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Correale M, Monaco I, Tricarico L, Bottigliero D, Sicuranza M, Del Forno B, Godeas G, Teri A, Maiorano A, Perulli R, Centola A, De Bonis M, Di Biase M, Brunetti ND. Advanced heart failure: non-pharmacological approach. Heart Fail Rev 2020; 24:779-791. [PMID: 30972521 DOI: 10.1007/s10741-019-09786-1] [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] [Indexed: 12/19/2022]
Abstract
Patients with advanced heart failure have poor prognosis despite traditional pharmacological therapies. The early identification of these subjects would allow them to be addressed on time in dedicated centers to select patients eligible for heart transplantation or ventricular assistance. In this article we will report the current management of these patients based on latest international guidelines, underlining some critical aspects, with reference to future perspectives.
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Affiliation(s)
- Michele Correale
- Cardiology Department, Ospedali Riuniti University Hospital, Viale Pinto 1, 71122, Foggia, Italy
| | - Ilenia Monaco
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Lucia Tricarico
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Dario Bottigliero
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Monica Sicuranza
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Benedetto Del Forno
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, San Raffaele Hospital, Milan, Italy
| | - Giulia Godeas
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonino Teri
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Annamaria Maiorano
- Nephrology Dialysis and Transplantation Unit, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Rossella Perulli
- Nephrology Dialysis and Transplantation Unit, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Antonio Centola
- Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, Vita-Salute San Raffaele University, San Raffaele Hospital, Milan, Italy
| | - Matteo Di Biase
- Santa Maria Hospital, Gruppo Villa Maria Research and Care, Bari, Italy
| | - Natale Daniele Brunetti
- Cardiology Department, Ospedali Riuniti University Hospital, Viale Pinto 1, 71122, Foggia, Italy.
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Sohn K, Wener Lv, Kichang Lee, Galea AM, Hirschman GB, Hayward AM, Cohen RJ, Armoundas AA. The Single Equivalent Moving Dipole Model Does Not Require Spatial Anatomical Information to Determine Cardiac Sources of Activation. IEEE J Biomed Health Inform 2014; 18:222-30. [DOI: 10.1109/jbhi.2013.2268012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ziv O, Schofield L, Lau E, Chaves L, Patel D, Jeng P, Peng X, Choi BR, Koren G. A novel, minimally invasive, segmental myocardial infarction with a clear healed infarct borderzone in rabbits. Am J Physiol Heart Circ Physiol 2012; 302:H2321-30. [PMID: 22447944 DOI: 10.1152/ajpheart.00031.2012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ventricular arrhythmias in the setting of a healed myocardial infarction have been studied to a much lesser degree than acute and subacute infarction, due to the pericardial scarring, which results from the traditional open-chest techniques used for myocardial infarction (MI) induction. We sought to develop a segmental MI with low perioperative mortality in the rabbit that allows optimal visualization and therefore improved study of the infarction borderzone. Rabbits underwent MI using endovascular coil occlusion of the first obtuse marginal artery. Three weeks postprocedure, we evaluated our model by echocardiography and electrophysiology studies, optical mapping of isolated hearts, and histological studies. Seventeen rabbits underwent the protocol (12 MI and 5 sham) with a 92% survival to completion of the study (11 MI and 5 sham). MI rabbits demonstrated wall motion abnormalities on echocardiography while shams did not. At electrophysiological study, two MI rabbits had inducible ventricular tachycardia and one had inducible ventricular fibrillation. Isolated hearts demonstrated no pericardial scarring with a smooth, easily identifiable infarct borderzone. Optical mapping of the borderzone region showed successful mapping of peri-infarct reentry formation, with ventricular fibrillation inducible in 11 of 11 MI hearts and 1 of 5 sham hearts. We demonstrate successful high resolution mapping in the borderzone, showing delayed conduction in this region corresponding to late deflections in the QRS on ECG. We report the successful development of a minimally invasive MI via targeted coil delivery to the obtuse marginal artery with an exceptionally high rate of procedural survival and an arrhythmogenic phenotype. This model mimics human post-MI on echocardiography, gross pathology, histology, and electrophysiology.
