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Shirai Y. Safety and efficacy of half normal saline irrigation during catheter ablation of outflow tract ventricular arrhythmia: what is the "normal" setting for half normal saline irrigation? J Interv Card Electrophysiol 2024; 67:433-434. [PMID: 38040854 DOI: 10.1007/s10840-023-01703-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/19/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Yasuhiro Shirai
- Department of Cardiology, NHO Disaster Medical Center, Midoricho Tachikawa, Tokyo, 3256, Japan.
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Zhou ZX, Zheng C, Hu YD, Lin JF. Mapping and ablation of ventricular arrhythmias arising from the left ventricular summit. Pacing Clin Electrophysiol 2024; 47:242-252. [PMID: 38291856 DOI: 10.1111/pace.14932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
The left ventricular summit (LVS) refers to the highest portion of the left ventricular outflow tract (LVOT). It is an epicardially delimited triangular area by the left coronary arteries and the coronary venous circulation. Its deep myocardium correlates closely with the left coronary cusp, aortic-mitral continuity, and right ventricular outflow tract (RVOT), complicating the anatomical relationship. Ventricular arrhythmias (VAs) originating from this area are common, accounting for 14.5% of all VAs origin from left ventricle. Specific electrocardiogram (ECG) characteristics may assist in locating LVS-VAs pre-procedure and facilitate procedure planning. However, catheter ablation of LVS-VAs remains challenging because of anatomical constraints. This paper reviews the recent understanding of LVS anatomy, concludes ECG characteristics, and summarizes current mapping and ablation methods for LVS-VAs.
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Affiliation(s)
- Zhi-Xiang Zhou
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Cheng Zheng
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - You-Dong Hu
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jia Feng Lin
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Hasegawa K, Yoneda ZT, Powers EM, Tokutake K, Kurata M, Richardson TD, Montgomery JA, Shen S, Estrada JC, Saavedra PJ, Emerson A, Walker ML, Tandri H, Michaud GF, Kanagasundram AN, Stevenson WG. Safety of ventricular arrhythmia radiofrequency ablation with half-normal saline irrigation. Europace 2024; 26:euae018. [PMID: 38367008 PMCID: PMC10898929 DOI: 10.1093/europace/euae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/05/2024] [Indexed: 02/19/2024] Open
Abstract
AIMS Failure of radiofrequency (RF) ablation of ventricular arrhythmias is often due to inadequate lesion size. Irrigated RF ablation with half-normal saline (HNS) has the potential to increase lesion size and reduce sodium delivery to the patient if the same volume of RF irrigant were used for normal saline (NS) and HNS but could increase risks related to steam pops and lesion size. This study aims to assess periprocedural complications and acute ablation outcome of ventricular arrhythmias ablation with HNS. METHODS AND RESULTS Prospective assessment of outcomes was performed in 1024 endocardial and/or epicardial RF ablation procedures in 935 consecutive patients (median age 64 years, 71.2% men, 73.4% cardiomyopathy, 47.2% sustained ventricular tachycardia). Half-normal saline was selected at the discretion of the treating physician. Radiofrequency ablation power was generally titrated to a ≤15 Ω impedance fall with intracardiac echocardiography monitoring. Half-normal saline was used in 900 (87.9%) and NS in 124 (12.1%) procedures. Any adverse event within 30 days occurred in 13.0% of patients treated with HNS RF ablation including 4 (0.4%) strokes/transient ischaemic attacks and 34 (3.8%) pericardial effusions requiring treatment (mostly related to epicardial access). Two steam pops with perforation required surgical repair (0.2%). Patients who received NS irrigation had less severe disease and arrhythmias. In multivariable models, adverse events and acute success of the procedure were not related to the type of irrigation. CONCLUSION Half-normal saline irrigation RF ablation with power guided by impedance fall and intracardiac echocardiography has an acceptable rate of complications and acute ablation success while administering half of the saline load expected for NS irrigation.
