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Chen M, Wang S, Zhu T, Li X, Wu Z, Liu Q, Zhou S. The comparison between the novel technique and conventional method in the catheter ablation of premature ventricular contractions originating from the free wall of tricuspid annulus. Clin Cardiol 2024; 47:e24179. [PMID: 37881031 PMCID: PMC10766136 DOI: 10.1002/clc.24179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/04/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND This study aimed to assess the safety and effectiveness of a novel technique for catheter ablation in patients with premature ventricular contraction (PVC) from the free wall of tricuspid annulus (TV). HYPOTHESIS We hypothesized that the novel technique is more efficacious than the traditional approach. METHODS We retrospectively investigated 59 consecutive patients with PVC originating from the free wall of TV between January 2013 and November 2021. The patients were divided into two groups: the reversed S-curve technique group (RST, n = 26) and the reversed C-curve technique group (RCT, n = 33). The RST under the support of a steerable sheath was used in RST group, while the RCT under the support of a nonsteerable sheath was used in the RCT group. Systematic mapping and radiofrequency ablation were preferentially performed under the valve in all patients. RESULTS Compared to the RCT group, total procedural time and fluoroscopic exposure time were significantly shorter in RST group. Two patients experienced cardiac tamponade in the RCT group, while no complications were observed in RST group (p = .498). The success rate was significantly higher in RST group compared to RCT group (81.9% vs. 100%, p = .029). Three patients in RCT group failed to ablate during the operation but were successfully ablated using the novel method. During regular follow-up, no patients in the RST group had a recurrence, while three patients in the RCT group did (p = .274). CONCLUSIONS It suggests that the reserved S-curve technique, supported by a steerable sheath, is a feasible and effective method for ablating PVC originating from the free wall of TV.
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Affiliation(s)
- Mingxian Chen
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityThe Second Xiangya Hospital of Central South UniversityChangshaHunanPeople's Republic of China
| | - Songyun Wang
- Department of CardiologyWuhan Renmin Hospital of Wuhan UniversityWuhanChina
| | - Tongjian Zhu
- Department of CardiologyXiangyang Central HospitalXiangyangHubeiChina
| | - Xuping Li
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityThe Second Xiangya Hospital of Central South UniversityChangshaHunanPeople's Republic of China
| | - Zhihong Wu
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityThe Second Xiangya Hospital of Central South UniversityChangshaHunanPeople's Republic of China
| | - Qiming Liu
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityThe Second Xiangya Hospital of Central South UniversityChangshaHunanPeople's Republic of China
| | - Shenghua Zhou
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityThe Second Xiangya Hospital of Central South UniversityChangshaHunanPeople's Republic of China
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Mori S, Bradfield JS. Ventricular Arrhythmias Ablated From the Noncoronary Aortic Sinus: Underrecognized Myocardium of the Right Ventricle. JACC Clin Electrophysiol 2023; 9:1292-1295. [PMID: 37354184 DOI: 10.1016/j.jacep.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Liao Z, Dai S, Nie Z, Song X, Huang X, Wang J, Yang F, Liu X, Du Z, Wei H, Liu F, Zhan X, Xue Y, Yang P, Ma J, Ouyang F, Ge J, Wu S. Reappraisal and New Observations on Idiopathic Ventricular Arrhythmias Ablated From the Noncoronary Aortic Sinus. JACC Clin Electrophysiol 2023; 9:1279-1291. [PMID: 36951815 DOI: 10.1016/j.jacep.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The electrophysiological characteristics of idiopathic ventricular arrhythmias (VAs) from the noncoronary sinus (NCS) have not been fully described. OBJECTIVES This study sought to investigate electrophysiological characteristics and catheter ablation in patients with idiopathic NCS-VA. METHODS This study comprised 11 patients undergoing radiofrequency (RF) catheter ablation for idiopathic NCS-VA. Angiography was performed to confirm the origin in the aortic sinus before RF ablation. RESULTS Clinical arrhythmias presented left bundle block/inferior axis morphology in all patients. QRS morphology of R' and R/s' pattern was dominantly found in lead III. Mapping in the right ventricle demonstrated the earliest ventricular activation (EVA) site at the His Bundle region, whereas mapping in the NCS demonstrated that the EVA preceded the activation at the His Bundle region by 12.1 ± 7.9 milliseconds. All VAs were successfully ablated in <2.5 seconds within the NCS with 1 RF application. The successful ablation site was at the nadir of NCS in 10 patients, and near the junction of NCS and the right coronary sinus in the remaining one. A discrete potential can be observed at the EVA site within the NCS in 10 patients (91%); however, an excellent pace mapping at the EVA site was obtained in only 2 patients. Junctional beats did not occur during RF application in all 11 patients. There were no complications or clinical recurrence during a mean follow-up of 26.0 ± 9.8 months. CONCLUSIONS NCS-VA presents a peculiar electrocardiogram. A discrete potential can be mapped within the NCS during VA and sinus rhythm, and can be used in guiding ablation.
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Affiliation(s)
- Zili Liao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China
| | - Shimo Dai
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, People's Republic of China
| | - Zhenning Nie
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, People's Republic of China
| | - Xudong Song
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Xingfu Huang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jing Wang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Fei Yang
- Department of Cardiology, the Third People's Hospital, Huizhou, People's Republic of China
| | - Xu Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhongpeng Du
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Huiqiang Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China
| | - Fangzhou Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China
| | - Xianzhang Zhan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China
| | - Yumei Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China.
| | - Pingzhen Yang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Feifan Ouyang
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany/Hongkong Asian Medical Group, Hong Kong, China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, People's Republic of China
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China
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Idiopathic Ventricular Tachycardia. J Clin Med 2023; 12:jcm12030930. [PMID: 36769578 PMCID: PMC9918172 DOI: 10.3390/jcm12030930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
Idiopathic ventricular tachycardia (VT) is an important cause of morbidity and less commonly, mortality in patients with structurally normal hearts. Appropriate diagnosis and management are predicated on an understanding of the mechanism, relevant cardiac anatomy, and associated ECG signatures. Catheter ablation is a viable strategy to adequately treat and potentially provide a cure in patients that are intolerant to medications or when these are ineffective. In this review, we discuss special approaches and considerations for effective and safe ablation of VT arising from the right ventricular outflow tract, left ventricular outflow tract, left ventricular fascicles, papillary muscles, and moderator band.
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Chang TY, Chen KW, Liu CM, Chang SL, Lin YJ, Lo LW, Hu YF, Chung FP, Lin CY, Kuo L, Chen SA. A High-Precision Deep Learning Algorithm to Localize Idiopathic Ventricular Arrhythmias. J Pers Med 2022; 12:jpm12050764. [PMID: 35629186 PMCID: PMC9145898 DOI: 10.3390/jpm12050764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/30/2022] [Accepted: 05/06/2022] [Indexed: 12/04/2022] Open
Abstract
Background: An accurate prediction of ventricular arrhythmia (VA) origins can optimize the strategy of ablation, and facilitate the procedure. Objective: This study aimed to develop a machine learning model from surface ECG to predict VA origins. Methods: We obtained 3628 waves of ventricular premature complex (VPC) from 731 patients. We chose to include all signal information from 12 ECG leads for model input. A model is composed of two groups of convolutional neural network (CNN) layers. We chose around 13% of all the data for model testing and 10% for validation. Results: In the first step, we trained a model for binary classification of VA source from the left or right side of the chamber with an area under the curve (AUC) of 0.963. With a threshold of 0.739, the sensitivity and specification are 90.7% and 92.3% for identifying left side VA. Then, we obtained the second model for predicting VA from the LV summit with AUC is 0.998. With a threshold of 0.739, the sensitivity and specificity are 100% and 98% for the LV summit. Conclusions: Our machine learning algorithm of surface ECG facilitates the localization of VPC, especially for the LV summit, which might optimize the ablation strategy.
