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Halaby RN, Bruce CG, Kolandaivelu A, Bhatia NK, Rogers T, Khan JM, Yildirim DK, Jaimes AE, O'Brien K, Babaliaros VC, Greenbaum AB, Lederman RJ. Ventricular Intramyocardial Navigation for Tachycardia Ablation Guided by Electrograms (VINTAGE): Deep Ablation in Inaccessible Targets. JACC Clin Electrophysiol 2024; 10:814-825. [PMID: 38811066 PMCID: PMC11372842 DOI: 10.1016/j.jacep.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Deep intramural ventricular tachycardia substrate targets are difficult to access, map, and ablate from endocardial and epicardial surfaces, resulting in high recurrence rates. OBJECTIVES In this study, the authors introduce a novel approach called ventricular intramyocardial navigation for tachycardia ablation guided by electrograms (VINTAGE) to access and ablate anatomically challenging ventricular tachycardia from within the myocardium. METHODS Guidewire/microcatheter combinations were navigated deep throughout the extravascular myocardium, accessed directly from the right ventricle cavity, in Yorkshire swine (6 naive, 1 infarcted). Devices were steered to various intramyocardial targets including the left ventricle summit, guided by fluoroscopy, unipolar electrograms, and/or electroanatomic mapping. Radiofrequency ablations were performed to characterize ablation parameters and reproducibility. Intramyocardial saline irrigation began 1 minute before ablation and continued throughout. Lesions were analyzed on cardiac magnetic resonance and necropsy. RESULTS VINTAGE was feasible in all animals within naive and infarcted myocardium. Forty-three lesions were created, using various guidewires and power settings. Forty-one (95%) lesions were detected on cardiac magnetic resonance and 38 (88%) on necropsy; all undetected lesions resulted from intentionally subtherapeutic ablation energy (10 W). Larger-diameter guidewires yielded larger size lesions. Lesion volumes on necropsy were significantly larger at 20 W than 10 W (178 mm3 [Q1-Q3: 104-382 mm3] vs 49 mm3 [Q1-Q3: 35-93 mm3]; P = 0.02). Higher power (30 W) did not create larger lesions. Median impedance dropped with preablation irrigation by 12 Ω (Q1-Q3: 8-17 Ω), followed by a further 15-Ω (Q1-Q3: 11-19 Ω) drop during ablation. Intramyocardial navigation, ablation, and irrigation were not associated with any complications. CONCLUSIONS VINTAGE was safe and effective at creating intramural ablation lesions in targets traditionally considered inaccessible from the endocardium and epicardium, both naive and infarcted. Intramyocardial guidewire irrigation and ablation at 20 W creates reproducibly large intramural lesions.
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Affiliation(s)
- Rim N Halaby
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA; Emory University Hospital, Atlanta, Georgia, USA
| | - Aravindan Kolandaivelu
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA; MedStar Washington Hospital Center, Washington, DC, USA
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA; St Francis Hospital, Roslyn, New York, USA
| | - D Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Andi E Jaimes
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kendall O'Brien
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
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Marashly Q, Najjar SN, Hahn J, Rector GJ, Khawaja M, Chelu MG. Innovations in ventricular tachycardia ablation. J Interv Card Electrophysiol 2023; 66:1499-1518. [PMID: 35879516 DOI: 10.1007/s10840-022-01311-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] [Received: 02/21/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
Catheter ablation of ventricular arrhythmias (VAs) has evolved significantly over the past decade and is currently a well-established therapeutic option. Technological advances and improved understanding of VA mechanisms have led to tremendous innovations in VA ablation. The purpose of this review article is to provide an overview of current innovations in VA ablation. Mapping techniques, such as ultra-high density mapping, isochronal late activation mapping, and ripple mapping, have provided improved arrhythmogenic substrate delineation and potential procedural success while limiting duration of ablation procedure and potential hemodynamic compromise. Besides, more advanced mapping and ablation techniques such as epicardial and intramyocardial ablation approaches have allowed operators to more precisely target arrhythmogenic substrate. Moreover, advances in alternate energy sources, such as electroporation, as well as stereotactic radiation therapy have been proposed to be effective and safe. New catheters, such as the lattice and the saline-enhanced radiofrequency catheters, have been designed to provide deeper and more durable tissue ablation lesions compared to conventional catheters. Contact force optimization and baseline impedance modulation are important tools to optimize VT radiofrequency ablation and improve procedural success. Furthermore, advances in cardiac imaging, specifically cardiac MRI, have great potential in identifying arrhythmogenic substrate and evaluating ablation success. Overall, VA ablation has undergone significant advances over the past years. Innovations in VA mapping techniques, alternate energy source, new catheters, and utilization of cardiac imaging have great potential to improve overall procedural safety, hemodynamic stability, and procedural success.
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Affiliation(s)
- Qussay Marashly
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Salim N Najjar
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA
| | - Joshua Hahn
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA
| | - Graham J Rector
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA
| | - Muzamil Khawaja
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA
| | - Mihail G Chelu
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA.
- Baylor St. Luke's Medical Center, Houston, USA.
- Texas Heart Institute, Houston, USA.
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Atreya AR, Yalagudri SD, Subramanian M, Rangaswamy VV, Saggu DK, Narasimhan C. Best Practices for the Catheter Ablation of Ventricular Arrhythmias. Card Electrophysiol Clin 2022; 14:571-607. [PMID: 36396179 DOI: 10.1016/j.ccep.2022.08.007] [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] [Indexed: 06/16/2023]
Abstract
Techniques for catheter ablation have evolved to effectively treat a range of ventricular arrhythmias. Pre-operative electrocardiographic and cardiac imaging data are very useful in understanding the arrhythmogenic substrate and can guide mapping and ablation. In this review, we focus on best practices for catheter ablation, with emphasis on tailoring ablation strategies, based on the presence or absence of structural heart disease, underlying clinical status, and hemodynamic stability of the ventricular arrhythmia. We discuss steps to make ablation safe and prevent complications, and techniques to improve the efficacy of ablation, including optimal use of electroanatomical mapping algorithms, energy delivery, intracardiac echocardiography, and selective use of mechanical circulatory support.
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Affiliation(s)
- Auras R Atreya
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India; Division of Cardiovascular Medicine, Electrophysiology Section, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sachin D Yalagudri
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | - Muthiah Subramanian
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | | | - Daljeet Kaur Saggu
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | - Calambur Narasimhan
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India.
