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Sun Y, Zhu X, Chen W, Weng W, Nakamura K. Computer simulation of low-power and long-duration bipolar radiofrequency ablation under various baseline impedances. Med Eng Phys 2024; 131:104226. [PMID: 39284653 DOI: 10.1016/j.medengphy.2024.104226] [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: 02/05/2024] [Revised: 08/05/2024] [Accepted: 08/12/2024] [Indexed: 09/19/2024]
Abstract
Compared to traditional unipolar radiofrequency ablation (RFA), bipolar RFA offers advantages such as more precise heat transfer and higher ablation efficiency. Clinically, myocardial baseline impedance (BI) is one of the important factors affecting the effectiveness of ablation. We aim at finding suitable ablation protocols and coping strategies by analyzing the ablation effects and myocardial impedance changes of bipolar RFA under different BIs. In this research, a three-dimensional local myocardial computer model was constructed for bipolar RFA simulation, and in vitro experimental data were used to validate accuracy. Four fixed low-power levels (20 W, 25 W, 30 W, and 35 W) and six myocardial BIs (91.02 Ω, 99.83 Ω, 111.03 Ω, 119.77 Ω, 130.03 Ω, and 135.45 Ω) were set as initial conditions, with an ablation duration of 120-s. In the context of low-power and long-duration (LPLD) ablation, the maximum TID (TIDM) decreased by 21-32 Ω, depending on the BI. In cases where steam pop did not occur, TIDM increased with the increase in power. For the same power, there was no significant difference in TIDM for the range of BIs. In cases where steam pop occurred, for every 1 Ω increase in BI, TIDM increased by 0.34-0.41 Ω. The simulation results also showed that using a higher power resulted in a smaller decrease in TIDM. This study provided appropriate ablation times and impedance decrease ranges for bipolar LPLD RFA. The combination of 25 W for 120-s offered optimal performance when considering effectiveness and safety simultaneously.
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Affiliation(s)
- Yao Sun
- Graduate Department of Computer Science and Engineering, The University of Aizu, Aizuwakamatsu, Fukushima 965-8580, Japan.
| | - Xin Zhu
- Graduate Department of Computer Science and Engineering, The University of Aizu, Aizuwakamatsu, Fukushima 965-8580, Japan.
| | - Wenxi Chen
- Graduate Department of Computer Science and Engineering, The University of Aizu, Aizuwakamatsu, Fukushima 965-8580, Japan.
| | - Weihao Weng
- Graduate Department of Computer Science and Engineering, The University of Aizu, Aizuwakamatsu, Fukushima 965-8580, Japan.
| | - Keijiro Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Meguro, Tokyo 153-8515, Japan.
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2
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Martins N, Landmesser U, Attanasio P, Huemer M. Bipolar catheter ablation of a left atrial anteroseptal line in a patient with peri-mitral atrial flutter: a case report. Eur Heart J Case Rep 2024; 8:ytae455. [PMID: 39286728 PMCID: PMC11404515 DOI: 10.1093/ehjcr/ytae455] [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: 03/02/2024] [Revised: 06/14/2024] [Accepted: 08/23/2024] [Indexed: 09/19/2024]
Abstract
Background Treatment of recurring atrial flutter can be challenging due to anatomical obstacles preventing complete conduction block of linear ablation lesions. Epicardial or bipolar ablation can be used as an alternative to create deeper ablation lesions but is still limitedly used in patients with atrial flutter. Case summary We describe a case of a 54-year-old patient with recurring peri-mitral flutter treated with ablation of an anteroseptal line using bipolar ablation to achieve a complete conduction block. Discussion As conventional ablation cannot always achieve, complete conduction block in linear ablation lesions alternatives may be used to create deeper lesions. In this, case bipolar ablation was used successfully for an anteroseptal line in a patient with recurring peri-mitral flutter.