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Affiliation(s)
- Kanae Hasegawa
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Zachary T Yoneda
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Edward M Powers
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Kenichi Tokutake
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Masaaki Kurata
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Travis D Richardson
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Jay A Montgomery
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Sharon Shen
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Juan C Estrada
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Pablo J Saavedra
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Amy Emerson
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Marilyn L Walker
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Harikrishna Tandri
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Gregory F Michaud
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - Arvindh N Kanagasundram
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
| | - William G Stevenson
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA
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Cherbi M, Voglimacci-Stephanopoli Q, Delasnerie H, Mandel F, Domain G, Foltran D, Mondoly P, Beneyto M, Rollin A, Maury P. Systematic use of half normal saline during ablation of ventricular tachycardia in structural heart disease. Pacing Clin Electrophysiol 2023; 46:1546-1552. [PMID: 37885373 DOI: 10.1111/pace.14845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/12/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Efficiency and safety of ablation using half normal saline (HNS) has been shown in refractory ventricular tachycardia (VT), but no evaluation in unselected larger populations has been made. OBJECTIVE To evaluate the efficiency and safety of systematic HNS ablation in VT ablation. METHODS All successive VT ablations in patients with structural heart disease from 2018 to 2021 used HNS in our center and were retrospectively included. RESULTS One hundred seventy-seven successive VT ablation procedures using HNS have been performed in 148 patients (91% males, mean 64 ± 12 years, ischemic cardiomyopathy 64%, left ventricular ejection fraction 38 ± 13%). A mean of 19 ± 7.5 min of RF was delivered, with a mean power of 44 ± 7 W. Relevant complications happened in 9% (strokes 2%, tamponades 3%, atrioventricular block during septal ablations 5%). Over a mean follow-up of 15 ± 9 months, VT recurred in 46%. Final recurrence rate after one or several procedures was 36% (18 months follow-up). Number of VT episodes decreased from 14 ± 35 before to 2.5 ± 10 after ablation (p < .0001) and number of ICD shocks decreased from 4.8 ± 6.8 to 1.5 ± 0.8 (p = .027). CONCLUSION Systematic use of HNS during VT ablations in patients with structural heart disease leads to long-term recurrences rates and complications in the range of what is reported using normal saline. Although controlled studies are needed for demonstrating the superiority of such attitude, the use of HNS in every scar-related VT ablation seems safe for standard cases and may be furthermore useful in case of refractory arrhythmias due to difficult-to-ablate substrates.
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Affiliation(s)
- Miloud Cherbi
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | | | - Hubert Delasnerie
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Franck Mandel
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Guillaume Domain
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Deborah Foltran
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Pierre Mondoly
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Maxime Beneyto
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
- Unité INSERM U 1048, Toulouse, France
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
- Unité INSERM U 1048, Toulouse, France
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Dong Y, Wang H, Ma K, Ling Z, Zhao D, Wang Y, Zhang Z, Shao M, Song H, Jiang W, Yang K, Chen Q, Kojodjojo P, Ullah I, Cao K, Chen M, Zhang F. Half versus normal saline irrigation during catheter ablation of outflow tract ventricular arrhythmias (HALF): a multi-center, parallel, open-label, randomized controlled study. J Interv Card Electrophysiol 2023; 66:2143-2151. [PMID: 37204671 DOI: 10.1007/s10840-023-01558-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/01/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Animal studies demonstrated that deeper lesions could be achieved during radio-frequency catheter ablation (RFCA) by using half saline (HS) compared to normal saline (NS) as irrigation. OBJECTIVES This study sought to compare the efficiency and safety of HS and NS for irrigation during RFCA of idiopathic outflow tract ventricular arrhythmia (OT-VA). METHODS In this multicenter, randomized controlled study, 167 patients undergoing RFCA of OT-VA were randomized 1:1 to receive HS- or NS-irrigated ablation. Acute success was defined as the absence of induced targeted premature ventricular contraction (PVC) at the end of the procedure. The 6-month success was defined as a ≥ 80% reduction of pre-procedural PVC burden. RESULTS There were no differences of baseline characteristics between the HS and NS group. Patients in HS group had shorter total ablation time (259.5 ± 155.5 S vs. 355.6 ± 230.7 S, P = 0.04) than that in NS group. The acute and 6-month success rates were similar between the HS and NS group (92.8 vs. 91.7%, P = 0.79; 90.9 vs. 92.1%, P = 0.79, respectively). No significant difference was observed in the incidence of steam pops between the HS and NS group (2.4 vs. 1.2%, P = 0.62). CONCLUSIONS The ablation using HS irrigation achieved similar success rate and safety compared to that using NS irrigation but was associated with a shorter total ablation time. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2200059205).