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4
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Zhou B, Yu J, Ju W, Li X, Zhang F, Chen H, Li M, Gu K, Xie X, Cheng D, Wang X, Wu Y, Zhou J, Zhang B, Kojodjojo P, Cao K, Yang B, Chen M. Bipolar Catheter Ablation Strategies for Outflow Tract Ventricular Arrhythmias Refractory to Unipolar Ablation. J Cardiovasc Electrophysiol 2022; 33:1769-1778. [PMID: 35634859 DOI: 10.1111/jce.15579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/02/2022] [Accepted: 05/17/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Benjun Zhou
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingP.R. China
- Department of CardiologyThe Affiliated Jiangning Hospital of Nanjing Medical UniversityNanjingP.R. China
| | - Jinbo Yu
- Department of Cardiology, Shanghai East HospitalTongji University School of MedicineShanghaiP.R. China
| | - Weizhu Ju
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingP.R. China
| | - Xiaorong Li
- Department of Cardiology, Shanghai East HospitalTongji University School of MedicineShanghaiP.R. China
| | - Fengxiang Zhang
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingP.R. China
| | - Hongwu Chen
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingP.R. China
| | - Mingfang Li
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingP.R. China
| | - Kai Gu
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingP.R. China
| | - Xin Xie
- Department of Cardiology, Shanghai East HospitalTongji University School of MedicineShanghaiP.R. China
| | - Dian Cheng
- Department of Cardiology, Shanghai East HospitalTongji University School of MedicineShanghaiP.R. China
| | - Xuecheng Wang
- Department of Cardiology, Shanghai East HospitalTongji University School of MedicineShanghaiP.R. China
| | - Yizhang Wu
- Department of Cardiology, Shanghai East HospitalTongji University School of MedicineShanghaiP.R. China
| | - Jian Zhou
- Department of Cardiology, Shanghai East HospitalTongji University School of MedicineShanghaiP.R. China
| | - Baowei Zhang
- Department of Cardiology, Shanghai East HospitalTongji University School of MedicineShanghaiP.R. China
| | - Pipin Kojodjojo
- Department of CardiologyNg Teng Fong General HospitalSingaporeSingapore
| | - Kejiang Cao
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingP.R. China
| | - Bing Yang
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingP.R. China
- Department of Cardiology, Shanghai East HospitalTongji University School of MedicineShanghaiP.R. China
| | - Minglong Chen
- Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingP.R. China
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5
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Boosting Bipolar Radiofrequency Energy Deployment to Target Deep Intramural Substrates. JACC Clin Electrophysiol 2022; 8:511-512. [PMID: 35450606 DOI: 10.1016/j.jacep.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 11/20/2022]
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[Update on ablation of ventricular tachyarrhythmias]. Herzschrittmacherther Elektrophysiol 2022; 33:42-48. [PMID: 35157111 DOI: 10.1007/s00399-022-00840-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
Catheter ablation of ventricular tachycardia (VT) is performed with increasing frequency in clinical practice. Whereas the reported success rates of idiopathic VT are high, catheter ablation of VT in patients with structural heart disease with its scar-related re-entry mechanism may remain a challenge especially if deep intramyocardial or epicardial portions exist. The integration of modern cardiac imaging, new functional mapping strategies and catheter technologies allow optimized identification and characterization of the critical arrhythmogenic substrate and hence a more targeted VT ablation. The extent to which these innovations will have the potential to improve VT ablation success rates will be determined by future studies.
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7
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Guarracini F, Casella M, Muser D, Barbato G, Notarstefano P, Sgarito G, Marini M, Grandinetti G, Mariani MV, Boriani G, Ricci RP, De Ponti R, Lavalle C. Clinical management of electrical storm: a current overview. J Cardiovasc Med (Hagerstown) 2021; 22:669-679. [PMID: 32925390 DOI: 10.2459/jcm.0000000000001107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The number of patients affected by electrical storm has been continuously increasing in emergency departments. Patients are often affected by multiple comorbidities requiring multidisciplinary interventions to achieve a clinical stability. Careful reprogramming of cardiac devices, correction of electrolyte imbalance, knowledge of underlying heart disease and antiarrhythmic drugs in the acute phase play a crucial role. The aim of this review is to provide a comprehensive overview of pharmacological treatment, latest transcatheter ablation techniques and advanced management of patients with electrical storm.
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Affiliation(s)
| | - Michela Casella
- Heart Rhythm Center, Centro Cardiologico Monzino, Milan.,Department of Clinical, Special and Dental Sciences, Cardiology and Arrhythmology Clinic, University Hospital 'UmbertoI-Lancisi-Salesi', Marche Polytechnic University, Ancona
| | - Daniele Muser
- Cardiothoracic Department, University Hospital of Udine, Udine
| | | | | | - Giuseppe Sgarito
- Cardiology Division, ARNAS Ospedale Civico e Benfratelli, Palermo
| | | | | | - Marco V Mariani
- Department of Cardiology, Policlinico Universitario Umberto I, Roma
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena
| | | | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo & Macchi Foundation, University of Insubria, Varese, Italy
| | - Carlo Lavalle
- Department of Cardiology, Policlinico Universitario Umberto I, Roma
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8
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Narayan SM, Badhwar N. Three-dimensional transmural mapping to guide ventricular arrhythmia ablation. Heart Rhythm 2021; 18:1452-1453. [PMID: 33964464 PMCID: PMC9045459 DOI: 10.1016/j.hrthm.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Sanjiv M Narayan
- Cardiovascular Institute and Cardiovascular Division, Stanford University, Stanford, California.
| | - Nitish Badhwar
- Cardiovascular Institute and Cardiovascular Division, Stanford University, Stanford, California
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9
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Peretto G, Sala S, Basso C, Rizzo S, Radinovic A, Frontera A, Limite LR, Paglino G, Bisceglia C, De Luca G, Campochiaro C, Sartorelli S, Palmisano A, Esposito A, Busnardo E, Villatore A, Baratto F, Cireddu M, Marzi A, D'Angelo G, Gulletta S, Vergara P, De Cobelli F, Dagna L, Mazzone P, Della Bella P. Inflammation as a Predictor of Recurrent Ventricular Tachycardia After Ablation in Patients With Myocarditis. J Am Coll Cardiol 2021; 76:1644-1656. [PMID: 33004129 DOI: 10.1016/j.jacc.2020.08.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/27/2020] [Accepted: 08/07/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Little is known about the risk stratification of patients with myocarditis undergoing ventricular tachycardia (VT) ablation. OBJECTIVES This study sought to describe VT ablation results and identify factors associated with arrhythmia recurrences in a cohort of patients with myocarditis. METHODS The authors enrolled 125 consecutive patients with myocarditis, undergoing VT ablation. Before ablation, disease stage was evaluated, to identify active (AM) versus previous myocarditis (PM). The primary study endpoint was assessment of VT recurrences by 12-month follow-up. Predictors of VT recurrences were retrospectively identified. RESULTS All patients (age 51 ± 14 years, 91% men, left ventricular ejection fraction 52% ± 9%) had history of myocarditis diagnosed by endomyocardial biopsy (59%) and/or cardiac magnetic resonance (90%). Furthermore, all had multiple episodes of drug-refractory VTs. Multimodal pre-procedural staging identified 47 patients with AM (38%) and 78 patients with PM (62%). All patients showed low-voltage areas (LVA) at electroanatomical map (97% epicardial or endoepicardial); of them, 25 (20%) had wide borderzone (WBZ, constituting >50% of the whole LVA). VT recurrences were documented in 25 patients (20%) by 12 months, and in 43 (34%) by last follow-up (median 63 months; interquartile range: 39 to 87). At multivariable analysis, AM stage was the only predictor of VT recurrences by 12 months (hazard ratio: 9.5; 95% confidence interval: 2.6 to 35.3; p < 0.001), whereas both AM stage and WBZ were associated with arrhythmia recurrences anytime during follow-up. No VT episodes were found after redo ablation was performed in 23 patients during PM stage. CONCLUSION Our findings suggest that VT ablation should be avoided during AM, but is often of benefit for recurrent VT after the acute phase of myocarditis.
