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Aras D, Topaloglu S, Ozeke O, Ozcan F, Cay S, Golbasi Z. Percutaneous Interventricular Septal Access Guided by Subcostal Echocardiography and Fluoroscopy for Ventricular Tachycardia Ablation in a Patient with Aortic and Mitral Mechanical Valves. J Innov Card Rhythm Manag 2020; 10:3719-3721. [PMID: 32477738 PMCID: PMC7252692 DOI: 10.19102/icrm.2019.100702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/04/2018] [Indexed: 01/25/2023] Open
Abstract
Mechanical prosthetic aortic and mitral valves preclude either a retrograde aortic or transseptal approach to the left ventricular (LV) endocardium. Several operators have reported on the application of nonconventional techniques for ventricular tachycardia (VT) ablation including transventricular septal puncture, epicardial approach, transmechanical valve approach, transcoronary venous approach, and transapical approach. Incorporating transventricular access to the LV under intracardiac echocardiography (ICE) guidance has been previously attempted in VT ablation procedures in patients with both aortic and mitral mechanical valves. However, while ICE is readily used in the United States, its use is less common in Europe, since the health insurance agencies largely do not cover the costs of ICE catheters. We therefore herein present a case of VT ablation in the LV using a transventricular approach in a patient who underwent mechanical double valve replacement performed under subcostal echocardiographic and fluoroscopic guidance.
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Affiliation(s)
- Dursun Aras
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Firat Ozcan
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Zehra Golbasi
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
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Gao MY, Zeng LJ, Li XX, Tian Y, Su PX, Yang XC, Liu XP. Ablation of ventricular tachycardia by direct left ventricle puncture through a minithoracotomy after double valve replacement: a case report and literature review. J Int Med Res 2020; 48:300060519897667. [PMID: 31996068 PMCID: PMC7113700 DOI: 10.1177/0300060519897667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
We herein describe a 33-year-old woman with a mechanical aortic and mitral valve who developed repetitive monomorphic ventricular tachycardia with unstable hemodynamics. Catheter ablation by direct puncture at the left ventricular apex through a minithoracotomy successfully terminated the ventricular tachycardia, which had originated from the apical-septal endocardium in the left ventricle, despite the hindrance to routine access. No procedure-related complications or recurrence of the clinical ventricular tachycardia developed during a 66-month follow-up, demonstrating that endocardial ablation through direct cardiac cavity puncture can be considered in select cases.
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Affiliation(s)
- Ming-Yang Gao
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Li-Jun Zeng
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xue-Xun Li
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ying Tian
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Pi-Xiong Su
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xin-Chun Yang
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xing-Peng Liu
- Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Vroomen M, Maesen B, La Meir M, Luermans JGL, Vernooy K, Maessen JG, Crijns HJ, Pison L. Hybrid Ablation of Ventricular Tachycardia: a Single-Centre Experience. J Atr Fibrillation 2019; 11:2118. [PMID: 31139299 DOI: 10.4022/jafib.2118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/25/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022]
Abstract
Background The long-term results of endocardial and percutaneous epicardial catheter ablation of ventricular tachycardia (VT) in patients with structural heart disease are disappointing. Arrhythmia recurrence after ablation and VTs with an epicardial substrate remain a clinical challenge. The purpose of this manuscript is to elaborate on feasibility and potential advantages of a surgical hybrid ablation (i.e., combined endocardial and surgical epicardial ablation) based on our initial experience consisting of five cases. Methods Endocardial electro-anatomical voltage and activation maps were created (Carto, Biosense Webster, California, USA), and endocardial radiofrequency (RF) applications were applied at exit sites, low voltage areas and isthmi. Next, after surgical access, epicardial voltage and activation maps were produced in combination with visual assessment of the epicardial substrate. Epicardial low voltage areas, isthmi and exit sites were identified and ablated using RF energy. Results After the procedure, VT was non-inducible in 80% of the cases (4/5, in one case no induction was performed). No peri-procedural complications occurred. After a mean follow-up of 18 months, one patient remained in sinus rhythm without, and 2 with use of antiarrhythmic drugs. One patient needed a redo procedure after 21 months, and in one patient the amiodarone dose was raised because of 2 sustained VTs. After this additional treatment, both kept sinus rhythm. Conclusions Hybrid VT ablation is a safe and effective patient tailored procedure that comprises the major advantage of combining direct anatomical visualization and enhanced catheter stability with high-density 3D mapping. As a consequence, this procedure should be considered as a valid treatment option in complex VT management.
