hospital, University of Sydney, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, University of Sydney, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, University of Sydney, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, University of Sydney, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Kaimin Huang
- Department of Cardiology, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Neil Ross
- Department of Cardiology, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Ivana Trivic
- Department of Cardiology, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Kasun De Silva
- Department of Cardiology, Westmead Hospital, University of Sydney, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Ashwin Bhaskaran
- Department of Cardiology, Westmead Hospital, University of Sydney, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, University of Sydney, Sydney, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, Australia.
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9
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Quinto L, Sanchez P, Alarcón F, Garre P, Zaraket F, Prat-Gonzalez S, Ortiz-Perez JT, JesúsPerea R, Guasch E, Tolosana JM, San Antonio R, Arbelo E, Sitges M, Brugada J, Berruezo A, Mont L, Roca-Luque I. Cardiac magnetic resonance to predict recurrences after ventricular tachycardia ablation: septal involvement, transmural channels, and left ventricular mass. Europace 2021; 23:1437-1445. [PMID: 34142121 DOI: 10.1093/europace/euab127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 05/07/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Ventricular tachycardia (VT) substrate-based ablation has an increasing role in patients with structural heart disease-related VT. VT is linked to re-entry in relation to myocardial scarring with areas of conduction block (core scar) and areas of slow conduction [border zone (BZ)]. VT substrate can be analysed by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Our study aims to analyse the role of LGE-CMR in identifying predictors of VT recurrence after ablation. METHODS AND RESULTS We analysed 110 consecutive patients who underwent VT ablation from 2013 to 2018. All patients underwent a preprocedural LGE-CMR, and in 94 patients (85.5%), the CMR was used to aid the ablation. All LGE-CMR images were semi-automatically processed using dedicated software to detect scarring and conducting channels. After a median follow-up of 2.7 ± 1.6 years, the overall VT recurrence was 41.8% with an implantable cardioverter-defibrillator shock reduction from 43.6% to 28.2% before and after ablation, respectively. The amount of BZ (26.6 ± 13.9 vs. 19.6 ± 9.7 g, P = 0.012), the total amount of scarring (37.1 ± 18.2 vs. 29 ± 16.3 g, P = 0,033), and left ventricular (LV) mass (168.3 ± 53.3 vs. 152.3 ± 46.4 g, P < 0.001) were associated with VT recurrence. LGE septal distribution [62.5% vs. 37.8%; hazard ratio (HR) 1.67 (1.02-3.93), P = 0.044], channels with transmural path [66.7% vs. 31.4%, HR 3.25 (1.70-6.23), P < 0.001], and midmural channels [54.3% vs. 27.6%, HR 2.49 (1.21-5.13), P = 0.013] were related with VT recurrence. Multivariate analysis showed that the presence of septal LGE [HR 3.67 (1.60-8.38), P = 0.002], transmural channels [HR 2.32 (1.15-4.72), P = 0.019], and LV mass [HR 1.01 (1.005-1.019), P = 0.002] were independent predictors of VT recurrence. CONCLUSION Pre-procedural LGE-CMR is a helpful and feasible technique to identify patients with high risk of VT recurrence after ablation. LV mass, septal LGE distribution, and transmural channels were predictive factors of post-ablation VT recurrence.
