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Santangeli P, Higuchi K, Sroubek J. Ventricular Tachycardia Ablation Endpoints: Moving Beyond Noninducibility. JACC Clin Electrophysiol 2024; 10:981-999. [PMID: 38385913 DOI: 10.1016/j.jacep.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/08/2023] [Accepted: 12/30/2023] [Indexed: 02/23/2024]
Abstract
In patients with structural heart disease and ventricular tachycardia (VT) undergoing catheter ablation, the response to programmed electrical stimulation (PES) at the end of the procedure has been traditionally used to evaluate the acute success and predict long-term outcomes. Although noninducibility at PES has been extensively investigated and validated in clinical trials and large multicenter registries, its performance in predicting long-term freedom from VT is suboptimal. In addition, PES has inherent limitations related to the influence of background antiarrhythmic drug therapy, periprocedural use of anesthesia, and the heterogeneity in PES protocols. The increased utilization of substrate-based ablation approaches that focus on ablation of abnormal electrograms identified with mapping in sinus or paced rhythm has been paralleled by a need for additional procedural endpoints beyond VT noninducibility at PES. This article critically appraises the relative merits and limitations of different procedural endpoints according to different ablation techniques for catheter ablation of scar-related VT.
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Affiliation(s)
- Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Koji Higuchi
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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2
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Packer DL, Wilber DJ, Kapa S, Dyrda K, Nault I, Killu AM, Kanagasundram A, Richardson T, Stevenson W, Verma A, Curley M. Ablation of Refractory Ventricular Tachycardia Using Intramyocardial Needle Delivered Heated Saline-Enhanced Radiofrequency Energy: a First-in-Man Feasibility Trial. Circ Arrhythm Electrophysiol 2022; 15:e010347. [PMID: 35776711 PMCID: PMC9388560 DOI: 10.1161/circep.121.010347] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ablation of ventricular tachycardia (VT) is limited by the inability to create penetrating lesions to reach intramyocardial origins. Intramural needle ablation using in-catheter, heated saline-enhanced radio frequency (SERF) energy uses convective heating to increase heat transfer and produce deeper, controllable lesions at intramural targets. This first-in-human trial was designed to evaluate the safety and efficacy of SERF needle ablation in patients with refractory VT. METHODS Thirty-two subjects from 6 centers underwent needle electrode ablation. Each had recurrent drug-refractory monomorphic VT after implantable cardioverter defibrillator implantation and prior standard ablation. During the SERF study procedure, one or more VTs were induced and mapped. The SERF needle catheter was used to create intramural lesions at targeted VT site(s). Acute procedural success was defined as noninducibility of the clinical VT after the procedure. Patients underwent follow-up at 30 days, and 3 and 6 months, with implantable cardioverter defibrillator interrogation at follow-up to determine VT recurrence. RESULTS These refractory VT patients (91% male, 66±10 years, ejection fraction 35±11%; 56% ischemic, and 44% nonischemic) had a median of 45 device therapies (shock/antitachycardia pacing) for VT in the 3 to 6 months pre-SERF ablation. The study catheter was used to deliver an average of 10±5 lesions per case, with an average of 430±295 seconds of radiofrequency time, 122±65 minute of catheter use time, and a procedural duration of 4.3±1.3 hours. Acute procedural success was 97% for eliminating the clinical VT. At average follow-up of 5 months (n=32), device therapies were reduced by 89%. Complications included 2 periprocedural deaths: an embolic mesenteric infarct and cardiogenic shock, 2 mild strokes, and a pericardial effusion treated with pericardiocentesis (n=1). CONCLUSIONS Intramural heated saline needle ablation showed complete acute and satisfactory mid-term control of difficult VTs failing 1 to 5 prior ablations and drug therapy. Further study is warranted to define safety and longer-term efficacy. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique Identifier: NCT03628534 and NCT02994446.
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Affiliation(s)
| | | | - Suraj Kapa
- Mayo Clinic, Rochester, MN (D.L.P., S.K., A.M.K.)
| | | | - Isabelle Nault
- Canada Quebec Heart and Lung Institute, Quebec City, Canada (I.N.)
| | | | | | - Travis Richardson
- Vanderbilt University Medical Center, Nashville, TN (A.K., T.R., W.S.)
| | - William Stevenson
- Vanderbilt University Medical Center, Nashville, TN (A.K., T.R., W.S.)
| | - Atul Verma
- Southlake Regional Health Centre, Newmarket Ontario, Canada (A.V.)
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3
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Atici A, Tatlisu MA, Baycan OF, Yılmaz Y, Caliskan M. A rare cause of idiopathic right outflow tract premature ventricular contraction: Type-4 renal tubular acidosis. Pacing Clin Electrophysiol 2022; 45:811-814. [PMID: 35067955 DOI: 10.1111/pace.14455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 12/29/2022]
Abstract
The premature ventricular contractions (PVCs) have usually good prognosis in patients without structural heart disease. In case of left ventricular ejection fraction depression or symptoms, antiarrhythmic drugs or cardiac ablations could be an option for management. We present a case of a patient with high burden of PVC admitted for cardiac ablation. Preoperative assessment revealed hyperkalemia and metabolic acidosis which ended up with type-4 renal tubular acidosis (RTA). Its rare cause and management may draw attention to the possibility of type -4 RTA as the cause of the PVC, and hyperkalemia.
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Affiliation(s)
- Adem Atici
- Cardiology Department, Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Adem Tatlisu
- Cardiology Department, Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Omer Faruk Baycan
- Cardiology Department, Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Yılmaz
- Cardiology Department, Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Caliskan
- Cardiology Department, Istanbul Medeniyet University Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul, Turkey
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4
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Spectral characterisation of ventricular intracardiac potentials in human post-ischaemic bipolar electrograms. Sci Rep 2022; 12:4782. [PMID: 35314732 PMCID: PMC8938475 DOI: 10.1038/s41598-022-08743-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/11/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractAbnormal ventricular potentials (AVPs) are frequently referred to as high-frequency deflections in intracardiac electrograms (EGMs). However, no scientific study performed a deep spectral characterisation of AVPs and physiological potentials in real bipolar intracardiac recordings across the entire frequency range imposed by their sampling frequency. In this work, the power contributions of post-ischaemic physiological potentials and AVPs, along with some spectral features, were evaluated in the frequency domain and then statistically compared to highlight specific spectral signatures for these signals. To this end, 450 bipolar EGMs from seven patients affected by post-ischaemic ventricular tachycardia were retrospectively annotated by an experienced cardiologist. Given the high variability of the morphologies observed, three different sub-classes of AVPs and two sub-categories of post-ischaemic physiological potentials were considered. All signals were acquired by the CARTO® 3 system during substrate-guided catheter ablation procedures. Our findings indicated that the main frequency contributions of physiological and pathological post-ischaemic EGMs are found below 320 Hz. Statistical analyses showed that, when biases due to the signal amplitude influence are eliminated, not only physiological potentials show greater contributions below 20 Hz whereas AVPs demonstrate higher spectral contributions above ~ 40 Hz, but several finer differences may be observed between the different AVP types.
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5
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Zhang DM, Navara R, Yin T, Szymanski J, Goldsztejn U, Kenkel C, Lang A, Mpoy C, Lipovsky CE, Qiao Y, Hicks S, Li G, Moore KMS, Bergom C, Rogers BE, Robinson CG, Cuculich PS, Schwarz JK, Rentschler SL. Cardiac radiotherapy induces electrical conduction reprogramming in the absence of transmural fibrosis. Nat Commun 2021; 12:5558. [PMID: 34561429 PMCID: PMC8463558 DOI: 10.1038/s41467-021-25730-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 08/25/2021] [Indexed: 02/08/2023] Open
Abstract
Cardiac radiotherapy (RT) may be effective in treating heart failure (HF) patients with refractory ventricular tachycardia (VT). The previously proposed mechanism of radiation-induced fibrosis does not explain the rapidity and magnitude with which VT reduction occurs clinically. Here, we demonstrate in hearts from RT patients that radiation does not achieve transmural fibrosis within the timeframe of VT reduction. Electrophysiologic assessment of irradiated murine hearts reveals a persistent supraphysiologic electrical phenotype, mediated by increases in NaV1.5 and Cx43. By sequencing and transgenic approaches, we identify Notch signaling as a mechanistic contributor to NaV1.5 upregulation after RT. Clinically, RT was associated with increased NaV1.5 expression in 1 of 1 explanted heart. On electrocardiogram (ECG), post-RT QRS durations were shortened in 13 of 19 patients and lengthened in 5 patients. Collectively, this study provides evidence for radiation-induced reprogramming of cardiac conduction as a potential treatment strategy for arrhythmia management in VT patients.
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Affiliation(s)
- David M Zhang
- Center for Noninvasive Cardiac Radioablation, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Rachita Navara
- Center for Noninvasive Cardiac Radioablation, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Tiankai Yin
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Jeffrey Szymanski
- Department of Radiation Oncology, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Uri Goldsztejn
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
- Department of Biomedical Engineering, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Camryn Kenkel
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
- Department of Biomedical Engineering, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Adam Lang
- Department of Pathology, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Cedric Mpoy
- Department of Radiation Oncology, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Catherine E Lipovsky
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
- Department of Developmental Biology, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Yun Qiao
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
- Department of Biomedical Engineering, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Stephanie Hicks
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Gang Li
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
- Department of Biomedical Engineering, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Kaitlin M S Moore
- Center for Noninvasive Cardiac Radioablation, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Carmen Bergom
- Center for Noninvasive Cardiac Radioablation, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
- Department of Radiation Oncology, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Buck E Rogers
- Department of Radiation Oncology, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Clifford G Robinson
- Center for Noninvasive Cardiac Radioablation, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
- Department of Radiation Oncology, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Phillip S Cuculich
- Center for Noninvasive Cardiac Radioablation, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
- Department of Radiation Oncology, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Julie K Schwarz
- Center for Noninvasive Cardiac Radioablation, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
- Department of Radiation Oncology, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA
| | - Stacey L Rentschler
- Center for Noninvasive Cardiac Radioablation, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA.