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Affiliation(s)
- Nadja Martins
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité-Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité-Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Philipp Attanasio
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité-Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Martin Huemer
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité-Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
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3
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Younis A, Tabaja C, Kleve R, Garrott K, Lehn L, Buck E, Hussein AA, Nakhla S, Nakagawa H, Krywanczyk A, Taigen T, Kanj M, Sroubek J, Saliba WI, Wazni OM, Santangeli P. Comparative Efficacy and Safety of Pulsed Field Ablation Versus Radiofrequency Ablation of Idiopathic LV Arrhythmias. JACC Clin Electrophysiol 2024; 10:1998-2009. [PMID: 38878017 DOI: 10.1016/j.jacep.2024.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/22/2024] [Accepted: 04/27/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND Comparative efficacy and safety data on radiofrequency ablation (RFA) versus pulsed field ablation (PFA) for common idiopathic left ventricular arrhythmia (LV-VAs) locations are lacking. OBJECTIVES This study sough to compare RFA with PFA of common idiopathic LV-VAs locations. METHODS Ten swine were randomized to PFA or RFA of LV interventricular septum, papillary muscle, LV summit via distal coronary sinus, and LV epicardium via subxiphoid approach. Ablations were delivered using an investigational dual-energy (RFA/PFA) contact force (CF) and local impedance-sensing catheter. After 1-week survival, animals were euthanized for lesion assessment. RESULTS A total of 55 PFA (4 applications/site of 2.0 KV, target CF ≥10 g) and 36 RFA (CF ≥10 g, 25-50 W targeting ≥50 Ω local impedance drop, 60-second duration) were performed. LV interventricular septum: average PFA depth 7.8 mm vs RFA 7.9 mm (P = 0.78) and no adverse events. Papillary muscle: average PFA depth 8.1 mm vs RFA 4.5 mm (P < 0.01). Left ventricular summit: average PFA depth 5.6 mm vs RFA 2.7 mm (P < 0.01). Steam-pop and/or ventricular fibrillation in 4 of 12 RFA vs 0 of 12 PFA (P < 0.01), no ST-segment changes observed. Epicardium: average PFA depth 6.4 mm vs RFA 3.3 mm (P < 0.01). Transient ST-segment elevations/depressions occurred in 4 of 5 swine in the PFA arm vs 0 of 5 in the RFA arm (P < 0.01). Angiography acutely and at 7 days showed normal coronaries in all cases. CONCLUSIONS In this swine study, compared with RFA, PFA of common idiopathic LV-VAs locations produced deeper lesions with fewer steam pops. However, PFA was associated with higher rates of transient ST-segment elevations and depressions with direct epicardium ablation.
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Affiliation(s)
- Arwa Younis
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chadi Tabaja
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ryan Kleve
- Boston Scientific Corporation, St. Paul, Minnesota, USA
| | - Kara Garrott
- Boston Scientific Corporation, St. Paul, Minnesota, USA
| | - Lauren Lehn
- Boston Scientific Corporation, St. Paul, Minnesota, USA
| | - Eric Buck
- Boston Scientific Corporation, St. Paul, Minnesota, USA
| | - Ayman A Hussein
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shady Nakhla
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hiroshi Nakagawa
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Tyler Taigen
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mohamed Kanj
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Walid I Saliba
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oussama M Wazni
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pasquale Santangeli
- Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
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4
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Derejko P, Janus I, Kułakowski P, Kuśnierz J, Baran J, Hangiel U, Proszek J, Frydrychowski P, Michałek M, Noszczyk-Nowak A. Bipolar endo-epicardial RF ablation: Animal feasibility study. Heart Rhythm 2024; 21:790-798. [PMID: 38336196 DOI: 10.1016/j.hrthm.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Bipolar radiofrequency ablation (B-RFA) is a method used to treat the arrhythmia substrate resistant to unipolar ablation. Few studies have addressed endo-epicardial B-RFA. OBJECTIVE The aim of the study was to evaluate chronic lesions resulting from endo-epicardial B-RFA and to determine optimal settings for such procedures in an animal model. METHODS In 7 pigs, up to 5 radiofrequency applications per animal were performed with 2 electrodes placed on both sides of the left ventricular free wall. Current was delivered for 60 seconds by a generator dedicated for B-RFA with power settings of 25, 30, 35, 40, and 50 W. RESULTS At 12 weeks after ablation, 31 lesions were assessed. Their maximal cross-sectional area ranged from 7.2 to 68 mm2 and correlated with total power delivered (r = 0.53), with temperature increment at the endocardial catheter (r = 0.65), and inversely with temperature decrement at the epicardial catheter (r = 0.54). For power values between 30 and 40 W, the lesion area did not differ significantly (P = .92). Lesion depth ranged from 1.9 to 11 mm and correlated with impedance decrement (r = 0.5). Lesions were transmural in 8 cases. Lesion depth/wall thickness ratio was on average 0.6 ± 0.3, with the smallest value for 25 W (0.5 ± 0.3) and the largest for 50 W (0.8 ± 0.3). Steam pops occurred at a power range of 30-50 W, with an incidence of 1 in 5 applications, with 1 case of fatal tamponade at 40 W. Impedance decrement, endocardial catheter temperature increment, and endocardial electrogram amplitude decrement were greater during applications with steam pops. CONCLUSION Chronic lesions resulting from endo-epicardial B-RFA appear smaller and less often transmural compared with acute lesions described in the literature. The incidence of steam pops during endo-epicardial B-RFA is relatively high even at low powers.