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Affiliation(s)
- Levio Quinto
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Paula Sanchez
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Francisco Alarcón
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Paz Garre
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Fatima Zaraket
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Susana Prat-Gonzalez
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Jose T Ortiz-Perez
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Rosario JesúsPerea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centre de Diagnòstic per la Imatge, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Eduard Guasch
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José Maria Tolosana
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rodolfo San Antonio
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Elena Arbelo
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Marta Sitges
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Josep Brugada
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Antonio Berruezo
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Lluís Mont
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ivo Roca-Luque
- Arrhythmia Section Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Villarroel, 170, 08036Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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10
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Lwin TS, Mitrakrishnan RN, Alama M, Chin SH. A case report reappraising the usefulness of Valsalva manoeuvre in drug-refractory ventricular tachycardia. Eur Heart J Case Rep 2021; 5:ytab171. [PMID: 34124569 PMCID: PMC8189301 DOI: 10.1093/ehjcr/ytab171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/23/2020] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ventricular tachycardia (VT) is often misdiagnosed as supraventricular tachycardia with aberrancy. Twelve-lead electrocardiogram remains a key diagnostic tool to differentiate them while providing insights to aid localization of VT. The use of Valsalva manoeuvre (VM) in terminating VT is not conventionally recommended due to lack of robust evidence of its effectiveness and poor understanding of its mechanism in terminating VT. CASE SUMMARY A 74-year-old man with history of ischaemic heart disease was admitted with broad complex tachycardia. VT-1 was diagnosed following failed tachycardia termination by adenosine. Haemodynamic compromise necessitated synchronized cardioversion with successful reversion. However, a different VT-2 occurred after cardioversion. VM led to successful termination of VT-2. Subsequently, recurrent episodes of VT-2 occurred with consistent termination by VM. Transthoracic echocardiogram, cardiac magnetic resonance imaging, and a coronary angiogram were performed. Findings suggested that these are likely scar-related VT. VT-1 originated from an anteroseptal scar, whilst VT-2, responsive to VM, likely originated from the Purkinje fibres. Patient remained eurhythmic after Day 1 following amiodarone and beta-blocker initiation. An implantable cardioverter-defibrillator was implanted prior to discharge. DISCUSSION VM is one of the vagal manoeuvres which are commonly used as initial management of supraventricular tachycardia. Its role in management of VT is obscure. Anecdotal case series recorded its successful use for managing particular VT. Exact mechanism remains elusive although postulated to involve change in cardiac size during strain and release of acetylcholine.
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Affiliation(s)
- Tin Sanda Lwin
- Department of Cardiology, Kettering General Hospital, NHS, Rothwell Road, Kettering, NN16 8UZ, UK
| | | | - Mohamed Alama
- Department of Cardiology, Kettering General Hospital, NHS, Rothwell Road, Kettering, NN16 8UZ, UK
| | - Shui Hao Chin
- Department of Cardiology, Glenfield Hospital, University of Leicester NHS Trust, Groby Road, Leicester, LE3 9QP, UK
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11
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Campos FO, Orini M, Arnold R, Whitaker J, O'Neill M, Razavi R, Plank G, Hanson B, Porter B, Rinaldi CA, Gill J, Lambiase PD, Taggart P, Bishop MJ. Assessing the ability of substrate mapping techniques to guide ventricular tachycardia ablation using computational modelling. Comput Biol Med 2021; 130:104214. [PMID: 33476992 DOI: 10.1016/j.compbiomed.2021.104214] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Identification of targets for ablation of post-infarction ventricular tachycardias (VTs) remains challenging, often requiring arrhythmia induction to delineate the reentrant circuit. This carries a risk for the patient and may not be feasible. Substrate mapping has emerged as a safer strategy to uncover arrhythmogenic regions. However, VT recurrence remains common. GOAL To use computer simulations to assess the ability of different substrate mapping approaches to identify VT exit sites. METHODS A 3D computational model of the porcine post-infarction heart was constructed to simulate VT and paced rhythm. Electroanatomical maps were constructed based on endocardial electrogram features and the reentry vulnerability index (RVI - a metric combining activation (AT) and repolarization timings to identify tissue susceptibility to reentry). Since scar transmurality in our model was not homogeneous, parameters derived from all signals (including dense scar regions) were used in the analysis. Potential ablation targets obtained from each electroanatomical map during pacing were compared to the exit site detected during VT mapping. RESULTS Simulation data showed that voltage cut-offs applied to bipolar electrograms could delineate the scar, but not the VT circuit. Electrogram fractionation had the highest correlation with scar transmurality. The RVI identified regions closest to VT exit site but was outperformed by AT gradients combined with voltage cut-offs. The performance of all metrics was affected by pacing location. CONCLUSIONS Substrate mapping could provide information about the infarct, but the directional dependency on activation should be considered. Activation-repolarization metrics have utility in safely identifying VT targets, even with non-transmural scars.
