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Almeida I, Lousinha A, Silva Cunha P, Valente B, Paulo M, Delgado AS, Ferreira R, Oliveira M. Long-term outcomes of non-contact multi-electrode balloon catheter mapping-guided ablation of ventricular arrhythmias originating from the outflow tract. Rev Port Cardiol 2022; 41:487-493. [DOI: 10.1016/j.repc.2021.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/03/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022] Open
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Martin CA, Orini M, Srinivasan NT, Bhar-Amato J, Honarbakhsh S, Chow AW, Lowe MD, Ben-Simon R, Elliott PM, Taggart P, Lambiase PD. Assessment of a conduction-repolarisation metric to predict Arrhythmogenesis in right ventricular disorders. Int J Cardiol 2018; 271:75-80. [PMID: 29871808 PMCID: PMC6152588 DOI: 10.1016/j.ijcard.2018.05.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/16/2018] [Accepted: 05/18/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The re-entry vulnerability index (RVI) is a recently proposed activation-repolarization metric designed to quantify tissue susceptibility to re-entry. This study aimed to test feasibility of an RVI-based algorithm to predict the earliest endocardial activation site of ventricular tachycardia (VT) during electrophysiological studies and occurrence of haemodynamically significant ventricular arrhythmias in follow-up. METHODS Patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) (n = 11), Brugada Syndrome (BrS) (n = 13) and focal RV outflow tract VT (n = 9) underwent programmed stimulation with unipolar electrograms recorded from a non-contact array in the RV. RESULTS Lowest values of RVI co-localised with VT earliest activation site in ARVC/BrS but not in focal VT. The distance between region of lowest RVI and site of VT earliest site (Dmin) was lower in ARVC/BrS than in focal VT (6.8 ± 6.7 mm vs 26.9 ± 13.3 mm, p = 0.005). ARVC/BrS patients with inducible VT had lower Global-RVI (RVIG) than those who were non-inducible (-54.9 ± 13.0 ms vs -35.9 ± 8.6 ms, p = 0.005) or those with focal VT (-30.6 ± 11.5 ms, p = 0.001). Patients were followed up for 112 ± 19 months. Those with clinical VT events had lower Global-RVI than both ARVC and BrS patients without VT (-54.5 ± 13.5 ms vs -36.2 ± 8.8 ms, p = 0.007) and focal VT patients (-30.6 ± 11.5 ms, p = 0.002). CONCLUSIONS RVI reliably identifies the earliest RV endocardial activation site of VT in BrS and ARVC but not focal ventricular arrhythmias and predicts the incidence of haemodynamically significant arrhythmias. Therefore, RVI may be of value in predicting VT exit sites and hence targeting of re-entrant arrhythmias.
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Affiliation(s)
- C A Martin
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK; Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - M Orini
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK; Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - N T Srinivasan
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK; Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - J Bhar-Amato
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - S Honarbakhsh
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - A W Chow
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - M D Lowe
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - R Ben-Simon
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - P M Elliott
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - P Taggart
- Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK
| | - P D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK; Institute of Cardiovascular Science, University College London, Gower Street, London WC1E 6BT, UK.
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Wieczorek M. Non-contact mapping in cardiac electrophysiology. Herzschrittmacherther Elektrophysiol 2018; 29:264-270. [PMID: 29992405 DOI: 10.1007/s00399-018-0575-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/25/2018] [Indexed: 11/29/2022]
Abstract
Catheter ablation of atrial and ventricular arrhythmias is now considered a standard technology for selected patients. In some patients, however, cure of the arrhythmia is hampered by the complexity of the arrhythmia or the way the arrhythmia presents in the electrophysiological laboratory: some focal atrial and ventricular arrhythmias are difficult to induce using electrical stimulation or medical provocation. Precise mapping of these arrhythmias is challenging or even impossible by contact mapping, while other arrhythmias are poorly tolerated and need early termination.In these scenarios, use of non-contact mapping technology can be an alternative to conventional mapping, since isopotential maps may require no more than one ectopic beat identical with the clinical focal arrhythmia to reconstruct its endocardial origin. This review article presents the technology of non-contact cardiac mapping, as well as various arrhythmias that have been successfully treated using this technology in the past. The possibilities and limitations of using non-contact cardiac mapping under various conditions are also presented.
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Affiliation(s)
- Marcus Wieczorek
- Department of Cardiology and Electrophysiology, St. Agnes-Hospital Bocholt, Witten/Herdecke University, School of Medicine, Barloer Weg 125, 46397, Bocholt, Germany.
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Song IG, Kim SH, Kim JY, Kim JH, Kim YR, Kim TS, Kim JH, Jang SW, Lee MY, Rho TH, Oh YS. Detailed Electrode Catheter Positioning is Important for the Ablation of Outflow Tract Origin Ventricular Arrhythmias. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2017. [DOI: 10.18501/arrhythmia.2017.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Badran H, Samir R, Amin M. Outflow tract ventricular premature beats ablation in the presence or absence of structural heart disease: Technical considerations and clinical outcomes. Egypt Heart J 2017; 69:273-280. [PMID: 29622988 PMCID: PMC5883497 DOI: 10.1016/j.ehj.2017.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/29/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Premature ventricular beats (PVBs) are early depolarization of the myocardium originating in the ventricle. In case of very frequent PVBs, patients are severely symptomatic with impaired quality of life and are at risk of pre-syncope, syncope, heart failure, and sudden cardiac death particularly in the presence of structural heart disease. Ventricular outflow tracts are the most common sites of origin of idiopathic PVBs especially in patients without structural heart disease. We examined the role of radiofrequency catheter ablation in suppression of monomorphic PVBs of outflow tract origin in the presence or absence of structural heart disease, and its impact on improvement of left ventricular (LV) systolic function. METHODS Thirty-seven highly symptomatic patients with PVBs burden exceeding 10% were enrolled, provided that PVBs are monomorphic, originating in ventricular outflow tracts and regardless the presence or absence of structural heart disease. Patients were divided into 2 groups according to PVB site origin (RVOT vs. LVOT). 3D electro-anatomical mapping modalities were used in all patients employing activation mapping technique in the majority of cases. Acute success was considered when PVBs completely disappeared or when residual sporadic PVBs ≤ 1 beats/min or ≤10 beats/30 min after RF ablation. Patients were followed up for a mean period of 5.4 ± 1.2 months with long-term success defined as complete disappearance or marked reduction by more than 75% in the PVBs absolute number on 24 h holter monitoring. RESULTS Mean age of the study group was 39.9 ± 12.97 years, including 22 (59.4%) males. PVBs originated in RVOT in 17 cases and in LVOT in the remaining 20 cases. Prevalence of structural heart disease and consequently shortness of breath was higher in LVOT group. Initial ECG localization matched EP localization in the majority (94%) of cases. R wave duration index was the only significant independent predictor for RVOT origin with cut off value of <0.3 (P = 0.0057) upon multivariate analysis. Acute success was encountered in 32 (86%) patients with all cases of failure in the LVOT group. Recurrence occurred in 5 (15%) cases without significant difference between both groups. All cases of recurrence had residual PVBs at the end of the procedure. 18 cases out of the study group showed significant improvement of their EF (>5%) at the end of the follow-up period with no significant differences between both groups (p = 0.09). A linear correlation was observed between PVBs burden at follow up and magnitude of improvement of LV EF, particularly in patients with resting LV dysfunction and increased LV internal dimensions. CONCLUSIONS RF ablation is an effective and safe method for elimination of outflow tract PVBs irrespective of their origin and the presence or absence of structural heart disease. PVBs burden after ablation appears to be the main determinant for reversal of PVB induced myopathy particularly in those with increased LV internal dimensions.