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Affiliation(s)
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Mark La Meir
- Department of Cardiac Surgery, UZ Brussel, Brussels, Belgium
| | | | | | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
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Ozeke O, Cay S, Ozcan F, Topaloglu S, Aras D. The reentry circuit and route in no entry left ventricle situations for ventricular tachycardia ablations. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:678. [PMID: 29656452 DOI: 10.1111/pace.13348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Ozcan Ozeke
- Department of Electrophysiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Serkan Cay
- Department of Electrophysiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Firat Ozcan
- Department of Electrophysiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Electrophysiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Dursun Aras
- Department of Electrophysiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Science University, Ankara, Turkey
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Gianni C, Mohanty S, Trivedi C, Di Biase L, Al-Ahmad A, Natale A, David Burkhardt J. Alternative Approaches for Ablation of Resistant Ventricular Tachycardia. Card Electrophysiol Clin 2017; 9:93-98. [PMID: 28167089 DOI: 10.1016/j.ccep.2016.10.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ventricular tachycardia (VT) ablation is usually performed with an ablation catheter that delivers unipolar radiofrequency (RF) energy to eliminate the re-entry circuit responsible for VT. However, there are some instances when unipolar RF ablation fails, notably in VTs with a deep intramural origin, or cases in which epicardial access is not attainable due to prior cardiac surgery. To overcome these limitations, several alternative approaches have been used in clinical practice, including alcohol ablation or coil embolization, simultaneous unipolar or bipolar RF ablation, surgical ablation, or noninvasive ablation with stereotactic radiosurgery. This review article describes some of these alternative techniques.
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Affiliation(s)
- Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA; Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas, Austin, TX, USA; Interventional Electrophysiology, Scripps Clinic, La Jolla, CA, USA; Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Division of Cardiology, Stanford University, Stanford, CA, USA; Atrial Fibrillation and Arrhythmia Center, California Pacific Medical Center, San Francisco, CA, USA
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA.
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Della Bella P, Brugada J, Zeppenfeld K, Merino J, Neuzil P, Maury P, Maccabelli G, Vergara P, Baratto F, Berruezo A, Wijnmaalen AP. Epicardial ablation for ventricular tachycardia: a European multicenter study. Circ Arrhythm Electrophysiol 2011; 4:653-9. [PMID: 21841191 DOI: 10.1161/circep.111.962217] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The purpose of this study was to describe the epicardial percutaneous ablation experience of 6 European high-volume ventricular tachycardia (VT) ablation centers. METHODS AND RESULTS Data from 218 patients with coronary artery disease (CAD, n=85 [39.0%]), idiopathic dilated of patients with idiopathic VT cardiomyopathy (IDCM, n=67 [30.7%]), arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARCD/C, n=13 [6%]), hypertrophic cardiomyopathy (HCM, n=5 [2.3%]), and absence of structural heart disease (n=48 [22%]) undergoing epicardial subxyphoid access for VT ablation were collected. The epicardial approach was attempted as first-line treatment in 78 patients (35.8%). Acute prevention of VT inducibility was obtained in 156 patients (71.6%). There were no procedure-related deaths. Cardiac tamponade occurred in 8 patients, and abdominal hemorrhage in 1 patient. Six patients died of electrical storm recurrence within 48 hours from the procedure. After a mean follow-up of 17.3±18.2 months, 60 patients (31.4%) presented with VT recurrence (39.3% of IDCM patients; 34.7% of CAD patients; 30.8% of ARVD/C patients; 25% of HCM patients; 17.1% of patients with idiopathic VT). Twenty patients (10.4%) died during follow-up (12 of heart failure, 2 of cardiac arrest, and 6 of extracardiac causes). CONCLUSIONS In experienced centers, epicardial ablation of VT has an acceptable risk and favorable outcome. In selected patients, it is reasonable to consider as a first-line ablation approach.
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Affiliation(s)
- Paolo Della Bella
- Arrhythmia Unit and Electrophysiology Laboratory, Ospedale S Raffaele, Milano, Italy.
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Michowitz Y, Mathuria N, Tung R, Esmailian F, Kwon M, Nakahara S, Bourke T, Boyle NG, Mahajan A, Shivkumar K. Hybrid procedures for epicardial catheter ablation of ventricular tachycardia: Value of surgical access. Heart Rhythm 2010; 7:1635-43. [DOI: 10.1016/j.hrthm.2010.07.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 07/10/2010] [Indexed: 11/16/2022]
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Syed F, Lachman N, Christensen K, Mears JA, Buescher T, Cha YM, Friedman PA, Munger TM, Asirvatham SJ. The Pericardial Space: Obtaining Access and an Approach to Fluoroscopic Anatomy. Card Electrophysiol Clin 2010; 2:9-23. [PMID: 28770739 DOI: 10.1016/j.ccep.2009.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The pericardial space is now increasingly used as a means and vantage point for mapping and ablating various arrhythmias. In this review, present techniques to access the pericardial space are examined and potential improvements over this technique discussed. The authors then examine in detail the regional anatomy of the pericardial space relevant to the major arrhythmias treated in contemporary electrophysiology. In each of these sections, emphasis is placed on anatomic fluoroscopic correlation and avoiding complications that may result.
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Affiliation(s)
- Faisal Syed
- Department of Internal Medicine, Mayo Clinic, 200 1st Street, SW, Rochester, MN 55905, USA
| | - Nirusha Lachman
- Department of Anatomy, Mayo Clinic, 200 1st Street, SW, Rochester, MN 55905, USA
| | - Kevin Christensen
- Mayo Medical School, Mayo Clinic, 200 1st Street, SW, Rochester, MN 55905, USA
| | - Jennifer A Mears
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN 55905, USA
| | - Traci Buescher
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN 55905, USA
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN 55905, USA
| | - Paul A Friedman
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN 55905, USA
| | - Thomas M Munger
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN 55905, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN 55905, USA; Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN 55905, USA
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