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Affiliation(s)
- Ohad Ziv
- Cardiovascular Research Center, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, USA
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VT ablation in heart failure. Herzschrittmacherther Elektrophysiol 2012; 23:38-44. [PMID: 22410757 DOI: 10.1007/s00399-012-0171-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 01/31/2012] [Indexed: 10/28/2022]
Abstract
Ventricular tachycardias (VT), shocks, and clusters of shock are ominous signs in patients with implantable cardioverter-defibrillators and herald an increased risk of hospitalization and mortality. VT clusters have been associated with aggravation of heart failure (19%), acute coronary events (14%), and electrolyte imbalance (10%). Yet, any association of potential causative factors and aggravation of VT is vague. Maybe, in patients with any substrate for re-entry, progressive aggravation of ventricular dysrhythmias is to be expected. The high recurrence rate of electrical storm despite antiarrhythmic drug therapy supports this view. The optimal timing of VT ablation is unknown, but current convention is to perform VT ablation after shock clusters or incessant VT has occurred. Preemptive VT ablation before VT has occurred is rarely performed (only in 15% of active centers) and the majority of centers never perform VT ablation even after the first shock. Such practice is within guidelines that recommend VT ablation only in ICD patients with recurrent or incessant VT. However, there is strong data in support of preemptive VT ablation.
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Alzand BSN, Timmermans CCMM, Wellens HJJ, Dennert R, Philippens SAM, Portegijs PJM, Rodriguez LM. Unmappable ventricular tachycardia after an old myocardial infarction. Long-term results of substrate modification in patients with an implantable cardioverter defibrillator. J Interv Card Electrophysiol 2011; 31:149-56. [PMID: 21340515 PMCID: PMC3141830 DOI: 10.1007/s10840-011-9549-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 01/26/2011] [Indexed: 01/15/2023]
Abstract
Purpose The frequent occurrence of ventricular tachycardia can create a serious problem in patients with an implantable cardioverter defibrillator. We assessed the long-term efficacy of catheter-based substrate modification using the voltage mapping technique of infarct-related ventricular tachycardia and recurrent device therapy. Methods The study population consisted of 27 consecutive patients (age 68 ± 8 years, 25 men, mean left ventricular ejection fraction 31 ± 9%) with an old myocardial infarction and multiple and/or hemodynamically not tolerated ventricular tachycardia necessitating repeated device therapy. A total of 31 substrate modification procedures were performed using the three-dimensional electroanatomical mapping system. Patients were followed up for a median of 23.5 (interquartile range 6.5–53.2) months before and 37.8 (interquartile range 11.7–71.8) months after ablation. Antiarrhythmic drugs were not changed after the procedure, and were stopped 6 to 9 months after the procedure in patients who did not show ventricular tachycardia recurrence. Results Median ventricular tachycardias were 1.6 (interquartile range 0.7–6.7) per month before and 0.2 (interquartile range 0.00–1.3) per month after ablation (P = 0.006). Nine ventricular fibrillation episodes were registered in seven patients before and two after ablation (P = 0.025). Median antitachycardia pacing decreased from 1.6 (interquartile range 0.01–5.5) per month before to 0.18 (interquartile range 0.00–1.6) per month after ablation (P = 0.069). Median number of shocks decreased from 0.19 (interquartile range 0.04–0.81) per month before to 0.00 (interquartile range 0.00–0.09) per month after ablation (P = 0.001). One patient had a transient ischemic attack during the procedure, and another developed pericarditis. Nine patients died during follow-up, eight patients due to heart failure and one patient during valve surgery. Conclusion Catheter-based substrate modification using voltage mapping results in a long-lasting reduction of cardioverter defibrillator therapy in patients with multiple and/or hemodynamically not tolerated infarct-related ventricular tachyarrhythmia.
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Affiliation(s)
- B S N Alzand
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.