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Affiliation(s)
- Haitham Badran
- Cardiology Department, Ain Shams University, Cairo, Egypt
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Miyazawa K, Ueda M, Kondo Y, Hayashi T, Nakano M, Ishimura M, Nakano M, Kobayashi Y. Rapid mapping and differentiation in ventricular outflow tract arrhythmia using non-contact mapping. J Interv Card Electrophysiol 2017; 49:41-49. [DOI: 10.1007/s10840-017-0250-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/29/2017] [Indexed: 11/24/2022]
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Te ALD, Higa S, Chung FP, Lin CY, Lo MT, Liu CA, Lin C, Chang YC, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao J, Chang YT, Lin CH, Hung Y, Yamada S, Pan KL, Lin YJ, Chen SA. The use of a novel signal analysis to identify the origin of idiopathic right ventricular outflow tract ventricular tachycardia during sinus rhythm: Simultaneous amplitude frequency electrogram transformation mapping. PLoS One 2017; 12:e0173189. [PMID: 28282453 PMCID: PMC5345764 DOI: 10.1371/journal.pone.0173189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 02/16/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The signal characteristics of intracardiac bipolar electrograms at the origin of idiopathic RVOT-VT during sinus rhythm remain unclear. OBJECTIVE The study sought to develop a novel real-time/online technique, simultaneous amplitude frequency electrogram transformation (SAFE-T), to quantify and localize the diseased ventricular substrate in idiopathic RVOT-VT. METHODS We retrospectively investigated the intracardiac bipolar recordings in 70 consecutive patients (26% male, mean age 42±12 years) who underwent successful radiofrequency catheter ablation of idiopathic RVOT-VT. We quantified the extent of the frequency fraction of ventricular potentials during sinus rhythm or ventricular pacing using a novel formula, the product of instantaneous amplitude and frequency, and showed that in a 3D geometry as an online SAFE-T map. RESULTS The characteristics of the HHT spectra of electrograms derived from VT origins demonstrated high frequency components (>70 Hz), which were independent of the rhythm. The density of the abnormal potentials at the VT origins were higher (VT origins, 7.5±2.3 sites/cm2 vs. surrounding myocardium, 1.5±1.3 sites/cm2, p<0.001), and were significantly decreased after ablation (0.7±0.6 sites/cm2, p<0.001). A small region of abnormal potentials were observed in the VT origins (mean area of 1.5±0.8 cm2). The SAFE-T maps predicted the VT origins with 92% sensitivity, 78% specificity with optimal cut-off value of >3.0 Hz·mV. CONCLUSION The online SAFE-T map was feasible for quantifying the diseased ventricular substrate, irrespective of the rhythm of activation, and can be used to identify the optimal ablation targets for idiopathic RVOT-VT. We found a limited region of abnormal potentials where the RVOT-VT origins were successfully ablated.
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Affiliation(s)
- Abigail Louise D. Te
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Satoshi Higa
- Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital, Okinawa, Japan
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Yu Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Men-Tzung Lo
- Research Center for Adaptive Data Analysis and Center for Dynamical Biomarkers and Translational Medicine, National Central University, Jhongli, Taiwan
| | - Che-An Liu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen Lin
- Research Center for Adaptive Data Analysis and Center for Dynamical Biomarkers and Translational Medicine, National Central University, Jhongli, Taiwan
| | - Yi-Chung Chang
- Research Center for Adaptive Data Analysis and Center for Dynamical Biomarkers and Translational Medicine, National Central University, Jhongli, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jonan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Ting Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Hsing Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuan Hung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shinya Yamada
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuo-Li Pan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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Catheter ablation of idiopathic right ventricular arrhythmias in children with limited fluoroscopy. J Interv Card Electrophysiol 2016; 46:355-60. [PMID: 27184808 DOI: 10.1007/s10840-016-0133-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Definitive therapy of idiopathic right ventricular arrhythmias (VA) remains a challenge in interventional electrophysiology. The aim of this study was to evaluate the utility of EnSite Velocity system in the catheter ablation of RV tachycardia in children. METHODS Thirty-five children with idiopathic right VA underwent catheter ablation procedure using the EnSite Velocity system guidance. RESULTS The mean patient age was 12.0 ± 3.7 years and the mean patient weight was 43.6 ± 18.7 kg. The origin of right VA was divided into right ventricular outflow tract (RVOT) (30 patients) and other right ventricular localizations (five patients). The mean procedure and fluoroscopy times were 175 ± 67 min and 2.35 ± 1.89 min, respectively. No fluoroscopy was used in 19 patients. Acute success was achieved in 29 patients (83 %). The focus of VA was epicardial in three failed procedures. Cryocatheter (6-mm or 8-mm tip) was used in six patients, radiofrequency ablation (RFA) (4-mm or 8-mm tip) in 26 patients, and 4-mm tip irrigated RFA in three patients. During a mean follow-up of 15.9 ± 7.1 months, ventricular tachycardia recurred in six patients (20 %). There were three complications (transient atrioventricular block developed in one patient during parahissian cryoablation and two patients developed transient complete right bundle branch block). CONCLUSIONS Catheter ablation of idiopathic right VA in children can be performed safely and effectively with limited fluoroscopy using the EnSite Velocity system.
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Marín JE, Díaz JC, García F, Velásquez JE, Aristizábal JM, Duque M, Uribe W. Capítulo 9. Ablación de extrasistolia ventricular y taquicardia ventricular en corazón sano. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Penela D, De Riva M, Herczku C, Catto V, Pala S, Fernández-Armenta J, Acosta J, Cipolletta L, Andreu D, Borras R, Rios J, Mont L, Brugada J, Carbucicchio C, Zeppenfeld K, Berruezo A. An easy-to-use, operator-independent, clinical model to predict the left vs. right ventricular outflow tract origin of ventricular arrhythmias. Europace 2015; 17:1122-8. [DOI: 10.1093/europace/euu373] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 11/25/2014] [Indexed: 01/18/2023] Open
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Rillig A, Lin T, Ouyang F, Kuck KH, Tilz RR. Which Is The Appropriate Arrhythmia Burden To Offer RF Ablation For RVOT Tachycardias? J Atr Fibrillation 2014; 7:1157. [PMID: 27957135 DOI: 10.4022/jafib.1157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 12/14/2022]
Abstract
Premature ventricular complexes (PVCs) and ventricular tachycardia (VT) in patients with structurally normal hearts originate from the right ventricular outflow tract (RVOT) in the majority of cases. In the last few decades catheter ablation of these arrhythmias has been proven to be effective. RVOT VT/PVCs may cause disabling symptoms or arrhythmia induced cardiomyopathy. However, the PVC burden at which catheter ablation should be recommended is still controversial. What adds to the controversy is why some patients with only a low number of PVCs can be highly symptomatic and may even develop arrhythmia induced cardiomyopathy, whilst others may have a higher PVC/VT burden and remain asymptomatic and do not develop cardiomyopathy for a long period of time. Therefore, although catheter ablation of RVOT PVCs has high success and low complication rates, the time point of when ablation should be recommended is currently still under debate. This review discusses the treatment strategies and prognosis for RVOT tachycardias and focuses on the question of which arrhythmia burden is appropriate to offer RF ablation.