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Affiliation(s)
- Ting-Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan
| | - Ke-Wei Chen
- Department of BioMedical Engineering, National Cheng Kung University, Tainan City 701401, Taiwan;
| | - Chih-Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Correspondence: ; Tel.: +886-2-7735-3832; Fax: +886-2-2872-4082
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Ling Kuo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan
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Supple GE. Don't Forget the Sinuses: an important site for some infarct-related VT. J Cardiovasc Electrophysiol 2022; 33:1208-1210. [PMID: 35388564 DOI: 10.1111/jce.15485] [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: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
The aortic sinuses of Valsalva are an important ablation site in non-ischemic substrates and in patients with idiopathic ventricular arrhythmias. Siontis and colleagues have demonstrated that these sites should also be considered for ablation in patients with infarct-related inferior axis VT. Low voltage in the aortic sinuses of Valsalva or in the sub-aortic region should prompt further evaluation of these regions for ablation. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Gregory E Supple
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Siontis KC, Njeim M, Dabbagh GS, Yokokawa M, Morady F, Bogun F. Ventricular Tachycardia Targeted in the Aortic Sinuses of Valsalva in Patients with Prior Myocardial Infarction. J Cardiovasc Electrophysiol 2022; 33:1199-1207. [PMID: 35388571 DOI: 10.1111/jce.15486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/04/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Ventricular tachycardia (VT) in structurally normal hearts or non-ischemic cardiomyopathy can originate from the aortic sinuses of Valsalva (SoV). It is unknown whether VT can originate from the SoVs in patients with prior myocardial infarction (MI). OBJECTIVE To evaluate the prevalence, arrhythmogenic substrate, and ablation outcomes of post-infarction VT originating from the SoVs. METHODS Among 217 consecutive patients with post-infarction VT undergoing ablation, we identified 13 (6%) patients who had ≥1 VT mapped in a SoV. Control groups of 13 patients with idiopathic SoV VT and 13 post-infarction patients without SoV VT were included. RESULTS In the study group, 17 VTs were mapped in a SoV (right n=5, left-right commissure n=6, left n=6). SoV VT target sites had low bipolar voltage during sinus rhythm [median 0.42 (IQR 0.16-0.53) mV] which was significantly lower than target sites in patients with idiopathic SoV VTs [median 1.02 (IQR 0.89-1.52) mV; p<0.001]. An area of endocardial low voltage was found below the aortic valve in all patients with post-infarction SoV VTs compared to 9 (69%) of the patients in the post-infarction control group without SoV VT (p=0.02). Morphology characteristics of post-infarction SoV VTs differed from idiopathic SoV VTs. None of the post-infarction SoV VTs were inducible after ablation and none recurred after a median follow-up of 14 months. CONCLUSION In patients with prior MI, VT can be targeted in an aortic SoV. The SoVs should be routinely investigated in post-infarction patients with inferior axis VT and an area of low-voltage below the aortic valve. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Mario Njeim
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Miki Yokokawa
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Fred Morady
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Kubala M, de Chillou C, Bohbot Y, Lancellotti P, Enriquez-Sarano M, Tribouilloy C. Arrhythmias in Patients With Valvular Heart Disease: Gaps in Knowledge and the Way Forward. Front Cardiovasc Med 2022; 9:792559. [PMID: 35242822 PMCID: PMC8885812 DOI: 10.3389/fcvm.2022.792559] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
The prevalence of both organic valvular heart disease (VHD) and cardiac arrhythmias is high in the general population, and their coexistence is common. Both VHD and arrhythmias in the elderly lead to an elevated risk of hospitalization and use of health services. However, the relationships of the two conditions is not fully understood and our understanding of their coexistence in terms of contemporary management and prognosis is still limited. VHD-induced left ventricular dysfunction/hypertrophy and left atrial dilation lead to both atrial and ventricular arrhythmias. On the other hand, arrhythmias can be considered as an independent condition resulting from a coexisting ischemic or non-ischemic substrate or idiopathic ectopy. Both atrial and ventricular VHD-induced arrhythmias may contribute to clinical worsening and be a turning point in the natural history of VHD. Symptoms developed in patients with VHD are not specific and may be attributable to hemodynamical consequences of valve disease but also to other cardiac conditions including arrhythmias which are notably prevalent in this population. The issue how to distinguish symptoms related to VHD from those related to atrial fibrillation (AF) during decision making process remains challenging. Moreover, AF is a traditional limit of echocardiography and an important source of errors in assessment of the severity of VHD. Despite recent progress in understanding the pathophysiology and prognosis of postoperative AF, many questions remain regarding its prevention and management. Furthermore, life-threatening ventricular arrhythmias can predispose patients with VHD to sudden cardiac death. Evidence for a putative link between arrhythmias and outcome in VHD is growing but available data on targeted therapies for VHD-related arrhythmias, including monitoring and catheter ablation, is scarce. Despite growing evidences, more research focused on the prognosis and optimal management of VHD-related arrhythmias is still required. We aimed to review the current evidence and identify gaps in knowledge about the prevalence, prognostic considerations, and treatment of atrial and ventricular arrhythmias in common subtypes of organic VHD.
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Affiliation(s)
- Maciej Kubala
- Department of Cardiology, Amiens University Hospital, Amiens, France
- Jules Verne University of Picardie, Amiens, France
| | - Christian de Chillou
- Department of Cardiology, University Hospital Nancy, Vandœuvre lès Nancy, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- Jules Verne University of Picardie, Amiens, France
| | - Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Valvular Disease Clinic, CHU Sart Tilman, Liège, Belgium
| | - Maurice Enriquez-Sarano
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- Jules Verne University of Picardie, Amiens, France
- *Correspondence: Christophe Tribouilloy
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: executive summary. Europace 2021; 22:450-495. [PMID: 31995197 DOI: 10.1093/europace/euz332] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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11
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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12
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Khan F, Srinivasan NT. Catheter ablation of the valsalva region using intracardiac echocardiography guidance. Indian Pacing Electrophysiol J 2021; 21:145-146. [PMID: 33934819 PMCID: PMC8116809 DOI: 10.1016/j.ipej.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Neil T Srinivasan
- Essex Cardiothoracic Centre, UK; Anglia Ruskin University (ARU) Medical School, UK.
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13
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Nakamura T, Nagata Y, Nitta G, Okata S, Nagase M, Mitsui K, Watanabe K, Miyazaki R, Kaneko M, Nagamine S, Hara N, Lee T, Nozato T, Ashikaga T, Goya M, Sasano T. Prediction of premature ventricular complex origins using artificial intelligence–enabled algorithms. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 2:76-83. [PMID: 35265893 PMCID: PMC8890345 DOI: 10.1016/j.cvdhj.2020.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Catheter ablation is a standard therapy for frequent premature ventricular complex (PVCs). Predicting their origin from a 12-lead electrocardiogram (ECG) is crucial but it requires specialized knowledge and experience. Objective The objective of the present study was to develop and evaluate machine learning algorithms that predicted PVC origins from an ECG. Methods We developed the algorithms utilizing a support vector machine (SVM) and a convolutional neural network (CNN). The training, validating, and testing data consisted of 116 PVCs from 111 patients who underwent catheter ablation. The ECG signals were labeled with the PVC origin, which was confirmed using a 3-dimensional electroanatomical mapping system. We classified the origins into 4 groups: right or left, outflow tract, or other sites. We trained and evaluated the model performance. The testing datasets were also evaluated by board-certified electrophysiologists and an existing classification algorithm. We also developed binary classification models that predicted whether the origin was on the right or left side of the heart. Results The weighted accuracies of the 4-class classification were as follows: SVM 0.85, CNN 0.80, electrophysiologists 0.73, and existing algorithm 0.86. The precision, recall, and F1 in the machine learning models marked better than physicians and comparable to the existing algorithm. The SVM model scored among the best accuracy in the binary classification (the accuracies were 0.94, 0.87, 0.79, and 0.90, respectively). Conclusion Artificial intelligence–enabled algorithms that predict the origin of PVCs achieved superior accuracy compared to the electrophysiologists and comparable accuracy to the existing algorithm.