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Affiliation(s)
- Yan Dong
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China
| | - Hongtao Wang
- Department of Cardiology, the Second Affiliated Hospital of Xi'an JiaoTong University, Xi'an, China
| | - Kezhong Ma
- Department of Cardiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Zhiyu Ling
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dongsheng Zhao
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China
| | - Yuegang Wang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhiyong Zhang
- Department of Cardiology, the Affiliated Suqian First People's Hospital of Nanjing Medical University, Jiangsu, China
| | - Mingliang Shao
- Department of Cardiology, the Affiliated Xuancheng Hospital of Wannan Medical College, Wuhu, China
| | - Hejian Song
- Department of Cardiology, the First Affiliated Hospital of Kangda College of Nanjing Medical University, Nanjing, China
| | - Wei Jiang
- Department of Cardiology, the Second Affiliated Hospital of Xi'an JiaoTong University, Xi'an, China
| | - Kai Yang
- Department of Cardiology, the First Affiliated Hospital of Kangda College of Nanjing Medical University, Nanjing, China
| | - Qiushi Chen
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China
| | - Pipin Kojodjojo
- National University of Singapore, Asian Heart and Vascular Centre, Singapore, Singapore
| | - Inam Ullah
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China
| | - Kejiang Cao
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China
| | - Minglong Chen
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China
| | - Fengxiang Zhang
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China.
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de Leon A, Hanson M, Alhammad N, Bakker D, Chacko S, Simpson C, Abdollah H, Baranchuk A, Redfearn D, Glover B, Enriquez A, Neira V. Half-Normal Saline vs Normal Saline for Cavotricuspid Isthmus-Dependent Atrial Flutter Ablation. CJC Open 2023; 5:965-970. [PMID: 38204850 PMCID: PMC10774089 DOI: 10.1016/j.cjco.2023.09.013] [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: 08/18/2023] [Accepted: 09/21/2023] [Indexed: 01/12/2024] Open
Abstract
Background Cavotricuspid isthmus (CTI) ablation requires permanent bidirectional block to prevent recurrence of typical atrial flutter (AFL). Catheter irrigation with half-normal saline (HNS) produces larger and deeper lesions in experimental models compared with normal saline (NS). This study was performed to compare the clinical efficacy and safety of HNS vs NS irrigation for typical AFL ablation. Methods Sixty patients undergoing catheter ablation of typical AFL were randomized 1:1 to NS or HNS irrigation. Endpoints included time to CTI block, acute reconnection, incidence of steam pops, and recurrence of AFL during follow-up. Results Baseline characteristics were comparable between both arms. The mean age of the patients was 68.5 ± 8.2 years, 20% were female, and 32% had atrial fibrillation before being enrolled. Bidirectional CTI block was obtained in all patients with no difference in time to CTI block between groups (6.4 ± 4.4 minutes vs 7.6 ± 4.5 minutes, respectively; P = 0.15). There was a trend to less acute reconnection in the HNS group compared with NS (13.3% vs 26.6%; P = 0.46). Steam pops occurred in 4 patients using HNS vs none in the NS group, but no major complications were observed. During the follow-up, rate of AFL recurrence was similar between groups (6.7% with HNS vs 10% with NS; P = 0.5). There was no difference in time to recurrence (7.6 ± 6.9 vs 4.9 ± 4.5 months; P = 0.6). Conclusions In this small pilot randomized controlled trial, there was no significant difference between HNS and NS for CTI ablation; however, HNS may increase the incidence of steam pops.