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Affiliation(s)
- Andreas Rillig
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Tina Lin
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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Hoshiyama T, Yamabe H, Koyama J, Kanazawa H, Ito M, Ogawa H. Usefulness of non-contact mapping for catheter ablation of ventricular tachycardias originating at the right ventricular outflow tract. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Trevisi N, Silberbauer J, Radinovic A, Bavila R, Sala S, Vergara P, Bella PD. New diagnostic criteria for identifying left-sided ventricular ectopy using non-contact mapping and virtual unipolar electrogram analysis. Europace 2014; 17:108-16. [DOI: 10.1093/europace/euu145] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Vaidya VR, Desimone CV, Madhavan M, Noheria A, Shahid M, Walters J, Ladewig DJ, Mikell SB, Johnson SB, Suddendorf SH, Asirvatham SJ. Compatibility of electroanatomical mapping systems with a concurrent percutaneous axial flow ventricular assist device. J Cardiovasc Electrophysiol 2014; 25:781-6. [PMID: 24758340 DOI: 10.1111/jce.12437] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/15/2014] [Accepted: 04/17/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hemodynamic instability hinders activation and entrainment mapping during ventricular tachycardia ablation. The Impella 2.5 microaxial flow device (MFD; Abiomed Inc., Danvers, MA, USA) is used to prevent hemodynamic instability during electrophysiologic study. However, electromagnetic interference (EMI) generated by this device can preclude accurate electroanatomic mapping. METHODS Impella was placed in the left ventricle of 7 canines for circulatory support. Electroanatomic mapping during sinus rhythm, ventricular pacing, and ventricular fibrillation (VF) was performed using magnet- (CARTO3, Biosense Webster Inc., Diamond Bar, CA, USA) and impedance- (EnSite Velocity System/EnSite NavX, St. Jude Medical Inc., St. Paul, MN, USA) based systems. Distance from device to points with severe EMI precluding acquisition was compared to points with mild/no EMI. Two methods were used to reduce EMI: (1) titration of MFD performance, and (2) impedance-only mapping combined with manual annotation of activation. RESULTS Severe EMI did not occur during impedance-based mapping. Severe EMI was observed using CARTO3 at 9.4% of all points attempted at maximum performance level (P8) of device. Severe EMI occurred at points closer to device (40.1 ± 16.8 mm) versus (55.5 ± 20.0 mm) for mild/no EMI, P < 0.0001. Severe EMI using CARTO3 was resolved by either (1) reduction of performance from P8 to P6 or (2) impedance-only mapping with manual annotation. CONCLUSION Concurrent use of MFD caused EMI to prevent acquisition of points with magnet-based mapping. Predictors for EMI were distance from device and performance level. Temporary reductions to P6 or impedance-only mapping are 2 methods to resolve EMI.
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Affiliation(s)
- Vaibhav R Vaidya
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Raja N, Tondo C, Bartoletti S, Carbucicchio C. Safety and efficacy of three-dimensional mapping systems in idiopathic ventricular tachycardia ablation. SAUDI JOURNAL FOR HEALTH SCIENCES 2014. [DOI: 10.4103/2278-0521.130199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tuan J, Ng GA. Ablation of right ventricular outflow tract tachycardia using a novel multipolar irrigated ablation catheter (nMARQ). Heart Rhythm 2013; 11:502-5. [PMID: 24239637 DOI: 10.1016/j.hrthm.2013.11.005] [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: 09/26/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Jiun Tuan
- Department of Cardiology, Glenfield Hospital, Leicester, United Kingdom
| | - G André Ng
- Department of Cardiology, Glenfield Hospital, Leicester, United Kingdom; Cardiology Group, Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, United Kingdom; Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, United Kingdom.
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Hai JJ, Desimone CV, Vaidya VR, Asirvatham SJ. Endocavitary structures in the outflow tract: anatomy and electrophysiology of the conus papillary muscles. J Cardiovasc Electrophysiol 2013; 25:94-8. [PMID: 24102678 DOI: 10.1111/jce.12291] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/03/2013] [Accepted: 09/10/2013] [Indexed: 12/01/2022]
Abstract
Catheter ablation is an increasingly used and successful treatment choice for right ventricular outflow tract (RVOT) arrhythmias. While the role of endocavitary structures and the regional morphology of the ventricular inflow tract and the right atrium as a cause for difficulty with successful ablation are well described, similar issues within the RVOT are not well understood. It is also not commonly appreciated that one of the papillary muscles is located within the proximal RVOT. We report 3 patients in which ventricular arrhythmia was targeted and ablated in the conus papillary muscle. The anatomic features, potential role of the fascicular conduction system, and unique challenges with mapping arrhythmia arising from this structure are discussed.
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Affiliation(s)
- Jo Jo Hai
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, Hong Kong
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Zhang F, Yang B, Chen H, Ju W, Kojodjojo P, Cao K, Chen M. Noncontact mapping to guide ablation of right ventricular outflow tract arrhythmias. Heart Rhythm 2013; 10:1895-902. [PMID: 24055941 DOI: 10.1016/j.hrthm.2013.09.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is limited data on outcomes after noncontact mapping (NCM)-guided right ventricular outflow tract (RVOT) ventricular arrhythmia (VA) ablation. OBJECTIVES To assess outcomes of NCM-guided RVOT VA ablation in a large cohort with extended follow-up, to determine optimal ablation site, and to analyze limitations of conventional mapping techniques. METHODS In consecutive patients undergoing RVOT VA ablation, 2 sites of early activation--earliest activation (EA) and breakout (BO) sites--were identified on NCM maps. Pace mapping and activation mapping were performed at both sites. The area of depolarized myocardium during the first 10 ms of spontaneous VA and pacing was measured. The initial site of ablation was randomized to either EA or BO sites, with crossover to the alternate site if ablation was not successful. RESULTS In 136 patients, prematurity of local activation and pace maps were similar at EA and BO sites. More myocardium was depolarized 10 ms after pacing than during spontaneous VA (12.9 ± 7.8 cm(2) vs 5.3 ± 3.9 cm(2); P < .01). Clinical success was more likely achieved when initial ablation was directed toward the EA site (P < .05). A wider EA-BO separation was associated with acute procedural failure (P < .01). With a follow-up of 36.2 ± 17.5 months, the success rate after a single procedure without antiarrhythmic agents was 86.8%. CONCLUSIONS NCM-guided RVOT VA ablation is highly effective, and clinical success is best achieved by ablating the EA site. Broad regions of early activation are associated with worsened clinical outcomes. Spatial resolution of activation and pace mapping is limited by rapid electrical propagation in the RVOT.