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Affiliation(s)
- Giovanni Peretto
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; San Raffaele Vita-Salute University, Milan, Italy.
| | - Simone Sala
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Basso
- Department of Cardiovascular Pathology, Padua Hospital and University, Padua, Italy
| | - Stefania Rizzo
- Department of Cardiovascular Pathology, Padua Hospital and University, Padua, Italy
| | - Andrea Radinovic
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Frontera
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Rosario Limite
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Paglino
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Bisceglia
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo De Luca
- San Raffaele Vita-Salute University, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Sartorelli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Palmisano
- San Raffaele Vita-Salute University, Milan, Italy; Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- San Raffaele Vita-Salute University, Milan, Italy; Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Busnardo
- Nuclear Medicine Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Francesca Baratto
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Manuela Cireddu
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Marzi
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe D'Angelo
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simone Gulletta
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pasquale Vergara
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- San Raffaele Vita-Salute University, Milan, Italy; Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- San Raffaele Vita-Salute University, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizio Mazzone
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; San Raffaele Vita-Salute University, Milan, Italy
| | - Paolo Della Bella
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; San Raffaele Vita-Salute University, Milan, Italy
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Della Bella P, Peretto G, Paglino G, Bisceglia C, Radinovic A, Sala S, Baratto F, Limite LR, Cireddu M, Marzi A, D’Angelo G, Vergara P, Gulletta S, Mazzone P, Frontera A. Bipolar radiofrequency ablation for ventricular tachycardias originating from the interventricular septum: Safety and efficacy in a pilot cohort study. Heart Rhythm 2020; 17:2111-2118. [DOI: 10.1016/j.hrthm.2020.06.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/03/2020] [Accepted: 06/12/2020] [Indexed: 12/21/2022]
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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12
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Saitoh O, Oikawa A, Sugai A, Chinushi M. Impedance decrement indexes for avoiding steam-pop during bipolar radiofrequency ablation: An experimental study using a dual-bath preparation. J Cardiovasc Electrophysiol 2020; 31:3302-3310. [PMID: 32981132 DOI: 10.1111/jce.14764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/10/2020] [Accepted: 09/21/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This experimental study was conducted to explore impedance monitoring for safely performing bipolar (BIP) radiofrequency (RF) ablation targeted to arrhythmia focus. METHODS AND RESULTS Using a newly designed dual-bath experimental model, contact-force-controlled (20-g) BIP ablation (50 W, 60 s) was attempted for porcine left ventricle (17.0 ± 2.7 mm thickness). BIP ablation was successfully accomplished for 60 s in 75 of the 89 RF applications (84.3%), whereas audible steam-pop occurred in the other 14 RF applications (15.7%). Receiver operating characteristic analysis demonstrated the optimal predictive values regarding the occurrence of steam-pop as follows; thinner myocardial wall (≤14.8 mm), low minimum impedance (≤89 ohm), greater total impedance decrement (TID) (≤ -25 ohm) and %TID (≤ -22.5%). Greater impedance decrement was not observed immediately preceding the occurrence of steam-pop but appeared around 15 s before. Four steam-pops happened before reaching the optimal predictive values of minimum impedance, whereas all 14 steam-pops developed 11.5 ± 9.2 and 8.1 ± 8.1 s after reaching the optimal predictive values of TID and %TID, respectively. Total lesion depth (endocardial plus epicardial) was 10.7 ± 1.2 mm on average, and was well correlated with TID and %TID. Transmural lesion through the myocardial wall was created in 22 RF applications. CONCLUSION Relatively thinner areas of the myocardium are likely to be at greater risk for steam-pop during BIP RF ablation. Lowering the RF application energy to reduce the impedance decrement may help to lessen this risk.
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Affiliation(s)
- Osamu Saitoh
- Cardiovascular Research of Graduate School of Health Sciences, Niigata University School of Medicine, Niigata, Japan
| | - Ayaka Oikawa
- Cardiovascular Research of Graduate School of Health Sciences, Niigata University School of Medicine, Niigata, Japan
| | - Ayari Sugai
- Cardiovascular Research of Graduate School of Health Sciences, Niigata University School of Medicine, Niigata, Japan
| | - Masaomi Chinushi
- Cardiovascular Research of Graduate School of Health Sciences, Niigata University School of Medicine, Niigata, Japan
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Igarashi M, Nogami A, Fukamizu S, Sekiguchi Y, Nitta J, Sakamoto N, Sakamoto Y, Kurosaki K, Takahashi Y, Kimata A, Komatsu Y, Machino T, Kuroki K, Yamasaki H, Aonuma K, Ieda M. Acute and long-term results of bipolar radiofrequency catheter ablation of refractory ventricular arrhythmias of deep intramural origin. Heart Rhythm 2020; 17:1500-1507. [DOI: 10.1016/j.hrthm.2020.04.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/23/2020] [Accepted: 04/01/2020] [Indexed: 11/25/2022]
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15
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Baszko A, Kochman K, Królak T, Kałmucki P, Telec W, Ożegowski S, Szyszka A. Long-term results of irrigated bipolar radiofrequency ablation in patients with recurrent arrhythmia after failed unipolar ablation. Medicine (Baltimore) 2020; 99:e19970. [PMID: 32481260 PMCID: PMC7250050 DOI: 10.1097/md.0000000000019970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The RF ablation of ventricular tachycardia (VT) or atrial flutter (AFl) can be unsuccessful due to lack of lesion transmurality. Bipolar ablation (BA) is more successful than unipolar ablation (UA). The purpose of our study was to investigate the long-term effect of BA ablation in patients after failed UA. METHODS Patients with septal VT (5) or AFL (2) after 2 to 5 unsuccessful UA were prospectively analysed after BA. All patients presented with heart failure or had ICD interventions. RESULTS BA was successful in 5 patients (1 failure each in the AFL and VT group). The follow-up duration was 10 to 26 months. In AFL group, BA was successful in 1 patient, unidirectional cavotricuspid block in was achieved in the other patient. All patients were asymptomatic for 12 months, but 1 had atrial fibrillation and the other had AFL reablation 19 months after BA. In VT group, all patients had several forms of septal VT. BA was successful in 4 patients. In 2 patients with high septal VT BA resulted in complete atrioventricular block. During follow-up, 1 patient had VT recurrence 26 months after BA and died after an unsuccessful reablation. Three patients had VT recurrences of different morphologies, which required reablation (UA in 2 and alcohol septal ablation in the other patient). CONCLUSION BA was successful in patients with AFL and septal VT resistant to standard ablation. Relapses of clinical arrhythmia are rare; however, long-term follow-up is complicated by recurrences of different arrhythmias related to complex arrhythmogenic substrate.
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Affiliation(s)
- Artur Baszko
- Department of Cardiology, Poznań University of Medical Sciences
| | - Karol Kochman
- Department of Cardiology, Poznań University of Medical Sciences
| | - Tomasz Królak
- Department of Cardiology, Medical University of Gdańsk, Poland
| | - Piotr Kałmucki
- Department of Cardiology, Poznań University of Medical Sciences
| | - Wojciech Telec
- Department of Cardiology, Poznań University of Medical Sciences
| | | | - Andrzej Szyszka
- Department of Cardiology, Poznań University of Medical Sciences
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16
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Soucek F, Caluori G, Lehar F, Jez J, Pesl M, Wolf J, Wojtaszczyk A, Belaskova S, Starek Z. Bipolar ablation with contact force-sensing of swine ventricles shows improved acute lesion features compared to sequential unipolar ablation. J Cardiovasc Electrophysiol 2020; 31:1128-1136. [PMID: 32083360 DOI: 10.1111/jce.14407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 01/31/2020] [Accepted: 02/19/2020] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Despite technical progress, ventricular tachycardia (VT) recurrence after unipolar ablation remains relatively high (12%-47%). Bipolar ablation has been proposed as an appealing solution that may overcome limitations associated with unipolar ablation settings. We designed an animal study to compare bipolar (BPA) vs sequential unipolar ablation (UPA) using contact force-sensing technology on both ablation catheters. METHODS Twenty large white female pigs (6-months-old, 50-60 kg) underwent multiple RF ablations (30 W, 60 seconds, 30 mL/min irrigation) on the ventricular myocardium from the epicardial and endocardial sides. The hearts were fixed and scanned with high-resolution cardiac magnetic resonance imaging. Thermal lesions were located and characterized in volume, depth, width, and transmurality. RESULTS Lesion volume was calculated as the sum of epicardial or endocardial conjoined/isolated lesions at one location. Linear dimensions (width and depth) were measured twice for each location, on the endocardial and epicardial side. We evaluated 35 lesions across the intraventricular septum (UPA, N = 17 vs BPA, N = 18). No difference in volume, linear dimensions or impedance drop was observed in this area between UPA and BPA. However, BPA required half RF time and showed an increased transmurality trend. We then analyzed 73 lesions from the endocardial side (UPA, N = 35 vs BPA, N = 38) and 50 from the epicardial side (UPA, N = 11 vs BPA N = 39) of the ventricular free walls. Lesion transmurality was markedly improved by BPA (P = .030, odds ratio, 23.73 [4.71,31.96]). Ventricular BPA lesions were significantly deeper on the epicardial side (P < .0001) and endocardial side (P = .015). CONCLUSION Bipolar ablation is more likely to create transmural and epicardial lesions in the ventricle wall. Half the time is needed for the creation of comparably deep and large lesions.