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Affiliation(s)
- Ana de Leon
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Matthew Hanson
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Nasser Alhammad
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - David Bakker
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Sanoj Chacko
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | | | - Hoshiar Abdollah
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Benedict Glover
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Andres Enriquez
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Victor Neira
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
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Limite LR, Laborie G, Constantin J, Maubon A, Arcari L, Hebert C, Bortone A. Left ventricular summit premature ventricular contractions treated by venous ethanol infusion: Scar assessment by magnetic resonance imaging. Pacing Clin Electrophysiol 2023; 46:1235-1238. [PMID: 36811180 DOI: 10.1111/pace.14680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/31/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
Left ventricular (LV) summit premature ventricular contractions (PVCs) are often unresponsive to radiofrequency (RF) ablation. Retrograde venous ethanol infusion (RVEI) can be a valuable alternative in this scenario. A 43-year-old woman without structural heart disease presented with LV summit PVCs unresponsive to RF ablation because of their deep-seated origin. Unipolar pace mapping performed through a wire inserted into a branch of the distal great cardiac vein (GCV) demonstrated 12/12 concordance with the clinical PVCs thus indicating close proximity to PVCs' origin. RVEI abolished the PVCs without complications. Subsequently, magnetic resonance imaging (MRI) evidenced an intramural myocardial scar produced by ethanol ablation. In conclusion, RVEI effectively and safely treated PVC arising from a deep site in the LVS. The scar provoked by chemical damage was well characterized by MRI imaging.
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Affiliation(s)
- Luca Rosario Limite
- Service de Cardiologie, Hôpital Privé Les Franciscaines, ELSAN, Nîmes, France
| | - Guillaume Laborie
- Service de Cardiologie, Hôpital Privé Les Franciscaines, ELSAN, Nîmes, France
| | | | - Antoine Maubon
- Service de Radiologie, Hôpital Privé Les Franciscaines, ELSAN, Nîmes, France
| | - Luca Arcari
- Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Caroline Hebert
- Biosense Webster France, Johnson & Johnson, Issy les Moulineaux, France
| | - Agustín Bortone
- Service de Cardiologie, Hôpital Privé Les Franciscaines, ELSAN, Nîmes, France
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8
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Bourier F. Local impedance, current, power-what should be considered in RF ablation? J Cardiovasc Electrophysiol 2023; 34:1681-1682. [PMID: 37386872 DOI: 10.1111/jce.15988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Felix Bourier
- Department of Electrophysiology, German Heart Center, Technical University Munich, Munich, Germany
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9
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Dukkipati SR, Nakamura T, Nakajima I, Oates C, Narui R, Tanigawa S, Sljapic T, Whang W, Koruth JS, Choudry S, Schaeffer B, Fujii A, Tedrow UB, Sapp JL, Stevenson WG, Reddy VY. Intramural Needle Ablation for Refractory Premature Ventricular Contractions. Circ Arrhythm Electrophysiol 2022; 15:e010020. [PMID: 35476455 DOI: 10.1161/circep.121.010020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Frequent premature ventricular contractions (PVCs) are often amenable to catheter ablation. However, a deep intramural focus may lead to failure due to inability of standard ablation techniques to penetrate the focus. We sought to assess the efficacy and safety of infusion needle ablation (INA) for PVCs that are refractory to standard radiofrequency ablation. METHODS Under 2 Food and Drug Administration approved protocols, INA was evaluated in patients with frequent PVCs that were refractory to standard ablation. Initial targets for ablation were selected by standard mapping techniques. INA was performed with a deflectable catheter equipped with an extendable/retractable needle at the tip that can be extended up to 12 mm into the myocardium and is capable of pacing and recording. After contrast injection for location assessment, radiofrequency ablation was performed with the needle tip using a temperature-controlled mode (maximum temperature 60 °C) with saline infusion from the needle. The primary end point was a decrease in PVC burden to <5000/24 hours at 6 months. The primary safety end point was incidence of procedure- or device-related serious adverse events. RESULTS At 4 centers, 35 patients (age 55.3±16.9 years, 74.2% male) underwent INA. The baseline median PVC burden was 25.4% (interquartile range, 18.4%-33.9%) and mean left ventricular ejection fraction was 37.7±12.3%. Delivering 10.3±8.0 INA lesions/patient (91% had adjunctive standard radiofrequency ablation also) resulted in acute PVC elimination in 71.4%. After a mean follow-up of 156±109 days, the primary efficacy end point was met in 73.3%. The median PVC burden decreased to 0.8% (interquartile range, 0.1%-6.0%; P<0.001). The primary safety end point occurred in 14.3% consisting of 1 (2.9%) heart block, 1 (2.9%) femoral artery dissection, and 3 (8.6%) pericardial effusions (all treated percutaneously). CONCLUSIONS INA is effective for the elimination of frequent PVCs that are refractory to conventional ablation and is associated with an acceptable safety profile. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01791543 and NCT03204981.