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Affiliation(s)
- Fengxiang Zhang
- Section of Pacing and Electrophysiology, Division of Cardiology, First Affiliated Hospital with Nanjing Medical University, Nanjing, People's Republic of China
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Zhang F, Yang B, Chen H, Ju W, Kojodjojo P, Cao K, Chen M. Magnetic versus manual catheter navigation for mapping and ablation of right ventricular outflow tract ventricular arrhythmias: A randomized controlled study. Heart Rhythm 2013; 10:1178-83. [DOI: 10.1016/j.hrthm.2013.05.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Indexed: 11/17/2022]
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Liu Y, Scherlag BJ, Fan Y, Mao J, Hepler E, Varma V, Male S, Xia W, Huang H, Po SS. Experimental model of focal atrial tachycardia: clinical correlates. J Cardiovasc Electrophysiol 2013; 24:909-13. [PMID: 23621576 DOI: 10.1111/jce.12160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 02/26/2013] [Accepted: 03/06/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The mechanisms underlying focal atrial tachycardia (AT) are unclear. METHODS In 14 pentobarbital anesthetized dogs, a right thoracotomy allowed electrical stimulation (ES) of the anterior right ganglionated plexi (ARGP). After ES was applied to the ARGP at baseline, atropine, 1 mg/cc, was injected into the ARGP and repeat stimulation applied. After a left thoracotomy (n = 8), a similar procedure was followed by atropine injected into the superior left (SL) GP. RESULTS ES (0.6-3.2 V) applied to the ARGP and SLGP caused an average reduction in sinus rate from 151 ± 14/min to 60 ± 11/min. At ≥4.5 V atrial fibrillation (AF) was induced (duration 48 ± 14 seconds). After injection of atropine into the ARGP or SLGP, ES applied to these GP induced no slowing of the sinus rate. Runs of AT were induced at an average voltage of 10 ± 2 V in 14 experiments (duration ≥4 minutes). AT was localized by ice mapping or by 3D noncontact mapping to the crista terminalis (n = 6), AV junction (n = 2) or a focal site at the left superior pulmonary vein (6). In AT lasting <4 minutes (n = 2), epinephrine injected into the GP significantly increased the AT duration. In 4/4 experiments, sustained AT could be terminated by intravenous esmolol. CONCLUSIONS Atropine injected into the ARGP or SLGP promotes ES-induced AT whose duration is increased by adrenergic agonists and terminated by beta blockade. Presumably cholinergic blockade and accentuated release of adrenergic neurotransmitters provide the AT mechanism. The induced AT was found to be localized at sites similar to those reported clinically.
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Affiliation(s)
- Yu Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
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Calvo N, Jongbloed M, Zeppenfeld K. Radiofrequency catheter ablation of idiopathic right ventricular outflow tract arrhythmias. Indian Pacing Electrophysiol J 2013; 13:14-33. [PMID: 23329871 PMCID: PMC3540113 DOI: 10.1016/s0972-6292(16)30585-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Idiopathic ventricular arrhythmias (VA) consist of various subtypes of VA that occur in the absence of clinically apparent structural heart disease. Affected patients account for approximately 10% of all patients referred for evaluation of ventricular tachycardia (VT). Arrhythmias arising from the outflow tract (OT) are the most common subtype of idiopathic VA and more than 70-80% of idiopathic VTs or premature ventricular contractions (PVCs) originate from the right ventricular (RV) OT. Idiopathic OT arrhythmias are thought to be caused by adenosine-sensitive, cyclic adenosine monophosphate (cAMP) mediated triggered activity and, in general, manifest at a relatively early age. Usually they present as salvos of paroxysmal ventricular ectopic beats and are rarely life-threatening. When highly symptomatic and refractory to antiarrhythmic therapy or causative for ventricular dysfunction, ablation is a recommended treatment with a high success rate and a low risk of complications.
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Affiliation(s)
- Naiara Calvo
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Nakagawa H, Ikeda A, Sharma T, Lazzara R, Jackman WM. Rapid High Resolution Electroanatomical Mapping. Circ Arrhythm Electrophysiol 2012; 5:417-24. [DOI: 10.1161/circep.111.968602] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hiroshi Nakagawa
- From the Heart Rhythm Institute and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Atsushi Ikeda
- From the Heart Rhythm Institute and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Tushar Sharma
- From the Heart Rhythm Institute and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Ralph Lazzara
- From the Heart Rhythm Institute and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Warren M. Jackman
- From the Heart Rhythm Institute and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Park J, Kim YH, Hwang C, Pak HN. Electroanatomical characteristics of idiopathic left ventricular tachycardia and optimal ablation target during sinus rhythm: significance of preferential conduction through Purkinje fibers. Yonsei Med J 2012; 53:279-88. [PMID: 22318814 PMCID: PMC3282975 DOI: 10.3349/ymj.2012.53.2.279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We hypothesized that Purkinje potential and their preferential conduction to the left ventricle (LV) posteroseptum during sinus rhythm (SR) are part of reentrant circuits of idiopathic left ventricular tachycardia (ILVT) and reentry anchors to papillary muscle. MATERIALS AND METHODS In 14 patients with ILVT (11 men, mean age 31.5±11.1 years), we compared Purkinje potential and preferential conduction during SR with VT by non-contact mapping (NCM). If clear Purkinje potential(SR) was observed in the LV posteroseptum and the earliest activation site (EA) of preferential conduction at SR (EA(SR)) was well matched with that of VT (EA(VT)), EA(SR) was targeted for radiofrequency catheter ablation (RFCA). Also, the anatomical locations of successful ablation sites were evaluated by echocardiography in five additional patients. RESULTS 1) All induced VTs exhibited clear Purkinje potential(VT) and preferential conduction in the LV posteroseptum. The Purkinje potential(VT) and EA(VT) was within 5.8±8.2 mm of EA(SR). However, the breakout sites of VT were separated by 30.2±12.6 mm from EA(VT) to the apical side. 2) Purkinje potential(SR) demonstrated a reversed polarity to Purkinje potential(VT), and the interval of Purkinje potential(SR)-QRS was longer than the interval of Purkinje potential(VT)-QRS (p<0.02) 3) RFCA targeting EA(SR) eliminated VT in all patients without recurrence within 23.3±7.5 months, and the successful ablation site was discovered at the base of papillary muscle in the five additional (100%) patients. CONCLUSION NCM-guided localization of EA(SR) with Purkinje potential(SR) matches well with EA(VT) with Purkinje potential(VT) and provides an effective target for RFCA, potentially at the base of papillary muscle in patients with ILVT.
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Affiliation(s)
- Junbeom Park
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | | | - Chun Hwang
- Utah Valley Regional Medical Center, Provo, UT and Krannert Heart Institute, Indiana University, Indianapolis, IN, USA
| | - Hui-Nam Pak
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
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Díaz Infante E, Cózar León R, Borrego I, Maldonado J, Nieto P, Cruz Fernández JM. [Ablation of premature ventricular contractions originating in the right ventricular outflow tract using non-contact mapping]. Rev Esp Cardiol 2011; 64:1198-201. [PMID: 21835534 DOI: 10.1016/j.recesp.2011.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 05/01/2011] [Indexed: 10/17/2022]
Abstract
Premature ventricular contractions originating in the right ventricular outflow tract may respond poorly to pharmacological treatment, and ablation using conventional fluoroscopically-guided systems may be complicated by the difficulty in inducing arrhythmias. We describe the use of a non-contact mapping system to ablate difficult-to-induce premature ventricular contractions originating in the right ventricular outflow tract. Five premature ventricular contractions sites in the right ventricular outflow tract were ablated in a prospective series of 4 patients. Patients had a poor quality of life and had not responded to antiarrhythmic drugs. A mean of 3 radiofrequency pulses per site was applied and mean application time was 113±15s. We achieved a 100% acute success rate and there were no complications. Patients were asymptomatic without drug therapy after a mean of 30±16 months of follow-up. The noncontact mapping system is highly effective in eliminating difficult to induce, isolated premature ventricular contractions.
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Affiliation(s)
- Ernesto Díaz Infante
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen Macarena, Sevilla, España.