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA.
- Department of Biomedical Engineering, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA.
- Department of Developmental Biology, Washington University in St. Louis, School of Medicine, Saint Louis, MO, USA.
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6
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Zhang DM, Szymanski J, Bergom C, Cuculich PS, Robinson CG, Schwarz JK, Rentschler SL. Leveraging Radiobiology for Arrhythmia Management: A New Treatment Paradigm? Clin Oncol (R Coll Radiol) 2021; 33:723-734. [PMID: 34535357 DOI: 10.1016/j.clon.2021.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 08/04/2021] [Accepted: 09/01/2021] [Indexed: 01/01/2023]
Abstract
Radiation therapy is a well-established approach for safely and non-invasively treating solid tumours and benign diseases with high precision and accuracy. Cardiac radiation therapy has recently emerged as a non-invasive treatment option for the management of refractory ventricular tachycardia. Here we summarise existing clinical and preclinical literature surrounding cardiac radiobiology and discuss how these studies may inform basic and translational research, as well as clinical treatment paradigms in the management of arrhythmias.
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Affiliation(s)
- D M Zhang
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, USA
| | - J Szymanski
- Department of Radiation Oncology, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, USA
| | - C Bergom
- Department of Radiation Oncology, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, USA
| | - P S Cuculich
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, USA; Department of Radiation Oncology, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, USA
| | - C G Robinson
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, USA; Department of Radiation Oncology, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, USA
| | - J K Schwarz
- Department of Radiation Oncology, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, USA
| | - S L Rentschler
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, USA; Department of Biomedical Engineering, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, USA; Department of Developmental Biology, Washington University in St. Louis, School of Medicine, Saint Louis, Missouri, USA.
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7
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Bakaeen FG, Gaudino M, Whitman G, Doenst T, Ruel M, Taggart DP, Stulak JM, Benedetto U, Anyanwu A, Chikwe J, Bozkurt B, Puskas JD, Silvestry SC, Velazquez E, Slaughter MS, McCarthy PM, Soltesz EG, Moon MR. 2021: The American Association for Thoracic Surgery Expert Consensus Document: Coronary artery bypass grafting in patients with ischemic cardiomyopathy and heart failure. J Thorac Cardiovasc Surg 2021; 162:829-850.e1. [PMID: 34272070 DOI: 10.1016/j.jtcvs.2021.04.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Faisal G Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Coronary Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Glenn Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Md
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David P Taggart
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - John M Stulak
- Division of Cardiothoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| | - Umberto Benedetto
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Anelechi Anyanwu
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute at Cedars-Sinai, Los Angeles, Calif
| | - Biykem Bozkurt
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Tex
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside Hospital, New York, NY
| | | | - Eric Velazquez
- Department of Cardiovascular Medicine, Heart and Vascular Center, Yale New Haven Health, New Haven, Conn
| | - Mark S Slaughter
- Department Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Ky
| | - Patrick M McCarthy
- Bluhm Cardiovascular Institute and Division of Cardiac Surgery in the Department of Surgery, Northwestern University, Chicago, Ill
| | - Edward G Soltesz
- Department of Thoracic and Cardiovascular Surgery, Coronary Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo
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8
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Garg L, Pothineni NVK, Daw JM, Hyman MC, Arkles J, Tschabrunn CM, Santangeli P, Marchlinski FE. Impact of Left Atrial Bipolar Electrogram Voltage on First Pass Pulmonary Vein Isolation During Radiofrequency Catheter Ablation. Front Physiol 2021; 11:594654. [PMID: 33384608 PMCID: PMC7769759 DOI: 10.3389/fphys.2020.594654] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background First pass pulmonary vein isolation (PVI) is associated with durable isolation and reduced recurrence of atrial fibrillation (AF). Objective We sought to investigate the relationship between left atrial electrogram voltage using multielectrode fast automated mapping (ME-FAM) and first pass isolation with radiofrequency ablation. Methods We included consecutive patients (pts) undergoing first time ablation for paroxysmal AF (pAF), and compared the voltage characteristics between patients with and without first pass isolation. Left atrium (LA) adjacent to PVs was divided into 6 regions, and mean voltages obtained with ME-FAM (Pentaray, Biosense Webster) in each region and compared. LA electrograms with marked low voltage (<0.5 mV) were identified and the voltage characteristics at the site of difficult isolation was compared to the voltage in adjacent region. Results Twenty consecutive patients (10 with first pass and 10 without) with a mean age of 63.3 ± 6.2 years, 65% males, were studied. Difficult isolation occurred on the right PVs in eight pts and left PVs in three pts. The mean voltage in pts without first pass isolation was lower in all 6 regions; posterior wall (1.93 ± 1.46 versus 2.99 ± 2.19; p < 0.001), roof (1.83 ± 2.29 versus 2.47 ± 1.99; p < 0.001), LA-LPV posterior (1.85 ± 3.09 versus 2.99 ± 2.19, p < 0.001), LA-LPV ridge (1.42 ± 1.04 versus 1.91 ± 1.61; p < 0.001), LA-RPV posterior (1.51 ± 1.11 versus 2.30 ± 1.77, p < 0.001) and LA-RPV septum (1.55 ± 1.23 versus 2.31 ± 1.40, p < 0.001). Patients without first pass isolation also had a larger percentage of signal with an amplitude of <0.5 mV for each of the six regions (12.8% versus 7.5%). In addition, the mean voltage at the site of difficult isolation was lower at 8 out of 11 sites compared to mean voltage for remaining electrograms in that region. Conclusion In patients undergoing PVI for paroxysmal AF, failure in first pass isolation was associated with lower global LA voltage, more marked low amplitude signal (<0.5 mV) and lower local signal voltage at the site with difficult isolation. The results suggest that a greater degree of global and segmental fibrosis may play a role in ease of PV isolation with radiofrequency energy.
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Affiliation(s)
- Lohit Garg
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Naga Venkata K Pothineni
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - J Michael Daw
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Matthew C Hyman
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Jeffrey Arkles
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Cory M Tschabrunn
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Pasquale Santangeli
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Francis E Marchlinski
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
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9
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Affiliation(s)
| | - Joann Slack
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, USA
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10
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Wittwer ED, Radosevich MA, Ritter M, Cha YM. Stellate Ganglion Blockade for Refractory Ventricular Arrhythmias: Implications of Ultrasound-Guided Technique and Review of the Evidence. J Cardiothorac Vasc Anesth 2020; 34:2245-2252. [DOI: 10.1053/j.jvca.2019.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 01/29/2023]
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11
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Liu C, Su Z, Wang L, Li B, Wang J, Yu Y, Gu C. Surgical Endoepicardial Linear Ablation for Ventricular Tachycardia With Postinfarction Left Ventricular Aneurysm. Tex Heart Inst J 2020; 47:194-201. [PMID: 32997773 DOI: 10.14503/thij-18-6615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This retrospective study evaluated the feasibility of surgical endoepicardial linear ablation for ventricular tachycardia in patients with postinfarction left ventricular aneurysm. Sixty-four patients with multivessel coronary artery disease and left ventricular aneurysm but no mural thrombosis of the aneurysm or valve disease were treated at our institution from March 2012 through July 2015. All underwent off-pump coronary artery bypass grafting and left ventricular aneurysm repair by linear plication. Twenty-three patients (35.9%) had ventricular tachycardia and underwent surgical endoepicardial linear ablation on the beating heart guided by epicardial substrate mapping with the Carto 3 system. The remaining 41 patients (64.1%) composed the no-ablation group. The effectiveness of surgical linear ablation in the ablation group was evaluated. Safety and clinical outcomes were evaluated and compared between the groups. The ventricular tachycardia recurrence rate in the ablation group was 17.4% in the immediate postoperative period and 23.8% at last follow-up (39 ± 21 mo). Early (<30-d) mortality rates were 8.7% in the ablation group and 4.9% in the no-ablation group (P=0.41); the respective late mortality rates were 19.1% and 18% (P=0.70). Multivariate Cox regression analysis indicated that preoperatively poor left ventricular function was an independent risk factor for early and late death in both groups. The groups were similar in terms of the need for postoperative mechanical circulatory support, intensive care unit stay, and cumulative survival rate. We conclude that, for carefully selected candidates, surgical endoepicardial linear ablation combined with off-pump coronary artery bypass grafting and left ventricular aneurysm linear plication is a feasible treatment for ventricular tachycardia with postinfarction left ventricular aneurysm.
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Affiliation(s)
- Changcheng Liu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing 100029, People's Republic of China
| | - Zhaoping Su
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing 100029, People's Republic of China
| | - Liangshan Wang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing 100029, People's Republic of China
| | - Bo Li
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing 100029, People's Republic of China
| | - Jin Wang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing 100029, People's Republic of China
| | - Yang Yu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing 100029, People's Republic of China
| | - Chengxiong Gu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing 100029, People's Republic of China
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12
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Frontera A, Prolic Kalinsek T, Hadjis A, Della Bella P. Noninvasive programmed stimulation in the setting of ventricular tachycardia catheter ablation. J Cardiovasc Electrophysiol 2020; 31:1828-1835. [PMID: 32329104 DOI: 10.1111/jce.14516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 11/29/2022]
Abstract
In the setting of catheter ablation of ventricular tachycardia (VT), invasive programmed ventricular stimulation (PVS) is considered an important tool to assess the (residual) inducibility of ventricular arrhythmias and determine the acute success of the procedure. In patients with cardiovascular implantable electronic devices, noninvasive programmed stimulation via implantable cardioverter-defibrillator (ICD) leads can be an alternative to the invasive PVS with intracardiac catheters. The advantages of noninvasive programmed stimulation include preprocedure planning of the electrophysiology procedure to ensure optimal conditions for successful catheter ablation of VT. Following the procedure, noninvasive programmed stimulation has been shown to be used as a guide for repeat early ablation, to offer better programming of ICD, to offer prognostic value regarding the VT recurrence, and to guide antiarrhythmic drug therapy. The noninvasive nature of noninvasive programmed stimulation makes it an attractive alternative to PVS in patients with ICD who have not undergone catheter ablation of VT to obtain prognostic value regarding the occurrence of VT.