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Affiliation(s)
- Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (S.R.D., C.O., T.S., W.W., J.S.K., S.C., V.Y.R.)
| | - Tomofumi Nakamura
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (T.N., I.N., R.N., W.G.S.)
| | - Ikutaro Nakajima
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (T.N., I.N., R.N., W.G.S.)
| | - Connor Oates
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (S.R.D., C.O., T.S., W.W., J.S.K., S.C., V.Y.R.)
| | - Ryohsuke Narui
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (T.N., I.N., R.N., W.G.S.)
| | - Shinichi Tanigawa
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.T., B.S., A.F., U.B.T.)
| | - Tatjana Sljapic
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (S.R.D., C.O., T.S., W.W., J.S.K., S.C., V.Y.R.)
| | - William Whang
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (S.R.D., C.O., T.S., W.W., J.S.K., S.C., V.Y.R.)
| | - Jacob S Koruth
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (S.R.D., C.O., T.S., W.W., J.S.K., S.C., V.Y.R.)
| | - Subbarao Choudry
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (S.R.D., C.O., T.S., W.W., J.S.K., S.C., V.Y.R.)
| | - Benjamin Schaeffer
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.T., B.S., A.F., U.B.T.)
| | - Akira Fujii
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.T., B.S., A.F., U.B.T.)
| | - Usha B Tedrow
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (S.T., B.S., A.F., U.B.T.)
| | - John L Sapp
- Heart Rhythm Service, Division of Cardiology, Department of Medicine, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada (J.L.S.)
| | - William G Stevenson
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (T.N., I.N., R.N., W.G.S.)
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, NY (S.R.D., C.O., T.S., W.W., J.S.K., S.C., V.Y.R.)
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10
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Kao PH, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Lin CY, Chang TY, Kuo L, Wu CI, Liu CM, Liu SH, Cheng WH, Lin L, Ton AKN, Hsu CY, Chhay C, Chen SA. Application of Ensite TM LiveView Function for Identification of Scar-related Ventricular Tachycardia Isthmus. J Cardiovasc Electrophysiol 2022; 33:1223-1233. [PMID: 35304796 DOI: 10.1111/jce.15455] [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: 01/10/2022] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Dynamic display of real-time wavefront activation pattern may facilitate the recognition of reentrant circuits, particularly the diastolic path of ventricular tachycardia (VT). OBJECTIVE We aimed to evaluate the feasibility of LiveView Dynamic Display for mapping the critical isthmus of scar-related reentrant VT. METHODS Patients with mappable scar-related reentrant VT were selected. The characteristics of the underlying substrates and VT circuits were assessed using HD grid multi-electrode catheter. The VT isthmuses were identified based on the activation map, entrainment, and ablation results. The accuracy of the LiveView findings in detecting potential VT isthmus was assessed. RESULTS We studied 18 scar-related reentrant VTs in 10 patients (median age: 59.5 years, 100% male) including 6 and 4 patients with ischemic and non-ischemic cardiomyopathy, respectively. The median VT cycle length was 426 ms (interquartile range: 386-466 ms). Among 590 regional mapping displays, 92.0% of the VT isthmus sites were identified by LiveView Dynamic Display. The accuracy of LiveView for isthmus identification was 84%, with positive and negative predictive values of 54.8% and 97.8%, respectively. The area with abnormal electrograms was negatively correlated with the accuracy of LiveView Dynamic Display (r = -0.506, p = 0.027). The median time interval to identify a VT isthmus using LiveView was significantly shorter than that using conventional activation maps (50.5 [29.8-120] vs. 219 [157.5-400.8] s, p = 0.015). CONCLUSION This study demonstrated the feasibility of LiveView Dynamic Display in identifying the critical isthmus of scar-related VT with modest accuracy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Pei-Heng Kao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ting-Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ling Kuo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-I Wu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shin-Huei Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Han Cheng