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Affiliation(s)
- Paweł Derejko
- Department of Cardiology, Medicover Hospital, Warsaw, Poland; Department of Cardiac Arrhythmias, National Institute of Cardiology, Warsaw, Poland.
| | - Izabela Janus
- Faculty of Veterinary Medicine, University of Environmental and Life Sciences, Wroclaw, Poland
| | - Piotr Kułakowski
- Department of Cardiology, Centre for Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Jacek Kuśnierz
- Department of Cardiology, Medicover Hospital, Warsaw, Poland
| | - Jakub Baran
- Department of Cardiology, Centre for Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | | | | | - Piotr Frydrychowski
- Faculty of Veterinary Medicine, University of Environmental and Life Sciences, Wroclaw, Poland
| | - Marcin Michałek
- Faculty of Veterinary Medicine, University of Environmental and Life Sciences, Wroclaw, Poland
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Tonko JB, Lambiase P. Exploring the Full Potential of Radiofrequency Technology: A Practical Guide to Advanced Radiofrequency Ablation for Complex Ventricular Arrhythmias. Curr Cardiol Rep 2024; 26:269-282. [PMID: 38700597 PMCID: PMC11136806 DOI: 10.1007/s11886-024-02048-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW Percutaneous radiofrequency (RF) catheter ablation is an established strategy to prevent ventricular tachycardia (VT) recurrence and ICD shocks. Yet delivery of durable lesion sets by means of traditional unipolar radiofrequency ablation remains challenging, and left ventricular transmurality is rarely achieved. Failure to ablate and eliminate functionally relevant areas is particularly common in deep intramyocardial substrates, e.g. septal VT and cardiomyopathies. Here, we aim to give a practical-orientated overview of advanced and emerging RF ablation technologies to target these complex VT substrates. We summarize recent evidence in support of these technologies and share experiences from a tertiary VT centre to highlight important "hands-on" considerations for operators new to advanced RF ablation strategies. RECENT FINDINGS A number of innovative and modified radiofrequency ablation approaches have been proposed to increase energy delivery to the myocardium and maximize RF lesion dimensions and depth. These include measures of impedance modulation, combinations of simultaneous unipolar ablations or true bipolar ablation, intramyocardial RF delivery via wires or extendable RF needles and investigational linear or spherical catheter designs. Recent new clinical evidence for the efficacy and safety of these investigational technologies and strategies merits a re-evaluation of their role and clinic application for percutaneous VT ablations. Complexity of substrates targeted with percutaneous VT ablation is increasing and requires detailed preprocedural imaging to characterize the substrate to inform the procedural approach and selection of ablation technology. Depending on local experience, options for additional and/or complementary interventional treatments should be considered upfront in challenging substrates to improve the success rates of index procedures. Advanced RF technologies available for clinical VT ablations include impedance modulation via hypotonic irrigation or additional dispersive patches and simultaneous unipolar as well as true bipolar ablation. Promising investigational RF technologies involve an extendable needle RF catheter, intramyocardial RF delivery over intentionally perforated wires as well as a variety of innovative ablation catheter designs including multipolar linear, spherical and partially insulated ablation catheters.
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Affiliation(s)
- J B Tonko
- Institute of Cardiovascular Science, University College London, 62 Huntley St, London, WC1E 6DD, UK.
- Bartholomew s Hospital, W Smithfield, London, UK.
| | - P Lambiase
- Institute of Cardiovascular Science, University College London, 62 Huntley St, London, WC1E 6DD, UK
- Bartholomew s Hospital, W Smithfield, London, UK
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6
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Gardziejczyk P, Piotrowski R, Kryński T, Sikorska A, Kułakowski P, Baran J. Bipolar catheter ablation with dedicated radiofrequency system for highly refractory ventricular arrhythmia-Does the rate of success depend on arrhythmia origin? J Cardiovasc Electrophysiol 2024; 35:667-674. [PMID: 38293729 DOI: 10.1111/jce.16186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/28/2023] [Accepted: 01/06/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Despite rapid technological progress, some arrhythmias are still resistant to standard unipolar ablation. These include arrhythmias arising from the base of the heart, cardiac crux, or epicardium. Bipolar radiofrequency ablation (B-RFA) may be useful in some cases, however, data on the efficacy of this approach in various arrhythmia localizations are scarce. The aim of this study was to assess the efficacy of B-RFA in patients with ventricular arrhythmias originating from various locations, occurring refractory to standard unipolar ablation approaches. METHODS An observational, single center study was conducted over a 30-month period. B-RFA were performed using dedicated radio frequency (RF) generator and electroanatomic mapping system. RESULTS Twenty-four procedures, in 23 patients with a median (range) of 1 (1-2) previously failed unipolar ablation procedures, were included in the final analysis. There were 12 ablations of ventricular arrhythmias originating from interventricular septum with an acute success rate of 75%, and 12 from left ventricular (LV) summit with an acute success rate of 58%. The midterm success rate (median interquartile range follow-up of 205 days [188-338]) was 66% and 50%, respectively. CONCLUSIONS B-RFA is a promising method of catheter ablation for refractory cardiac arrhythmias. A higher success rate was observed in ablation for difficult ventricular arrhythmias originating from interventricular septal region than LV summit.