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Affiliation(s)
- Tomofumi Nakamura
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
- Address reprint requests and correspondence: Dr Tomofumi Nakamura, Japanese Red Cross Musashino Hospital, 1-26-1, Kyonancho, Musashino City, Tokyo, Japan.
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Giichi Nitta
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Shinichiro Okata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Masashi Nagase
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Kentaro Mitsui
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Keita Watanabe
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Ryoichi Miyazaki
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Masakazu Kaneko
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Sho Nagamine
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Nobuhiro Hara
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Tetsumin Lee
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Toshihiro Nozato
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Tokyo, Japan
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14
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 219] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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15
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: Executive summary. J Interv Card Electrophysiol 2020; 59:81-133. [PMID: 31960344 PMCID: PMC7508755 DOI: 10.1007/s10840-019-00664-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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16
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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17
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Distinguishing Ventricular Arrhythmias Originating from the Posterior Right Ventricular Outflow Tract, or Near the Right Coronary Cusp or Near the His-Bundle. Am J Cardiol 2020; 126:37-44. [PMID: 32336534 DOI: 10.1016/j.amjcard.2020.03.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 11/21/2022]
Abstract
Differentiation of outflow tract ventricular arrhythmias (OT-VAs) which originate from the posterior right ventricular outflow tract (RVOT), right coronary cusp (RCC) or near the His-bundle are still a challenge until now. This study was aimed to develop a stepwise electrocardiogram (ECG) algorithm to distinguish their locations. Seventy-five consecutive patients with VAs successfully ablated from the posterior RVOT (n = 57), near the His-bundle (n = 5) or RCC (n = 13) were enrolled in our study. Measurements with highest diagnostic performance were chosen to develop a diagnostic algorithm. Of all these ECG measurements, the R-wave amplitude in lead I and V2S/V3R index showed the best diagnostic performance to discriminate these anatomical sites. The optimal ECG discriminators were different combination of lead I and V2S/V3R index as follows: the posterior RVOT, Lead I R-wave amplitude <0.65 mV and V2S/V3R index>1.5 (96.2% sensitivity, 69.6% specificity); the near the His-bundle, lead I R-wave amplitude ≥0.65 mV and V2S/V3R index>1.5 (100% sensitivity, 70% specificity); RCC, lead I R-wave amplitude<0.65 mV and V2S/V3R index ≤1.5 (52.9% sensitivity, 93.1% specificity). Sequential algorithmic application of these criteria resulted in an overall accuracy of 83% in predicting site of OT-VA origin. A predominantly positive R-wave in lead I is seen in OT-VAs originated near the His-bundle. A stepwise ECG algorithm of combination with R-wave amplitude in lead I and V2S/V3R index could localize the origins of OT-VAs from the posterior RVOT, near the His-bundle and the RCC with a high accuracy.
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18
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Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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19
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Im SI, Lee SH, Gwag HB, Park Y, Park SJ, Kim JS, On YK, Park KM. Electrocardiographic characteristics for successful radiofrequency ablation of right coronary cusp premature ventricular contractions. Medicine (Baltimore) 2020; 99:e19398. [PMID: 32176065 PMCID: PMC7220497 DOI: 10.1097/md.0000000000019398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Electrocardiographic (ECG) criteria identifying right- and left-sided outflow tract origins have been established. The purpose of this study was to define the criteria for premature ventricular contractions (PVCs) originating from the right coronary cusp (RCC) adequately.We analyzed ECG and electrophysiologic study data from patients who underwent successful ablation of PVCs originating from the RCC and right ventricular outflow tract (RVOT). Eighteen RCC and 28 septal RVOT PVCs were studied. Among these 18 successful RCC PVCs, a predominantly positive QRS in lead I in 18/18 (100%), longer V1-2 R-wave duration (81.4 ± 31.1 vs 44.8 ± 7.0 ms, P = .02), V1-2 R wave duration index (RWDI) (51.3 ± 22.0 vs 31.2 ± 7.5%, P = .06) were observed compared to those with posteroseptal RVOT. Local ventricular activation time preceding QRS onset was significantly earlier (-38 ± 12 ms) at the successful RCC ablation site compared to the failed ablation site of the septal RVOT (-22 ± 8 ms), even without good pace mapping at the RVOT (P < .001). The receiver operating characteristic curve showed that a pre-QRS time of ≥-31 ms predicted successful RCC ablation with 67% sensitivity and 94% specificity. A predominantly positive QRS in lead I, longer R-wave duration and RWDI in lead V1 or V2 with a local ventricular activation preceding QRS onset by an average of -31 ms suggests an effective RCC ablation site.
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Affiliation(s)
- Sung Il Im
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan
| | - Sung Ho Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital
| | - Hye Bin Gwag
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
| | - Youngjun Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
| | - June Soo Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
| | - Young Keun On
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
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20
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Nishimura T, Kannan A, Tung R. Reentrant para-Hisian ventricular tachycardia eliminated from the noncoronary cusp: Importance of regional anatomy for vantage-point ablation. J Cardiovasc Electrophysiol 2020; 31:968-971. [PMID: 32077542 DOI: 10.1111/jce.14401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/09/2019] [Accepted: 12/23/2019] [Indexed: 11/28/2022]
Abstract
We present a rare case of reentrant ventricular tachycardia proven by entrainment maneuvers that was successfully ablated from the noncoronary cusp. The case highlights regional anatomy, pacing maneuvers with multi-modality images from fluoroscopy, intracardiac echo, and electroanatomical mapping.
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Affiliation(s)
- Takuro Nishimura
- Department of Medicine, Section of Cardiology, Pritzker School of Medicine, Center for Arrhythmia Care, The University of Chicago Medicine, Chicago, Illinois
| | - Arun Kannan
- Department of Medicine, Section of Cardiology, Pritzker School of Medicine, Center for Arrhythmia Care, The University of Chicago Medicine, Chicago, Illinois
| | - Roderick Tung
- Department of Medicine, Section of Cardiology, Pritzker School of Medicine, Center for Arrhythmia Care, The University of Chicago Medicine, Chicago, Illinois
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21
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Trends in Successful Ablation Sites and Outcomes of Ablation for Idiopathic Outflow Tract Ventricular Arrhythmias. JACC Clin Electrophysiol 2020; 6:221-230. [DOI: 10.1016/j.jacep.2019.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/10/2019] [Accepted: 10/03/2019] [Indexed: 11/21/2022]
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22
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Toh H, Mori S, Tretter JT, Izawa Y, Shimoyama S, Suzuki M, Takahashi Y, Tsuda D, Toba T, Fujiwara S, Hirata KI, Anderson RH. Living Anatomy of the Ventricular Myocardial Crescents Supporting the Coronary Aortic Sinuses. Semin Thorac Cardiovasc Surg 2020; 32:230-241. [DOI: 10.1053/j.semtcvs.2020.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/09/2020] [Indexed: 02/01/2023]
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23
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Alfonso-Almazán JM, Quintanilla JG, García-Torrent MJ, Laguna-Castro S, Rodríguez-Bobada C, González P, González-Ferrer JJ, Salinas P, Cañadas-Godoy V, Moreno J, Borrego-Bernabé L, Pérez-Castellano N, Jalife J, Perez-Villacastín J, Filgueiras-Rama D. Lesion Index Titration Using Contact-Force Technology Enables Safe and Effective Radiofrequency Lesion Creation at the Root of the Aorta and Pulmonary Artery. Circ Arrhythm Electrophysiol 2019; 12:e007080. [PMID: 30879334 PMCID: PMC6426438 DOI: 10.1161/circep.118.007080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ablation of some myocardial substrates requires catheter-based radiofrequency delivery at the root of a great artery. We studied the safety and efficacy parameters associated with catheter-based radiofrequency delivery at the root of the aorta and pulmonary artery. METHODS Thirty-six pigs underwent in-vivo catheter-based ablation under continuous contact-force and lesion index (power, contact-force, and time) monitoring during 60-s radiofrequency delivery with an open-irrigated tip catheter. Twenty-eight animals were allocated to groups receiving 40 W (n=9), 50 W (n=10), or 60 W (n=9) radiofrequency energy, and acute (n=22) and chronic (n=6) arterial wall damage was quantified by multiphoton microscopy in ex vivo samples. Adjacent myocardial lesions were quantified in parallel samples. The remaining 8 pigs were used to validate safety and efficacy parameters. RESULTS Acute collagen and elastin alterations were significantly associated with radiofrequency power, although chronic assessment revealed vascular wall recovery in lesions without steam pop. The main parameters associated with steam pops were median peak temperature >42°C and impedance falls >23 ohms. Unlike other parameters, lesion index values of 9.1 units (interquartile range, 8.7-9.8) were associated with the presence of adjacent myocardial lesions in both univariate ( P=0.03) and multivariate analyses ( P=0.049; odds ratio, 1.99; 95% CI, 1.02-3.98). In the validation group, lesion index values using 40 W over a range of contact-forces correlated with the size of radiofrequency lesions (R2=0.57; P=0.03), with no angiographic or histopathologic signs of coronary artery damage. CONCLUSIONS Lesion index values obtained during 40 W radiofrequency applications reliably monitor safe and effective lesion creation at the root of the great arteries.