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Affiliation(s)
| | | | - Alexios Hadjis
- Arrhythmology Department, IRCCS San Raffaele, Milan, Italy
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13
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Chung FP, Liao YC, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Lin CY, Chang TY, Vicera JJB, Chin CG, Wu CI, Liu CM, Lee PT, Huang TC, Lugtu IC, Chen SA. Outcome of rescue ablation in patients with refractory ventricular electrical storm requiring mechanical circulation support. J Cardiovasc Electrophysiol 2019; 31:9-17. [PMID: 31808239 DOI: 10.1111/jce.14309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The management of refractory electrical storm (ES) requiring mechanical circulation support (MCS) remains a clinical challenge in structural heart disease (SHD). OBJECTIVE The study sought to explore the 30-day and 1-year outcome of rescue ablation for refractory ES requiring MCS in SHD. METHODS A total of 81 patients (mean age: 55.3 ± 18.9, 73 men [90.1%]) undergoing ablation were investigated, including 26 patients with ES requiring MCS (group 1) and 55 patients without (group 2). The 30-day and 1-year outcome, including mortality and recurrent ventricular tachyarrhythmias (VAs) receiving appropriate implantable cardioverter defibrillators therapies, were assessed. RESULTS The patients in group 1 were characterized by older age, more ischemic cardiomyopathies, worse left ventricular ejection fraction, and more comorbidities. Thirty days after ablation, overall events were seen in 15 patients (mortality in 10 and recurrent VA in 7), including pumping failure-related mortality in 6 (60%). During a 30-day follow-up, higher mortality was noted in group 1. After a 1-year follow-up, in spite of the higher mortality in group 1 (P < .001), the overall events and VA recurrences were similar between these two groups (P = .154 and P = .466, respectively). There was a significant reduction of VA burden in both groups and two patients had recurrent ES. CONCLUSION Higher 30-day mortality was observed in patients undergoing rescue ablation for refractory ES requiring MCS, and pumping failure was the major cause of periprocedural death. Rescue ablation successfully prevented VA recurrences and resulted in a comparable 1-year prognosis between ES with and without MCS.
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Affiliation(s)
- Fa-Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Chieh Liao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of medicine, Division of cardiology, Changhua Christian Hospital, Changhua, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ting-Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jennifer Jeanne B Vicera
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,University of Santo Tomas Hospital, Manila, Philippines
| | - Chye-Gen Chin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Cheng-I Wu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Tseng Lee
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,National Cheng-Kung University Hospital, Tainan, Taiwan
| | - Ting-Chun Huang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,National Cheng-Kung University Hospital, Tainan, Taiwan
| | - Isaiah C Lugtu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Cardiovascular Research Center, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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14
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Fujita H, Cimr D. Computer Aided detection for fibrillations and flutters using deep convolutional neural network. Inf Sci (N Y) 2019. [DOI: 10.1016/j.ins.2019.02.065] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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15
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Valdigem BP, Moreira DAR, Andalaft RB, Santana MVT, Sierra-Reyes CA, Mizzacci C. Successful Treatment of Ventricular Arrhythmia in Tetralogy of Fallot Repair Using Catheter Ablation. Braz J Cardiovasc Surg 2018; 33:418-423. [PMID: 30184040 PMCID: PMC6122762 DOI: 10.21470/1678-9741-2017-0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/03/2018] [Indexed: 11/04/2022] Open
Abstract
Tetralogy of Fallot (ToF) is one of the most prevalent congenital heart disease. Its surgical corrections may haemodinamically correct a disease, but the incisions may create scars that will originate ventricular arrhythmias. Even though life threatening arrhythmias are not common, some patients present unstable ventricular tachycardia (VT) of ectopic ventricular beats triggering heart failure and symptoms. We describe the treatment of a 16-years-old woman with late ToF repair and drug refractory Implantable cardioverter defibrillator (ICD) shocks. The patient underwent successful ablation of VT using X-ray and anatomic landmarks without the use of electroanatomical mapping. We were able to reduce drugs after one month of ablation and improve quality of life and symptoms. In this paper we describe the indications and perform a brief review of the key points for successful radiofrequency catheter ablation of VT in ToF patients.
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16
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Kapa S, Vaidya V, Hodge DO, McLeod CJ, Connolly HM, Warnes CA, Asirvatham SJ. Right ventricular dysfunction in congenitally corrected transposition of the great arteries and risk of ventricular tachyarrhythmia and sudden death. Int J Cardiol 2018; 258:83-89. [DOI: 10.1016/j.ijcard.2018.01.107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/06/2018] [Accepted: 01/22/2018] [Indexed: 11/25/2022]
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17
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Aziz Z, Tung R. Novel Mapping Strategies for Ventricular Tachycardia Ablation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:34. [PMID: 29572643 DOI: 10.1007/s11936-018-0615-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite advances in antiarrhythmic and device therapy, ventricular tachycardia (VT) continues to be a major cause of increased morbidity and mortality. During scar-mediated monomorphic ventricular tachycardia ablation, the search for critical isthmus sites continues to be the primary goal during successful ablative procedures. However, given the overwhelming hemodynamic instability of most ventricular arrhythmias (> 70%), VT ablation is increasingly performed during sinus rhythm. This technique requires either a greater reliance on isthmus surrogates, or more extensive ablation techniques and is a more probabilistic approach to substrate modification. We believe that a better understanding of scar physiology and activation during sinus rhythm has important implications for clinical workflow and mechanistic improvements with current ablation strategies. With advancements in high-density mapping and multi-electrode catheter technology, mapping of VT substrates is performed with higher resolution, with improved visualization of local abnormal ventricular activities (LAVA), and with a more nuanced functional understanding of late potentials. As a prerequisite, our practice for VT ablation starts with a high-density structural map to identify voltage abnormalities as well as an isochronal functional map of sinus rhythm activation to identify region of discontinuous wavefront propagation. As the era of increased automation has emerged, there continues to be vast array of customizable features, and we have adopted the use of multiple wavefront mapping to further elucidate possible arrhythmogenic substrate. Our emerging understanding of how scar propagation patterns relate to areas of abnormal signals and critical isthmuses may greatly improve the ability to identify surrogates during sinus rhythm and help localize the most arrhythmogenic regions within a given scar. In the hemodynamically unstable patients, we routinely integrate isochronal late activation mapping (ILAM) to identify areas of slow conduction to initiate our targeted ablation and substrate modification. Multi-electrode delineation of the entire reentrant VT circuit has value in understanding the size of the circuit, rotational nature, and transmural extent of human reentry. Correlative studies between the activation of the complete VT circuit and sinus rhythm are likely to provide important mechanistic insights on where fixed and/or functional block occurs within a complex scar substrate.
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Affiliation(s)
- Zaid Aziz
- Center for Arrhythmia Care, Pritzker School of Medicine, The University of Chicago Medicine, 5841 S. Maryland Ave. MC 6080, Chicago, IL, 60637, USA
| | - Roderick Tung
- Center for Arrhythmia Care, Pritzker School of Medicine, The University of Chicago Medicine, 5841 S. Maryland Ave. MC 6080, Chicago, IL, 60637, USA.
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18
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Lü F, Huang W, Benditt DG. A feasibility study of noninvasive ablation of ventricular tachycardia using high-intensity focused ultrasound. J Cardiovasc Electrophysiol 2018; 29:788-794. [PMID: 29431260 DOI: 10.1111/jce.13459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 11/07/2017] [Accepted: 01/25/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Current transcatheter ablation of ventricular tachycardia (VT) techniques is limited in part by its invasive nature and superficial depth of ablation lesions. OBJECTIVES This study was aimed at evaluating the feasibility of targeted ablation of cardiac tissues using high-intensity focused ultrasound (HIFU) as a potential means for noninvasive ablation of VT. METHODS Ablation of ventricular myocardium was performed in anesthetized closed-chest dogs using a HIFU therapeutic system that is currently used clinically for ablation of human solid tumors. Ventricular pacing using a bipolar catheter was performed at a rate slightly higher than intrinsic sinus rate to mimic VT. The myocardium at the tip of the pacing catheter was targeted for ablation. Ablation endpoint was loss of ventricular capture first and confirmed by electrical nonexcitation with 10-mA, 2-ms pulse-width unipolar stimulation. RESULTS Optimal ablation energy was identified at 400 W for 2-4 seconds. In five separate experimental preparations, pacing could be terminated successfully during HIFU energy delivery, which was further confirmed by electrical nonexcitation. However, capture could be obtained at other nonablated locations using the same pacing catheter. Both transmural and localized lesions could be created in a controlled fashion without apparent injury to skin, lung, or pericardium on postmortem examination. CONCLUSION This pilot study suggests that HIFU is potentially useful for noninvasive ablation of targeted, localized myocardial tissues, and it may be potentially applicable for VT ablation, particularly for those with intramyocardial/epicardial origins.
