1
|
Gunawardene MA, Harloff T, Jularic M, Dickow J, Wahedi R, Anwar O, Wohlmuth P, Gessler N, Hartmann J, Willems S. Contemporary catheter ablation of complex atrial tachycardias after prior atrial fibrillation ablation: pulsed field vs. radiofrequency current energy ablation guided by high-density mapping. Europace 2024; 26:euae072. [PMID: 38513110 PMCID: PMC11034699 DOI: 10.1093/europace/euae072] [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: 01/20/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
AIMS Catheter ablation (CA) of post-ablation left atrial tachycardias (LATs) can be challenging. So far, pulsed field ablation (PFA) has not been compared to standard point-by-point radiofrequency current (RFC) energy for LAT ablation. To compare efficacy of PFA vs. RFC in patients undergoing CA for LAT. METHODS AND RESULTS Consecutive patients undergoing LAT-CA were prospectively enrolled (09/2021-02/2023). After electro-anatomical high-density mapping, ablation with either a pentaspline PFA catheter or RFC was performed. Patients were matched 1:1. Ablation was performed at the assumed critical isthmus site with additional ablation, if necessary. Right atrial tachycardia (RAT) was ablated with RFC. Acute and chronic success were assessed. Fifty-six patients (n = 28 each group, age 70 ± 9 years, 75% male) were enrolled.A total of 77 AT (n = 67 LAT, n = 10 RAT; 77% macroreentries) occurred with n = 32 LAT in the PFA group and n = 35 LAT in the RFC group. Of all LAT, 94% (PFA group) vs. 91% (RFC group) successfully terminated to sinus rhythm or another AT during ablation (P = 1.0). Procedure times were shorter (PFA: 121 ± 41 vs. RFC: 190 ± 44 min, P < 0.0001) and fluoroscopy times longer in the PFA group (PFA: 15 ± 9 vs. RFC: 11 ± 6 min, P = 0.04). There were no major complications. After one-year follow-up, estimated arrhythmia free survival was 63% (PFA group) and 87% (RFC group), [hazard ratio 2.91 (95% CI: 1.11-7.65), P = 0.0473]. CONCLUSION Pulsed field ablation of post-ablation LAT using a pentaspline catheter is feasible, safe, and faster but less effective compared to standard RFC ablation after one year of follow-up. Future catheter designs and optimization of the electrical field may further improve practicability and efficacy of PFA for LAT.
Collapse
Affiliation(s)
- Melanie A Gunawardene
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany
| | - Tim Harloff
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
| | - Mario Jularic
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
| | - Jannis Dickow
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany
| | - Rahin Wahedi
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
| | - Omar Anwar
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
| | - Peter Wohlmuth
- Asklepios Proresearch Research Insitute, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
| | - Nele Gessler
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany
- Asklepios Proresearch Research Insitute, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
| | - Stephan Willems
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
- Semmelweis University Budapest Hungary, Asklepios Campus Hamburg, Lohmuehlenstrasse 5, 20099 Hamburg and Ülloi ut 26, 1085 Budapest
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Potsdamer Strasse 58, 10785 Berlin, Germany
| |
Collapse
|
2
|
Kahle AK, Alken FA, Scherschel K, Meyer C. Prognostic implications of baseline rhythm during catheter ablation for atrial tachycardia. Clin Res Cardiol 2023:10.1007/s00392-023-02292-3. [PMID: 37710016 DOI: 10.1007/s00392-023-02292-3] [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: 03/13/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Atrial tachycardias (AT) occurring in patients after previous atrial fibrillation (AF) ablation are increasingly observed in clinical practice. Catheter ablation is the treatment of choice but an optimal workflow to improve patient outcome has not been defined. The purpose of this study was to assess procedural and clinical outcome depending on baseline rhythm at the beginning of AT ablation. METHODS A total of 380 patients (69 (61-75) years, 56.6% male) who underwent catheter ablation for consecutive AT after previous AF ablation were studied. RESULTS At the beginning of the procedure, 140 patients (36.8%) presented in sinus rhythm (SR), 208 (54.7%) with AT and 32 (8.4%) with AF. Patients in SR or with AT underwent shorter procedures (173 (132-213) minutes vs. 161 (120-203) minutes vs. 226 (154-249) minutes; p = 0.002) with more frequent termination to SR (87.9% vs. 81.3% vs. 56.3%; p < 0.001) than patients with AF. Acute procedural success did not differ between patients in SR or with AT but was higher compared to those with AF (96.4% vs. 97.1% vs. 87.5%; p = 0.033). During a follow-up of 290 (181-680) days, patients in baseline SR experienced arrhythmia recurrences less often (36.4% vs. 49.5% vs. 68.8%; p = 0.002) than patients with AT or AF. CONCLUSION Baseline rhythm during AT ablation predicts procedural and clinical outcome. Whereas acute procedural success does not differ between patients in SR or with AT, patients presenting in SR have a more favorable mid-term success rate.