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Affiliation(s)
- Piotr Gardziejczyk
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Roman Piotrowski
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Tomasz Kryński
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Agnieszka Sikorska
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Piotr Kułakowski
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Jakub Baran
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
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Lenarczyk R, Zeppenfeld K, Tfelt-Hansen J, Heinzel FR, Deneke T, Ene E, Meyer C, Wilde A, Arbelo E, Jędrzejczyk-Patej E, Sabbag A, Stühlinger M, di Biase L, Vaseghi M, Ziv O, Bautista-Vargas WF, Kumar S, Namboodiri N, Henz BD, Montero-Cabezas J, Dagres N. Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC-endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society. Europace 2024; 26:euae049. [PMID: 38584423 PMCID: PMC10999775 DOI: 10.1093/europace/euae049] [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: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/09/2024] Open
Abstract
Electrical storm (ES) is a state of electrical instability, manifesting as recurrent ventricular arrhythmias (VAs) over a short period of time (three or more episodes of sustained VA within 24 h, separated by at least 5 min, requiring termination by an intervention). The clinical presentation can vary, but ES is usually a cardiac emergency. Electrical storm mainly affects patients with structural or primary electrical heart disease, often with an implantable cardioverter-defibrillator (ICD). Management of ES requires a multi-faceted approach and the involvement of multi-disciplinary teams, but despite advanced treatment and often invasive procedures, it is associated with high morbidity and mortality. With an ageing population, longer survival of heart failure patients, and an increasing number of patients with ICD, the incidence of ES is expected to increase. This European Heart Rhythm Association clinical consensus statement focuses on pathophysiology, clinical presentation, diagnostic evaluation, and acute and long-term management of patients presenting with ES or clustered VA.
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Affiliation(s)
- Radosław Lenarczyk
- Medical University of Silesia, Division of Medical Sciences, Department of Cardiology and Electrotherapy, Silesian Center for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- The Department of Forensic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frank R Heinzel
- Cardiology, Angiology, Intensive Care, Städtisches Klinikum Dresden Campus Friedrichstadt, Dresden, Germany
| | - Thomas Deneke
- Clinic for Interventional Electrophysiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
- Clinic for Electrophysiology, Klinikum Nuernberg, University Hospital of the Paracelsus Medical University, Nuernberg, Germany
| | - Elena Ene
- Clinic for Interventional Electrophysiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Christian Meyer
- Division of Cardiology/Angiology/Intensive Care, EVK Düsseldorf, Teaching Hospital University of Düsseldorf, Düsseldorf, Germany
| | - Arthur Wilde
- Department of Cardiology, Amsterdam UMC University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Tel Hashomer, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Markus Stühlinger
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Luigi di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA
| | - Marmar Vaseghi
- UCLA Cardiac Arrythmia Center, Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Ohad Ziv
- Case Western Reserve University, Cleveland, OH, USA
- The MetroHealth System Campus, Cleveland, OH, USA
| | | | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | | | - Benhur Davi Henz
- Instituto Brasilia de Arritmias-Hospital do Coração do Brasil-Rede Dor São Luiz, Brasilia, Brazil
| | - Jose Montero-Cabezas
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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8
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Volkov D, Lopin D, Skoriy D, Gianni C, La Fazia VM, Gallinghouse GJ, Horton R, Burkhardt JD, Mohanty S, Natale A. Bailout Deep Septal LV Pacing to Treat Inadvertent Complete AV Block During Complex Ablation Procedure. JACC Case Rep 2024; 29:102227. [PMID: 38464799 PMCID: PMC10920119 DOI: 10.1016/j.jaccas.2024.102227] [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: 09/28/2023] [Revised: 11/29/2023] [Accepted: 01/03/2024] [Indexed: 03/12/2024]
Abstract
We present a case of persistent complete atrioventricular block that occurred during the diagnostic portion of a premature ventricular contractions' radiofrequency ablation in a complex heart failure patient. The case was managed by bailout deep left ventricular septal pacing after bipolar radiofrequency elimination of premature ventricular contractions.