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Affiliation(s)
- Fei Lü
- Deborah Heart and Lung Center, Browns Mills, New Jersey, USA
| | - Wei Huang
- Chongqing Medical University, Chongqing, China
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19
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Güneş HM, Demir GG, Karaca O, Yılmaz FK, İbişoğlu E, Gökdeniz T, Omaygenç MO, Güler E, Güler GB, Savur Ü, Çakal B, Barutçu İ, Kılıçaslan F. The relationship between the S-wave in lead 1 and recurrence of RVOT PVC ablation. J Electrocardiol 2017; 51:519-523. [PMID: 29277286 DOI: 10.1016/j.jelectrocard.2017.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Radiofrequency catheter ablation (CA) is a common non-pharmacological treatment option for ventricular premature contractions (PVCs) originating from right ventricular outflow tract (RVOT). In this study, we aimed to investigate the relationship between recurrence after CA for RVOT-PVC and S-wave in lead 1 that was shown to be associated with RVOT depolarization. METHODOLOGY A total of 104 patients who were referred to our clinic for CA for idiopathic RVOT-PVC between 2012 and 2015years were enrolled. All ECG parameters were measured before and after the ablation procedure. RESULTS Ablation was successful in 100 patients (96,1%). These patients with successful ablation were followed for a mean duration of 1078days. 13 patients (13%) had recurrence. Univariate logistic regression analysis revealed age (odds ratio: 1.916, p:0,012), presence of post-procedural S1 (odds ratio:1.040 p:0,028), post-procedural S1 area (oddsratio:1.023 p:0,041), ΔS1 area (odds ratio:1.242 p:0,004) as predictors for recurrence. Multivariate logistic regression analysis detected age (odds ratio:1.053 p:0,032) and ΔS1 area (odds ratio:0.701 p:0,009) as predictors for recurrence. CONCLUSION Radiofrequency CA for RVOT-PVC can be performed with high procedural success and low complication rates. Age and ΔS1 area might be helpful for prediction of recurrence after CA.
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Affiliation(s)
- Hacı Murat Güneş
- Medipol University Faculty of Medicine, Cardiology Department, Istanbul, Turkey.
| | | | - Oğuz Karaca
- Medipol University Faculty of Medicine, Cardiology Department, Istanbul, Turkey
| | | | - Ersin İbişoğlu
- Medipol University Faculty of Medicine, Cardiology Department, Istanbul, Turkey
| | - Tayyar Gökdeniz
- Medipol University Faculty of Medicine, Cardiology Department, Istanbul, Turkey
| | | | - Ekrem Güler
- Medipol University Faculty of Medicine, Cardiology Department, Istanbul, Turkey
| | - Gamze Babur Güler
- Medipol University Faculty of Medicine, Cardiology Department, Istanbul, Turkey
| | - Ümeyir Savur
- Medipol University Faculty of Medicine, Cardiology Department, Istanbul, Turkey
| | - Beytullah Çakal
- Medipol University Faculty of Medicine, Cardiology Department, Istanbul, Turkey
| | - İrfan Barutçu
- Medipol University Faculty of Medicine, Cardiology Department, Istanbul, Turkey
| | - Fethi Kılıçaslan
- Medipol University Faculty of Medicine, Cardiology Department, Istanbul, Turkey
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20
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Lin CY, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Liao JN, Tuan TC, Chao TF, Chang YT, Chen YY, Te ALD, Yamada S, Kuo L, Vicera JJB, Chang TY, Minh HQ, Salim S, Huang TC, Chen SA. Novel electrophysiological criteria for septal ventricular outflow tract tachycardias requiring a sequential bilateral ablation. J Cardiovasc Electrophysiol 2017; 29:298-307. [PMID: 29071756 DOI: 10.1111/jce.13376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Septal ventricular outflow tract ventricular arrhythmias (OT-VAs) are defined as septal origin VAs from the right ventricular or left ventricular OT. Patients with septal OT-VAs may require a sequential bilateral OT ablation. This study aimed to evaluate the electrophysiological characteristics and ablation outcome in patients with septal OT-VAs. METHODS We retrospectively analyzed the electrocardiography and electrophysiological parameters in 96 patients (mean age 49 ± 15 years, 49 male) undergoing bilateral activation mapping before catheter ablation of idiopathic septal OT-VAs. The patients were categorized into three groups based on the successful ablation sites, including the right ventricular outflow tract (RVOT), RVOT/left ventricular outflow tract (LVOT), and LVOT. RESULTS Mapping in the three groups demonstrated a gradually decreasing and increasing trend in the earliest activation time obtained from the RVOT and LVOT, respectively. The absolute earliest activation time discrepancy (AEAD) of ≤18 milliseconds could predict the requirement for a sequential bilateral ablation with a sensitivity and specificity of 100.0% and 93.7%, respectively. The small AEAD (≤21 milliseconds) was associated with a higher recurrence rate in patients receiving a successful unilateral ablation, while patients with a longer distance between the bilateral OT earliest activation sites (DEA > 26 mm) increased future recurrences after an initially successful sequential bilateral ablation. CONCLUSIONS The application of bilateral OT-VA activation mapping and the measurement of the AEAD and DEA provided not only pivotal information for the ablation strategy, but also prognostic implications for recurrences in patients with septal OT-VAs.
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Affiliation(s)
- Chin-Yu Lin
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, Taipei Veterans General Hospital, YuanShan Branch, Yi-Lan, Taiwan
| | - Fa-Po Chung
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Lin Chang
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Wei Lo
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Feng Hu
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jo-Nan Liao
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tze-Fan Chao
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yao-Ting Chang
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yun-Yu Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Abigail Louise D Te
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shinya Yamada
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ling Kuo
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jennifer Jeanne B Vicera
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ting-Yung Chang
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hoang Quang Minh
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Simon Salim
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ting-Chung Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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21
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New tools to make percutaneous epicardial access safer: Is the real-time pressure/frequency monitoring on the needle tip the best way? Heart Rhythm 2017; 14:989-990. [DOI: 10.1016/j.hrthm.2017.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Indexed: 11/24/2022]
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22
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Meglan DA, Lv W, Cohen RJ, Riviere CN. Techniques for epicardial mapping and ablation with a miniature robotic walker. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:25-31. [PMID: 28966928 PMCID: PMC5619864 DOI: 10.2147/rsrr.s127047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Present treatments for ventricular tachycardia have significant drawbacks. To ameliorate these drawbacks, it may be advantageous to employ an epicardial robotic walker that performs mapping and ablation with precise control of needle insertion depth. This paper examines the feasibility of such a system. Methods This paper describes the techniques for epicardial mapping and depth-controlled ablation with the robotic walker. The mapping technique developed for the current form of the system uses a single equivalent moving dipole (SEMD) model combined with the navigation capability of the walker. The intervention technique provides saline-enhanced radio frequency ablation, with sensing of needle penetration depth. The mapping technique was demonstrated in an artificial heart model with a simulated arrhythmia focus, followed by preliminary testing in the porcine model in vivo. The ablation technique was demonstrated in an artificial tissue model and then in chicken breast tissue ex vivo. Results The walker located targets to within 2 mm by using the SEMD mapping technique. No epicardial damage was found subsequent to the porcine trial in vivo. Needle insertion for ablation was controlled to within 2 mm of the target depth. Lesion size was repeatable, with diameter varying consistently in proportion to the volume of saline injected. Conclusion The experiments demonstrated the general feasibility of the techniques for mapping and depth-controlled ablation with the robotic walker.
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Affiliation(s)
| | - Wener Lv
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Richard J Cohen
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Cameron N Riviere
- The Robotics Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
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23
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Briceño DF, Romero J, Gianni C, Mohanty S, Villablanca PA, Natale A, Di Biase L. Substrate Ablation of Ventricular Tachycardia: Late Potentials, Scar Dechanneling, Local Abnormal Ventricular Activities, Core Isolation, and Homogenization. Card Electrophysiol Clin 2017; 9:81-91. [PMID: 28167088 DOI: 10.1016/j.ccep.2016.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bhandary SP, Joseph N, Hofmann JP, Saranteas T, Papadimos TJ. Extracorporeal life support for refractory ventricular tachycardia. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:73. [PMID: 28275618 DOI: 10.21037/atm.2017.01.39] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Extracorporeal life support (ECLS) is a very effective bridging therapy in patients with refractory ventricular tachycardia (VT) associated with cardiogenic shock. A moribund patient in extremis, is not amenable to optimization by standard ACC/AHA guidelines. New approaches and novel salvage techniques are necessary to improve outcomes in patients with refractory clinical settings such as malignant ventricular arrhythmias, cardiac arrest, cardiogenic shock and/or pulmonary failure until further management options are explored. Data base searches were done using key words such as ECLS, VT, cardiac arrest, VT ablation, venoarterial extra-corporeal membrane oxygenation (VA-ECMO). The use of ECLS has been described in a few case reports to facilitate VT ablation for incessant VT refractory to medical therapy. For patients with, out-of- hospital ventricular fibrillation (VF) and VT, Minnesota Resuscitation Consortium has implemented emergent advanced perfusion and reperfusion strategy, followed by coronary angiography and primary coronary intervention to improve outcome. The major indications for ECLS are cardiogenic shock related to acute myocardial infarction, myocarditis, post embolic acute cor pulmonale, drug intoxication and post cardiac arrest syndrome with the threat of multi-organ failure. ECLS permits the use of negative inotropic antiarrhythmic drug therapy, facilitates the weaning of catecholamine administration, thereby ending the vicious cycle of catecholamine driven electric storm. ECLS provides hemodynamic support during ablation procedure, while mapping and induction of VT is undertaken. ECLS provides early access to cardiac catheterization laboratory in patients with cardiac arrest due to shockable rhythm. The current evidence from literature, supports the use of ECLS to ensure adequate vital organ perfusion in patients with refractory VT. ECLS is a safe, feasible and effective therapeutic option when conventional therapies are insufficient to support cardiopulmonary function. A highly driven multidisciplinary team approach is essential to accomplish this task.