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Affiliation(s)
- Fernando O Campos
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom.
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Electrophysiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Robert Arnold
- Gottfried Schatz Research Center (for Cell Signaling, Metabolism and Aging), Division of Biophysics, Graz, Austria
| | - John Whitaker
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Mark O'Neill
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Gernot Plank
- Gottfried Schatz Research Center (for Cell Signaling, Metabolism and Aging), Division of Biophysics, Graz, Austria
| | - Ben Hanson
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Bradley Porter
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom; Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom
| | | | - Jaswinder Gill
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom; Department of Cardiology, Guys and St Thomas' NHS Trust, London, United Kingdom
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Electrophysiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Peter Taggart
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Electrophysiology Department, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Martin J Bishop
- School of Biomedical Engineering and Imaging Sciences, Rayne Institute, 4th Floor, Lambeth Wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
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12
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Ablation strategies for intramural ventricular arrhythmias. Heart Rhythm 2020; 17:1176-1184. [DOI: 10.1016/j.hrthm.2020.02.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/07/2020] [Indexed: 11/23/2022]
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13
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Stevenson WG, Kanagasundram A. VT Ablation. JACC Clin Electrophysiol 2020; 6:241-243. [DOI: 10.1016/j.jacep.2019.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
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14
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Enriquez A, Neira V, Bakker D, Baley J, Bisleri G, Baranchuk A, Redfearn D. Bipolar ablation with half normal saline for deep intramural outflow tract premature ventricular contraction. HeartRhythm Case Rep 2019; 5:436-439. [PMID: 31453098 PMCID: PMC6701005 DOI: 10.1016/j.hrcr.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Affiliation(s)
- Andres Enriquez
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Victor Neira
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | | | - Jason Baley
- Division of Surgery, Queen's University, Kingston, Ontario, Canada
| | | | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
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15
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Atrioventricular Block During Catheter Ablation for Ventricular Arrhythmias. JACC Clin Electrophysiol 2019; 5:104-112. [DOI: 10.1016/j.jacep.2018.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 01/18/2023]
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16
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Al-Hadithi ABAK, Khakpour H, Cruz D, Boyle NG, Shivkumar K, Bradfield JS. Incessant intraseptal ventricular tachycardia ablated utilizing extracorporeal membrane oxygenation and bipolar ablation. HeartRhythm Case Rep 2018; 4:557-560. [PMID: 30581730 PMCID: PMC6301887 DOI: 10.1016/j.hrcr.2018.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Affiliation(s)
- Ali B A K Al-Hadithi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Houman Khakpour
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Daniel Cruz
- UCLA Cardiomyopathy Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
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17
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Protection of Critical Structures During Radiofrequency Ablation of Adjacent Myocardial Tissue Using Catheter Tips Partially Insulated With Thermally Conductive Material. JACC Clin Electrophysiol 2016; 2:838-846. [PMID: 29759769 DOI: 10.1016/j.jacep.2016.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/05/2016] [Accepted: 03/17/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study sought to determine whether partially insulated focused ablation (PIFA) catheters can minimize risk of injury to critical structures, such as the phrenic nerve and atrioventricular (AV) node, during ablation of adjacent myocardial tissue. BACKGROUND PIFA catheters using thermally conductive materials may have differential radiofrequency (RF) heating properties allowing for tailored RF application with more precision. METHODS Open-irrigated, 4- and 8-mm RF ablation catheter tips were insulated partially by coating one-half of their surfaces with a layer of vinyl, silicone, vinyl-silicone, polyurethane, or a composite of aluminum oxide/boron nitride (AOBN). These coated catheters or corresponding noninsulated catheters were positioned with 10 g of force on viable bovine myocardial tissue during RF application in an ex vivo setup. Tip temperatures, power, and lesion volumes were compared. The most effective coating, AOBN, was modified further by adding fenestrations to aid in passive cooling. PIFA catheters with fenestrated AOBN coating were then tested in an in vivo porcine model to target myocardial tissue adjacent to the AV node and the phrenic nerve. RESULTS PIFA catheters all demonstrated higher tip temperatures, although silicone- and AOBN-catheters demonstrated this to a lesser degree. Significant differences in lesion volumes and temperature-limited powers were noted between control, silicone, and AOBN tips. Steam pops were significantly higher for silicone but not AOBN. In contrast with non-PIFA catheters, injuries to the phrenic nerve and AV node during in vivo ablations with AOBN insulation positioned over these structures were reduced significantly. CONCLUSIONS RF ablation using catheter tips partially coated with a thermally conductive insulation material such as AOBN results in larger ablation lesion volumes without temperature limitations. Partial insulation of the catheter tip will protect adjacent critical structures during RF ablation.