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Affiliation(s)
- Dmytro Volkov
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, Texas, USA
- Institute of General and Urgent Surgery of NAMS, Kharkiv, Ukraine
| | - Dmytro Lopin
- Institute of General and Urgent Surgery of NAMS, Kharkiv, Ukraine
| | - Dmytro Skoriy
- Institute of General and Urgent Surgery of NAMS, Kharkiv, Ukraine
| | - Carola Gianni
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, Texas, USA
| | - Vincenzo Mirko La Fazia
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, Texas, USA
| | - G. Joseph Gallinghouse
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, Texas, USA
| | - Rodney Horton
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, Texas, USA
| | - John D. Burkhardt
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, Texas, USA
| | - Sanghamitra Mohanty
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, Texas, USA
| | - Andrea Natale
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, Texas, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA
- Department of Internal Medicine, Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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9
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Futyma P, Chen S, Enriquez A, Pürerfellner H, Santangeli P. Bipolar ablation of ventricular arrhythmias: Step-by-step. J Cardiovasc Electrophysiol 2023; 34:2599-2606. [PMID: 37968834 DOI: 10.1111/jce.16131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023]
Abstract
Radiofrequency (RF) ablation of intramural ventricular arrhythmias (VAs) may require advanced ablation techniques to achieve effective energy transfer to the targeted tissue. As an alternative to standard RF ablation, catheter ablation can also be conducted in bipolar configuration when two ablation catheters participate in the RF circuit. This strategy has proved to result in deeper lesion formation and may be effective for eliminating arrhythmias that have been refractory to standard ablation. In this article, we provide a step-by-step guide on when and how to perform bipolar ablation of VAs.
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Affiliation(s)
- Piotr Futyma
- St. Joseph's Heart Rhythm Center, Rzeszów, Poland
- Medical College, University of Rzeszów, Rzeszów, Poland
| | - Shaojie Chen
- Department Kardiologe, Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
| | - Andres Enriquez
- Kingston Health Science Centre, Queen's University, Kingston, Ontario, Canada
| | | | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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10
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Natale A, Zeppenfeld K, Della Bella P, Liu X, Sabbag A, Santangeli P, Sommer P, Sticherling C, Zhang X, Di Biase L. Twenty-five years of catheter ablation of ventricular tachycardia: a look back and a look forward. Europace 2023; 25:euad225. [PMID: 37622589 PMCID: PMC10451002 DOI: 10.1093/europace/euad225] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 08/26/2023] Open
Abstract
This article will discuss the past, present, and future of ventricular tachycardia ablation and the continuing contribution of the Europace journal as the platform for publication of milestone research papers in this field of ventricular tachycardia ablation.
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Affiliation(s)
- Andrea Natale
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, 3000 N. I-35, Suite 720, Austin, TX 78705, USA
| | - Katja Zeppenfeld
- Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands
| | - Paolo Della Bella
- Department of Cardiac Electrophysiology and Arrhythmology, San Raffaele University Hospital, Milan, Italy
| | - Xu Liu
- Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Avi Sabbag
- Sheba Medical Center, Tel HaShomer, Israel and the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Philipp Sommer
- Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | - Xiaodong Zhang
- Montefiore Health System, Einstein Medical School, New York, USA
| | - Luigi Di Biase
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, 3000 N. I-35, Suite 720, Austin, TX 78705, USA
- Montefiore Health System, Einstein Medical School, New York, USA
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11
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Vázquez-Calvo S, Roca-Luque I, Althoff TF. Management of Ventricular Arrhythmias in Heart Failure. Curr Heart Fail Rep 2023; 20:237-253. [PMID: 37227669 DOI: 10.1007/s11897-023-00608-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE OF REVIEW Despite substantial progress in medical and device-based heart failure (HF) therapy, ventricular arrhythmias (VA) and sudden cardiac death (SCD) remain a major challenge. Here we review contemporary management of VA in the context of HF with one particular focus on recent advances in imaging and catheter ablation. RECENT FINDINGS Besides limited efficacy of antiarrhythmic drugs (AADs), their potentially life-threatening side effects are increasingly acknowledged. On the other hand, with tremendous advances in catheter technology, electroanatomical mapping, imaging, and understanding of arrhythmia mechanisms, catheter ablation has evolved into a safe, efficacious therapy. In fact, recent randomized trials support early catheter ablation, demonstrating superiority over AAD. Importantly, CMR imaging with gadolinium contrast has emerged as a central tool for the management of VA complicating HF: CMR is not only essential for an accurate diagnosis of the underlying entity and subsequent treatment decisions, but also improves risk stratification for SCD prevention and patient selection for ICD therapy. Finally, 3-dimensional characterization of arrhythmogenic substrate by CMR and imaging-guided ablation approaches substantially enhance procedural safety and efficacy. VA management in HF patients is highly complex and should be addressed in a multidisciplinary approach, preferably at specialized centers. While recent evidence supports early catheter ablation of VA, an impact on mortality remains to be demonstrated. Moreover, risk stratification for ICD therapy may have to be reconsidered, taking into account imaging, genetic testing, and other parameters beyond left ventricular function.