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Affiliation(s)
- Sujatha P Bhandary
- Department of Anesthesiology, Division of Cardiothoracic and Vascular Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nicholas Joseph
- Department of Anesthesiology, Division of Cardiothoracic and Vascular Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA;; Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - James P Hofmann
- Department of Anesthesiology, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | | | - Thomas J Papadimos
- Department of Anesthesiology, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
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Kurzendorfer T, Mewes PW, Maier A, Strobel N, Brost A. Cryo-Balloon Catheter Localization Based on a Support-Vector-Machine Approach. IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:1892-1902. [PMID: 26978663 DOI: 10.1109/tmi.2016.2537052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cryo-balloon catheters have attracted an increasing amount of interest in the medical community as they can reduce patient risk during left atrial pulmonary vein ablation procedures. As cryo-balloon catheters are not equipped with electrodes, they cannot be localized automatically by electro-anatomical mapping systems. As a consequence, X-ray fluoroscopy has remained an important means for guidance during the procedure. Most recently, image guidance methods for fluoroscopy-based procedures have been proposed, but they provide only limited support for cryo-balloon catheters and require significant user interaction. To improve this situation, we propose a novel method for automatic cryo-balloon catheter detection in fluoroscopic images by detecting the cryo-balloon catheter's built-in X-ray marker. Our approach is based on a blob detection algorithm to find possible X-ray marker candidates. Several of these candidates are then excluded using prior knowledge. For the remaining candidates, several catheter specific features are introduced. They are processed using a machine learning approach to arrive at the final X-ray marker position. Our method was evaluated on 75 biplane fluoroscopy images from 40 patients, from two sites, acquired with a biplane angiography system. The method yielded a success rate of 99.0% in plane A and 90.6% in plane B, respectively. The detection achieved an accuracy of 1.00 mm±0.82 mm in plane A and 1.13 mm±0.24 mm in plane B. The localization in 3-D was associated with an average error of 0.36 mm±0.86 mm.
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Duell J, Dilsizian V, Smith M, Chen W, Dickfeld T. Nuclear Imaging Guidance for Ablation of Ventricular Arrhythmias. Curr Cardiol Rep 2016; 18:19. [DOI: 10.1007/s11886-015-0697-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chen J, Hocini M, Larsen TB, Proclemer A, Sciaraffia E, Blomström-Lundqvist C. Clinical management of arrhythmias in elderly patients: results of the European Heart Rhythm Association survey. Europace 2015; 17:314-7. [PMID: 25634939 DOI: 10.1093/europace/euv010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The purpose of this survey was to assess clinical practice in management of cardiac arrhythmias in elderly patients (age ≥75 years) in the European countries. The data are based on an electronic questionnaire sent to the European Heart Rhythm Association Research Network members. Responses were received from 50 centres in 20 countries. The results of the survey have shown that management of cardiac arrhythmias is generally in accordance with the guidelines and consensus recommendations on management of cardiac arrhythmias, although there are some areas of variation, especially on age limit and exclusion of elderly patients for anticoagulation, ablation, and device therapy.
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Affiliation(s)
- Jian Chen
- Department of Heart Disease, Haukeland University Hospital, N-5021 Bergen, Norway Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut Lévêque Université Victor Segalen Bordeaux II, 33600 Bordeaux, Pessac, France
| | | | - Alessandro Proclemer
- Division of Cardiology, University Hospital S. Maria della Misericordia, IRCAB Foundation Udine, Udine, Italy
| | - Elena Sciaraffia
- Department of Cardiology, Institution of Medical Science, Uppsala University, 75185 Uppsala, Sweden
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Jackson N, Gizurarson S, Viswanathan K, King B, Massé S, Kusha M, Porta-Sanchez A, Jacob JR, Khan F, Das M, Ha ACT, Pashaei A, Vigmond E, Downar E, Nanthakumar K. Decrement Evoked Potential Mapping: Basis of a Mechanistic Strategy for Ventricular Tachycardia Ablation. Circ Arrhythm Electrophysiol 2015; 8:1433-42. [PMID: 26480929 DOI: 10.1161/circep.115.003083] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 10/13/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Substrate-based mapping for ventricular tachycardia (VT) ablation is hampered by its inability to determine critical sites of the VT circuit. We hypothesized that those potentials, which delay with a decremental extrastimulus (decrement evoked potentials or DEEPs), are more likely to colocalize with the diastolic pathways of VT circuits. METHODS AND RESULTS DEEPs were identified in intraoperative left ventricular maps from 6 patients with ischemic cardiomyopathy (total 9 VTs) and were compared with late potential (LP) and activation maps of the diastolic pathway for each VT. Mathematical modeling was also used to further validate and elucidate the mechanisms of DEEP mapping. All patients demonstrated regions of DEEPs and LPs. The mean endocardial surface area of these potentials was 18±4% and 21±6%, respectively (P=0.13). The mean sensitivity for identifying the diastolic pathway in VT was 50±23% for DEEPs and 36±32% for LPs (P=0.31). The mean specificity was 43±23% versus 20±8% for DEEP and LP mapping, respectively (P=0.031). The electrograms that displayed the greatest decrement in each case had a sensitivity and specificity for the VT isthmus of 29±10% and 95±1%, respectively. Mathematical modeling studies recapitulated DEEPs at the VT isthmus and demonstrated their role in VT initiation with a critical degree of decrement. CONCLUSIONS In this preliminary study, DEEP mapping was more specific than LP mapping for identifying the critical targets of VT ablation. The mechanism of DEEPs relates to conduction velocity restitution magnified by zigzag conduction within scar channels.
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Affiliation(s)
- Nicholas Jackson
- From the Toronto General Hospital, Toronto, Ontario, Canada (N.J., S.G., K.V., B.K., S.M., M.K., A.P.-S., J.R.J., F.K., M.D., A.C.T.H., E.D., K.N.); Laboratory IMB, University of Bordeaux, Talence, France (A.P., E.V.); and LIRYC Cardiac Electrophysiology and Heart Modelling Institute, University of Bordeaux Foundation, Pessac, France (A.P., E.V.)
| | - Sigfus Gizurarson
- From the Toronto General Hospital, Toronto, Ontario, Canada (N.J., S.G., K.V., B.K., S.M., M.K., A.P.-S., J.R.J., F.K., M.D., A.C.T.H., E.D., K.N.); Laboratory IMB, University of Bordeaux, Talence, France (A.P., E.V.); and LIRYC Cardiac Electrophysiology and Heart Modelling Institute, University of Bordeaux Foundation, Pessac, France (A.P., E.V.)
| | - Karthik Viswanathan
- From the Toronto General Hospital, Toronto, Ontario, Canada (N.J., S.G., K.V., B.K., S.M., M.K., A.P.-S., J.R.J., F.K., M.D., A.C.T.H., E.D., K.N.); Laboratory IMB, University of Bordeaux, Talence, France (A.P., E.V.); and LIRYC Cardiac Electrophysiology and Heart Modelling Institute, University of Bordeaux Foundation, Pessac, France (A.P., E.V.)
| | - Benjamin King
- From the Toronto General Hospital, Toronto, Ontario, Canada (N.J., S.G., K.V., B.K., S.M., M.K., A.P.-S., J.R.J., F.K., M.D., A.C.T.H., E.D., K.N.); Laboratory IMB, University of Bordeaux, Talence, France (A.P., E.V.); and LIRYC Cardiac Electrophysiology and Heart Modelling Institute, University of Bordeaux Foundation, Pessac, France (A.P., E.V.)
| | - Stephane Massé
- From the Toronto General Hospital, Toronto, Ontario, Canada (N.J., S.G., K.V., B.K., S.M., M.K., A.P.-S., J.R.J., F.K., M.D., A.C.T.H., E.D., K.N.); Laboratory IMB, University of Bordeaux, Talence, France (A.P., E.V.); and LIRYC Cardiac Electrophysiology and Heart Modelling Institute, University of Bordeaux Foundation, Pessac, France (A.P., E.V.)
| | - Marjan Kusha
- From the Toronto General Hospital, Toronto, Ontario, Canada (N.J., S.G., K.V., B.K., S.M., M.K., A.P.-S., J.R.J., F.K., M.D., A.C.T.H., E.D., K.N.); Laboratory IMB, University of Bordeaux, Talence, France (A.P., E.V.); and LIRYC Cardiac Electrophysiology and Heart Modelling Institute, University of Bordeaux Foundation, Pessac, France (A.P., E.V.)
| | - Andreu Porta-Sanchez
- From the Toronto General Hospital, Toronto, Ontario, Canada (N.J., S.G., K.V., B.K., S.M., M.K., A.P.-S., J.R.J., F.K., M.D., A.C.T.H., E.D., K.N.); Laboratory IMB, University of Bordeaux, Talence, France (A.P., E.V.); and LIRYC Cardiac Electrophysiology and Heart Modelling Institute, University of Bordeaux Foundation, Pessac, France (A.P., E.V.)
| | - John Roshan Jacob
- From the Toronto General Hospital, Toronto, Ontario, Canada (N.J., S.G., K.V., B.K., S.M., M.K., A.P.-S., J.R.J., F.K., M.D., A.C.T.H., E.D., K.N.); Laboratory IMB, University of Bordeaux, Talence, France (A.P., E.V.); and LIRYC Cardiac Electrophysiology and Heart Modelling Institute, University of Bordeaux Foundation, Pessac, France (A.P., E.V.)
| | - Fakhar Khan
- From the Toronto General Hospital, Toronto, Ontario, Canada (N.J., S.G., K.V., B.K., S.M., M.K., A.P.-S., J.R.J., F.K., M.D., A.C.T.H., E.D., K.N.); Laboratory IMB, University of Bordeaux, Talence, France (A.P., E.V.); and LIRYC Cardiac Electrophysiology and Heart Modelling Institute, University of Bordeaux Foundation, Pessac, France (A.P., E.V.)