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Affiliation(s)
- José Manuel Alfonso-Almazán
- Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Myocardial Pathophysiology Area (J.M.A.-A., J.G.Q., S.L.-C., J.J., D.F.-R.)
| | - Jorge G Quintanilla
- Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Myocardial Pathophysiology Area (J.M.A.-A., J.G.Q., S.L.-C., J.J., D.F.-R.).,Cardiovascular Institute, Department of Cardiology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) (J.G.Q., J.J.G.-F., P.S., V.C.-G., L.B.-B., N.P.-C., J.P.-V.).,CIBER de Enfermedades Cardiovasculares (J.G.Q., J.J.G.-F., V.C.-G., J.M., N.P.-C., J.J., J.P.-V., D.F.-R.)
| | | | - Santiago Laguna-Castro
- Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Myocardial Pathophysiology Area (J.M.A.-A., J.G.Q., S.L.-C., J.J., D.F.-R.)
| | - Cruz Rodríguez-Bobada
- Experimental Medicine and Surgery Unit, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) (C.R.-B., P.G.)
| | - Pablo González
- Experimental Medicine and Surgery Unit, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) (C.R.-B., P.G.)
| | - Juan José González-Ferrer
- Cardiovascular Institute, Department of Cardiology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) (J.G.Q., J.J.G.-F., P.S., V.C.-G., L.B.-B., N.P.-C., J.P.-V.).,CIBER de Enfermedades Cardiovasculares (J.G.Q., J.J.G.-F., V.C.-G., J.M., N.P.-C., J.J., J.P.-V., D.F.-R.)
| | - Pablo Salinas
- Cardiovascular Institute, Department of Cardiology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) (J.G.Q., J.J.G.-F., P.S., V.C.-G., L.B.-B., N.P.-C., J.P.-V.)
| | - Victoria Cañadas-Godoy
- Cardiovascular Institute, Department of Cardiology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) (J.G.Q., J.J.G.-F., P.S., V.C.-G., L.B.-B., N.P.-C., J.P.-V.).,CIBER de Enfermedades Cardiovasculares (J.G.Q., J.J.G.-F., V.C.-G., J.M., N.P.-C., J.J., J.P.-V., D.F.-R.)
| | - Javier Moreno
- CIBER de Enfermedades Cardiovasculares (J.G.Q., J.J.G.-F., V.C.-G., J.M., N.P.-C., J.J., J.P.-V., D.F.-R.).,Hospital Universitario Ramón y Cajal, Department of Cardiology, Madrid, Spain (J.M.)
| | - Luis Borrego-Bernabé
- Cardiovascular Institute, Department of Cardiology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) (J.G.Q., J.J.G.-F., P.S., V.C.-G., L.B.-B., N.P.-C., J.P.-V.)
| | - Nicasio Pérez-Castellano
- Cardiovascular Institute, Department of Cardiology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) (J.G.Q., J.J.G.-F., P.S., V.C.-G., L.B.-B., N.P.-C., J.P.-V.).,CIBER de Enfermedades Cardiovasculares (J.G.Q., J.J.G.-F., V.C.-G., J.M., N.P.-C., J.J., J.P.-V., D.F.-R.)
| | - José Jalife
- Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Myocardial Pathophysiology Area (J.M.A.-A., J.G.Q., S.L.-C., J.J., D.F.-R.).,CIBER de Enfermedades Cardiovasculares (J.G.Q., J.J.G.-F., V.C.-G., J.M., N.P.-C., J.J., J.P.-V., D.F.-R.).,Center for Arrhythmia Research, Cardiovascular Research Center, Department of Internal Medicine, University of Michigan, Ann Arbor (J.J.)
| | - Julián Perez-Villacastín
- Cardiovascular Institute, Department of Cardiology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) (J.G.Q., J.J.G.-F., P.S., V.C.-G., L.B.-B., N.P.-C., J.P.-V.).,CIBER de Enfermedades Cardiovasculares (J.G.Q., J.J.G.-F., V.C.-G., J.M., N.P.-C., J.J., J.P.-V., D.F.-R.).,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC) (M.J.G.-T., J.P.-V.)
| | - David Filgueiras-Rama
- Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Myocardial Pathophysiology Area (J.M.A.-A., J.G.Q., S.L.-C., J.J., D.F.-R.).,Cardiovascular Institute, Department of Cardiology, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) (J.G.Q., J.J.G.-F., P.S., V.C.-G., L.B.-B., N.P.-C., J.P.-V.).,CIBER de Enfermedades Cardiovasculares (J.G.Q., J.J.G.-F., V.C.-G., J.M., N.P.-C., J.J., J.P.-V., D.F.-R.)
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24
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Kodali S, Santangeli P, Garcia FC. Mapping and Ablation of Arrhythmias from Uncommon Sites (Aortic Cusp, Pulmonary Artery, and Left Ventricular Summit). Card Electrophysiol Clin 2019; 11:665-674. [PMID: 31706473 DOI: 10.1016/j.ccep.2019.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite advances in our understanding of the relevant anatomy and mapping and catheter ablation techniques of idiopathic outflow tract ventricular arrhythmias, challenging sites for catheter ablation remain the aortic cusps, pulmonary artery, and notably the left ventricular summit. A systematic approach should be used to direct mapping efforts efficiently between endocardial, coronary venous, and epicardial sites. Foci at the left ventricular summit, particularly intraseptal and at the inaccessible epicardial region, remain difficult to reach and when percutaneous techniques fail, surgical ablation remains an option but with risk of late coronary artery stenosis.
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Affiliation(s)
- Santhisri Kodali
- Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 9 Founders Pavilion, Philadelphia, PA 19104, USA
| | - Pasquale Santangeli
- Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 9 Founders Pavilion, Philadelphia, PA 19104, USA
| | - Fermin C Garcia
- Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 9 Founders Pavilion, Philadelphia, PA 19104, USA.