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Affiliation(s)
- Sara Vázquez-Calvo
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC Barcelona University Hospital, C/Villarroel N° 170, 08036, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Ivo Roca-Luque
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC Barcelona University Hospital, C/Villarroel N° 170, 08036, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Till F Althoff
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC Barcelona University Hospital, C/Villarroel N° 170, 08036, Barcelona, Catalonia, Spain.
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
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12
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Meyer C, Kahle AK. Thermosensitive Liposomes for Improved Lesion Durability After Catheter Ablation: A Simple Solution? JACC Clin Electrophysiol 2023; 9:1409-1411. [PMID: 37227344 DOI: 10.1016/j.jacep.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Christian Meyer
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Düsseldorf, Germany; Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany.
| | - Ann-Kathrin Kahle
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Düsseldorf, Germany; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
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13
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Futyma P, Kułakowski P. Bipolar Ablation: The Perfect Recipe for a Well-Done Endo-Epicardial Lesion Set. JACC Clin Electrophysiol 2023; 9:738-739. [PMID: 37380309 DOI: 10.1016/j.jacep.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Piotr Futyma
- St. Joseph's Heart Rhythm Center, Rzeszów, Poland; Medical College, University of Rzeszów, Rzeszów, Poland.
| | - Piotr Kułakowski
- St. Joseph's Heart Rhythm Center, Rzeszów, Poland; Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
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14
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Mohanty S, Burkhardt JD, Di Biase L, Mohanty P, Shetty SS, Gianni C, Della Rocca DG, Baho KK, Morris T, Mayedo A, MacDonald B, Al-Ahmad A, Bassiouny M, Gallinghouse GJ, Horton R, Natale A. Best ablation strategy in patients with premature ventricular contractions with multiple morphology: a single-centre experience. Europace 2023; 25:euad038. [PMID: 36942834 PMCID: PMC10227647 DOI: 10.1093/europace/euad038] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/22/2022] [Indexed: 03/23/2023] Open
Abstract
AIMS This study aimed to examine the clinical benefits of targeted ablation of all Premature ventricular complex (PVC) morphologies vs. predominant PVC only. METHODS AND RESULTS A total of 171 consecutive patients with reduced left ventricular ejection fraction (LVEF) and ≥2 PVC morphology with high burden (>10%/day) undergoing their first ablation procedure were included in the analysis. At the initial procedure, prevalent PVC alone was ablated in the majority. However, at the redo, all PVC morphologies were targeted for ablation. : At the first procedure, 152 (89%) patients received ablation of the dominant PVC only. In the remaining 19 (11%) patients, all PVC morphologies were ablated. At two years, high PVC burden was detected in 89 (52%) patients. Repeat procedure was performed in 78 of 89, where all PVC morphologies were ablated. At 5 years after the repeat procedure, 71 (91%) had PVC burden of <5% [3.8 ± 1.1% vs. 15.4 ± 4.3% in successful vs. failed subjects (P < 0.001)]. In patients with low PVC burden after the initial procedure, LVEF improved from 37.5% to 41.6% [mean difference (MD): 3.39 ± 2.9%, P < 0.001], whereas a reduction in LVEF from 39.8% to 34.5% (MD: 6.45 ± 4.7%, P < 0.001) was recorded in patients with high PVC burden. One year after the repeat procedure, LVEF improved from 36.2% to 41.7% (MD: 5.5 ± 4.3%, P < 0.001) in patients with successful ablation. CONCLUSION In this observational series, ablation of all PVC morphologies was associated with significantly lower PVC burden and improvement of LVEF at long-term follow-up, compared with ablation of the dominant morphology only.