| | - Moloy Das
- From the Toronto General Hospital, Toronto, Ontario, Canada (N.J., S.G., K.V., B.K., S.M., M.K., A.P.-S., J.R.J., F.K., M.D., A.C.T.H., E.D., K.N.); Laboratory IMB, University of Bordeaux, Talence, France (A.P., E.V.); and LIRYC Cardiac Electrophysiology and Heart Modelling Institute, University of Bordeaux Foundation, Pessac, France (A.P., E.V.)
| | - Andrew C T Ha
- From the Toronto General Hospital, Toronto, Ontario, Canada (N.J., S.G., K.V., B.K., S.M., M.K., A.P.-S., J.R.J., F.K., M.D., A.C.T.H., E.D., K.N.); Laboratory IMB, University of Bordeaux, Talence, France (A.P., E.V.); and LIRYC Cardiac Electrophysiology and Heart Modelling Institute, University of Bordeaux Foundation, Pessac, France (A.P., E.V.)
| | - Ali Pashaei
- From the Toronto General Hospital, Toronto, Ontario, Canada (N.J., S.G., K.V., B.K., S.M., M.K., A.P.-S., J.R.J., F.K., M.D., A.C.T.H., E.D., K.N.); Laboratory IMB, University of Bordeaux, Talence, France (A.P., E.V.); and LIRYC Cardiac Electrophysiology and Heart Modelling Institute, University of Bordeaux Foundation, Pessac, France (A.P., E.V.)
| | - Edward Vigmond
- From the Toronto General Hospital, Toronto, Ontario, Canada (N.J., S.G., K.V., B.K., S.M., M.K., A.P.-S., J.R.J., F.K., M.D., A.C.T.H., E.D., K.N.); Laboratory IMB, University of Bordeaux, Talence, France (A.P., E.V.); and LIRYC Cardiac Electrophysiology and Heart Modelling Institute, University of Bordeaux Foundation, Pessac, France (A.P., E.V.)
| | - Eugene Downar
- From the Toronto General Hospital, Toronto, Ontario, Canada (N.J., S.G., K.V., B.K., S.M., M.K., A.P.-S., J.R.J., F.K., M.D., A.C.T.H., E.D., K.N.); Laboratory IMB, University of Bordeaux, Talence, France (A.P., E.V.); and LIRYC Cardiac Electrophysiology and Heart Modelling Institute, University of Bordeaux Foundation, Pessac, France (A.P., E.V.)
| | - Kumaraswamy Nanthakumar
- From the Toronto General Hospital, Toronto, Ontario, Canada (N.J., S.G., K.V., B.K., S.M., M.K., A.P.-S., J.R.J., F.K., M.D., A.C.T.H., E.D., K.N.); Laboratory IMB, University of Bordeaux, Talence, France (A.P., E.V.); and LIRYC Cardiac Electrophysiology and Heart Modelling Institute, University of Bordeaux Foundation, Pessac, France (A.P., E.V.).
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Conti S, Pala S, Biagioli V, Del Giorno G, Zucchetti M, Russo E, Marino V, Dello Russo A, Casella M, Pizzamiglio F, Catto V, Tondo C, Carbucicchio C. Electrical storm: A clinical and electrophysiological overview. World J Cardiol 2015; 7:555-61. [PMID: 26413232 PMCID: PMC4577682 DOI: 10.4330/wjc.v7.i9.555] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/04/2015] [Accepted: 07/29/2015] [Indexed: 02/06/2023] Open
Abstract
Electrical storm (ES) is a clinical condition characterized by three or more ventricular arrhythmia episodes leading to appropriate implantable cardioverter-defibrillator (ICD) therapies in a 24 h period. Mostly, arrhythmias responsible of ES are multiple morphologies of monomorphic ventricular tachycardia (VT), but polymorphic VT and ventricular fibrillation can also result in ES. Clinical presentation is very dramatic in most cases, strictly related to the cardiac disease that may worsen electrical and hemodynamic decompensation. Therefore ES management is challenging in the majority of cases and a high mortality is the rule both in the acute and in the long-term phases. Different underlying cardiomyopathies provide significant clues into the mechanism of ES, which can arise in the setting of structural arrhythmogenic cardiomyopathies or rarely in patients with inherited arrhythmic syndrome, impacting on pharmacological treatment, on ICD programming, and on the opportunity to apply strategies of catheter ablation. This latter has become a pivotal form of treatment due to its high efficacy in modifying the arrhythmogenic substrate and in achieving rhythm stability, aiming at reducing recurrences of ventricular arrhythmia and at improving overall survival. In this review, the most relevant epidemiological and clinical aspects of ES, with regard to the acute and long-term follow-up implications, were evaluated, focusing on these novel therapeutic strategies of treatment.
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Affiliation(s)
- Sergio Conti
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Salvatore Pala
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Viviana Biagioli
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Giuseppe Del Giorno
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Martina Zucchetti
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Eleonora Russo
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Vittoria Marino
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Antonio Dello Russo
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Michela Casella
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Francesca Pizzamiglio
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Valentina Catto
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Claudio Tondo
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Corrado Carbucicchio
- Sergio Conti, Salvatore Pala, Viviana Biagioli, Giuseppe Del Giorno, Martina Zucchetti, Eleonora Russo, Vittoria Marino, Antonio Dello Russo, Michela Casella, Francesca Pizzamiglio, Valentina Catto, Claudio Tondo, Corrado Carbucicchio, Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
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DILLING-BOER DAGMARA, VANDUYNHOVEN PHILIPPE. Lessons Learned from Asymptomatic Acute Coronary Occlusion Complicating Radiofrequency Ablation of Right Ventricular Outflow Tract Tachycardia. J Cardiovasc Electrophysiol 2015; 26:1269-1272. [DOI: 10.1111/jce.12777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/23/2015] [Accepted: 08/06/2015] [Indexed: 11/27/2022]
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Berte B, Relan J, Sacher F, Pillois X, Appetiti A, Yamashita S, Mahida S, Casassus F, Hooks D, Sellal JM, Amraoui S, Denis A, Derval N, Cochet H, Hocini M, Haïssaguerre M, Weerasooriya R, Jaïs P. Impact of Electrode Type on Mapping of Scar-Related VT. J Cardiovasc Electrophysiol 2015. [PMID: 26198475 DOI: 10.1111/jce.12761] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Substrate-based VT ablation is mostly based on maps acquired with ablation catheters. We hypothesized that multipolar mapping catheters are more effective for identification of scar and local abnormal ventricular activity (LAVA). METHODS AND RESULTS Phase1: In a sheep infarction model (2 months postinfarction), substrate mapping and LAVA tagging (CARTO® 3) was performed, using a Navistar (NAV) versus a PentaRay (PR) catheter (Biosense Webster). Phase2: Consecutive VT ablation patients from a single center underwent NAV versus PR mapping. Point pairs were defined as a PR and a NAV point located within a 3D-distance of ≤3 mm. Agreement was defined as both points in a pair being manually tagged as normal or LAVA. Four sheep (4 years, 50 ± 4.8 kg) and 9 patients were included (53 ± 14 years, 8 male, 6 ischemic cardiomyopathy). Mapping density was higher within the scar with PR versus NAV (3.2 vs. 0.7 points/cm2 , P = 0.001) with larger bipolar scar area (68 ± 55 cm2 vs. 58 ± 48 cm2 , P = 0.001). In total, 818 point pairs were analyzed. Using PR, far-field voltages were smaller (PR vs. NAV; bipolar: 1.43 ± 1.84 mV vs. 1.64 ± 2.04 mV, P = 0.001; unipolar; 4.28 ± 3.02 mV vs. 4.59 ± 3.67 mV, P < 0.001). More LAVA were also detected with PR (PR vs. NAV; 126 ± 113 vs. 36 ± 29, P = 0.001). When agreement on LAVA was reached (overall: 72%; both LAVA, 40%; both normal, 82%) higher LAVA voltages were recorded on PR (0.48 ± 0.33 mV vs. 0.31 ± 0.21 mV, P = 0.0001). CONCLUSION Multipolar mapping catheters with small electrodes provide more accurate and higher density maps, with a higher sensitivity to near-field signals. Agreement between PR and NAV is low.
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Affiliation(s)
- Benjamin Berte
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
| | - Jatin Relan
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
| | - Frederic Sacher
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
| | - Xavier Pillois
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
| | - Anthony Appetiti
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
| | - Seigo Yamashita
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
| | - Saagar Mahida
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
| | - Frederic Casassus
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
| | - Darren Hooks
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
| | - Jean-Marc Sellal
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
| | - Sana Amraoui
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
| | - Arnaud Denis
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
| | - Hubert Cochet
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
| | - Mélèze Hocini
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
| | - Rukshen Weerasooriya
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut-L'évêque, Université de Bordeaux, LIRYC Institute, Bordeaux, France
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Tanawuttiwat T, Nazarian S, Calkins H. The role of catheter ablation in the management of ventricular tachycardia. Eur Heart J 2015; 37:594-609. [DOI: 10.1093/eurheartj/ehv421] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/07/2015] [Indexed: 12/11/2022] Open
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Healy C, Viles-Gonzalez JF, Sáenz LC, Soto M, Ramírez JD, d'Avila A. Arrhythmias in chagasic cardiomyopathy. Card Electrophysiol Clin 2015; 7:251-268. [PMID: 26002390 DOI: 10.1016/j.ccep.2015.03.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Chagas disease, a chronic parasitosis caused by the protozoa Trypanosoma cruzi, is an increasing worldwide problem because of the number of cases in endemic areas and the migration of infected individuals to more developed regions. Chagas disease affects the heart through cardiac parasympathetic neuronal depopulation, immune-mediated myocardial injury, parasite persistence in cardiac tissue with secondary antigenic stimulation, and coronary microvascular abnormalities causing myocardial ischemia. A lack of knowledge exists for risk stratification, management, and prevention of ventricular arrhythmias in patients with chagasic cardiomyopathy. Catheter ablation can be effective for the management of recurrent ventricular tachycardia.