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Affiliation(s)
- Filip Soucek
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic
| | - Guido Caluori
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,Nanobiotechnology, CEITEC, Masaryk University, Brno, Czech Republic
| | - Frantisek Lehar
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic
| | - Jiri Jez
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic
| | - Martin Pesl
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic.,Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Wolf
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic
| | - Adam Wojtaszczyk
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Silvie Belaskova
- Biostatistics, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Zdenek Starek
- Interventional Cardiac Electrophysiology, International Clinical Research Center, St Anne's University Hospital Brno, Brno, Czech Republic.,First Department of Internal Medicine/Cardioangiology, St Anne's Hospital, Masaryk University, Brno, Czech Republic
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17
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Nguyen DM, Qian P, Barry T, McEwan A. Cardiac radiofrequency ablation tracking using electrical impedance tomography. Biomed Phys Eng Express 2020; 6:015015. [PMID: 33438603 DOI: 10.1088/2057-1976/ab5ce8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is a need for accessible high speed imaging of Radiofrequency (RF) cardiac electrosurgery to improve safety and efficacy of the ablation time course, where lesion information is critical to safety and efficacy but currently lacking in real time. In this paper, Electrical Impedance Tomography (EIT) using existing cardiac EP electrodes was optimised to confirm (1) that removal of measurements with low signal sensitivity leads to improved images and (2) that multiple signal thresholds are needed to track the lesion accurately over time. A novel ventricle-shaped gel phantom with realistic fluid flow to mimic blood flow, lung ventilation and myocardium conductivity was developed to study the capability and motivate transition to in-vivo measurements. When using 8 external (ECG) electrodes, 4 internal coronary sinus electrodes and 4 RF catheter-based electrodes, the optimal setup for sensitivity and dynamic tracking was 77 measurements within an error of 20%. Higher thresholds were more suitable for the earlier phase of the ablation when lesions are small while lower thresholds suited later phases. Patient-specific thresholds could be optimised in pre-surgical planning where detailed anatomical images are available. While the error reported in this initial study appears large, it is a major advance over the current situation for the cardiologist where no real-time lesion visualization is accessible in a regular EP suite/cath lab.
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Affiliation(s)
- Duc M Nguyen
- Department of Biomedical Engineering, Hanoi University of Science and Technology, Hanoi, Vietnam. School of Electrical and Information Engineering, University of Sydney, Sydney, Australia
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18
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Liu X, Chen Q, Fan B, Zhu W, Zhao H, Zhu Y, Zhao P, Zhang F, Kojodjojo P. Bipolar catheter ablation in ventricular myocardium. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 43:54-61. [PMID: 31721241 DOI: 10.1111/pace.13844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/17/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Xiaolin Liu
- Section of Pacing and Electrophysiology, Division of Cardiologythe First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Qiushi Chen
- Section of Pacing and Electrophysiology, Division of Cardiologythe First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Baohan Fan
- Section of Pacing and Electrophysiology, Division of Cardiologythe First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Wenwu Zhu
- Section of Pacing and Electrophysiology, Division of Cardiologythe First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Hongyan Zhao
- Section of Pacing and Electrophysiology, Division of Cardiologythe First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Yeqian Zhu
- Section of Pacing and Electrophysiology, Division of Cardiologythe First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Pengcheng Zhao
- Section of Pacing and Electrophysiology, Division of Cardiologythe First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Fengxiang Zhang
- Section of Pacing and Electrophysiology, Division of Cardiologythe First Affiliated Hospital with Nanjing Medical University Nanjing China
| | - Pipin Kojodjojo
- Department of CardiologyNational University Heart Centre Singapore
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Bhaskaran A, De Silva K, Rao K, Campbell T, Trivic I, Bennett RG, Kizana E, Kumar S. Ventricular Tachycardia Ablation in Non-ischemic Cardiomyopathy. Korean Circ J 2019; 50:203-219. [PMID: 31845552 PMCID: PMC7043965 DOI: 10.4070/kcj.2019.0292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 09/22/2019] [Indexed: 11/11/2022] Open
Abstract
Non-ischemic cardiomyopathies are a heterogeneous group of diseases of the myocardium that have a distinct proclivity to ventricular arrhythmias. Of these, ventricular tachycardias pose significant management challenges with the risk of sudden cardiac death and morbidity from multiple causes. Catheter ablation of ventricular tachycardias is becoming an increasingly utilised intervention that has been found to have significant benefits with improving symptoms, reducing anti-arrhythmic drug burden and debilitating device therapies, thereby improving quality of life. Nonetheless, the approach to the ablation of ventricular tachycardias in non-ischemic cardiomyopathies is governed heavily by the disease process, with several distinct differences from ischemic cardiomyopathy including a preponderance to epicardial and deep intramural substrate. This contemporary review aims to present the various disease processes within non-ischemic cardiomyopathies, catheter ablation techniques which have been developed to target ventricular tachycardia and more novel adjunctive therapeutic measures.
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Affiliation(s)
- Ashwin Bhaskaran
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Kasun De Silva
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Karan Rao
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Ivana Trivic
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Eddy Kizana
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia.,Centre for Heart Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia.