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Linda Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - An Khanh-Nu Ton
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chu-Yu Hsu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chheng Chhay
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Cardiovascular center, Taichung Veterans General Hospital, Taichung, Taiwan
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11
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Stevenson WG, Sapp JL. Newer Methods for VT Ablation and When to Use Them. Can J Cardiol 2021; 38:502-514. [PMID: 34942300 DOI: 10.1016/j.cjca.2021.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/03/2021] [Accepted: 12/11/2021] [Indexed: 02/07/2023] Open
Abstract
Radiofrequency (RF) catheter ablation has long been an important therapy for ventricular tachycardia and frequent symptomatic premature ventricular beats and nonsustained arrhythmias when antiarrhythmic drugs fail to suppress the arrhythmias. It is increasingly used in preference to antiarrhythmic drugs, sparing the patient drug adverse effects. Ablation success varies with the underlying heart disease and type of arrhythmia, being very effective for patients without structural heart disease, less in structural heart disease. Failure occurs when a target for ablation cannot be identified, or ablation lesions fail to reach and abolish the arrhythmia substrate that may be extensive, intramural or subepicardial in location. Approaches to improving ablation lesion creation are modifications to RF ablation and emerging investigational techniques. Easily implemented modifications to RF methods include manipulating the size and location of the cutaneous dispersive electrode, increasing RF delivery duration, and use of lower tonicity catheter irrigation (usually 0.45% saline). When catheters can be placed on either side of culprit substrate RF can be delivered in a bipolar or simultaneous unipolar configuration that can be successful. Catheters with extendable/retractable irrigated needles for RF delivery are under investigation in clinical trials. Cryoablation is potentially useful in specific situations when maintaining contact is difficult. Transvascular ethanol ablation and stereotactic radioablation have both shown promise for arrhythmias that fail other ablation strategies. Although substantial clinical progress has been achieved, further improvement is clearly needed. With ability to increase ablation lesion size, continued careful evaluation of safety, which has been excellent for standard RF ablation, remains important.
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Affiliation(s)
- William G Stevenson
- The Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; The Heart Rhythm Service, Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
| | - John L Sapp
- The Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; The Heart Rhythm Service, Department of Medicine, Division of Cardiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
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12
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Huang HD, Ravi V, Rhodes P, Du-Fay-de-Lavallaz JM, Winterfield J, Allen-Proctor M, Wasserlauf J, Krishnan K, Trohman R, Sharma PS, Larsen TR. Use of infrared thermography to delineate temperature gradients and critical isotherms during catheter ablation with normal and half normal saline: Implications for safety and efficacy. J Cardiovasc Electrophysiol 2021; 32:2035-2044. [PMID: 34061411 DOI: 10.1111/jce.15121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Radiofrequency (RF) ablation with half-normal saline (HNS) has shown promise as a bail-out strategy following failed ventricular tachycardia ablation using standard approaches. OBJECTIVE To use a novel infrared thermal imaging (ITI) model to evaluate biophysical and lesion characteristics during RF ablation