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Affiliation(s)
- Chris Healy
- Department of Cardiac Electrophysiology, University of Miami Miller School of Medicine, 1295 NW 14th Street, South Building, Suite A, Miami, FL 33125, USA
| | - Juan F Viles-Gonzalez
- Department of Cardiac Electrophysiology, University of Miami Miller School of Medicine, 1295 NW 14th Street, South Building, Suite A, Miami, FL 33125, USA
| | - Luis C Sáenz
- Cardiólogo-Electrofisiólogo, Fundación Cardio Infantil-Instituto de Cardiología, Calle 163A No 13B-60, Bogotá, Colombia
| | - Mariana Soto
- Cardiólogo-Electrofisiólogo, Fundación Cardio Infantil-Instituto de Cardiología, Calle 163A No 13B-60, Bogotá, Colombia
| | - Juan D Ramírez
- Cardiólogo-Electrofisiólogo, Fundación Cardio Infantil-Instituto de Cardiología, Calle 163A No 13B-60, Bogotá, Colombia
| | - Andre d'Avila
- Hospital Cardiologico, Rodovia SC 401, 121, Itacorubi, Florianopolis, Santa Catarina, Brazil, CEP: 88030-000.
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35
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Santangeli P, Frankel DS, Marchlinski FE. End Points for Ablation of Scar-Related Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2014; 7:949-60. [DOI: 10.1161/circep.114.001585] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Pasquale Santangeli
- From the Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
| | - David S. Frankel
- From the Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Francis E. Marchlinski
- From the Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
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36
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Nakahara S, Hori Y, Kobayashi S, Tsukada N, Sakai Y, Takayanagi K. Dissociated late potentials during sinus rhythm after radiofrequency ablation in a patient with postinfarction ventricular tachycardia. J Arrhythm 2014. [DOI: 10.1016/j.joa.2013.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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37
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Galvão Santos P, Cavaco D, Adragão P, Scanavacca M, Reis Santos K, Belo Morgado F, Carmo P, Costa F, Bernardo R, Nunes M, Abecasis M, Neves J, Mendes M. Percutaneous epicardial ablation in ventricular arrhythmias. Rev Port Cardiol 2014; 33:273-9. [PMID: 24865890 DOI: 10.1016/j.repc.2013.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 10/24/2013] [Accepted: 10/26/2013] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Reentrant circuits of ventricular tachycardia may involve not only the endocardium but also the epicardium. Epicardial ablation can be useful in these situations. OBJECTIVE The aim of this study was to assess efficacy, safety and complications in a series of consecutive patients who underwent ablation of ventricular tachycardia with epicardial mapping. METHODS The study included all patients undergoing ventricular tachycardia ablation with epicardial mapping from 2004 to 2012. Of a total of 95 ablations, an epicardial approach was attempted in nine patients, eight male, mean age 58±12 years. Endocardial mapping was performed in all patients previously or simultaneously. The etiology of the arrhythmia was non-ischemic in eight patients and ischemic in one. We compared the number of events in the six months prior to the epicardial procedure and six months after. RESULTS Percutaneous epicardial access was achieved in eight patients. In one case it was not possible due to the presence of adhesions. In none of the patients was the procedure repeated and there were no major complications during hospitalization. In a mean follow-up of 3.5±1.2 years, one patient suffered stroke; there were no other medium-to-long-term complications and the number of ventricular tachycardia episodes was reduced in all patients after ablation. CONCLUSIONS Epicardial radiofrequency ablation of ventricular tachycardia was effective in reducing morbidity in eight patients, with a low risk of complications in the short and medium-to-long term.
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Affiliation(s)
- Pedro Galvão Santos
- Serviço de Cardiologia, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal.
| | - Diogo Cavaco
- Serviço de Cardiologia, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Pedro Adragão
- Serviço de Cardiologia, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Mauricio Scanavacca
- Instituto do Coração (InCor), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Katya Reis Santos
- Serviço de Cardiologia, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Francisco Belo Morgado
- Serviço de Cardiologia, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Pedro Carmo
- Serviço de Cardiologia, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Francisco Costa
- Serviço de Cardiologia, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Ricardo Bernardo
- Serviço de Cardiologia, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Manuela Nunes
- Serviço de Cardiologia, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Miguel Abecasis
- Serviço de Cardiologia, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - José Neves
- Serviço de Cardiologia, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
| | - Miguel Mendes
- Serviço de Cardiologia, Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Carnaxide, Portugal
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38
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Galvão Santos P, Cavaco D, Adragão P, Scanavacca M, Reis Santos K, Belo Morgado F, Carmo P, Costa F, Bernardo R, Nunes M, Abecasis M, Neves J, Mendes M. Percutaneous epicardial ablation in ventricular arrhythmias. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2013.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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39
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Ling Z, Hari A, Tandri H. VT ablation: New Developments and Approaches. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:297. [PMID: 24515355 DOI: 10.1007/s11936-014-0297-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OPINION STATEMENT Over the past decade, catheter ablation has emerged as an important therapeutic option for ventricular tachycardia (VT) in both patients with and without structural heart disease. In patients without structural heart disease, catheter ablation serves as sole therapy for the treatment of VT. For those with structural heart disease, VT ablation has generally been reserved for patients who experience ICD therapies, and particularly those who fail antiarrhythmic agents. With the growing number of patients with implantable devices as well as improvements in heart failure therapy resulting in improved survival among ICD patients, the overall number of patients needing therapy for VT continues to increase. The past years have witnessed significant advances in our understanding of the arrhythmic substrate in various cardiomyopathies, resulting in substrate-based approaches for targeted VT ablation. Further, the growth in better technologies and techniques for VT ablation, such as the use of percutaneous epicardial ablation, the innovation of multielectrode catheters for rapid mapping, the use of intracardiac echocardiography (ICE) for mapping unusual sites, and activation and entrainment mapping of previously unmappable VTs assisted by mechanical circulatory support devices, has overcome the limitations and greatly improved the success rates of catheter ablation. This review summarizes recent advances and novel approaches in both technology and techniques for catheter ablation of ventricular tachycardia.
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Affiliation(s)
- Zhiyu Ling
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
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40
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Schleifer JW, Mookadam F, Srivathsan K. Recent developments in the ablation of ventricular arrhythmias. Future Cardiol 2013; 9:799-808. [PMID: 24180538 DOI: 10.2217/fca.13.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Catheter ablation for the management of recurrent ventricular arrhythmias (VAs) is an emerging technology, with good efficacy in selected patients. It is an effective treatment for recurrent VA and can terminate VA during electrical storm. Recent innovations enhance the accuracy of ventricular mapping, allowing for substrate modification while the patient remains in sinus rhythm, thus facilitating the treatment of different types of VA. Epicardial ablation is now a feasible option for treating VA and increases the likelihood of success in certain types of VA. Percutaneous hemodynamic support facilitates successful ablation during poorly tolerated VA. This article reviews recent advances in catheter ablation techniques for VA and approaches to the management of specific types of VA, with a view toward future developments.
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Affiliation(s)
- John William Schleifer
- Mayo Clinic Arizona, Division of Cardiovascular Diseases, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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41
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Komatsu Y, Daly M, Sacher F, Derval N, Pascale P, Roten L, Scherr D, Jadidi A, Ramoul K, Denis A, Jesel L, Zellerhoff S, Lim HS, Shah A, Cochet H, Hocini M, Haïssaguerre M, Jaïs P. Electrophysiologic characterization of local abnormal ventricular activities in postinfarction ventricular tachycardia with respect to their anatomic location. Heart Rhythm 2013; 10:1630-7. [DOI: 10.1016/j.hrthm.2013.08.031] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Indexed: 11/27/2022]
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42
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Lü F, Eckman PM, Liao KK, Apostolidou I, John R, Chen T, Das GS, Francis GS, Lei H, Trohman RG, Benditt DG. Catheter ablation of hemodynamically unstable ventricular tachycardia with mechanical circulatory support. Int J Cardiol 2013; 168:3859-65. [DOI: 10.1016/j.ijcard.2013.06.035] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 04/26/2013] [Accepted: 06/21/2013] [Indexed: 12/17/2022]
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43
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Carbucicchio C, Ahmad Raja N, Di Biase L, Volpe V, Dello Russo A, Trivedi C, Bartoletti S, Zucchetti M, Casella M, Russo E, Santangeli P, Moltrasio M, Tundo F, Fassini G, Natale A, Tondo C. High-density substrate-guided ventricular tachycardia ablation: role of activation mapping in an attempt to improve procedural effectiveness. Heart Rhythm 2013; 10:1850-8. [PMID: 24055940 DOI: 10.1016/j.hrthm.2013.09.059] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Indexed: 01/29/2023]
Abstract
BACKGROUND Advanced techniques of electroanatomical mapping efficiently guide ventricular tachycardia (VT) ablation strategies; in this context, the adjunctive value of combining activation mapping (AMap) to improve accuracy has not been elucidated. OBJECTIVE To investigate whether conventional AMap further contributes to the identification of critical sites of VT reentry and whether this translates into a more effective ablation outcome in a cohort of patients undergoing VT ablation. METHODS We prospectively enrolled 126 patients (mean age 65.3 ± 10.5 years; left ventricular ejection fraction 33.3% ± 7.2%) with ischemic (n = 89) or idiopathic (n = 37) dilated cardiomyopathy undergoing endocardial (n = 105) or endo-epicardial (n = 21) electroanatomical mapping and ablation. A substrate-guided strategy targeting surrogate markers of reentry was accomplished in all patients, but the feasibility and efficacy of AMap was preliminarily assessed for all induced VTs focusing on early VT suppression obtained during radiofrequency delivery. VT-free survival was assessed by ICD interrogation. RESULTS AMap successfully guided ablation in 62 of 104 (59.6%) patients with inducible VT(s). At 1 year, 6 of 126 (4.8%) patients died; VT recurred in 28 of 126 (22.2%) patients. No significant difference in VT recurrence rate was observed between patients in whom AMap proved effective versus those in whom substrate-guided ablation was not corroborated by AMap (16 of 62 [25.8%] vs 12 of 64 [18.8%]; log-rank test, P = .3). CONCLUSIONS Our findings support the efficacy of a substrate-guided strategy targeting specific markers of arrhythmogenicity identified during sinus rhythm. AMap proves highly efficient acutely but does not improve overall VT-free survival, suggesting that in patients with advanced cardiac disease, life-threatening arrhythmias can be successfully treated by ablation in sinus rhythm, thus limiting procedural risks.