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20
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Ventricular Tachycardia Ablation. JACC Clin Electrophysiol 2019; 5:1363-1383. [DOI: 10.1016/j.jacep.2019.09.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 11/23/2022]
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21
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Nguyen DT, Zheng L, Zipse MM, Borne RT, Tzou WS, Fleeman B, Sauer WH. Bipolar radiofrequency ablation creates different lesion characteristics compared to simultaneous unipolar ablation. J Cardiovasc Electrophysiol 2019; 30:2960-2967. [DOI: 10.1111/jce.14213] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/21/2019] [Accepted: 09/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Duy T. Nguyen
- Section of Cardiac Electrophysiology, Division of CardiologyStanford UniversityPalo Alto California
| | - Lijun Zheng
- Section of Cardiac Electrophysiology, Division of CardiologyUniversity of ColoradoAurora Colorado
| | - Matthew M. Zipse
- Section of Cardiac Electrophysiology, Division of CardiologyUniversity of ColoradoAurora Colorado
| | - Ryan T. Borne
- Section of Cardiac Electrophysiology, Division of CardiologyUniversity of ColoradoAurora Colorado
| | - Wendy S. Tzou
- Section of Cardiac Electrophysiology, Division of CardiologyUniversity of ColoradoAurora Colorado
| | - Blake Fleeman
- Section of Cardiac Electrophysiology, Division of CardiologyUniversity of ColoradoAurora Colorado
| | - William H. Sauer
- Section of Cardiac Electrophysiology, Division of CardiologyBrigham and Women's HospitalBoston Massachusetts
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22
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Uhm J, Kim J, Jin M, Kim I, Cho MS, Yang P, Yu HT, Kim T, Joung B, Pak H, Nam G, Choi K, Kim Y, Hwang C, Lee M. Radiofrequency catheter ablation of accessory pathways at the site of prior valve surgery. J Arrhythm 2019; 35:645-653. [PMID: 31410235 PMCID: PMC6686296 DOI: 10.1002/joa3.12213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/02/2019] [Accepted: 06/09/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Radiofrequency catheter ablation (RFCA) for accessory pathways (APs) at the site of prior valve surgery (VS) remains challenging. We aimed to clarify the factors associated with successful RFCA for such APs. METHODS Upon reviewing a RFCA registry and previous case reports, we included nine patients who underwent RFCA of APs at the site of prior VS (total-VS group; age, 34.0 [24.5-45.0] years; men, 4/9) and 196 patients who underwent RFCA of APs with no history of VS (no-VS group; age, 40.5 [23.0-54.0] years; men, 114/196). Electrophysiological features, procedural details, and outcomes were examined. RESULTS Accessory pathway exhibited decremental conduction in four of nine patients in the total-VS group. The number of RFCA attempts was significantly higher in the total-VS group than in the no-VS group (10.0 [4.5-14.5] vs 2.0 [1.0-3.0]; P < 0.001). In four patients who underwent mitral VS, successful RFCA was achieved using the transaortic approach, coronary sinus (CS) approach, or bipolar ablation. In three patients who underwent tricuspid VS, successful RFCA was achieved using the above-prosthetics or trans-prosthetics approach. In two patients, RFCA failed. The trans-prosthetics approach and bipolar ablation technique were effective. The transaortic and CS approaches were occasionally effective. The transseptal approach was ineffective. CONCLUSIONS Successful RFCA of APs at the site of prior VS can be achieved by detailed mapping of the areas both above and below the prosthetic valve, as well as by ensuring effective radiofrequency energy delivery using various catheter approaches and RFCA techniques.
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Affiliation(s)
- Jae‐Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Jun Kim
- Department of Cardiology, Asan Medical Center, The Heart InstituteUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Moo‐Nyun Jin
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - In‐Soo Kim
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Min Soo Cho
- Department of Cardiology, Asan Medical Center, The Heart InstituteUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Pil‐Sung Yang
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Tae‐Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Hui‐Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Gi‐Byoung Nam
- Department of Cardiology, Asan Medical Center, The Heart InstituteUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Kee‐Joon Choi
- Department of Cardiology, Asan Medical Center, The Heart InstituteUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - You‐Ho Kim
- Department of Cardiology, Asan Medical Center, The Heart InstituteUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Chun Hwang
- Department of CardiologyRevere HealthProvoUtah
| | - Moon‐Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
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23
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Kumar S, Tedrow UB, Stevenson WG. Adjunctive Interventional Techniques When Percutaneous Catheter Ablation for Drug Refractory Ventricular Arrhythmias Fail: A Contemporary Review. Circ Arrhythm Electrophysiol 2019; 10:e003676. [PMID: 28213504 DOI: 10.1161/circep.116.003676] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Saurabh Kumar
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.K., U.B.T., W.G.S.); and Department of Cardiology, Westmead Hospital, University of Sydney, NSW, Australia (S.K.)
| | - Usha B Tedrow
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.K., U.B.T., W.G.S.); and Department of Cardiology, Westmead Hospital, University of Sydney, NSW, Australia (S.K.)
| | - William G Stevenson
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (S.K., U.B.T., W.G.S.); and Department of Cardiology, Westmead Hospital, University of Sydney, NSW, Australia (S.K.).
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Bhaskaran A, Tung R, Stevenson WG, Kumar S. Catheter Ablation of VT in Non-Ischaemic Cardiomyopathies: Endocardial, Epicardial and Intramural Approaches. Heart Lung Circ 2019; 28:84-101. [DOI: 10.1016/j.hlc.2018.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023]
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Al-Hadithi ABAK, Khakpour H, Cruz D, Boyle NG, Shivkumar K, Bradfield JS. Incessant intraseptal ventricular tachycardia ablated utilizing extracorporeal membrane oxygenation and bipolar ablation. HeartRhythm Case Rep 2018; 4:557-560. [PMID: 30581730 PMCID: PMC6301887 DOI: 10.1016/j.hrcr.2018.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Affiliation(s)
- Ali B A K Al-Hadithi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Houman Khakpour
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Daniel Cruz
- UCLA Cardiomyopathy Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California
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Soucek F, Starek Z. Use of Bipolar Radiofrequency Catheter Ablation in the Treatment of Cardiac Arrhythmias. Curr Cardiol Rev 2018; 14:185-191. [PMID: 29792146 PMCID: PMC6131405 DOI: 10.2174/1573403x14666180524100608] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 12/04/2022] Open
Abstract
Background: Arrhythmia management is a complex process involving both pharmacological and non-pharmacological approaches. Radiofrequency ablation is the pillar of non-pharmacological arrhythmia treatment. Unipolar ablation is considered to be the gold standard in the treatment of the majority of arrhythmias; however, its efficacy is limited to specific cases. In particular, the creation of deep or transmural lesions to eliminate intramurally originating arrhythmias remains inadequate. Bipolar ablation is proposed as an alternative to overcome unipolar ablation boundaries. Results: Despite promising results gained from in vitro and animal studies showing that bipolar ablation is superior in creating transmural lesions, the use of bipolar ablation in daily clinical practice is limited. Several studies have been published showing that bipolar ablation is effective in the treatment of clinical arrhythmias after failed unipolar ablation, however, there is inconsistency regarding the safety of bipolar ablation within the available research papers. According to research evidence, the most common indications for bipolar ablation use are ventricular originating rhythmic disorders in patients with structural heart disease resistant to standard radiofrequency ablation. Conclusion: To allow wider clinical application the efficiency and safety of bipolar ablation need to be verified in future studies.
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Affiliation(s)
- Filip Soucek
- International Clinical Research Center, St. Anne`s University Hospital Brno, Brno, Czech Republic and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Zdenek Starek
- International Clinical Research Center, St. Anne`s University Hospital Brno, Brno, Czech Republic and Faculty of Medicine, Masaryk University, Brno, Czech Republic
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28
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Can We Produce Deeper Radiofrequency Lesions? JACC Clin Electrophysiol 2018; 3:1111-1113. [PMID: 29759493 DOI: 10.1016/j.jacep.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 06/08/2017] [Indexed: 11/22/2022]
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Nguyen DT, Gerstenfeld EP, Tzou WS, Jurgens PT, Zheng L, Schuller J, Zipse M, Sauer WH. Radiofrequency Ablation Using an Open Irrigated Electrode Cooled With Half-Normal Saline. JACC Clin Electrophysiol 2017; 3:1103-1110. [PMID: 29759492 DOI: 10.1016/j.jacep.2017.03.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/11/2017] [Accepted: 03/16/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study evaluated the use of half-normal saline (HNS) as the radiofrequency ablation (RFA) cooling irrigant. BACKGROUND Some instances of ventricular arrhythmia may originate deep within myocardium and can be refractory to standard ablation using open irrigated RFA. Recent data suggest that deeper ablation lesions can be created by decreasing the irrigant ionic concentration delivered through open irrigated RFA than by using normal saline (NS). METHODS Bovine myocardium was placed in a circulating saline bath. Two RFA catheters were oriented across from each other, with myocardium in between. Sequential unipolar HNS-irrigated RFA was performed and compared to bipolar ablation by using NS or HNS. Unipolar HNS ablation of the ventricles in a porcine model was performed and compared to ablation using NS. RESULTS Sequential ex vivo unipolar RFA with HNS produced larger lesions than sequential unipolar RFA with NS and produced lesions of similar size to those created with bipolar RFA using NS. Ex vivo bipolar RFA using HNS created the largest lesions. In vivo unipolar HNS ablation in porcine endocardium created larger lesion volumes, 152.9 ± 29.2 μl, compared to 94.7 ± 33.4 μl for unipolar ablation using NS. CONCLUSIONS By decreasing ionic concentration and charge density in RFA using HNS instead of NS irrigant, larger ablation lesions can be created and are similar in size to lesions created using bipolar ablation. This may be a useful ablation strategy for deep myocardial circuits refractory to standard ablation. Further studies are needed to evaluate this novel RFA strategy.