using normal saline (NS) and HNS irrigation. METHODS Left ventricular strips of myocardium were excised from fresh porcine hearts. RF ablation was performed using an open-irrigated ablation catheter (Thermocool ST/SF) with NS (n = 75) and HNS (n = 75) irrigation using different power settings (40/50 W), RF durations (30/60 s), contact force of 10-15 g, and flow rate of 15 ml/min. RF lesions were recorded using an infrared thermal camera and border zone, lethal, 100° isotherms were matched with necrotic borders after 2% triphenyltetrazolium chloride staining. Lesion dimensions and isotherms (mm2 ) were measured. RESULTS In total, 150 lesions were delivered. HNS lesions were deeper (6.4 ± 1.1 vs. 5.7 ±0.8 mm; p = .03), and larger in volume (633 ± 153 vs. 468 ± 107 mm3 ; p = .007) than NS lesions. Steam pops (SPs) occurred during 19/75 lesions (25%) in the NS group and 32/75 lesions (43%) in the HNS group (p = .34). Lethal (57.8 ± 6.5 vs. 36.0 ± 3.9 mm2 ; p = .001) and 100°C isotherm areas (16.9 ± 6.9 vs. 3.8 ± 4.2 mm2 ; p = .003) areas were larger and were reached earlier in the HNS group. CONCLUSIONS RFA using HNS created larger lesions than NS irrigation but led to more frequent SPs. The presence of earlier lethal isotherms and temperature rises above 100°C on ITI suggest a potentially narrower therapeutic-safety window with HNS.
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Affiliation(s)
- Henry D Huang
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Venkatesh Ravi
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Paul Rhodes
- Biosense-Webster, Diamond Bar, California, USA
| | | | - Jeffrey Winterfield
- Divison of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mary Allen-Proctor
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Jeremiah Wasserlauf
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Kousik Krishnan
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Richard Trohman
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Parikshit S Sharma
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy R Larsen
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
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13
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Kamioka M, Hijioka N, Nodera M, Yamada S, Kaneshiro T, Takeishi Y. Electrophysiological properties and involvement of anatomical factors for the prediction of intramural origin in patients with ventricular tachyarrhythmia arising from the left ventricular outflow tract. J Interv Card Electrophysiol 2021; 63:115-123. [PMID: 33564988 DOI: 10.1007/s10840-021-00959-3] [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: 10/22/2020] [Accepted: 02/04/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To elucidate the electrophysiological predictors of the intramural origins of left ventricular outflow tract-ventricular tachyarrhythmias (LVOT-VAs), and to clarify the involvement of anatomical factors. METHODS Twenty-nine successfully ablated LVOT-VAs patients with origins in the aortomitral continuity (AMC) (n = 8), aortic sinus of valsalva (ASV) (n = 9), great cardiac vein (GCV) (n = 5), and intramural myocardium (n = 7) were enrolled. Intramural origins were defined as when effective ablation from AMC and epicardium (ASV and/or GCV) was needed. The local activation time difference (LATD) was calculated as follows: (earliest AMC activation) - (earliest epicardial activation), and was presented as an absolute value. Electrophysiological parameters and anatomical factors predisposing the intramural origins were investigated. RESULTS LATD of intramural origins was significantly shorter than that of AMC and GCV (4.5 ± 2.6 vs. 12.1 ± 7.4 vs. 17.4 ± 4.7, P < 0.05), respectively. In multivariate logistic regression analysis, LATD was associated with intramural origins (odds ratio: 0.711, confidence interval: 0.514-0.985, P = 0.040). ROC analysis revealed LATD of 7 ms as cut-off value. In computed tomography analysis, some patients who had thick fat tissue below the GCV, and an unusual GCV running pattern might be misdiagnosed as intramural origins. CONCLUSION LATD ≤ 7 ms was associated with intramural origins, but with some anatomical limitations.