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Catanchin A, Liew R, Behr ER, Ward DE. Cardiac arrhythmia management using a noncontact mapping multielectrode array. Clin Cardiol 2011; 33:E19-24. [PMID: 20155856 DOI: 10.1002/clc.20421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The multielectrode array (MEA) enables noncontact mapping of cardiac arrhythmias; our experience is reviewed and reported. HYPOTHESIS The MEA has a role as first line therapy in multiple arrhythmias. METHODS Retrospective and prospective analysis of all consecutive cases performed using the MEA over a 6 year period. RESULTS Electrophysiological study and catheter ablation, 46% under general anaesthesia, using radiofrequency (RF), cryothermal and low energy direct current (DC) was performed in 66 procedures on 31 females and 29 males, average age 50.2 yrs (19.3-81.6); 8 patients underwent multiple procedures. 24 patients (36%) had undergone past ablation for the same arrhythmia. A wide variety of arrhythmias from all chambers were treated, majority right atrial (56%) and right ventricular (29%). Procedural success was complete in 77.4% and partial/indeterminate in 11.3%, highest in right atrial tachycardia, right ventricular outflow tract ectopy and typical atrial flutter (79, 82 and 100%). RF energy was most commonly used (67%) and DC carried 100% success. Ablation was delivered at 'early activation' and 'breakout' in focal arrhythmias. In re-entrant circuits linear ablation transecting path of activation extending to regions of functional/anatomic block was performed. Two of 7 complications were attributed to the MEA: groin haematomas. At mean 12.4 mo follow up 56% were arrhythmia free, 15% asymptomatic or minimally symptomatic and 12 patients had new arrhythmias. CONCLUSIONS The MEA is effective, safe and suitable for first line therapy in multiple cardiac arrhythmias particularly in the right heart. Further study is warranted comparing it to other mapping techniques.
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Affiliation(s)
- Andrei Catanchin
- Division of Cardiac and Vascular Sciences, St George's University of London, Cranmer Terrace, London, UK.
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Okumura Y, Watanabe I, Nakai T, Ohkubo K, Kofune T, Ashino S, Kofune M, Nagashima K, Hiro T, Hirata A, Nikaido M, Hirayama A. A quantitative and qualitative analysis of the virtual unipolar electrograms from non-contact mapping of right or left-sided outflow tract premature ventricular contractions/ventricular tachycardia origins. J Interv Card Electrophysiol 2010; 30:17-25. [PMID: 21161574 DOI: 10.1007/s10840-010-9522-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 10/05/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study was conducted to examine the virtual unipolar electrogram configuration of right/left outflow tract (OT) premature ventricular contraction (PVC)/ventricular tachycardia (VT) origins obtained from a non-contact mapping system (NCMS). METHODS The subjects consisted of 30 patients with OT-PVCs/VT who underwent NCMS-guided ablation. We evaluated the virtual unipolar electrograms of the origin on 3D right ventricular (RV)-OT isochronal maps. RESULTS Successful ablation was achieved from the RV in 20 patients (RVOT group), and it failed in 10 (non-RVOT group: including left-sided/pulmonary artery/deep RVOT foci). On the virtual unipolar electrograms, the earliest activation (EA) preceded the QRS onset by 11.2 ± 2.6 ms in the RVOT group and by 7.4 ± 10.5 ms in the non-RVOT group (P = 0.138). The negative slope of the electrogram at the EA site (EA slope(5)), quantified by the virtual unipolar voltage amplitude 5 ms after the EA onset, was significantly steeper in the RVOT group than in the non-RVOT group (0.66 ± 0.52 mV vs. 0.14 ± 0.17 mV, P = 0.005). Cutoff values for the EA-to-QRS onset time and EA slope(5) of ≥ 8 ms and >0.3 mV, respectively, completely differentiated the RVOT group from the non-RVOT group. A lesser EA slope(5) was associated with a greater radiofrequency energy delivery required to terminate RVOT-PVCs/VT. CONCLUSIONS These demonstrate the importance of the virtual unipolar electrograms from OT-PVC/VT origins obtained with the NCMS. The virtual EA predicts both successful and potentially difficult ablation sites from the RV side.
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Affiliation(s)
- Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kami machi, Itabashi-ku, Tokyo 173-8610, Japan.
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Gami AS, Noheria A, Lachman N, Edwards WD, Friedman PA, Talreja D, Hammill SC, Munger TM, Packer DL, Asirvatham SJ. Anatomical correlates relevant to ablation above the semilunar valves for the cardiac electrophysiologist: a study of 603 hearts. J Interv Card Electrophysiol 2010; 30:5-15. [DOI: 10.1007/s10840-010-9523-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 10/11/2010] [Indexed: 10/18/2022]
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Affiliation(s)
- Malini Madhavan
- From the Department of Internal Medicine (M.M.), Division of Cardiovascular Diseases (S.J.A.) and Department of Pediatrics and Adolescent Medicine (S.J.A.), Mayo Clinic, Rochester, Minn
| | - Samuel J. Asirvatham
- From the Department of Internal Medicine (M.M.), Division of Cardiovascular Diseases (S.J.A.) and Department of Pediatrics and Adolescent Medicine (S.J.A.), Mayo Clinic, Rochester, Minn
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Schneider HE, Kriebel T, Jung K, Gravenhorst VD, Paul T. Catheter ablation of idiopathic left and right ventricular tachycardias in the pediatric population using noncontact mapping. Heart Rhythm 2010; 7:731-9. [DOI: 10.1016/j.hrthm.2010.02.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 02/23/2010] [Indexed: 11/30/2022]
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Asirvatham SJ. Correlative anatomy for the invasive electrophysiologist: outflow tract and supravalvar arrhythmia. J Cardiovasc Electrophysiol 2010; 20:955-68. [PMID: 19490263 DOI: 10.1111/j.1540-8167.2009.01472.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Radiofrequency ablation in the outflow tract and great arteries is increasingly performed to treat a variety of symptomatic cardiac arrhythmias. The regional anatomy of these structures is among the most complex of those encountered by cardiac electrophysiologists. An exact appreciation of the relationships between these overlapping structures and their proximity to the coronary arterial and conduction system is essential for rational, safe, and effective ablation for these arrhythmias. A supravalvar portion of the aorta is a unique site for arrhythmia origin where the arrhythmogenic substrate for atrial arrhythmias, ventricular arrhythmias, and accessory pathways may all be located. Discussed in this review are the main principles of outflow tract and supravalvar arrhythmia, and these are correlated with fluoroscopy, electrograms, and electrocardiography that help guide the invasive electrophysiologist.