Collapse
Affiliation(s)
- Ann-Kathrin Kahle
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217, Düsseldorf, Germany
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Fares-Alexander Alken
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217, Düsseldorf, Germany
| | - Katharina Scherschel
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217, Düsseldorf, Germany
- Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Christian Meyer
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217, Düsseldorf, Germany.
- Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany.
| |
Collapse
|
3
|
Gunawardene MA, Schaeffer BN, Jularic M, Eickholt C, Akbulak RÖ, Hedenus K, Wahedi R, Anwar O, Gessler N, Hartmann J, Willems S. Pulsed field ablation in patients with complex consecutive atrial tachycardia in conjunction with ultra-high density mapping: Proof of concept. J Cardiovasc Electrophysiol 2022; 33:2431-2443. [PMID: 36259717 DOI: 10.1111/jce.15713] [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: 06/27/2022] [Revised: 08/19/2022] [Accepted: 09/17/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Catheter-ablation (CA) of consecutive left atrial tachycardias (LAT) can be challenging. Pulsed field ablation (PFA) yields a novel nonthermal CA technology for treatment of atrial fibrillation (AF). There is no data regarding PFA of LAT. This study sought to investigate PFA of consecutive LAT following prior CA of AF. METHODS Consecutive patients with LAT underwent ultrahigh-density (UHDx) mapping. Subsequent to identification of the AT mechanism, PFA was performed at the assumed critical sites for LAT maintenance. Continuous ablation lines were performed if required and evaluated with pre- and post-PFA HDx-mapping. RESULTS Fifteen patients (age 70 ± 10, male 73%) who underwent 3.6 ± 2 prior AF-CA procedures were included. The total mean procedure and fluoroscopy times were 141 ± 43 and 18 ± 10 min, respectively. All 19 of 19 (100%) LAT were successfully ablated with PFA. Two AT located at the right atria required RF-ablation. LAT were identified as localized reentry (n = 1) and macro-reentry LAT (n = 18) and targeted with PFA. All LAT terminated with PFA either to sinus rhythm (9/15) or a secondary AT (6/15 and subsequently to SR); 63% (12/19) terminated with the first PFA-application. All lines (13 roof, 11 anterior, 1 mitral) were blocked. LA-posterior-wall isolation (LAPWI) was successfully achieved when performed (10/10). AF/AT free survival was 80% (12/15) after 153 [88-207] days of follow-up. No procedure-related complications occurred. CONCLUSION PFA of consecutive LAT is feasible and safe. Successful creation of ablation lines and LAPWI can be achieved in a short time. PFA may offer the opportunity for effective ablation of atrial arrhythmias beyond AF.
Collapse
Affiliation(s)
- Melanie A Gunawardene
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Benjamin N Schaeffer
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Mario Jularic
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Christian Eickholt
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Ruken Ö Akbulak
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Katja Hedenus
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Rahin Wahedi
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Omar Anwar
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Nele Gessler
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany.,Asklepios Proresearch, Hamburg, Germany
| | - Jens Hartmann
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary
| | - Stephan Willems
- Asklepios Hospital St. Georg, Department of Cardiology and Intensive Care Medicine, Hamburg, Germany.,Semmelweis University, Budapest, Hungary.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
| |
Collapse
|
4
|
Kahle AK, Jungen C, Scherschel K, Alken FA, Meyer C. Relationship Between Early and Late Recurrences After Catheter Ablation for Atrial Tachycardia in Patients With a History of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2022; 15:e010727. [PMID: 35622433 DOI: 10.1161/circep.121.010727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ann-Kathrin Kahle
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Düsseldorf, Germany (A.-K.K., K.S., F.-A.A., C.M.).,Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany (A.-K.K., K.S., F.-A.A., C.M.)
| | - Christiane Jungen
- Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (C.J.).,Clinic for Cardiology, University Heart & Vascular Center, University Hospital Hamburg- Eppendorf (C.J.)
| | - Katharina Scherschel
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Düsseldorf, Germany (A.-K.K., K.S., F.-A.A., C.M.).,Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany (A.-K.K., K.S., F.-A.A., C.M.)
| | - Fares-Alexander Alken
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Düsseldorf, Germany (A.-K.K., K.S., F.-A.A., C.M.).,Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany (A.-K.K., K.S., F.-A.A., C.M.)
| | - Christian Meyer
- Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Düsseldorf, Germany (A.-K.K., K.S., F.-A.A., C.M.).,Institute of Neural and Sensory Physiology, cNEP, cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany (A.-K.K., K.S., F.-A.A., C.M.)