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Stellbrink C. What an emergency physician needs to know about acute care of cardiac arrhythmias. J Emerg Trauma Shock 2010; 3:126-8. [PMID: 20606788 PMCID: PMC2884442 DOI: 10.4103/0974-2700.62109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 01/08/2010] [Indexed: 11/16/2022] Open
Abstract
The treat of cardiac arrhythmias has been studied extensively in the last decades. There has been a major shift in antiarrhythmia treatment from drugs to interventional electrophysiological procedures and implantable devices. Published data indicate that for long-term treatment of arrhythmias, non-pharmacological treatment is more effective than drugs in many patients. Similarly, the overhelming success of radiofrequency catheter ablation of supraventricular tachycardias has almost eliminated the need for chronic drug treatment. Today, catheter ablation plays an increasingly important role in the prevention of atrial fibrillation recurrences. However, in the emergency room or in the intensive care unit, drug treatment remains the gold standard for the treatment of cardiac arrhythmias. Arrhythmias are very common in emergency medicine, occurring in 12% to 20% of all patients in an intensive care unit and there is great need for good diagnostic and therapeutic algorithms to aid the emergency physician dealing with patients suffering from arrhythmias
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Affiliation(s)
- Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, Bielefeld Medical Center, Germany
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Montijano Cabrera ÁM, Barrera Cordero A, Alzueta Rodríguez J, Robledo Carmona J, de Teresa Galván E. Seguimiento a largo plazo tras la ablación con radiofrecuencia de taquicardias ventriculares en pacientes portadores de un desfibrilador automático implantable. Rev Esp Cardiol 2005. [DOI: 10.1157/13074843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Brunckhorst CB, Delacretaz E, Soejima K, Maisel WH, Friedman PL, Stevenson WG. Identification of the Ventricular Tachycardia Isthmus After Infarction by Pace Mapping. Circulation 2004; 110:652-9. [PMID: 15289385 DOI: 10.1161/01.cir.0000138107.11518.af] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Ventricular tachycardia (VT) isthmuses can be defined by fixed or functional block. During sinus rhythm, pace mapping near the exit of an isthmus should produce a QRS similar to that of VT. Pace mapping at sites proximal to the exit may produce a similar QRS with a longer stimulus-to-QRS interval (S-QRS). The aim of the study was to determine whether a VT isthmus could be identified and followed by pace mapping.
Methods and Results—
Left ventricular pace mapping during sinus rhythm was performed at 819 sites in 11 patients with VT late after infarction, and corresponding CARTO maps were reconstructed. An isthmus site was defined by entrainment and/or VT termination by ablation. Pace-mapping data were analyzed from the identified isthmus site and from sites at progressively increasing distances from this initial isthmus site. Sites where pace mapping produced the same QRS with different S-QRS delays were identified to attempt to trace the course of the isthmus. In 11 patients, 13 confluent low-voltage infarct regions were present. In all these regions, parts of VT isthmuses were identified by pace mapping. In 11 of 13 of the identified isthmus parts, the QRS morphology of the pace map matched a VT QRS. In 10 of 11 patients, radiofrequency ablation rendered clinical VTs noninducible. Successful ablation sites were localized within an isthmus identified by pace mapping in all of these 10 patients.
Conclusions—
VT isthmuses can be identified and part of their course delineated by pace mapping during sinus rhythm. This method could help target isthmus sites for ablation during stable sinus rhythm.
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Affiliation(s)
- Corinna B Brunckhorst
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass, USA.
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Brunckhorst CB, Stevenson WG, Soejima K, Maisel WH, Delacretaz E, Friedman PL, Ben-Haim SA. Relationship of slow conduction detected by pace-mapping to ventricular tachycardia re-entry circuit sites after infarction. J Am Coll Cardiol 2003; 41:802-9. [PMID: 12628726 DOI: 10.1016/s0735-1097(02)02932-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study sought to characterize the relationship of conduction delays detected by pace-mapping, evident as a stimulus to QRS interval (S-QRS) delay >or=40 ms, to ventricular tachycardia (VT) re-entry circuit isthmuses defined by entrainment and ablation. BACKGROUND Areas of slow conduction and block in old infarcts cause re-entrant VT. METHODS In 12 patients with VT after infarction, pace-mapping was performed at 890 sites. Stimulus to QRS intervals were measured and plotted in three-dimensional reconstructions of the left ventricle. Conduction delay was defined as >or=40 ms and marked delay as >80 ms. The locations of conduction delays were compared to the locations of 14 target areas, defined as the region within a radius of 2 cm of a re-entry circuit isthmus. RESULTS Pacing captured at 829 sites; 465 (56%) had no S-QRS delay, 364 (44%) had a delay >or=40 ms, and 127 (15%) had a delay >80 ms. Sites with delays were clustered in 14 discrete regions, 13 of which overlapped target regions. Only 1 of the 14 target regions was not related to an area of S-QRS delay. Sites with marked delays >80 ms were more often in the target (52%) than sites with delays 40 to 80 ms (29%) (p < 0.0001). CONCLUSIONS Identification of abnormal conduction during pace-mapping can be used to focus mapping during induced VT to a discrete region of the infarct. Further study is warranted to determine if targeting regions of conduction delay may allow ablation of VT during stable sinus rhythm without mapping during VT.