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Affiliation(s)
- Duy T Nguyen
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado.
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California
| | - Wendy S Tzou
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Paul T Jurgens
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Lijun Zheng
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Joseph Schuller
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - Matthew Zipse
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - William H Sauer
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
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Sakamoto K, Nozoe M, Tsutsui Y, Suematsu N, Kubota T, Okabe M, Yamamoto Y. Successful bipolar ablation for ventricular tachycardia with potential substrate identification by pre-procedural cardiac magnetic resonance imaging. Int Med Case Rep J 2017; 10:167-171. [PMID: 28546773 PMCID: PMC5436767 DOI: 10.2147/imcrj.s135952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Cardiac magnetic resonance imaging (MRI) is a useful tool for detecting the arrhythmogenic substrate in cardiac sarcoidosis. We herein present a case of bipolar radiofrequency catheter ablation for ventricular tachycardia (VT) complicated with cardiac sarcoidosis, guided by pre-procedural cardiac MRI. Neither echocardiography nor endocardial voltage mapping suggested a septal VT substrate. However, MRI alone detected intramural lesions in the septum. Although application of endocardial energy failed to treat the VT, bipolar ablation targeting the potential substrate identified by MRI successfully eliminated the VT. Even when no abnormalities are depicted on echocardiography and endocardial voltage mapping, intramural scar tissue identified by cardiac MRI could be critical for VT.
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Affiliation(s)
- Kazuo Sakamoto
- Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Masatsugu Nozoe
- Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Yoshitomo Tsutsui
- Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Nobuhiro Suematsu
- Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Toru Kubota
- Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Masanori Okabe
- Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Yusuke Yamamoto
- Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
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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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Thompson N, Frontera A, Takigawa M, Cheniti G, Massoullie G, Cochet H, Denis A, Chaumeil A, Derval N, Hocini M, Haissaguerre M, Jais P, Sacher F. Catheter Ablation for Ventricular Tachycardia in Patients with Nonischemic Cardiomyopathy. Card Electrophysiol Clin 2017; 9:47-54. [PMID: 28167085 DOI: 10.1016/j.ccep.2016.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Although catheter ablation has been successful in reducing the recurrence of ventricular tachycardia in patients with ischemic disease, outcomes in patients with nonischemic cardiomyopathy (NICM) have not met with the same results. Success is predicated on a methodical approach to diagnosis of disease type and identification of critical substrate, and the ablation strategies used. Cardiac MRI with delayed enhancement is able to identify areas of substrate involvement, particularly in situations when conventional catheter mapping is not able to do so. Radiofrequency needle, irrigated bipolar radiofrequency, and transcoronary alcohol ablation are effective and alternative techniques to endocardial and epicardial ablation.
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Affiliation(s)
- Nathaniel Thompson
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France.
| | - Antonio Frontera
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Masateru Takigawa
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Ghassen Cheniti
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Gregoire Massoullie
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Hubert Cochet
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Arnaud Denis
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Arnaud Chaumeil
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Nicolas Derval
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Meleze Hocini
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Michel Haissaguerre
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Pierre Jais
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute, INSERM 1045, Bordeaux University, France
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Chinushi M, Saitoh O, Watanabe J, Sugai A, Suzuki K, Hosaka Y, Furushima H. Electrode Contact Force-Controlled Bipolar Radiofrequency Ablation: Different Effects on Lesion Size between Dual- and Single-Bath Preparations. Pacing Clin Electrophysiol 2017; 40:223-231. [PMID: 27943352 DOI: 10.1111/pace.12993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/21/2016] [Accepted: 11/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND During bipolar (BIP) radiofrequency (RF) ablation using two catheters in humans, each catheter is placed in separate cardiac chambers or spaces. We developed a contact force-controlled experimental preparation, and compared measurements made with two catheters placed in a single bath (SB), versus each catheter placed in separate baths, in order to assess the preparation-dependent differences in the results of BIP-RF ablation. METHODS In the SB experiments, a porcine heart was placed in the center of the bath, while in the dual-bath (DB) experiments, it was placed between two half baths communicating through windows. RESULTS The initial impedance was greatest (110.5 ± 7.2 Ω) with the BIP-DB, followed by the BIP-SB (92.0 ± 5.6 Ω) and the unipolar (UNIP) DB (84.9 ± 4.7 Ω) configurations. During 50-W ablation for 60 seconds at a 20-g contact force, the root mean square voltage was 75.7 ± 2.5 V in the BIP-DB, 68.0 ± 2.1 V in the BIP-SB, and 66.8 ± 2.0 V in the UNIP-DB. The mean surface lesion diameters were similar among the three configurations. However, the endocardial lesion depth was 5.60 ± 0.56 mm with the BIP-DB, 4.71 ± 0.64 mm with the BIP-SB, and 4.24 ± 0.58 mm with the UNIP-DB configuration. On average, the endocardial lesions were significantly deeper than the epicardial ones. CONCLUSIONS BIP ablation created much deeper lesions as compared to UNIP ablation. Lesion depth could be different depending on experimental preparation, and contact force-controlled DB preparation may be a much more appropriate model for studying the effects of BIP ablation.
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Affiliation(s)
- Masaomi Chinushi
- Cardiovascular Research of Graduate School of Health Sciences, Niigata University School of Medicine, Niigata, Japan
| | - Osamu Saitoh
- Cardiovascular Research of Graduate School of Health Sciences, Niigata University School of Medicine, Niigata, Japan
| | - Junya Watanabe
- Cardiovascular Research of Graduate School of Health Sciences, Niigata University School of Medicine, Niigata, Japan
| | - Ayari Sugai
- Cardiovascular Research of Graduate School of Health Sciences, Niigata University School of Medicine, Niigata, Japan
| | - Katsuya Suzuki
- Cardiovascular Research of Graduate School of Health Sciences, Niigata University School of Medicine, Niigata, Japan
| | - Yukio Hosaka
- Cardiology Department, Niigata City General Hospital, Niigata, Japan
| | - Hiroshi Furushima
- Cardiovascular Research of Graduate School of Health Sciences, Niigata University School of Medicine, Niigata, Japan
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Clinical and biophysical evaluation of variable bipolar configurations during radiofrequency ablation for treatment of ventricular arrhythmias. Heart Rhythm 2016; 13:2161-2171. [DOI: 10.1016/j.hrthm.2016.07.011] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Indexed: 11/23/2022]
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Sauer WH, Steckman DA, Zipse MM, Tzou WS, Aleong RG. High-power bipolar ablation for incessant ventricular tachycardia utilizing a deep midmyocardial septal circuit. HeartRhythm Case Rep 2015; 1:397-400. [PMID: 28491595 PMCID: PMC5419695 DOI: 10.1016/j.hrcr.2015.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- William H Sauer
- Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado
| | - David A Steckman
- Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado
| | - Mathew M Zipse
- Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado
| | - Wendy S Tzou
- Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado
| | - Ryan G Aleong
- Section of Cardiac Electrophysiology, University of Colorado, Aurora, Colorado
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Kumar S, Barbhaiya CR, Balindger S, John RM, Epstein LM, Koplan BA, Tedrow UB, Stevenson WG, Michaud GF. Better Lesion Creation And Assessment During Catheter Ablation. J Atr Fibrillation 2015; 8:1189. [PMID: 27957200 DOI: 10.4022/jafib.1189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 04/03/2015] [Accepted: 07/02/2015] [Indexed: 12/17/2022]
Abstract
Permanent destruction of abnormal cardiac tissue responsible for cardiac arrhythmogenesis whilst avoiding collateral tissue injury forms the cornerstone of catheter ablation therapy. As the acceptance and performance of catheter ablation increases worldwide, limitations in current technology are becoming increasingly apparent in the treatment of complex arrhythmias such as atrial fibrillation. This review will discuss the role of new technologies aimed to improve lesion formation with the ultimate goal of improving arrhythmia-free survival of patients undergoing catheter ablation of atrial arrhythmias.