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25
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Kawamura M, Arai S, Gokan T, Yoshikawa K, Ogawa K, Ochi A, Chiba Y, Onishi Y, Munetsugu Y, Ito H, Onuki T, Kobayashi Y, Shinke T. Idiopathic basal crux ventricular arrhythmias with left bundle branch block and superior axis: A comparison with inferior-septal valvular arrhythmias. J Cardiovasc Electrophysiol 2019; 30:1914-1922. [PMID: 31392788 DOI: 10.1111/jce.14103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/05/2019] [Accepted: 08/05/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Left bundle branch block (LBBB) with superior axis is common in patients with idiopathic-ventricular arrhythmia (VA) originating from the tricuspid annulus (TA) and rarely from the cardiac basal crux and mitral annulus (MA). We described the electrocardiography and electrophysiological findings of idiopathic-VA presenting with LBBB and superior axis. METHODS AND RESULTS We described 42 idiopathic-VA patients who had an LBBB and superior axis; 15 basal crux-VA, 17 TA-VA, and 10 MA-VA. No patient had a structural heart disease. Among patients with idiopathic-VA referred for ablation, we investigated the electrocardiogram and clinical characteristics of basal crux-VA as compared with other LBBB and superior axis-VA. The left ventricular ejection fraction with MA-VA was significantly lower in comparison with basal crux-VA (P = .01). All patients had a positive R wave in lead I and aVL. The maximum deflection index with basal crux-VA was significantly higher in comparison with TA-VA or MA-VA (P = .01). Patients with basal crux-VA presented with QS wave in lead II more frequently as compared with TA-VA or MA-VA (P = .001). All MA-VA patients had Rs wave in V6, and basal crux-VA, and TA-VA patients had a monophasic R wave or Rs wave in V6. Basal crux-VA patients underwent ablation in the middle cardiac vein (MCV) or coronary sinus (success rate: 94%, recurrence rate: 6%). CONCLUSIONS We could distinguish basal crux-VA, TA-VA, and MA-VA, using a combination of clinical and electrocardiographic findings. These findings might be useful for counseling patients about an ablation strategy. Ablation via the MCV is effective for eliminating basal crux-VA.
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Affiliation(s)
- Mitsuharu Kawamura
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Shuhei Arai
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Toshihiko Gokan
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Kosuke Yoshikawa
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Ko Ogawa
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Akinori Ochi
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Yuta Chiba
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Yoshimi Onishi
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Yumi Munetsugu
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroyuki Ito
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Tatsuya Onuki
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Youichi Kobayashi
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Toshiro Shinke
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
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26
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: Executive summary. Heart Rhythm 2019; 17:e155-e205. [PMID: 31102616 PMCID: PMC8459311 DOI: 10.1016/j.hrthm.2019.03.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Indexed: 12/16/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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27
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Klaudel J, Trenkner W, Glaza M, Miekus P. Analysis of reported cases of left main coronary artery injury during catheter ablation: In search of a pattern. J Cardiovasc Electrophysiol 2019; 30:410-426. [DOI: 10.1111/jce.13833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Jacek Klaudel
- Department of CardiologySt Vincent de Paul HospitalGdynia Poland
- Department of CardiologySt Adalbert's HospitalGdansk Poland
| | | | - Michal Glaza
- Department of CardiologySt Vincent de Paul HospitalGdynia Poland
| | - Pawel Miekus
- Department of CardiologySt Vincent de Paul HospitalGdynia Poland
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29
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Low power ablation for left coronary cusp ventricular tachycardia-Efficacy and long-term outcome. Indian Heart J 2019; 70 Suppl 3:S384-S388. [PMID: 30595294 PMCID: PMC6309714 DOI: 10.1016/j.ihj.2018.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/30/2018] [Accepted: 08/16/2018] [Indexed: 11/21/2022] Open
Abstract
Background The left coronary cusp is an uncommon but well-known site for the ablation of idiopathic ventricular tachycardia (VT). Proximity to the left coronary ostium makes ablation of this arrhythmia challenging. Different power settings have been described by various operators. Our objective was to describe the outcomes with low power ablation. Methods Once mapping confirmed origin from the left coronary cusp, ablation was performed if the best site was situated at least 5 mm from the left coronary ostium. Ablation was started at 15 W and, if successful, was stopped after 30 s. When required, higher powers were used up to 30 W. Results Ten patients with VT or premature ventricular beats mapped to the left coronary cusp were included in the study. No ablation was performed in one patient because of proximity to the left coronary ostium. Successful ablation was performed in eight of the other nine patients with a mean power of 18.1 ± 5.3 W and duration of 42.2 ± 13.5 s. There were no complications. All the eight patients remained free of recurrence at 16.8 ± 16.5 months of follow-up. Conclusions VT can be ablated from the left coronary cusp close to the left coronary ostium. Ablation with low power is effective in achieving immediate success which is also durable with time while avoiding complications.
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30
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Qin F, Zhao Y, Bai F, Ma Y, Sun C, Liu N, Li B, Li Y, Liu C, Liu Q, Zhou S. Coupling interval variability: A new diagnostic method for distinguishing left from right ventricular outflow tract origin in idiopathic outflow tract premature ventricular contractions patients with precordial R/S transition at lead V3. Int J Cardiol 2018; 269:126-132. [DOI: 10.1016/j.ijcard.2018.07.045] [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: 06/09/2018] [Revised: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 11/26/2022]
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31
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Muresan L, Cismaru G, Martins RP, Bataglia A, Rosu R, Puiu M, Gusetu G, Mada RO, Muresan C, Ispas DR, Le Bouar R, Diene LL, Rugina E, Levy J, Klein C, Sellal JM, Poull IM, Laurent G, de Chillou C. Recommendations for the use of electrophysiological study: Update 2018. Hellenic J Cardiol 2018; 60:82-100. [PMID: 30278230 DOI: 10.1016/j.hjc.2018.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 08/31/2018] [Accepted: 09/24/2018] [Indexed: 12/16/2022] Open
Abstract
The field of cardiac electrophysiology has greatly developed during the past decades. Consequently, the use of electrophysiological studies (EPSs) in clinical practice has also significantly augmented, with a progressively increasing number of certified electrophysiology centers and specialists. Since Zipes et al published the Guidelines for Clinical Intracardiac Electrophysiology and Catheter Ablation Procedures in 1995, no official document summarizing current EPS indications has been published. The current paper focuses on summarizing all relevant data of the role of EPS in patients with different types of cardiac pathologies and provides up-to-date recommendations on this topic. For this purpose, the PubMed database was screened for relevant articles in English up to December 2018 and ESC and ACC/AHA Clinical Practice Guidelines, and EHRA/HRS/APHRS position statements related to the current topic were analyzed. Current recommendations for the use of EPS in clinical practice are discussed and presented in 17 distinct cardiac pathologies. A short rationale, evidence, and indications are provided for each cardiac disease/group of diseases. In conclusion, because of its capability to establish a diagnosis in patients with a variety of cardiac pathologies, the EPS remains a useful tool in the evaluation of patients with cardiac arrhythmias and conduction disorders and is capable of establishing indications for cardiac device implantation and guide catheter ablation procedures.
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Affiliation(s)
- Lucian Muresan
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France.
| | - Gabriel Cismaru
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Raphaël Pedro Martins
- Centre Hospitalier Universitaire de Rennes, Cardiology Department, 35000 Rennes, France
| | - Alberto Bataglia
- Institut Lorrain du Coeur et des Vaisseaux « Louis Mathieu », Cardiology Department, Electrophysiology Department, 54000 Vandoeuvre-les-Nancy, France
| | - Radu Rosu
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Mihai Puiu
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Gabriel Gusetu
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Razvan Olimpiu Mada
- "Niculae Stancioiu" Heart Institute, Cardiology Department, 400005 Cluj-Napoca, Romania
| | - Crina Muresan
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France
| | - Daniel Radu Ispas
- Rehabilitation Hospital, Cardiology Department, 400347 Cluj-Napoca, Romania
| | - Ronan Le Bouar
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France
| | | | - Elena Rugina
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France
| | - Jacques Levy
- "Emile Muller" Hospital, Cardiology Department, 68100 Mulhouse, France
| | - Cedric Klein
- Centre Hospitalier Universitaire de Lille, Cardiology Department, 59000 Lille, France
| | - Jean Marc Sellal
- Institut Lorrain du Coeur et des Vaisseaux « Louis Mathieu », Cardiology Department, Electrophysiology Department, 54000 Vandoeuvre-les-Nancy, France
| | - Isabelle Magnin Poull
- Institut Lorrain du Coeur et des Vaisseaux « Louis Mathieu », Cardiology Department, Electrophysiology Department, 54000 Vandoeuvre-les-Nancy, France
| | - Gabriel Laurent
- Centre Hospitalier Universitaire de Dijon, Cardiology Department, 21000 Dijon, France
| | - Christian de Chillou
- Institut Lorrain du Coeur et des Vaisseaux « Louis Mathieu », Cardiology Department, Electrophysiology Department, 54000 Vandoeuvre-les-Nancy, France
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32
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Haqqani HM, Marchlinski FE. The Surface Electrocardiograph in Ventricular Arrhythmias: Lessons in Localisation. Heart Lung Circ 2018; 28:39-48. [PMID: 30301671 DOI: 10.1016/j.hlc.2018.08.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/20/2018] [Indexed: 11/18/2022]
Abstract
The 12-lead electrocardiograph (ECG) is of critical importance both in the diagnosis of wide complex tachycardia and in the further classification, characterisation and management of ventricular arrhythmias. With its diligent application and interpretation, remarkable precision can be achieved in the localisation of the site of origin of ventricular arrhythmias and this may have major implications in the care of these patients. This review discusses the technical, anatomic and mechanistic basis of ECG interpretation in ventricular arrhythmias.