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Affiliation(s)
- Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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ABUISSA HUSSAM, ROSHAN JOHN, LIM BERNARD, ASIRVATHAM SAMUELJ. Use of the Impella™ Microaxial Blood Pump for Ablation of Hemodynamically Unstable Ventricular Tachycardia. J Cardiovasc Electrophysiol 2010; 21:458-461. [DOI: 10.1111/j.1540-8167.2009.01673.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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ABOUEZZEDDINE OMAR, SULEIMAN MAHMOUD, BUESCHER TRACI, KAPA SURAJ, FRIEDMAN PAULA, JAHANGIR ARSHAD, MEARS JENNIFERA, LADEWIG DOROTHYJ, MUNGER THOMASM, HAMMILL STEPHENC, PACKER DOUGLASL, ASIRVATHAM SAMUELJ. Relevance of Endocavitary Structures in Ablation Procedures for Ventricular Tachycardia. J Cardiovasc Electrophysiol 2010; 21:245-54. [DOI: 10.1111/j.1540-8167.2009.01621.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Natale A, Raviele A, Al-Ahmad A, Alfieri O, Aliot E, Almendral J, Breithardt G, Brugada J, Calkins H, Callans D, Cappato R, Camm JA, Della Bella P, Guiraudon GM, Haïssaguerre M, Hindricks G, Ho SY, Kuck KH, Marchlinski F, Packer DL, Prystowsky EN, Reddy VY, Ruskin JN, Scanavacca M, Shivkumar K, Soejima K, Stevenson WJ, Themistoclakis S, Verma A, Wilber D. Venice Chart International Consensus document on ventricular tachycardia/ventricular fibrillation ablation. J Cardiovasc Electrophysiol 2010; 21:339-79. [PMID: 20082650 DOI: 10.1111/j.1540-8167.2009.01686.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
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The Importance of the Spatial Relationship between the Position of the Non-contact Mapping Balloon Array and the Arrhythmogenic Target Sites for Successful Catheter Ablation. J Arrhythm 2010. [DOI: 10.1016/s1880-4276(10)80022-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Hasan R, Clifford SM, Ghanbari H, Schmidt M, Segerson NM, Daccarett M. Imaging modalities in cardiac electrophysiology. Future Cardiol 2009; 6:113-27. [PMID: 20014991 DOI: 10.2217/fca.09.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cardiac imaging, both noninvasive and invasive, has become a crucial part of evaluating patients during the electrophysiology procedure experience. These anatomical data allow electrophysiologists to not only assess who is an appropriate candidate for each procedure, but also to determine the rate of success from these procedures. This article incorporates a review of the various cardiac imaging techniques available today, with a focus on atrial arrhythmias, ventricular arrhythmias and device therapy.
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Affiliation(s)
- Reema Hasan
- Division of Cardiac Electrophysiology, Providence Hospital & Medical Center, Wayne State University, Southfield, MI, USA.
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Bella PD, Maccabelli G, Trevisi N. Catheter ablation of ventricular tachycardia guided by noncontact mapping. Future Cardiol 2009; 4:527-40. [PMID: 19804346 DOI: 10.2217/14796678.4.5.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Catheter ablation of untolerated and unstable ventricular tachycardia may not be performed using a conventional activation mapping tecnique. The noncontact mapping system enables reconstruction of the spreading of activation wave through a virtually generated ventricular chamber, even from a single tachycardia beat, and was introduced as a tool to guide mapping and ablation of untolerated or unsustained ventricular arrhythmias. The reduced accuracy in the setting of enlarged ventricles is recognized as the main limitation of this tecnique. While noncontract mapping appears to be especially suitable in guiding the ablation of unsustained idiopathic ventricular arrhythmias, it can also be successfully used as a guide to perform ablation of untolerated re-entry-related ventricular tachycardias during sinus rhythm.
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Affiliation(s)
- Paolo Della Bella
- University of Milan, Centro Cardiologico Monzino, Institute of Cardiology, Via Parea 4, 20138 Milano, Italy.
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Hameedullah I, Chauhan VS. Clinical considerations for allied professionals: Understanding and optimizing three-dimensional electroanatomic mapping of complex arrhythmias—Part 1. Heart Rhythm 2009; 6:1249-52. [DOI: 10.1016/j.hrthm.2009.04.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Indexed: 10/20/2022]
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Aliot EM, Stevenson WG, Almendral-Garrote JM, Bogun F, Calkins CH, Delacretaz E, Bella PD, Hindricks G, Jais P, Josephson ME, Kautzner J, Kay GN, Kuck KH, Lerman BB, Marchlinski F, Reddy V, Schalij MJ, Schilling R, Soejima K, Wilber D. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Europace 2009; 11:771-817. [DOI: 10.1093/europace/eup098] [Citation(s) in RCA: 283] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bhushan M, Asirvatham SJ. The conundrum of ventricular arrhythmia and cardiomyopathy: Which abnormality came first? Curr Heart Fail Rep 2009; 6:7-13. [DOI: 10.1007/s11897-009-0003-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yu J, Yang B, Chen ML, Chen HW, Ju WZ, Shan QJ, Zou JG, Chen C, Xu DJ, Hou XF, Cao KJ. Premature ventricular contractions originating from the right ventricular outflow tract: three-dimensional distribution of the target sites and their electrocardiographic characteristics. Clin Exp Pharmacol Physiol 2009; 36:834-8. [PMID: 19228172 DOI: 10.1111/j.1440-1681.2009.05154.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
1. The purpose of the present study was to explore the relationship between electrocardiogram (ECG) patterns of right ventricular outflow tract (RVOT) premature ventricular contractions and the three-dimensional distribution of the target sites. 2. Thirty-three consecutive patients were included in the study. The target sites were identified by non-contact mapping and confirmed by successful ablation. The distribution of the target sites in the three-dimensional reconstructed geometry of the RVOT was classified in three directions: (i) anterior (A)/posterior (P); (ii) free wall (F)/septal (Se); and (iii) superior (Su)/inferior (I). The ECG characteristics were then analysed according to the three-dimensional distribution of the target sites. 3. The following indices were helpful to identify the position of the target site: (i) QRS duration (> or = 150 msec = F; < 150 msec = Se; P < 0.05); (ii) the R wave pattern in the inferior leads (RR' or Rr' = F; R = Se; P < 0.05); (iii) the R wave amplitude in the inferior leads (high = Se; low = F; P < 0.05); (iv) the initial r wave width in lead V(1) (wide = F; narrow = Se; P < 0.05); (v) the QS wave amplitude in aVR and aVL (if aVR < aVL, A; if aVR > or = aVL, P; P < 0.05); and (vi) the initial r wave amplitude in lead V(1) and V(2) (if V(1) > or = 0.15 mV and V(2) > or = 0.3 mV, Su; if V(1) < 0.15 mV or V(2) < 0.3 mV, I; P < 0.05). 4. In conclusion, the ECG characteristics were associated with target site locations in all three directions.
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Affiliation(s)
- Jian Yu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Wilber DJ. Catheter ablation of ventricular tachycardia: Two decades of progress. Heart Rhythm 2008; 5:S59-63. [DOI: 10.1016/j.hrthm.2008.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Indexed: 11/28/2022]
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Srivathsan KS, Bunch TJ, Asirvatham SJ, Edwards WD, Friedman PA, Munger TM, Hammill SC, Cha YM, Brady PA, Jahangir A, Bradley DJ, Rea RF, Packer DL, Shen WK. Mechanisms and Utility of Discrete Great Arterial Potentials in the Ablation of Outflow Tract Ventricular Arrhythmias. Circ Arrhythm Electrophysiol 2008; 1:30-8. [DOI: 10.1161/circep.107.750315] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Komandoor S. Srivathsan
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Scottsdale, Ariz (K.S.S.), and Rochester, Minn (T.J.B., S.J.A., P.A.F., T.M.M., S.C.H., Y.-M.C., P.A.B., A.J., D.J.B., R.F.R., D.L.P., W.-K.S.), and the Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn (W.D.E.)
| | - T. Jared Bunch
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Scottsdale, Ariz (K.S.S.), and Rochester, Minn (T.J.B., S.J.A., P.A.F., T.M.M., S.C.H., Y.-M.C., P.A.B., A.J., D.J.B., R.F.R., D.L.P., W.-K.S.), and the Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn (W.D.E.)
| | - Samuel J. Asirvatham
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Scottsdale, Ariz (K.S.S.), and Rochester, Minn (T.J.B., S.J.A., P.A.F., T.M.M., S.C.H., Y.-M.C., P.A.B., A.J., D.J.B., R.F.R., D.L.P., W.-K.S.), and the Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn (W.D.E.)