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Affiliation(s)
- Saurabh Kumar
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Chirag R Barbhaiya
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Samuel Balindger
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Roy M John
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Laurence M Epstein
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Bruce A Koplan
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Usha B Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - William G Stevenson
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Gregory F Michaud
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
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Yamagata K, Wichterle D, Peichl P, Aldhoon B, Čihák R, Kautzner J. Bipolar radiofrequency catheter ablation for refractory perimitral flutter: a case report. BMC Cardiovasc Disord 2015; 15:139. [PMID: 26510461 PMCID: PMC4625938 DOI: 10.1186/s12872-015-0132-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mitral isthmus is often targeted as a part of stepwise approach during radiofrequency ablation for persistent atrial ablation. Acute success rate in achieving the mitral isthmus block is only modest, late reconduction rate is relatively high and, consequently, incomplete lesion may be proarrhythmic. We describe the first-in-man experience with successful MI ablation by bipolar RF energy delivery. CASE PRESENTATION A 64-year-old caucasian man after two previous ablation procedures for drug resistant atrial fibrillation in recent four years, which included pulmonary vein isolation and linear left atrial lesions, was referred for the treatment of recurrent perimitral flutter. Despite the third attempt to create bidirectional block at the mitral isthmus region, we were not even able to stop the arrhythmia by aggressive unipolar radiofrequency ablation both from the left atrium and coronary sinus, because of deeply embedded slow conducting channel probably around the vein of Marshall. Arrhythmia was finally terminated and the block was achieved by bipolar radiofrequency ablation between two irrigated-tip catheters positioned at the left atrial endocardium and contralaterally inside the coronary sinus. CONCLUSION Bipolar radiofrequency energy delivery can be an option for ablation of perimitral flutter resistant to standard unipolar radiofrequency ablation. This may improve clinical outcome of patients undergoing non-pharmacological treatment for persistent atrial fibrillation. The safety and efficacy of this technique has to be confirmed in future studies.
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Affiliation(s)
- Kenichiro Yamagata
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958/9, Prague, 140 21, Czech Republic.
| | - Dan Wichterle
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958/9, Prague, 140 21, Czech Republic.
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958/9, Prague, 140 21, Czech Republic.
| | - Bashar Aldhoon
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958/9, Prague, 140 21, Czech Republic.
| | - Robert Čihák
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958/9, Prague, 140 21, Czech Republic.
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958/9, Prague, 140 21, Czech Republic.
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González-Suárez A, Trujillo M, Koruth J, d’Avila A, Berjano E. Radiofrequency cardiac ablation with catheters placed on opposing sides of the ventricular wall: Computer modelling comparing bipolar and unipolar modes. Int J Hyperthermia 2014; 30:372-84. [DOI: 10.3109/02656736.2014.949878] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mahida S, Berte B, Yamashita S, Derval N, Denis A, Shah A, Amraoui S, Hocini M, Haissaguerre M, Jais P, Sacher F. New Ablation Technologies and Techniques. Arrhythm Electrophysiol Rev 2014; 3:107-12. [PMID: 26835075 PMCID: PMC4711538 DOI: 10.15420/aer.2014.3.2.107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/28/2014] [Indexed: 11/04/2022] Open
Abstract
Catheter ablation is an established treatment strategy for a range of different cardiac arrhythmias. Over the past decade two major areas of expansion have been ablation of atrial fibrillation (AF) and ventricular tachycardia (VT) in the context of structurally abnormal hearts. In parallel with the expanding role of catheter ablation for AF and VT, multiple novel technologies have been developed which aim to increase safety and procedural success. Areas of development include novel catheter designs, novel navigation technologies and higher resolution imaging techniques. The aim of the present review is to provide an overview of novel developments in AF ablation and VT ablation in patients with of structural cardiac diseases.
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Affiliation(s)
- Saagar Mahida
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Benjamin Berte
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Seigo Yamashita
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Arnaud Denis
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Ashok Shah
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Sana Amraoui
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Meleze Hocini
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Michel Haissaguerre
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Frederic Sacher
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
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TEH ANDREWW, REDDY VIVEKY, KORUTH JACOBS, MILLER MARCA, CHOUDRY SUBBARAO, D'AVILA ANDRE, DUKKIPATI SRINIVASR. Bipolar Radiofrequency Catheter Ablation for Refractory Ventricular Outflow Tract Arrhythmias. J Cardiovasc Electrophysiol 2014; 25:1093-9. [DOI: 10.1111/jce.12460] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/12/2014] [Accepted: 05/19/2014] [Indexed: 11/28/2022]
Affiliation(s)
- ANDREW W. TEH
- Helmsley Electrophysiology Center; Mount Sinai School of Medicine; New York City New York USA
- Cardiology Department; Monash University Eastern Health; Victoria Australia
- Department of Cardiology; Austin Hospital; Victoria Australia
| | - VIVEK Y. REDDY
- Helmsley Electrophysiology Center; Mount Sinai School of Medicine; New York City New York USA
| | - JACOB S. KORUTH
- Helmsley Electrophysiology Center; Mount Sinai School of Medicine; New York City New York USA
| | - MARC A. MILLER
- Helmsley Electrophysiology Center; Mount Sinai School of Medicine; New York City New York USA
| | - SUBBARAO CHOUDRY
- Helmsley Electrophysiology Center; Mount Sinai School of Medicine; New York City New York USA
| | - ANDRE D'AVILA
- Helmsley Electrophysiology Center; Mount Sinai School of Medicine; New York City New York USA
| | - SRINIVAS R. DUKKIPATI
- Helmsley Electrophysiology Center; Mount Sinai School of Medicine; New York City New York USA
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Gizurarson S, Spears D, Sivagangabalan G, Farid T, Ha ACT, Masse S, Kusha M, Chauhan VS, Nair K, Harris L, Downar E, Nanthakumar K. Bipolar ablation for deep intra-myocardial circuits: human ex vivo development and in vivo experience. Europace 2014; 16:1684-8. [DOI: 10.1093/europace/euu001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Successful simultaneous unipolar radiofrequency ablation of septal ventricular tachycardia using 2 ablation catheters. Heart Rhythm 2013; 11:710-3. [PMID: 24333923 DOI: 10.1016/j.hrthm.2013.12.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Indexed: 11/23/2022]