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Affiliation(s)
- Haris M Haqqani
- Faculty of Medicine, University of Queensland, Department of Cardiology, Prince Charles Hospital, Brisbane, Qld, Australia.
| | - Francis E Marchlinski
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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33
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Enriquez A, Garcia F. Ventricular Arrhythmias From the Infundibular Muscles: Another Step in Understanding the Complex Right Ventricular Anatomy. Circ Arrhythm Electrophysiol 2018; 11:e006248. [PMID: 29874172 DOI: 10.1161/circep.118.006248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andres Enriquez
- From the Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia (A.E., F.G.); and Arrhythmia Service, Hospital Guillermo Grant Benavente, Concepcion, Chile (A.E.)
| | - Fermin Garcia
- From the Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia (A.E., F.G.); and Arrhythmia Service, Hospital Guillermo Grant Benavente, Concepcion, Chile (A.E.).
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34
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Della Rocca DG, Gianni C, Mohanty S, Trivedi C, Di Biase L, Natale A. Localization of Ventricular Arrhythmias for Catheter Ablation: The Role of Surface Electrocardiogram. Card Electrophysiol Clin 2018; 10:333-354. [PMID: 29784487 DOI: 10.1016/j.ccep.2018.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The surface ECG is a valuable mapping tool in patients with idiopathic and scar-related ventricular arrhythmias (VAs). A detailed analysis of 12-lead ECG can provide useful information in localizing the VA site of origin. This might help tailoring the ablation strategy to optimize procedural duration, increase the probability of success, and prevent complications. The aim of this article is to review the ECG features of both idiopathic and scar-related VAs and discuss their potential implications for optimizing the ablation strategy.
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Affiliation(s)
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Department of Biomedical Engineering, University of Texas, Austin, TX, USA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Department of Biomedical Engineering, University of Texas, Austin, TX, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA; Electrophysiology and Arrhythmia Services, California Pacific Medical Center, San Francisco, CA, USA
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35
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Yamada T. Which ventricle should be mapped first in catheter ablation of ventricular arrhythmias originating from the ventricular outflow tract? J Cardiovasc Electrophysiol 2018; 29:600-602. [PMID: 29436088 DOI: 10.1111/jce.13461] [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: 02/04/2018] [Accepted: 02/07/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
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36
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Reithmann C, Fiek M. Left ventricular outflow tract arrhythmias with divergent QRS morphology: mapping of different exits and ablation strategy. J Interv Card Electrophysiol 2017; 51:61-69. [PMID: 29280039 DOI: 10.1007/s10840-017-0307-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 12/15/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ventricular arrhythmias (VAs) from the left ventricular outflow tract (LVOT) can have multiple exits exhibiting divergent ECG features. METHODS In a series of 131 patients with VAs with LVOT origin, 10 patients presented with divergent QRS morphologies. Multisite endo- and epicardial mapping of different exit sites was performed. RESULTS The earliest ventricular activity of 23 LVOT VAs in 10 patients was detected in the endocardium of the LV in 7 patients, the aortic sinuses of Valsalva (SoV) in 3 patients, the distal coronary sinus in 6 patients, the anterior interventricular vein in 3 patients, and the posterior right ventricular outflow tract (RVOT) in 4 patients. Simultaneous elimination of two divergent QRS morphologies of LVOT VAs by ablation from a single site was achieved in 5 patients (aorto-mitral continuity in 3 patients, SoV and RVOT in each 1 patient) using a mean maximum ablation energy of 46 ± 5 W. Sequential ablation from two or three different sites, including trans-pericardial and distal coronary sinus ablation in each 2 patients, led to elimination of the divergent VA QRS morphologies in the other 5 patients. During the follow-up of 28 ± 29 months, 4 of the 10 patients had recurrence of at least one LVOT VA. A 43-year-old patient with muscular dystrophy Curschmann-Steinert had recurrence of sustained LVOT VTs and died of sudden cardiac death. CONCLUSIONS Multisite mapping of different exit sites of LVOT VAs can guide ablation of intramural foci but the recurrence rate after initially successful ablation was high.
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Affiliation(s)
| | - Michael Fiek
- Medizinische Klinik I, HELIOS Klinikum München West, Munich, Germany
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37
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Nguyen MB, Ceresnak SR, Janson CM, Fishberger SB, Love BA, Blaufox AD, Motonaga KS, Dubin AM, Nappo L, Pass RH. A multicenter review of ablation in the aortic cusps in young people. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:798-802. [DOI: 10.1111/pace.13126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 03/22/2017] [Accepted: 05/02/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Minh B. Nguyen
- The Children's Hospital at Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
| | - Scott R. Ceresnak
- Lucile Packard Children's Hospital; Stanford University; Palo Alto CA USA
| | - Christopher M. Janson
- The Children's Hospital at Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
| | | | - Barry A. Love
- Mt. Sinai Medical Center; Icahn School of Medicine; New York NY USA
| | - Andrew D. Blaufox
- Cohen Children's Medical Center of New York; Hofstra School of Medicine; New Hyde Park NY USA
| | - Kara S. Motonaga
- Lucile Packard Children's Hospital; Stanford University; Palo Alto CA USA
| | - Anne M. Dubin
- Lucile Packard Children's Hospital; Stanford University; Palo Alto CA USA
| | - Lynn Nappo
- The Children's Hospital at Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
| | - Robert H. Pass
- The Children's Hospital at Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
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38
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Padmanabhan D, Sugrue A, Gaba P, Asirvatham SJ. Outflow tract ventricular arrhythmias : Electrocardiographic features in relation to mapping and ablation. Herzschrittmacherther Elektrophysiol 2017; 28:177-186. [PMID: 28534205 DOI: 10.1007/s00399-017-0507-1] [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: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 10/19/2022]
Abstract
Ventricular arrhythmia arising from the outflow tracts can manifest itself as frequent premature ventricular complexes (PVCs), salvos of ventricular tachycardia (VT), and/or sustained VT. It is amenable to management with medication and catheter ablation without need for an intracardiac defibrillator. The electrocardiogram (ECG) is a crucial tool in the management of these patients as it is can help localize the site of origin, thereby helping guide the electrophysiologist. An appreciation of the unique anatomy of the outflow tracts as well as their relationships with the surrounding structures is essential in interpreting the ECG. In this review, we examine the ECG features of the various outflow tract arrhythmia morphologies with a focus on anatomy and provide an approach to the ablation of these abnormal rhythms.
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Affiliation(s)
- Deepak Padmanabhan
- Department of Cardiovascular Sciences, Mayo Clinic, 55901, Rochester, MN, USA
| | - Alan Sugrue
- Department of Cardiovascular Sciences, Mayo Clinic, 55901, Rochester, MN, USA
| | - Prakriti Gaba
- Department of Cardiovascular Sciences, Mayo Clinic, 55901, Rochester, MN, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Sciences, Mayo Clinic, 55901, Rochester, MN, USA.