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Affiliation(s)
- Masashi Kamioka
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.
| | - Naoko Hijioka
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shinya Yamada
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takashi Kaneshiro
- Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
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14
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Campbell T, Bennett RG, Kotake Y, Kumar S. Updates in Ventricular Tachycardia Ablation. Korean Circ J 2021; 51:15-42. [PMID: 33377327 PMCID: PMC7779814 DOI: 10.4070/kcj.2020.0436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023] Open
Abstract
Sudden cardiac death (SCD) due to recurrent ventricular tachycardia is an important clinical sequela in patients with structural heart disease. As a result, ventricular tachycardia (VT) has emerged as a major clinical and public health problem. The mechanism of VT is predominantly mediated by re-entry in the presence of arrhythmogenic substrate (scar), though focal mechanisms are also important. Catheter ablation for VT, when compared to standard medical therapy, has been shown to improve VT-free survival and burden of device therapies. Approaches to VT ablation are dependent on the underlying disease process, broadly classified into idiopathic (no structural heart disease) or structural heart disease (ischemic or non-ischemic heart disease). This update aims to review recent advances made for the treatment of VT ablation, with respect to current clinical trials, peri-procedure risk assessments, pre-procedural cardiac imaging, electro-anatomic mapping and advances in catheter and non-catheter based ablation techniques.
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Affiliation(s)
- Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Yasuhito Kotake
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, New South Wales, Australia.
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15
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Chung FP, Lin CY, Shirai Y, Futyma P, Santangeli P, Lin YJ, Chang SL, Lo LW, Hu YF, Chang HY, Marchlinski FE, Chen SA. Outcomes of catheter ablation of ventricular arrhythmia originating from the left ventricular summit: A multicenter study. Heart Rhythm 2020; 17:1077-1083. [DOI: 10.1016/j.hrthm.2020.02.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/19/2020] [Indexed: 11/28/2022]
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16
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Tschabrunn CM, Pothineni NVK, Sauer WH, Doynow D, Salas J, Liao TW, Santangeli P, Arkles J, Hyman MC, Frankel DS, Supple GE, Garcia FC, Nazarian S, Dixit S, Epstein AE, Schaller RD, Callans DJ, Marchlinski FE. Evaluation of Radiofrequency Ablation Irrigation Type: In Vivo Comparison of Normal Versus Half-Normal Saline Lesion Characteristics. JACC Clin Electrophysiol 2020; 6:684-692. [PMID: 32553219 DOI: 10.1016/j.jacep.2020.02.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/23/2020] [Accepted: 02/20/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study investigated the impact of the type of catheter irrigant used during delivery of radiofrequency ablation. BACKGROUND The use of half-normal saline (HNS) as an irrigant has been suggested as a method for increasing ablation lesion size but has not been rigorously studied in the beating heart or the use of a low-flow irrigation catheter. METHODS Sixteen swine underwent left ventricular mapping and ablation using either normal saline (NS) (group 1: n = 9) or half-normal saline (HNS) (group 2: n = 7). All lesions were delivered using identical parameters (40 W with 10-second ramp, 30-second duration, 15 ml/min flow, and 8- to14-g target contact force). An occurrence of steam pop, catheter char, or thrombus was assessed using intracardiac echocardiography and catheter inspection following each application. Lesion depth, width, and area were measured using electronic calibers. RESULTS A total of 109 lesions were delivered in group 1 and 77 in group 2. There were significantly more steam pops in group 2 (32 of 77 [42%] vs. 24 of 109 [22%], respectively). The frequencies of catheter tip char were similar (group 1: 9 of 109 [8%] vs. group 2: 10 of 77 [13%]; p = 0.29). Lesion depths, widths, and areas also were similar in both groups. CONCLUSIONS The use of an HNS irrigant using a low-flow open irrigated ablation catheter platform results in more tissue heating due to higher radiofrequency current delivery directed to tissue, but this can lead to higher rate of steam pops. In this in vivo porcine beating-heart model, the use of HNS does not appear to significantly increase lesion size in normal myocardium despite evidence of increased radiofrequency heating.
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Affiliation(s)
- Cory M Tschabrunn
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Penn Cardiovascular Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Naga Venkata K Pothineni
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Doynow
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jonathan Salas
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ting-Wei Liao
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey Arkles
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew C Hyman
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David S Frankel
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory E Supple
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fermin C Garcia
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saman Nazarian
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay Dixit
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew E Epstein
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert D Schaller
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Callans
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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