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43
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CHIK WILLIAMW, BARRY MICHAELANTHONYTONY, THAVAPALACHANDRAN SUJITHA, MIDEKIN CHRISTINE, POULIOPOULOS JIM, LIM TOONWEI, SIVAGANGABALAN GOPAL, THOMAS STUARTP, ROSS DAVIDL, McEWAN ALISTAIRL, KOVOOR PRAMESH, THIAGALINGAM ARAVINDA. High Spatial Resolution Thermal Mapping of Radiofrequency Ablation Lesions Using a Novel Thermochromic Liquid Crystal Myocardial Phantom. J Cardiovasc Electrophysiol 2013; 24:1278-86. [DOI: 10.1111/jce.12209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 04/29/2013] [Accepted: 05/06/2013] [Indexed: 11/28/2022]
Affiliation(s)
- WILLIAM W.B. CHIK
- Cardiology Department; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Australia
| | | | | | | | | | - TOON WEI LIM
- Cardiology Department; Westmead Hospital; Sydney Australia
| | | | | | - DAVID L. ROSS
- Cardiology Department; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Australia
| | - ALISTAIR L. McEWAN
- School of Electrical and Information Engineering; University of Sydney; Australia
| | - PRAMESH KOVOOR
- Cardiology Department; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Australia
| | - ARAVINDA THIAGALINGAM
- Cardiology Department; Westmead Hospital; Sydney Australia
- Sydney Medical School; University of Sydney; Australia
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Koruth JS, Dukkipati S, Miller MA, Neuzil P, d'Avila A, Reddy VY. Bipolar irrigated radiofrequency ablation: A therapeutic option for refractory intramural atrial and ventricular tachycardia circuits. Heart Rhythm 2012; 9:1932-41. [DOI: 10.1016/j.hrthm.2012.08.001] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Indexed: 11/26/2022]
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Roten L, Derval N, Pascale P, Jais P, Coste P, Sacher F. What next after failed septal ventricular tachycardia ablation? Indian Pacing Electrophysiol J 2012; 12:180-5. [PMID: 22912538 PMCID: PMC3407410 DOI: 10.1016/s0972-6292(16)30524-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Ablation of ventricular tachycardia (VT) by conventional radiofrequency ablation can be impossible if the ventricular wall at the targeted ablation site is very thick, as for example the ventricular septum. We present a case of a patient with incessant, non-sustained slow VT originating from the septal part of the lower outflow tracts. Radiofrequency catheter ablation from both ventricles as well as from the anterior cardiac vein were not successful. Both high power radiofrequency ablation and bipolar radiofrequency ablation neither were successfull. Finally, ethanol ablation of the first septal perforator successfully terminated arrhythmia. We discuss the possibilities to overcome failed conventional radiofrequency VT ablation of a septal focus.
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Affiliation(s)
- Laurent Roten
- Service de Rythmologie, Hopital Cardiologique du Haut-Leveque and the Universite Victor Segalen Bordeaux II, Bordeaux, France
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Piers SR, Dyrda K, Tao Q, Zeppenfeld K. Bipolar Ablation of Ventricular Tachycardia in a Patient After Atrial Switch Operation for Dextro-Transposition of the Great Arteries. Circ Arrhythm Electrophysiol 2012; 5:e38-40. [DOI: 10.1161/circep.111.969345] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sebastiaan R.D. Piers
- From the Department of Cardiology (S.R.D.P., K.D., K.Z.) and Department of Radiology (Q.T.), Leiden University Medical Center, Leiden, The Netherlands
| | - Katia Dyrda
- From the Department of Cardiology (S.R.D.P., K.D., K.Z.) and Department of Radiology (Q.T.), Leiden University Medical Center, Leiden, The Netherlands
| | - Qian Tao
- From the Department of Cardiology (S.R.D.P., K.D., K.Z.) and Department of Radiology (Q.T.), Leiden University Medical Center, Leiden, The Netherlands
| | - Katja Zeppenfeld
- From the Department of Cardiology (S.R.D.P., K.D., K.Z.) and Department of Radiology (Q.T.), Leiden University Medical Center, Leiden, The Netherlands
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Nagashima K, Watanabe I, Okumura Y, Sonoda K, Kofune M, Mano H, Ohkubo K, Nakai T, Kunimoto S, Kasamaki Y, Hirayama A. Epicardial ablation with irrigated electrodes: – effect of bipolar vs. unipolar ablation on lesion formation –. Circ J 2011; 76:322-7. [PMID: 22166835 DOI: 10.1253/circj.cj-11-0984] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Ablation of ventricular tachycardia originating from the left ventricular (LV) epicardium is often limited by the radiofrequency power delivery. We compared the effect of bipolar vs. unipolar epicardial ablation on lesion size. METHODS AND RESULTS Eleven excised pig hearts were superfused with saline (2 L/min). Unipolar ablation (25 or 30 W for 120 s) was performed between the LV epicardial saline-irrigated electrode and an indifferent electrode (n = 33 lesions). Bipolar ablation (25 or 30 W for 120 s) was performed between a 4-mm saline-irrigated-tip (20 ml/min) electrode on the LV epicardium and an opposing 10-mm non-irrigated-tip electrode on the LV endocardium (n = 38 lesions). Wall thickness did not differ between experiments (15.4 ± 2.4 vs. 15.3 ± 2.1 mm). Impedance was lower at the beginning and end of unipolar ablation than at the beginning and end of bipolar ablation (163.2 ± 20.3Ω and 109.9 ± 16.0Ω vs. 194.6 ± 23.3Ω and 127.1 ± 16.4Ω, respectively) (P<0.001). Epicardial lesion width did not differ between unipolar and bipolar ablation (10.1 ± 2.7 vs. 10.2 ± 2.4 mm), but lesion depth was greater with bipolar ablation (10.6 ± 2.7 vs. 7.5 ± 1.0 mm) (P<0.001). Unipolar ablation produced no transmural lesion, but bipolar ablation produced 15 (46%) (P<0.001). Steam pop occurred in 11 (29%) and 3 (9%) cases, respectively (P = 0.036). CONCLUSIONS Bipolar ablation of the LV free wall is highly effective at creating an appropriately deep epicardial lesion.
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Affiliation(s)
- Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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CHIK WILLIAMW, BARRY MA, MALCHANO ZACH, WYLIE BRYAN, POULIOPOULOS JIM, HUANG KAIMIN, LU JUNTANG, THAVAPALACHANDRAN SUJITHA, ROBINSON DAVID, SAADAT VAHID, THOMAS STUARTP, ROSS DAVIDL, KOVOOR PRAMESH, THIAGALINGAM ARAVINDA. In Vivo Evaluation of Virtual Electrode Mapping and Ablation Utilizing a Direct Endocardial Visualization Ablation Catheter. J Cardiovasc Electrophysiol 2011; 23:88-95. [DOI: 10.1111/j.1540-8167.2011.02169.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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49
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Current World Literature. Curr Opin Cardiol 2011; 26:71-8. [DOI: 10.1097/hco.0b013e32834294db] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Nagashima K, Watanabe I, Okumura Y, Ohkubo K, Kofune M, Ohya T, Kasamaki Y, Hirayama A. Lesion Formation by Ventricular Septal Ablation With Irrigated Electrodes - Comparison of Bipolar and Sequential Unipolar Ablation -. Circ J 2011; 75:565-70. [DOI: 10.1253/circj.cj-10-0870] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Ichiro Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Masayoshi Kofune
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Toshiyuki Ohya
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yuji Kasamaki
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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