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Affiliation(s)
- Sanghamitra Mohanty
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA
| | - John D Burkhardt
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA
| | - Luigi Di Biase
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA
- Department of Electrophysiology, Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
| | - Prasant Mohanty
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA
| | - Sai Shishir Shetty
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA
| | - Carola Gianni
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA
| | - Domenico G Della Rocca
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA
| | - Karim K Baho
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA
| | - Trevor Morris
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA
| | - Angel Mayedo
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA
| | - Bryan MacDonald
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA
| | - Amin Al-Ahmad
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA
| | - Mohamed Bassiouny
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA
| | - Gerald Joseph Gallinghouse
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA
| | - Rodney Horton
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA
| | - Andrea Natale
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA
- Interventional Electrophysiology, Scripps Clinic, 3811 Valley Centre Dr., SD, CA 92130, USA
- Metro Health Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
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15
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Hanson M, Futyma P, Bode W, Liang JJ, Tapia C, Adams C, Zarębski Ł, Wrzos A, Saenz L, Sadek M, Muser D, Baranchuk A, Marchlinski F, Santangeli P, Garcia F, Enriquez A. Catheter ablation of intramural outflow tract premature ventricular complexes: a multicentre study. Europace 2023; 25:euad100. [PMID: 37096979 PMCID: PMC10228610 DOI: 10.1093/europace/euad100] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/20/2023] [Indexed: 04/26/2023] Open
Abstract
AIMS Ablation of outflow tract ventricular arrhythmias may be limited by a deep intramural location of the arrhythmogenic source. This study evaluates the acute and long-term outcomes of patients undergoing ablation of intramural outflow tract premature ventricular complexes (PVCs). METHODS AND RESULTS This multicenter series included patients with structurally normal heart or nonischemic cardiomyopathy and intramural outflow tract PVCs defined by: (a) ≥ 2 of the following criteria: (1) earliest endocardial or epicardial activation < 20ms pre-QRS; (2) Similar activation in different chambers; (3) no/transient PVC suppression with ablation at earliest endocardial/epicardial site; or (b) earliest ventricular activation recorded in a septal coronary vein. Ninety-two patients were included, with a mean PVC burden of 21.5±10.9%. Twenty-six patients had had previous ablations. All PVCs had inferior axis, with LBBB pattern in 68%. In 29 patients (32%) direct mapping of the intramural septum was performed using an insulated wire or multielectrode catheter, and in 13 of these cases the earliest activation was recorded within a septal vein. Most patients required special ablation techniques (one or more), including sequential unipolar ablation in 73%, low-ionic irrigation in 26%, bipolar ablation in 15% and ethanol ablation in 1%. Acute PVC suppression was achieved in 75% of patients. Following the procedure, the PVC burden was reduced to 5.8±8.4%. The mean follow-up was 15±14 months and 16 patients underwent a repeat ablation. CONCLUSION Ablation of intramural PVCs is challenging; acute arrhythmia elimination is achieved in 3/4 patients, and non-conventional approaches are often necessary for success.
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Affiliation(s)
- Matthew Hanson
- Division of Cardiology, Queen’s University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada
| | - Piotr Futyma
- University of Rzeszów and St. Joseph's Heart Rhythm Center, Rzeszów, Poland
| | - Weeranun Bode
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jackson J Liang
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Carlos Tapia
- Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia
| | - Christian Adams
- Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia
| | - Łukasz Zarębski
- University of Rzeszów and St. Joseph's Heart Rhythm Center, Rzeszów, Poland
| | - Aleksandra Wrzos
- University of Rzeszów and St. Joseph's Heart Rhythm Center, Rzeszów, Poland
| | - Luis Saenz
- Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia
| | - Mouhannad Sadek
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Daniele Muser
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adrian Baranchuk
- Division of Cardiology, Queen’s University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada
| | - Francis Marchlinski
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fermin Garcia
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andres Enriquez
- Division of Cardiology, Queen’s University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada
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16
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Fink T, Sciacca V, Sommer P. Catheter ablation of premature ventricular contractions with multiple morphologies in tachycardia-induced cardiomyopathy: all or nothing? Europace 2023; 25:euad064. [PMID: 36942441 PMCID: PMC10227652 DOI: 10.1093/europace/euad064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Affiliation(s)
- Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, Bad Oeynhausen 32545, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, Bad Oeynhausen 32545, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, Bad Oeynhausen 32545, Germany
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17
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Derejko P, Kuśnierz J, Bardyszewski A, Dzwonkowska D, Polańska-Skrzypczyk M, Szumowski ŁJ, Verma A. Bipolar Endo-Epicardial Radiofrequency Ablation of Therapy-Resistant Ventricular Arrhythmias: A Brief Case Series. JACC Clin Electrophysiol 2023:S2405-500X(23)00208-6. [PMID: 37227350 DOI: 10.1016/j.jacep.2023.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/23/2023] [Accepted: 02/08/2023] [Indexed: 05/26/2023]
Abstract
Despite extensive conventional endoepicardial ablation, significant intramural arrhythmogenic substrate may remain out of reach of unipolar radiofrequency ablation (RFA). The authors present clinical findings and procedural workflow for bipolar radiofrequency ablation (B-RFA) with 1 catheter placed against the endocardium and the other in the pericardial sac to ablate refractory ventricular arrhythmias. No serious adverse events occurred during B-RFA procedures, and the short-term and midterm clinical results were satisfactory. Optimal catheter choice and ablation parameters settings for B-RFA remain to be determined.