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Yoshida K, Nogami A. Optimal configurations for bipolar radiofrequency ablation that allow deeper lesion formation: Good catheter-tip cooling, good catheter-tissue contact, and the next approach. Heart Rhythm 2016; 13:2172-2173. [PMID: 27484714 DOI: 10.1016/j.hrthm.2016.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Kentaro Yoshida
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan,; Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan.
| | - Akihiko Nogami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Yokokawa M, Jung DY, Hero III AO, Baser K, Morady F, Bogun F. Single- and dual-site pace mapping of idiopathic septal intramural ventricular arrhythmias. Heart Rhythm 2016; 13:72-7. [DOI: 10.1016/j.hrthm.2015.08.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Indexed: 10/23/2022]
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20
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NJEIM MARIO, YOKOKAWA MIKI, FRANK LUBA, CRAWFORD THOMAS, GOOD ERIC, MORADY FRED, BOGUN FRANK. Value of Cardiac Magnetic Resonance Imaging in Patients With Failed Ablation Procedures for Ventricular Tachycardia. J Cardiovasc Electrophysiol 2015; 27:183-9. [DOI: 10.1111/jce.12848] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 09/02/2015] [Accepted: 09/27/2015] [Indexed: 11/28/2022]
Affiliation(s)
- MARIO NJEIM
- Division of Cardiovascular Medicine and the Department of Radiology; University of Michigan; Ann Arbor Michigan USA
| | - MIKI YOKOKAWA
- Division of Cardiovascular Medicine and the Department of Radiology; University of Michigan; Ann Arbor Michigan USA
| | - LUBA FRANK
- Division of Cardiovascular Medicine and the Department of Radiology; University of Michigan; Ann Arbor Michigan USA
| | - THOMAS CRAWFORD
- Division of Cardiovascular Medicine and the Department of Radiology; University of Michigan; Ann Arbor Michigan USA
| | - ERIC GOOD
- Division of Cardiovascular Medicine and the Department of Radiology; University of Michigan; Ann Arbor Michigan USA
| | - FRED MORADY
- Division of Cardiovascular Medicine and the Department of Radiology; University of Michigan; Ann Arbor Michigan USA
| | - FRANK BOGUN
- Division of Cardiovascular Medicine and the Department of Radiology; University of Michigan; Ann Arbor Michigan USA
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21
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Kumar S, Barbhaiya CR, Sobieszczyk P, Eisenhauer AC, Couper GS, Nagashima K, Mahida S, Baldinger SH, Choi EK, Epstein LM, Koplan BA, John RM, Michaud GF, Stevenson WG, Tedrow UB. Role of alternative interventional procedures when endo- and epicardial catheter ablation attempts for ventricular arrhythmias fail. Circ Arrhythm Electrophysiol 2015; 8:606-15. [PMID: 25925229 DOI: 10.1161/circep.114.002522] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 04/21/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Ventricular tachycardia (VT) refractory to antiarrhythmic drugs and standard percutaneous catheter ablation techniques portends a poor prognosis. We characterized the reasons for ablation failure and describe alternative interventional procedures in this high-risk group. METHODS AND RESULTS Sixty-seven patients with VT refractory to 4±2 antiarrhythmic drugs and 2±1 previous endocardial/epicardial catheter ablation attempts underwent transcoronary ethanol ablation, surgical epicardial window (Epi-window), or surgical cryoablation (OR-Cryo; age, 62±11 years; VT storm in 52%). Failure of endo/epicardial ablation attempts was because of VT of intramural origin (35 patients), nonendocardial origin with prohibitive epicardial access because of pericardial adhesions (16), and anatomic barriers to ablation (8). In 8 patients, VT was of nonendocardial origin with a coexisting condition also requiring cardiac surgery. Transcoronary ethanol ablation alone was attempted in 37 patients, OR-Cryo alone in 21 patients, and a combination of transcoronary ethanol ablation and OR-Cryo (5 patients), or transcoronary ethanol ablation and Epi-window (4 patients), in the remainder. Overall, alternative interventional procedures abolished ≥1 inducible VT and terminated storm in 69% and 74% of patients, respectively, although 25% of patients had at least 1 complication. By 6 months post procedures, there was a significant reduction in defibrillator shocks (from a median of 8 per month to 1; P<0.001) and antiarrhythmic drug requirement although 55% of patients had at least 1 VT recurrence, and mortality was 17%. CONCLUSIONS A collaborative strategy of alternative interventional procedures offers the possibility of achieving arrhythmia control in high-risk patients with VT that is otherwise uncontrollable with antiarrhythmic drugs and standard percutaneous catheter ablation techniques.