| | - William D. Edwards
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Scottsdale, Ariz (K.S.S.), and Rochester, Minn (T.J.B., S.J.A., P.A.F., T.M.M., S.C.H., Y.-M.C., P.A.B., A.J., D.J.B., R.F.R., D.L.P., W.-K.S.), and the Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn (W.D.E.)
| | - Paul A. Friedman
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Scottsdale, Ariz (K.S.S.), and Rochester, Minn (T.J.B., S.J.A., P.A.F., T.M.M., S.C.H., Y.-M.C., P.A.B., A.J., D.J.B., R.F.R., D.L.P., W.-K.S.), and the Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn (W.D.E.)
| | - Thomas M. Munger
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Scottsdale, Ariz (K.S.S.), and Rochester, Minn (T.J.B., S.J.A., P.A.F., T.M.M., S.C.H., Y.-M.C., P.A.B., A.J., D.J.B., R.F.R., D.L.P., W.-K.S.), and the Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn (W.D.E.)
| | - Stephen C. Hammill
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Scottsdale, Ariz (K.S.S.), and Rochester, Minn (T.J.B., S.J.A., P.A.F., T.M.M., S.C.H., Y.-M.C., P.A.B., A.J., D.J.B., R.F.R., D.L.P., W.-K.S.), and the Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn (W.D.E.)
| | - Yong-Mei Cha
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Scottsdale, Ariz (K.S.S.), and Rochester, Minn (T.J.B., S.J.A., P.A.F., T.M.M., S.C.H., Y.-M.C., P.A.B., A.J., D.J.B., R.F.R., D.L.P., W.-K.S.), and the Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn (W.D.E.)
| | - Peter A. Brady
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Scottsdale, Ariz (K.S.S.), and Rochester, Minn (T.J.B., S.J.A., P.A.F., T.M.M., S.C.H., Y.-M.C., P.A.B., A.J., D.J.B., R.F.R., D.L.P., W.-K.S.), and the Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn (W.D.E.)
| | - Arshad Jahangir
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Scottsdale, Ariz (K.S.S.), and Rochester, Minn (T.J.B., S.J.A., P.A.F., T.M.M., S.C.H., Y.-M.C., P.A.B., A.J., D.J.B., R.F.R., D.L.P., W.-K.S.), and the Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn (W.D.E.)
| | - David J. Bradley
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Scottsdale, Ariz (K.S.S.), and Rochester, Minn (T.J.B., S.J.A., P.A.F., T.M.M., S.C.H., Y.-M.C., P.A.B., A.J., D.J.B., R.F.R., D.L.P., W.-K.S.), and the Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn (W.D.E.)
| | - Robert F. Rea
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Scottsdale, Ariz (K.S.S.), and Rochester, Minn (T.J.B., S.J.A., P.A.F., T.M.M., S.C.H., Y.-M.C., P.A.B., A.J., D.J.B., R.F.R., D.L.P., W.-K.S.), and the Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn (W.D.E.)
| | - Douglas L. Packer
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Scottsdale, Ariz (K.S.S.), and Rochester, Minn (T.J.B., S.J.A., P.A.F., T.M.M., S.C.H., Y.-M.C., P.A.B., A.J., D.J.B., R.F.R., D.L.P., W.-K.S.), and the Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn (W.D.E.)
| | - Win-Kuang Shen
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Scottsdale, Ariz (K.S.S.), and Rochester, Minn (T.J.B., S.J.A., P.A.F., T.M.M., S.C.H., Y.-M.C., P.A.B., A.J., D.J.B., R.F.R., D.L.P., W.-K.S.), and the Division of Anatomic Pathology, Mayo Clinic, Rochester, Minn (W.D.E.)
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Whitwam W, Rule S, Narayan SM. Noncontact mapping of small pulmonary artery potentials preceding ectopy from the right ventricular outflow tract. Heart Rhythm 2007; 4:959-63. [PMID: 17599686 DOI: 10.1016/j.hrthm.2007.01.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Accepted: 01/22/2007] [Indexed: 11/30/2022]
Abstract
Idiopathic right ventricular tachycardia typically originates from the right ventricular outflow tract (RVOT). However, it also may originate from above the pulmonic valve. We describe a patient with a 2-year history of symptoms of palpitations associated with premature ventricular contractions (PVCs) in whom radiofrequency catheter ablation at the PVC exit site in the lateral RVOT failed despite the presence of several favorable criteria. However, using a multiple electrode array catheter, we demonstrated above the pulmonic valve clear evidence of low-amplitude preceding electrical activity ("blue ghost") that swept 3 cm inferolaterally over 20 ms to the previously identified lateral RVOT exit. Catheter mapping even at 128x gain demonstrated only very-low-amplitude potentials at this site, and pacing was unable to capture the ventricle from this region. However, ablation at this site immediately terminated the arrhythmia, and the patient has remained PVC-free after 1 year. This case supports the existence of previously hypothesized myocardial sleeves above the pulmonary valve that may be responsible for RVOT tachycardia and shows that they can be detected using noncontact mapping.
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Affiliation(s)
- Wayne Whitwam
- University of California San Diego, San Diego, CA 92161, USA
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Clyne CA, Athar H, Shah A, Kahr R, Rentas A. Thermal mapping of right ventricular outflow tract tachycardia. Pacing Clin Electrophysiol 2007; 30:343-51. [PMID: 17367353 DOI: 10.1111/j.1540-8159.2007.00674.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute and long-term success of catheter ablation of right ventricular outflow tract tachycardia (RVOT VT) may be limited by the inability to reproduce the arrhythmia at the time of activation (AM) and pace mapping (PM). We have observed early initiation of the clinical VT when subtherapeutic radiofrequency (RF) energy was applied to the target area (TA), defined as a 2-cm(2) area around a pace match. We describe a novel approach using thermal mapping (TM) to guide the ablation of RVOT VT. METHODS Thirteen patients (10 female, mean age 46.2 +/- 13.7 years) with symptomatic VT of left bundle branch block (LBBB) inferior axis morphology and no structural heart disease underwent standard electrophysiologic evaluation with PM (n = 13), AM (n = 13), and 3D noncontact mapping (n = 4). Thermal mapping was performed after standard techniques failed to induce stable sustained VT for mapping in all 13 patients: RF was applied for 5-10 seconds in the TA to achieve a tip temperature of 45-50 degrees C. At sites where morphologically consistent with the clinical VT was induced, RF was applied at target temperature between 50 and 60 degrees C for 30-60 seconds. TM was repeated before and after intravenous Isoproterenol infusion until no further VT could be induced by low temperature application. RESULTS Noninducibility was achieved in all 13 patients. During a mean follow-up of 29 months (9-69 months), all patients remain arrhythmia-free, off antiarrhythmic medications. CONCLUSION Thermal mapping is a safe and effective adjunctive technique for the mapping and ablation of RVOT VT when sustained tolerated clinical VT cannot be induced.
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Affiliation(s)
- Christopher A Clyne
- Henry Low Heart Center at Hartford Hospital, and University of Connecticut School of Medicine, Hartford, Connecticut, USA.