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39
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HAYASHI TATSUYA, SANTANGELI PASQUALE, PATHAK RAJEEVK, MUSER DANIELE, LIANG JACKSONJ, CASTRO SIMONA, GARCIA FERMINC, HUTCHINSON MATHEWD, SUPPLE GREGORYE, FRANKEL DAVIDS, RILEY MICHAELP, LIN DAVID, SCHALLER ROBERTD, DIXIT SANJAY, CALLANS DAVIDJ, ZADO ERICAS, MARCHLINSKI FRANCISE. Outcomes of Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias With an R Wave Pattern Break in Lead V2: A Distinct Clinical Entity. J Cardiovasc Electrophysiol 2017; 28:504-514. [DOI: 10.1111/jce.13183] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/09/2017] [Accepted: 01/18/2017] [Indexed: 11/30/2022]
Affiliation(s)
- TATSUYA HAYASHI
- Cardiac Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - PASQUALE SANTANGELI
- Cardiac Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - RAJEEV K. PATHAK
- Cardiac Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - DANIELE MUSER
- Cardiac Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - JACKSON J. LIANG
- Cardiac Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - SIMON A. CASTRO
- Cardiac Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - FERMIN C. GARCIA
- Cardiac Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - MATHEW D. HUTCHINSON
- Cardiac Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - GREGORY E. SUPPLE
- Cardiac Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - DAVID S. FRANKEL
- Cardiac Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - MICHAEL P. RILEY
- Cardiac Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - DAVID LIN
- Cardiac Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - ROBERT D. SCHALLER
- Cardiac Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - SANJAY DIXIT
- Cardiac Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - DAVID J. CALLANS
- Cardiac Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - ERICA S. ZADO
- Cardiac Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - FRANCIS E. MARCHLINSKI
- Cardiac Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
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40
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Wackel PL, McCrary AW, Idriss SF, Asirvatham SJ, Cannon BC. Radiofrequency Ablation in the Sinus of Valsalva for Ventricular Arrhythmia in Pediatric Patients. Pediatr Cardiol 2016; 37:1534-1538. [PMID: 27562131 DOI: 10.1007/s00246-016-1467-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022]
Abstract
The need to perform catheter ablation of ventricular arrhythmia from within the sinuses of Valsalva in a pediatric patient is uncommon. This has been reported in adults, but there are little data about the feasibility, safety or efficacy of catheter ablation in the sinuses of Valsalva in the pediatric patients. This is a retrospective review of all patients aged 18 years or less, at two separate institutions with no structural heart disease that underwent an ablation procedure for ventricular arrhythmia mapped to the sinus of Valsalva from 2010 to 2015. We identified 8 total patients meeting inclusion criteria. Median age was 16 years and the median weight was 61 kg. All patients were symptomatic or had developed arrhythmia-induced ventricular dysfunction. Ablation was performed in the left sinus in 4 patients and the right sinus in 4 patients. No ablations were required in the non-coronary sinus. All 8 patients had an acutely successful ablation using radiofrequency energy. There were no complications. At a mean follow-up of 7 months (4-15 months), all patients were known to be living. Follow-up data regarding arrhythmia were available in 6 of the 8 patients, and none had recurrence of their ventricular arrhythmia off of all antiarrhythmic medications. Radiofrequency catheter ablation of ventricular arrhythmia in the sinus of Valsalva can be done safely and effectively in pediatric patients.
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41
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New electrocardiographic criteria for predicting successful ablation of premature ventricular contractions from the right coronary cusp. Int J Cardiol 2016; 224:199-205. [DOI: 10.1016/j.ijcard.2016.09.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/23/2016] [Accepted: 09/15/2016] [Indexed: 11/20/2022]
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42
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Ben Ameur Y, Rajhi M, Naccache S, Guerram H, Chettaoui R, Tlili R, Boujnah MR. [Cardiomyopathy induced by an aortic cusp ventricular tachycardia: Case report]. Presse Med 2016; 46:130-134. [PMID: 27856125 DOI: 10.1016/j.lpm.2016.06.027] [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: 04/26/2016] [Accepted: 06/06/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- Youssef Ben Ameur
- Faculté de médecine de Tunis, hôpital Mongi-Slim, service de cardiologie, 2046, Sidi Daoud, La Marsa, Tunisie
| | - Monoom Rajhi
- Faculté de médecine de Tunis, hôpital Mongi-Slim, service de cardiologie, 2046, Sidi Daoud, La Marsa, Tunisie.
| | - Soufia Naccache
- Faculté de médecine de Tunis, hôpital Mongi-Slim, service de cardiologie, 2046, Sidi Daoud, La Marsa, Tunisie
| | - Hela Guerram
- Faculté de médecine de Tunis, hôpital Mongi-Slim, service de cardiologie, 2046, Sidi Daoud, La Marsa, Tunisie
| | - Rafik Chettaoui
- Faculté de médecine de Tunis, cliniques les Berges du Lac, rue du Lac de Constance, Tunis, Tunisie
| | - Rami Tlili
- Faculté de médecine de Tunis, hôpital Mongi-Slim, service de cardiologie, 2046, Sidi Daoud, La Marsa, Tunisie
| | - Mohammed Rachid Boujnah
- Faculté de médecine de Tunis, hôpital Mongi-Slim, service de cardiologie, 2046, Sidi Daoud, La Marsa, Tunisie
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43
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ROCA-LUQUE IVO, RIVAS NURIA, FRANCISCO JAUME, PEREZ JORDI, ACOSTA GABRIEL, ORISTRELL GERARD, TERRICABRES MARIA, GARCIA-DORADO DAVID, MOYA ANGEL. Selective Angiography Using the Radiofrequency Catheter: An Alternative Technique for Mapping and Ablation in the Aortic Cusps. J Cardiovasc Electrophysiol 2016; 28:126-131. [PMID: 27759948 DOI: 10.1111/jce.13109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/30/2016] [Accepted: 10/10/2016] [Indexed: 12/14/2022]
Affiliation(s)
| | - NURIA RIVAS
- Electrophysiology and Arrhythmia Unit; Barcelona Spain
| | | | - JORDI PEREZ
- Electrophysiology and Arrhythmia Unit; Barcelona Spain
| | | | - GERARD ORISTRELL
- Cardiology Department; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | - MARIA TERRICABRES
- Cardiology Department; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | | | - ANGEL MOYA
- Electrophysiology and Arrhythmia Unit; Barcelona Spain
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44
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Sustained ventricular tachycardia developed following successful ablation of target idiopathic left ventricular premature complexes. Int J Cardiol 2016; 222:686-688. [PMID: 27517664 DOI: 10.1016/j.ijcard.2016.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/03/2016] [Indexed: 11/23/2022]
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45
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PATHAK RAJEEVK, BETENSKY BRIANP, SANTANGELI PASQUALE, DIXIT SANJAY. Distinct Electrocardiographic Form of Idiopathic Ventricular Arrhythmia Originating From the Left Bundle Branch. J Cardiovasc Electrophysiol 2016; 28:115-119. [DOI: 10.1111/jce.13085] [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: 06/21/2016] [Revised: 08/21/2016] [Accepted: 08/23/2016] [Indexed: 11/28/2022]
Affiliation(s)
- RAJEEV K. PATHAK
- Cardiovascular Medicine Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - BRIAN P. BETENSKY
- Cardiovascular Medicine Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - PASQUALE SANTANGELI
- Cardiovascular Medicine Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - SANJAY DIXIT
- Cardiovascular Medicine Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
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46
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Yamada T, Doppalapudi H, Maddox WR, McElderry HT, Plumb VJ, Kay GN. Prevalence and Electrocardiographic and Electrophysiological Characteristics of Idiopathic Ventricular Arrhythmias Originating From Intramural Foci in the Left Ventricular Outflow Tract. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004079. [DOI: 10.1161/circep.116.004079] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 07/19/2016] [Indexed: 11/16/2022]
Abstract
Backgrounds—
Idiopathic ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT) sometimes require catheter ablation from both the endocardial and epicardial sides for their elimination, suggesting the presence of intramural VA foci. This study investigated the prevalence and electrocardiographic and electrophysiological characteristics of these idiopathic intramural LVOT VAs when compared with the idiopathic endocardial and epicardial LVOT VAs.