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Affiliation(s)
- Saurabh Kumar
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA.
| | - Chirag R Barbhaiya
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Piotr Sobieszczyk
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Andrew C Eisenhauer
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Gregory S Couper
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Koichi Nagashima
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Saagar Mahida
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Samuel H Baldinger
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Eue-Keun Choi
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Laurence M Epstein
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Bruce A Koplan
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Roy M John
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Gregory F Michaud
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - William G Stevenson
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA
| | - Usha B Tedrow
- From the Arrhythmia Unit (S.K., C.R.B., K.N., S.M., S.H.B., E.-K.C., L.M.E., B.A.K., R.M.J., G.F.M., W.G.S., U.B.T.), Interventional Cardiology and Vascular Medicine, Cardiovascular Division (P.S., A.C.E.), and Division of Cardiac Surgery (G.S.C.), Brigham and Women's Hospital, Boston, MA.
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22
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Berte B, Derval N, Sacher F, Yamashita S, Haïssaguerre M, Jaïs P. A case of incessant VT from an intramural septal focus: Ethanol or bipolar ablation? HeartRhythm Case Rep 2015; 1:89-94. [PMID: 28491520 PMCID: PMC5418617 DOI: 10.1016/j.hrcr.2015.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | | | | | | | - Pïerre Jaïs
- Address reprint requests and correspondence: Dr Pierre Jaïs, Hôpital Cardiologique du Haut-Lévêque, Université de Bordeaux, LIRYC Institute, Bordeaux-Pessac 33604, France
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23
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Kumar S, Barbhaiya C, Nagashima K, Choi EK, Epstein LM, John RM, Maytin M, Albert CM, Miller AL, Koplan BA, Michaud GF, Tedrow UB, Stevenson WG. Ventricular tachycardia in cardiac sarcoidosis: characterization of ventricular substrate and outcomes of catheter ablation. Circ Arrhythm Electrophysiol 2014; 8:87-93. [PMID: 25527825 DOI: 10.1161/circep.114.002145] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cardiac sarcoid-related ventricular tachycardia (VT) is a rare disorder; the underlying substrate and response to ablation are poorly understood. We sought to examine the ventricular substrate and outcomes of catheter ablation in this population. METHODS AND RESULTS Of 435 patients with nonischemic cardiomyopathy referred for VT ablation, 21 patients (5%) had cardiac sarcoidosis. Multiple inducible VTs were observed with mechanism consistent with scar-mediated re-entry in all VTs. Voltage maps showed widespread and confluent right ventricular scarring. Left ventricular scarring was patchy with a predilection for the basal septum, anterior wall, and perivalvular regions. Epicardial right ventricular scar overlay and exceeded the region of corresponding endocardial scar. After ≥1 procedures, ablation abolished ≥1 inducible VT in 90% and eliminated VT storm in 78% of patients; however, multiple residual VTs remained inducible. Failure to abolish all inducible VTs was because of septal intramural circuits or extensive right ventricular scarring. Multiple procedure VT-free survival was 37% at 1 year, but VT control was achievable in the majority of patients with fewer antiarrhythmic drugs compared with preablation (2.1±0.8 versus 1.1±0.8; P<0.001). CONCLUSIONS Patients with cardiac sarcoidosis and VT exhibit ventricular substrate characterized by confluent right ventricular scarring and patchy left ventricular scarring capable of sustaining a large number of re-entrant circuits. Catheter ablation is effective in terminating VT storm and eliminating ≥1 inducible VT in the majority of patients, but recurrences are common. Ablation in conjunction with antiarrhythmic drugs can help palliate VT in this high-risk population.