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Nabar A, Rodriguez LM, Batra RK, Timmermans C, Cheriex E, Wellens HJJ. Echocardiographic predictors of survival in patients undergoing radiofrequency ablation of postinfarct clinical ventricular tachycardia. J Cardiovasc Electrophysiol 2002; 13:S118-21. [PMID: 11852887 DOI: 10.1111/j.1540-8167.2002.tb01965.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of this study was to determine the predictive value of echocardiographic parameters of systolic left ventricular (LV) dysfunction for survival in a group of patients with "mappable" ventricular tachycardia (VT) after myocardial infarction who underwent radiofrequency ablation (RFA) of their clinical VT(s). METHODS AND RESULTS RFA of at least one inducible, "mappable," and clinical VT was attempted in 61 patients. In total, 63 (79%) of 80 target clinical VTs were ablated successfully, such that clinical VT(s) were noninducible in 49 (80%) of 61 patients. At the last recorded follow-up (range 2 to 98 months; mean 21 +/- 20), nonfatal VT recurrences were observed in 11 (22%) patients; 10 (16%) patients died. On univariate analysis, a higher LV end-diastolic volume (LVEDV; P = 0.008) and, by multivariate analysis, applying backward selection of variables, older age (P = 0.03) with a higher LVEDV (P = 0.003) predicted patients more likely to die. When age and LV ejection fraction (LVEF) were excluded, LV end-systolic diameter (LVESD; P = 0.007) was the most significant predictor of survival. CONCLUSION In our patient population with postinfarct VT who underwent RFA of mappable clinical VT(s), LVEF did not predict survival. In this group of patients with overall low mean LVEF (<35%), older age together with higher LVEDV and LVESD predicted patients who were more prone to die. LV size rather than LVEF correlated with survival.
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Affiliation(s)
- Ashish Nabar
- Department of Cardiology, Academic Hospital Maastricht, The Netherlands
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Miller JM, Coppess MA, Altemose GT, Gervacio-Domingo G, Scott LR. Management of postinfarct ventricular tachycardias. Cardiol Clin 2000; 18:293-307. [PMID: 10849874 DOI: 10.1016/s0733-8651(05)70142-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The clinical profile of patients with postinfarct VT has changed in the past two decades. Along with these changes, existing treatments have improved, and entirely new therapeutic approaches have been developed. The expanded range of treatment options has made postinfarct VT a less imposing clinical problem than it once was. Emerging therapies promise to make an even greater beneficial impact. The challenge in treating patients with postinfarct VT has changed from merely keeping patients alive to keeping up with innovations in therapy that can provide them with a better quantity and quality of life.
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Affiliation(s)
- J M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, USA.