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Affiliation(s)
- Paweł Derejko
- Cardiac Arrhythmias Department, National Institute of Cardiology, Warsaw, Poland; Department of Cardiology, Medicover Hospital, Warsaw, Poland.
| | - Jacek Kuśnierz
- Department of Cardiology, Medicover Hospital, Warsaw, Poland
| | | | | | | | - Łukasz Jan Szumowski
- Cardiac Arrhythmias Department, National Institute of Cardiology, Warsaw, Poland
| | - Atul Verma
- Division of Cardiology, McGill University Health Centre, Montreal, Canada
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18
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Mueller J, Chakarov I, Halbfass P, Nentwich K, Ene E, Berkovitz A, Sonne K, Barth S, Waechter C, Behnes M, Akin I, Fodor S, Lehmkuhl L, Deneke T. Adverse Prognosis of Patients with Septal Substrate After VT Ablation Due to Electrical Storm. JACC Clin Electrophysiol 2023:S2405-500X(23)00067-1. [PMID: 36951814 DOI: 10.1016/j.jacep.2023.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/20/2022] [Accepted: 01/18/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Data about ventricular tachycardia (VT) ablation in patients with electrical storm (ES) is limited. OBJECTIVES This study sought to compare the prognostic outcome of patients undergoing VT ablation after ES with and without a septal substrate. METHODS In this large single-center study, consecutive patients presenting with ES and undergoing VT ablation from June 2018 to April 2021 were included. Patients with septal substrate were compared with patients without septal substrate regarding endpoints of cardiovascular mortality, VT recurrences, recurrences of the clinical VT, and rehospitalization rates. RESULTS A total of 107 patients undergoing a first VT ablation because of electrical storm (ES) were included (age 65 ± 13 years, 86% male, 45% ischemic cardiomyopathy). Major complications occurred in 11% of all patients with increased postinterventional third-degree atrioventricular blocks among patients with septal substrate (9% vs 0%; P = 0.063). Partial ablation successes were similar (95% with a septal substrate vs 100% without a septal substrate; P = 0.251). Complete ablation success was achieved in 63% with a septal substrate and in 87% without a septal substrate (P = 0.004). After a median 22 months of follow-up, patients with septal substrate died significantly more often from cardiovascular causes (26% vs 7%; log-rank P = 0.018). In univariate analysis cardiovascular mortality for ES patients with septal substrate was 4.1-fold higher (HR: 4.192; CI: 1.194-14.719; P = 0.025). Independent predictors of adverse outcome in multivariable regression analysis were presence of septal substrate (HR: 5.723; P = 0.025) and increased age (HR: 1.104; P = 0.003). Recurrences of any ventricular arrhythmia (67% vs 56%; log rank P = 0.554) and rehospitalization rates (80% vs 66%; log rank P = 0.515) were similar between groups. Recurrences of clinical VT were similar (7% vs 2%; P = 0.252). CONCLUSIONS Presence of a septal substrate is associated with adverse long-term cardiovascular mortality in patients admitted for VT ablation after ES. Despite decreased acute ablation successes in these patients, VT recurrence rates were similar to those without a septal substrate during follow-up.
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Affiliation(s)
- Julian Mueller
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Bad Neustadt a. d. Saale, Germany; Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany; First Department of Medicine, University Medical Centre Mannheim, Mannheim, Germany.
| | - Ivaylo Chakarov
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Bad Neustadt a. d. Saale, Germany
| | - Philipp Halbfass
- Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany; Department of Cardiology, Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University, Oldenburg, Germany
| | - Karin Nentwich
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Bad Neustadt a. d. Saale, Germany; Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Elena Ene
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Bad Neustadt a. d. Saale, Germany
| | - Artur Berkovitz
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Bad Neustadt a. d. Saale, Germany
| | - Kai Sonne
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Bad Neustadt a. d. Saale, Germany
| | - Sebastian Barth
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Bad Neustadt a. d. Saale, Germany; Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Christian Waechter
- Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim, Mannheim, Germany
| | - Stefan Fodor
- Department of Radiology, Heart Center Bad Neustadt, Bad Neustadt a. d. Saale, Germany
| | - Lukas Lehmkuhl
- Department of Radiology, Heart Center Bad Neustadt, Bad Neustadt a. d. Saale, Germany
| | - Thomas Deneke
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Bad Neustadt a. d. Saale, Germany
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19
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Toya C, Sasaki T, Yasuhiro S, Sugiyama K, Goya M, Sasano T. Successful Bipolar Radiofrequency Catheter Ablation in a Case of Scar-related Ventricular Tachycardia with Intramural Critical Isthmus in Basal Posterior Right Ventricle Identified by Coherent Mapping. HeartRhythm Case Rep 2022; 8:524-528. [PMID: 35860772 PMCID: PMC9289049 DOI: 10.1016/j.hrcr.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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