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Affiliation(s)
- Corrado Carbucicchio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
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44
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Schmidt E, Schneider R, Lauschke J, Wendig I, Bänsch D. The HATCH and CHA2DS2-VASc scores. Herz 2013; 39:343-8. [DOI: 10.1007/s00059-013-3835-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
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45
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BIASE LUIGIDI, SANTANGELI PASQUALE, BURKHARDT JDAVID, NATALE ANDREA. Ventricular Tachycardia Ablation as First Line Therapy: Are We There Yet? J Cardiovasc Electrophysiol 2013; 24:530-3. [DOI: 10.1111/jce.12107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- LUIGI DI BIASE
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
- Albert Einstein College of Medicine at Montefiore Hospital; Bronx, New York USA
- Department of Biomedical Engineering; University of Texas; Austin Texas USA
- Department of Cardiology; University of Foggia; Foggia Italy
| | - PASQUALE SANTANGELI
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
- Department of Cardiology; University of Foggia; Foggia Italy
- Division of Cardiology; Stanford University; Palo Alto California USA
| | - J. DAVID BURKHARDT
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
| | - ANDREA NATALE
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin Texas USA
- Department of Biomedical Engineering; University of Texas; Austin Texas USA
- Division of Cardiology; Stanford University; Palo Alto California USA
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46
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HAQQANI HARISM, MARCHLINSKI FRANCISE. Improving the Resolution of Ventricular Tachycardia Substrate Mapping: Marrying (Ultra)Structure and Function. J Cardiovasc Electrophysiol 2012; 24:427-9. [DOI: 10.1111/jce.12061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Kleemann T, Kouraki K, Strauss M, Skarlos A, Zeymer U, Zahn R. Prognostic value of electromagnetic QRS fragmentation in survivors of sustained ventricular tachycardia or ventricular fibrillation compared with healthy controls. J Interv Card Electrophysiol 2012. [PMID: 23179924 DOI: 10.1007/s10840-012-9754-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Magnet field imaging (MFI) is a noninvasive method to determine cardiac electromagnetic activity. AIM OF THE STUDY This study aims to compare the electromagnetic QRS fragmentation index (eQFI) in survivors of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) to healthy individuals. METHODS Twenty-five consecutive patients with documented sustained VT or VF who underwent a MFI investigation between December 2009 and October 2011 were compared with 25 age- and sex-matched healthy individuals. RESULTS Patients with documented VT or VF showed a trend to higher eQFI values compared with the control group (p = 0.06). This increase was mainly driven by VT/VF patients with ischemic cardiomyopathy (CMP) which was markedly elevated compared with the healthy controls (1.48 vs. 1.07; p = 0.01). In patients with nonischemic CMP or acute coronary syndrome, eQFI was not different from the healthy group. CONCLUSIONS Electromagnetic QRS fragmentation is increased in VT/VF patients with ischemic CMP but not in patients with ventricular arrhythmias of other origin. Further investigations in prospective cohorts should evaluate the prognostic value of electromagnetic QRS fragmentation in patients with ischemic heart disease to predict the occurrence of VT/VF and to guide therapy.
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Affiliation(s)
- Thomas Kleemann
- Medizinische Klinik B, Klinikum Ludwigshafen, Bremserstraße 79, 67063, Ludwigshafen, Germany.
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48
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Mahnkopf C, Halbfass P, Turschner O, Brachmann J. [Use of cardiac MRI in the field of electrophysiology. Present status and future aspects]. Herzschrittmacherther Elektrophysiol 2012; 23:275-80. [PMID: 23132745 DOI: 10.1007/s00399-012-0238-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 10/01/2012] [Indexed: 01/15/2023]
Abstract
In recent years, ablation therapy has become the first-line treatment of modern electrophysiology in patients with cardiac arrhythmias. Today, cardiac magnetic resonance imaging (cMRI) is an important supportive imaging technique in the implementation of complex electrophysiological investigations and ablation therapy. In clinical routine, cMRI is used not only to generate accurate three-dimensional (3D) models of cavities of the heart but also for visualization of complex anatomical structures. The development of cMRI makes it possible to detect the underlying substrate of complex arrhythmias such as myocardial scar in patients with ventricular tachycardia or the structural remodeling of the left atrium in patients with atrial fibrillation. The opportunity of fusion of the different imaging modalities (e.g., fluoroscopy, cMRI) has become essential for the planning and the implementation of a safe ablation therapy. The possibility of direct visualization of induced lesions using cMRI after and in the long term after ablation can predict the success of therapy and detects potential complications. The continuous research in the field of cMRI and the development of MRI-compatible pacing and ablation catheters provided the basics for performing electrophysiological treatment in humans directly inside the MRI. The implementation of ablation using exact visualization of the anatomical substrate, precise catheter navigation and real-time visualization of lesions in cMRI promises to improve success rates and the safety of complex ablation treatment and may revolutionize electrophysiology in the future.
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Affiliation(s)
- Christan Mahnkopf
- II. Medizinische Klinik, Klinik für Kardiologie, Angiologie, Pneumologie, Klinikum Coburg, Ketschendorferstr. 33, 96450, Coburg, Deutschland.
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49
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The Role of Preventive Ablation of Ventricular Tachycardia in the Patient with Coronary Artery Disease, Reduced Left Ventricular Function, and a New Implantable Cardioverter Defibrillator Implant. Card Electrophysiol Clin 2012; 4:189-98. [PMID: 26939816 DOI: 10.1016/j.ccep.2012.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Most patients referred for ventricular tachycardia (VT) ablation have already suffered multiple therapies for recurrent VT, typically in the form of implantable cardioverter defibrillator (ICD) shocks. Recent landmark trials have looked at these populations and suggest potential usefulness of early, preventive ablation of VT in patients with ischemic cardiomyopathy. In this review the potential role of early VT ablation in patients with ischemic cardiomyopathy, current controversies regarding VT ablation in this population, and ongoing and future research that may further inform clinical decision making regarding optimal timing of ablation in these patients are discussed.
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50
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Herczku C, Berruezo A, Andreu D, Fernández-Armenta J, Mont L, Borràs R, Arbelo E, Tolosana JM, Trucco E, Ríos J, Brugada J. Mapping Data Predictors of a Left Ventricular Outflow Tract Origin of Idiopathic Ventricular Tachycardia With V
3
Transition and Septal Earliest Activation. Circ Arrhythm Electrophysiol 2012; 5:484-91. [DOI: 10.1161/circep.111.969592] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background—
The proximity of the outflow tracts (OTs) frequently results in an overlap in surface electrocardiographic features of ventricular arrhythmias originating from this anatomic region, particularly when the transition occurs in lead V
3
. In addition, no reliable criteria to discriminate between a right ventricular OT (RVOT) and a left ventricular OT (LVOT) site of origin (SOO) are derived from intracardiac mapping.
Methods and Results—
A series of 15 patients underwent ablation because of OT ventricular arrhythmias having a V
3
transition, and a septal earliest activation on the RVOT was included in the study. Electrocardiographic and mapping data were collected to analyze accuracy in predicting the RVOT versus the LVOT SOO of the ventricular arrhythmia. A 10-ms isochronal map area in the RVOT was smaller in the RVOT SOO group (1.2 [0.4–2.1] versus 3.4 [2.4–3.9] cm
2
, respectively;
P
=0.004) and had a shorter perpendicular diameter (13 [7–17] versus 28 [20–29] mm;
P
=0.001) and a higher longitudinal/perpendicular axis ratio (1.04 [0.95–1.11] versus 0.49 [0.44–0.57];
P
=0.001). A 10-ms isochronal map area >2.3 cm
2
predicted an LVOT origin with 85.7% sensitivity and 87.5% specificity, whereas a longitudinal/perpendicular axis ratio <0.8 predicted an LVOT origin with 100% sensitivity and 100% specificity. Electrocardiography-derived parameters showed lower values of sensitivity and specificity. The distal coronary sinus activation mapping did not permit distinction between RVOT and LVOT SOO.
Conclusions—
The 10-ms isochronal map area and the longitudinal/perpendicular axis ratio accurately predict the RVOT versus the LVOT SOO in patients with OT ventricular arrhythmias, a V
3
transition, and a septal earliest activation.
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Affiliation(s)
- Csaba Herczku
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and Institut d’Investigació Agustí Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Antonio Berruezo
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and Institut d’Investigació Agustí Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - David Andreu
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and Institut d’Investigació Agustí Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Juan Fernández-Armenta
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and Institut d’Investigació Agustí Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Lluis Mont
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and Institut d’Investigació Agustí Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Roger Borràs
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and Institut d’Investigació Agustí Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Elena Arbelo
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and Institut d’Investigació Agustí Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Jose M. Tolosana
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and Institut d’Investigació Agustí Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Emilce Trucco
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and Institut d’Investigació Agustí Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - José Ríos
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and Institut d’Investigació Agustí Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Josep Brugada
- From the Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clinic and Institut d’Investigació Agustí Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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