Methods and Results—
We studied 82 consecutive VAs with origins in the aortomitral continuity (n=30), LV summit (n=34), and intramural site (n=18). The maximum deflection index (the time to the maximum deflection in the precordial leads/QRS duration) was the largest in LV summit VAs (0.52±0.07), smallest in aortomitral continuity VAs (0.45±0.06), and midrange in intramural VAs (0.49±0.05). The electrocardiographic and electrophysiological characteristics of the intramural LVOT VAs were similar to those of the aortomitral continuity VAs. The intramural LVOT VAs exhibited a significantly smaller R-wave amplitude ratio in leads III to II, and ratio of the Q-wave amplitude in leads aVL to aVR, and a significantly earlier and later local ventricular activation time relative to the QRS onset at the His bundle and successful ablation sites than the LV summit VAs, respectively.
Conclusions—
Intramural sites account for a significant proportion of LVOT VAs. The electrocardiographic and electrophysiological characteristics of the idiopathic intramural LVOT VAs were midrange between those of the idiopathic endocardial and epicardial LVOT VAs, and more similar to those of the idiopathic endocardial LVOT VAs than those of the idiopathic epicardial LVOT VAs.
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Affiliation(s)
- Takumi Yamada
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - Harish Doppalapudi
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - William R. Maddox
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - H. Thomas McElderry
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - Vance J. Plumb
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - G. Neal Kay
- From the Division of Cardiovascular Disease, University of Alabama at Birmingham
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47
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Kawamura M, Scheinman MM, Tseng ZH, Lee BK, Marcus GM, Badhwar N. Comparison of remote magnetic navigation ablation and manual ablation of idiopathic ventricular arrhythmia after failed manual ablation. J Interv Card Electrophysiol 2016; 48:35-42. [PMID: 27314679 DOI: 10.1007/s10840-016-0158-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 06/07/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Mitsuharu Kawamura
- The Division of Cardiac Electrophysiology, University of California, 500 Parnassus Avenue, MUE 434, San Francisco, CA, 94143-1354, USA.
| | - Melvin M Scheinman
- The Division of Cardiac Electrophysiology, University of California, 500 Parnassus Avenue, MUE 434, San Francisco, CA, 94143-1354, USA
| | - Zian H Tseng
- The Division of Cardiac Electrophysiology, University of California, 500 Parnassus Avenue, MUE 434, San Francisco, CA, 94143-1354, USA
| | - Byron K Lee
- The Division of Cardiac Electrophysiology, University of California, 500 Parnassus Avenue, MUE 434, San Francisco, CA, 94143-1354, USA
| | - Gregory M Marcus
- The Division of Cardiac Electrophysiology, University of California, 500 Parnassus Avenue, MUE 434, San Francisco, CA, 94143-1354, USA
| | - Nitish Badhwar
- The Division of Cardiac Electrophysiology, University of California, 500 Parnassus Avenue, MUE 434, San Francisco, CA, 94143-1354, USA
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48
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Zheng C, Li J, Lin JX, Wang LP, Lin JF. Where is the exact origin of narrow premature ventricular contractions manifesting qR in inferior wall leads? BMC Cardiovasc Disord 2016; 16:64. [PMID: 27044385 PMCID: PMC4820958 DOI: 10.1186/s12872-016-0240-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/01/2016] [Indexed: 12/19/2022] Open
Abstract
Background In recent years, radiofrequency catheter ablation(RFCA) has been established as an effective therapy for idiopathic premature ventricular contractions (PVCs), however, its effect on the narrow PVCs (QRS duration < 130 msec) with qR pattern in inferior leads, may not been fully concluded. Methods Characteristics of 12-lead electrocardiogram (ECG) and electrophysiologic recordings were analyzed in 40 patients with symptomatic PVCs manifesting narrow QRS complex with qR pattern in inferior leads. The procedure of RFCA was performed based on pace mapping and activation mapping. Results Among the 40 patients with narrow PVCs, complete elimination of PVCs was achieved by RFCA in 35 patients during a median follow-up period of 23 months. Successful ablation was achieved on 19 patients at the sites where earliest Purkinje potentials were recorded in left ventricular anterosuperior septum, thus PVCs arising from left anterior fascicle (LAF) were confirmed, for these PVCs, the QRS morphology were right bundle branch and left posterior fascicle block (RBBB + LPFB) with rightward axis, the average QRS duration 116.07 ± 7.96 ms, R or rsR’in lead V1,with transition zone ahead of lead V1 in precordial leads. Another 16 successful RFCA were achieved by energy delivery at interleaflet triangle(ILT) between right coronary cusp(RCC) and left coronary cusp(LCC) where no Purkinje potentials were recorded, for narrow PVCs arising from the L-RCC ILT, the QRS morphology were similar to the PVCs arising from LAF but much narrower in QRS duration (100.44 ± 3.49 vs. 116.07 ± 7.96 ms, p < 0.05), they were also R or Rs in lead V1 with the transition zone ahead of lead V1. For 5 symptomatic narrow PVCs failed to the procedure of RFCA, their electrocardiographic characteristics showed that the narrowest QRS duration (91.80 ± 6.94 vs. 100.44 ± 3.49, 116.07 ± 7.96 ms, p < 0.05), rs or rS (r/s or r/S≦1) morphology in lead V1 with the precordial transition zone behind lead V3. Conclusions Most of idiopathic PVCs of narrow QRS duration (<130 msec) with qR pattern in inferior leads can be cured by the procedure of RFCA. On the basis of our study, we proposed that for narrow PVCs presenting qR pattern in inferior leads, when the ablation procedure failed at proximity of LAF within left anterosuperior septum, mapping and ablation in L-RCC ILT can be tried. The present findings can be helpful for planning catheter ablation for narrow PVCs manifesting qR in inferior leads.
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Affiliation(s)
- Cheng Zheng
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Road, Wenzhou, Zhejiang, China
| | - Jin Li
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Road, Wenzhou, Zhejiang, China
| | - Jia-Xuan Lin
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Road, Wenzhou, Zhejiang, China
| | - Lu-Ping Wang
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Road, Wenzhou, Zhejiang, China
| | - Jia-Feng Lin
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, 109 Xueyuan Road, Wenzhou, Zhejiang, China.
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Abstract
Distinguishing premature ventricular contractions/ventricular tachycardia from the right ventricular outflow tract versus the left ventricular outflow tract can be difficult by electrocardiogram findings alone. A thorough understanding of the outflow tract anatomy and a systematic and meticulous approach to mapping of the ventricular outflow regions and great vessels increases the success rate and decreases the risk of damage to adjacent structures and the conduction system. The use of multimodality imaging, particularly real-time intracardiac echocardiographic guidance, is essential for defining anatomy, ensuring adequate catheter contact, and minimizing risks.
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Affiliation(s)
- Kara S Motonaga
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, Palo Alto, CA, USA.
| | - Scott R Ceresnak
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, Palo Alto, CA, USA
| | - Henry H Hsia
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, CA, USA
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KANESHIRO TAKASHI, SUZUKI HITOSHI, NODERA MINORU, YAMADA SHINYA, KAMIOKA MASASHI, KAMIYAMA YOSHIYUKI, TAKEISHI YASUCHIKA. Mapping Strategy Associated with QRS Morphology for Catheter Ablation in Patients with Idiopathic Ventricular Outflow Tract Tachyarrhythmia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:338-44. [DOI: 10.1111/pace.12810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 12/22/2015] [Accepted: 01/01/2016] [Indexed: 11/27/2022]
Affiliation(s)
- TAKASHI KANESHIRO
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - HITOSHI SUZUKI
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
- Department of Arrhythmia and Cardiac Pacing; Fukushima Medical University; Fukushima Japan
| | - MINORU NODERA
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - SHINYA YAMADA
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - MASASHI KAMIOKA
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - YOSHIYUKI KAMIYAMA
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - YASUCHIKA TAKEISHI
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
- Department of Arrhythmia and Cardiac Pacing; Fukushima Medical University; Fukushima Japan
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