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Affiliation(s)
- Saurabh Kumar
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Chirag Barbhaiya
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - 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
| | - Laurence M Epstein
- 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
| | - Melanie Maytin
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Christine M Albert
- From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Amy L Miller
- 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
| | - Usha B Tedrow
- 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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Gizurarson S, Spears D, Sivagangabalan G, Farid T, Ha ACT, Masse S, Kusha M, Chauhan VS, Nair K, Harris L, Downar E, Nanthakumar K. Bipolar ablation for deep intra-myocardial circuits: human ex vivo development and in vivo experience. Europace 2014; 16:1684-8. [DOI: 10.1093/europace/euu001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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25
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A Review of JACC Articles on the Topic of Heart Rhythm Disorders: 2011–2012. J Am Coll Cardiol 2013; 62:e451-e519. [DOI: 10.1016/j.jacc.2013.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Komatsu Y, Daly M, Sacher F, Derval N, Pascale P, Roten L, Scherr D, Jadidi A, Ramoul K, Denis A, Jesel L, Zellerhoff S, Lim HS, Shah A, Cochet H, Hocini M, Haïssaguerre M, Jaïs P. Electrophysiologic characterization of local abnormal ventricular activities in postinfarction ventricular tachycardia with respect to their anatomic location. Heart Rhythm 2013; 10:1630-7. [DOI: 10.1016/j.hrthm.2013.08.031] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Indexed: 11/27/2022]
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27
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Sinno MC, Yokokawa M, Good E, Oral H, Pelosi F, Chugh A, Jongnarangsin K, Ghanbari H, Latchamsetty R, Morady F, Bogun F. Endocardial ablation of postinfarction ventricular tachycardia with nonendocardial exit sites. Heart Rhythm 2013; 10:794-9. [DOI: 10.1016/j.hrthm.2013.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Indexed: 11/16/2022]
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Abstract
Catheter ablation has emerged as an important and effective treatment option for many recurrent ventricular arrhythmias. The approach to ablation and the risks and outcomes are largely determined by the nature of the severity and type of underlying heart disease. In patients with structural heart disease, catheter ablation can effectively reduce ventricular tachycardia (VT) episodes and implantable cardioverter defibrillator (ICD) shocks. For VT and symptomatic premature ventricular beats that occur in the absence of structural heart disease, catheter ablation is often effective as the sole therapy. Advances in catheter technology, imaging and mapping techniques have improved success rates for ablation. This review discusses current approaches to mapping and ablation for ventricular arrhythmias.
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Affiliation(s)
- Eyal Nof
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, US
| | - William G Stevenson
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, US
| | - Roy M John
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, US
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Stern S. The Year of 2011 in Electrocardiology. Ann Noninvasive Electrocardiol 2012; 17:170-5. [DOI: 10.1111/j.1542-474x.2012.00536.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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