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Ciaccio EJ, Scheinman MM, Wit AL. Relationship of specific electrogram characteristics during sinus rhythm and ventricular pacing determined by adaptive template matching to the location of functional reentrant circuits that cause ventricular tachycardia in the infarcted canine heart. J Cardiovasc Electrophysiol 2000; 11:446-57. [PMID: 10809499 DOI: 10.1111/j.1540-8167.2000.tb00341.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION It would be advantageous, for ablation therapy, to localize reentrant circuits causing ventricular tachycardia by quantifying electrograms obtained during sinus rhythm (SR) or ventricular pacing (VP). In this study, adaptive template matching (ATM) was used to localize reentrant circuits by measuring dynamic electrogram shape using SR and VP data. METHODS AND RESULTS Four days after coronary occlusion, reentrant ventricular tachycardia was induced in the epicardial border zone of canine hearts by programmed electrical stimulation. Activation maps of circuits were constructed using electrograms recorded from a multichannel array to ascertain block line location. Electrogram recordings obtained during SR/VP then were used for ATM analysis. A template electrogram was matched with electrograms on subsequent cycles by weighting amplitude, vertical shift, duration, and phase lag for optimal overlap. Sites of largest cycle-to-cycle variance in the optimal ATM weights were found to be adjacent to block lines bounding the central isthmus during reentry (mean 61.1% during SR; 63.9% during VP). The distance between the mean center of mass of the ten highest ATM variance peaks and the narrowest isthmus width was determined. For all VP data, the center of mass resided in the isthmus region occurring during reentry. CONCLUSION ATM high variance measured from SR/VP data localizes functional block lines forming during reentry. The center of mass of the high variance peaks localizes the narrowest width of the isthmus. Therefore, ATM methodology may guide ablation catheter position without resorting to reentry induction.
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Affiliation(s)
- E J Ciaccio
- Department of Pharmacology, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
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Bogun F, Knight B, Goyal R, Michaud GF, Strickberger SA, Hohnloser SH, Morady F. Discrete systolic potentials during ventricular tachycardia in patients with prior myocardial infarction. J Cardiovasc Electrophysiol 1999; 10:364-9. [PMID: 10210499 DOI: 10.1111/j.1540-8167.1999.tb00684.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Isolated diastolic potentials have been found to be helpful in identifying critical sites for ablation of ventricular tachycardia (VT) in patients with coronary artery disease. However, discrete potentials that occur during systole have not been previously described. The purpose of this study was to determine the significance of discrete systolic potentials during VT in patients with coronary artery disease. METHODS AND RESULTS Twenty-seven patients with a mean age of 66 +/- 12 years ( +/- standard deviation) who had coronary artery disease underwent radiofrequency catheter ablation of 42 VTs that had a mean cycle length of 486 +/- 78 msec. The only criterion used to select target sites for ablation was concealed entrainment, which was present at 92 sites. Thirty-five of the 42 VTs (83%) were successfully ablated. A discrete systolic potential was recorded during 7 of the 42 VTs (17%). In all cases, the interval between the discrete systolic potential and the next QRS complex was equal to the stimulus-QRS interval during concealed entrainment. At all seven sites where a discrete systolic potential was recorded, delivery of radiofrequency energy resulted in successful ablation of the VT. CONCLUSION Discrete systolic potentials may be present in patients with coronary artery disease in approximately 17% of VTs in which there is concealed entrainment. If the interval between the discrete systolic potential and the next QRS complex matches the stimulus-QRS interval during concealed entrainment, delivery of radiofrequency energy is likely to result in successful ablation of the VT.
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Affiliation(s)
- F Bogun
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022, USA
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Miller JM, Engelstein ED, Groh WJ, Olgin JE, al-Sheikh T, Altemose GT. Radiofrequency catheter ablation for postinfarct ventricular tachycardia. Curr Opin Cardiol 1999; 14:30-5. [PMID: 9932205 DOI: 10.1097/00001573-199901000-00006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Catheter mapping and radiofrequency ablation of postinfarct sustained ventricular tachycardia (VT) remain one of the greatest challenges for the electrophysiologist. Although there were no major breakthroughs during the past year, several refinements and clarifications of existing mapping criteria were published. In addition, initial reports appeared describing new mapping systems and ablation technologies that may significantly impact the way ablation studies are performed as well as the way in which they affect success rates. Uncertainties remain as to how effective catheter ablation will be as a longterm cure for this type of VT. For the foreseeable future, catheter ablation in postinfarct VT will remain adjunctive rather than primary therapy.
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Affiliation(s)
- J M Miller
- Clinical Electrophysiology Service, Krannert Institute of Cardiology, Indianapolis, IN 46202, USA
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Friedman PL. Is the postpacing interval of any value during ablation of postinfarction ventricular tachycardia? J Cardiovasc Electrophysiol 1999; 10:52-5. [PMID: 9930909 DOI: 10.1111/j.1540-8167.1999.tb00641.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- P L Friedman
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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