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Heidbüchel H, Corrado D, Biffi A, Hoffmann E, Panhuyzen-Goedkoop N, Hoogsteen J, Delise P, Hoff PI, Pelliccia A. Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part II: ventricular arrhythmias, channelopathies and implantable defibrillators. ACTA ACUST UNITED AC 2007; 13:676-86. [PMID: 17001205 DOI: 10.1097/01.hjr.0000239465.26132.29] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This consensus paper on behalf of the Study Group on Sports Cardiology of the European Society of Cardiology follows a previous one on guidelines for sports participation in competitive and recreational athletes with supraventricular arrhythmias and pacemakers. The question of imminent life-threatening arrhythmias is especially relevant when some form of ventricular rhythm disorder is documented, or when the patient is diagnosed to have inherited a pro-arrhythmogenic disorder. Frequent ventricular premature beats or nonsustained ventricular tachycardia may be a hallmark of underlying pathology and increased risk. Their finding should prompt a thorough cardiac evaluation, including both imaging modalities and electrophysiological techniques. This should allow distinguishing idiopathic rhythm disorders from underlying disease that carries a more ominous prognosis. Recommendations on sports participation in inherited arrhythmogenic conditions and asymptomatic gene carriers are also discussed: congenital and acquired long QT syndrome, short QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, arrhythmogenic right ventricular cardiomyopathy and other familial electrical disease of unknown origin. If an implantable cardioverter defibrillator is indicated, it is no substitute for the guidelines relating to the underlying pathology. Moreover, some particular recommendations for patients/athletes with an implantable cardioverter defibrillator are to be observed.
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Affiliation(s)
- Hein Heidbüchel
- Cardiology-Electrophysiology, University Hospital Gasthuisberg, Leuven, Belgium.
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Greil GF, Gass M, Kuehlkamp V, Botnar RM, Wolf I, Miller S, Sieverding L. Radiofrequency ablation of right ventricular outflow tract tachycardia using a magnetic resonance 3D model for interactive catheter guidance. Clin Res Cardiol 2006; 95:610-3. [PMID: 16998745 DOI: 10.1007/s00392-006-0431-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Accepted: 06/26/2006] [Indexed: 10/24/2022]
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Thornton AS, Jordaens LJ. Remote magnetic navigation for mapping and ablating right ventricular outflow tract tachycardia. Heart Rhythm 2006; 3:691-6. [PMID: 16731472 DOI: 10.1016/j.hrthm.2006.01.028] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2005] [Accepted: 01/28/2006] [Indexed: 11/15/2022]
Abstract
BACKGROUND Navigation, mapping, and ablation in the right ventricular outflow tract (RVOT) can be difficult. Catheter navigation using external magnetic fields may allow more accurate mapping and ablation. OBJECTIVES The purpose of this study was to assess the feasibility of RVOT tachycardia ablation using remote magnetic navigation. METHODS Mapping and ablation were performed in eight patients with outflow tract ventricular arrhythmias. Tachycardia mapping was undertaken with a 64-polar basket catheter, followed by remote activation and pace-mapping using a magnetically enabled catheter. The area of interest was localized on the basket catheter in seven patients in whom an RVOT arrhythmia was identified. Remote navigation of the magnetic catheter to this area was followed by pace-mapping. Ablation was performed at the site of perfect pace-mapping, with earliest activation if possible. RESULTS Acute success was achieved in all patients (median four applications). Median procedural time was 144 minutes, with 13.4 minutes of patient fluoroscopy time and 3.8 minutes of physician fluoroscopy time. No complications occurred. One recurrence occurred during follow-up (mean 366 days). CONCLUSION RVOT tachycardias can be mapped and ablated using remote magnetic navigation, initially guided by a basket catheter. Precise activation and pace-mapping are possible. Remote magnetic navigation permitted low fluoroscopy exposure for the physician. Long-term results are promising.
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Affiliation(s)
- Andrew S Thornton
- Department of Clinical Electrophysiology, Thoraxcentre, Erasmus Medical Centre, Rotterdam, The Netherlands.
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Joshi S, Wilber DJ. Ablation of Idiopathic Right Ventricular Outflow Tract Tachycardia: Current Perspectives. J Cardiovasc Electrophysiol 2005; 16 Suppl 1:S52-8. [PMID: 16138887 DOI: 10.1111/j.1540-8167.2005.50163.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ventricular tachycardia (VT) arising from the right ventricular outflow tract (RVOT) in the absence of overt structural heart disease is a common entity. Exclusion of occult structural disease such as arrhythmogenic right ventricular cardiomyopathy is critical as this diagnosis impacts both ablation outcomes and long-term prognosis. VT is most commonly due to triggered activity. Induction of the target arrhythmia in the laboratory is often problematic, and is frequently facilitated by catecholamine infusion. Recent data indicate that high-density three-dimensional activation mapping facilitates identification of target sites for ablation, and that the spatial resolution of pacemapping may be more limited than previously recognized. A standard 12-lead electrocardiogram is useful in providing an initial approximation of the site of origin within the outflow tract, and may contain subtle clues to potentially confounding foci on the left ventricular endocardial or epicardial surface. When sufficient arrhythmia is present to permit mapping, successful ablation can be expected in 90-95% of patients, with a recurrence risk of approximately 5%. In experienced centers, major complications are <or=1% and outcomes should approach those obtained for the common forms of supraventricular tachycardia.
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Affiliation(s)
- Sandeep Joshi
- Cardiovascular Institute, Loyola University Medical Center, Maywood, Illinois 60153, USA
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Yarlagadda RK, Iwai S, Stein KM, Markowitz SM, Shah BK, Cheung JW, Tan V, Lerman BB, Mittal S. Reversal of Cardiomyopathy in Patients With Repetitive Monomorphic Ventricular Ectopy Originating From the Right Ventricular Outflow Tract. Circulation 2005; 112:1092-7. [PMID: 16103234 DOI: 10.1161/circulationaha.105.546432] [Citation(s) in RCA: 300] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Tachycardia-induced cardiomyopathy caused by ventricular tachycardia is a well-defined clinical entity. Less well appreciated is whether simple ventricular ectopy can result in cardiomyopathy. We sought to examine a potential causal relationship between repetitive monomorphic ventricular ectopy originating from the right ventricular outflow tract and cardiomyopathy and the role of ablation in reversing this process.
Methods and Results—
The study consisted of 27 patients (11 men; age, 47±15 years) with repetitive monomorphic ventricular ectopy, including 8 patients (30%) with depressed ventricular function (ejection fraction ≤45%). All patients underwent assessment of cardiac structure and function. The burden of ectopy was quantified through 24-hour Holter monitoring. Patients then underwent ablation guided by 3D mapping. After ablation, patients underwent repeated Holter monitoring and reassessment of cardiac function. Patients with depressed ventricular function were more likely to be older than patients with normal function (58±14 versus 42±18 years;
P
=0.013). However, the burden of ventricular ectopy was similar in patients with (17 859±13 488 ectopic beats per 24 hours) and without (17 541±11 479 ectopic beats per 24 hours;
P
=0.800) preserved ventricular function. Successful ablation was performed in 23 patients (85%), including 7 of 8 patients with depressed ventricular function. In this latter group, ventricular function improved in all patients (from 39±6% to 62±6%;
P
=0.017).
Conclusions—
Repetitive monomorphic ventricular ectopy (in the absence of sustained ventricular tachycardia) originating from the right ventricular outflow tract is an underappreciated cause of unexplained cardiomyopathy. Successful ablation of the focal source of ventricular ectopy results in normalization of left ventricular function. Patients with ectopy-induced cardiomyopathy are significantly older than patients with preserved ventricular function, which suggests either that older patients are more susceptible to the development of a cardiomyopathy or that the cardiomyopathy has had a longer period of time in which to evolve.
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Affiliation(s)
- Ravi K Yarlagadda
- Maurice and Corinne Greenberg Division of Cardiology, Cornell University Medical Center, New York, NY 10021, USA
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