| |
Collapse
|
5
|
Sarkozy A, Vijgen J, De Potter T, Schilling R, Markides V. An early multicenter experience of the novel high-density star-shaped mapping catheter in complex arrhythmias. J Interv Card Electrophysiol 2022; 64:223-232. [DOI: 10.1007/s10840-022-01176-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/27/2022] [Indexed: 01/10/2023]
|
6
|
Luik A, Schmidt K, Haas A, Unger L, Tzamalis P, Brüggenjürgen B. Ablation of Left Atrial Tachycardia following Catheter Ablation of Atrial Fibrillation: 12-Month Success Rates. J Clin Med 2022; 11:jcm11041047. [PMID: 35207318 PMCID: PMC8874450 DOI: 10.3390/jcm11041047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
The treatment of atrial tachycardia following catheter ablation of atrial fibrillation is often challenging. Electrophysiological studies using high-resolution 3D mapping systems have contributed significantly to their understanding, and new ablation approaches have shown high rates of acute terminations with low recurrences for the clinical AT. However, patient populations are very heterogeneous, and long-term data of the freedom from any atrial tachycardia or any arrhythmia are still sparse. To evaluate long-term success, a unified patient population and predefined ablation strategies are preferred. In this study, we present 12-month success and mean 30 month follow-up data of catheter ablation of left atrial tachycardia. All 35 patients had a history of pulmonary vein isolation (PVI), 71% of which had a previous substrate modification. A total of 54 ATs, with a mean cycle length 297 ± 86 ms, 31 macro-reentries, and 4 localized reentries, were targeted. The ablation strategy to be used was given by the study protocol, depending on the type of reentry and the number of critical isthmuses. All available ablation strategies were included: standard (anatomical) lines, individual lines, critical isthmuses, and focal ablation. All ATs were terminated by ablation. A total of 91% terminated upon the first ablation strategy. Freedom from any AT after 12 months was 82%, and from any arrhythmia, it was 77%. The multi-procedure success after 30 months was 65% for any AT and 55% for any arrhythmia. In conclusion, individual ablation strategies based on the reentry mechanism and the number of critical isthmuses seems promising and demonstrates a high long-term clinical success. Tachycardia comprising a single critical isthmus can be ablated by critical isthmus ablation only. These patients present with the highest 12-month and long-term success rates.
Collapse
Affiliation(s)
- Armin Luik
- Karlsruhe Municipal Hospital, Academic Teaching Hospital of the University of Freiburg, 76133 Karlsruhe, Germany; (K.S.); (A.H.); (P.T.)
- Correspondence: ; Tel.: +49-721-9740
| | - Kerstin Schmidt
- Karlsruhe Municipal Hospital, Academic Teaching Hospital of the University of Freiburg, 76133 Karlsruhe, Germany; (K.S.); (A.H.); (P.T.)
| | - Annika Haas
- Karlsruhe Municipal Hospital, Academic Teaching Hospital of the University of Freiburg, 76133 Karlsruhe, Germany; (K.S.); (A.H.); (P.T.)
| | - Laura Unger
- Institute of Biomedical Engineering, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany;
| | - Panagiotis Tzamalis
- Karlsruhe Municipal Hospital, Academic Teaching Hospital of the University of Freiburg, 76133 Karlsruhe, Germany; (K.S.); (A.H.); (P.T.)
| | - Bernd Brüggenjürgen
- Institute for Health Services Research and Technical Orthopaedics, Hanover Medical School, 30625 Hannover, Germany;
| |
Collapse
|
7
|
Jiang R, Nishimura T, Beaser AD, Aziz ZA, Upadhyay GA, Shatz DY, Nayak HM, Liao H, Zhan X, Chung FP, Xue Y, Wu S, Tung R. Spatial and transmural properties of the reentrant ventricular tachycardia circuit in arrhythmogenic right ventricular cardiomyopathy: Simultaneous epicardial and endocardial recordings. Heart Rhythm 2021; 18:916-925. [PMID: 33524624 DOI: 10.1016/j.hrthm.2021.01.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND While advances in the characterization of the structural substrate in arrhythmogenic right ventricular cardiomyopathy (ARVC) have been made, the ventricular tachycardia (VT) circuit remains incompletely described. OBJECTIVE The purpose of this study was to delineate the reentrant VT circuit with simultaneous epicardial and endocardial mapping (SEEM) in ARVC. METHODS Twenty-three consecutive patients with ARVC and VT underwent SEEM at 4 centers between 2014 and 2020. Retrospective analysis was performed on combined isochronal activation maps. RESULTS Of the 30 VT circuits, 24 were delineated with SEEM (956 [341-1843] endocardial points and 1763 [882-3054] epicardial points). The apex and outflow tract rarely harbored VT circuits, with 50% distributed in the inferior wall and 43% in the free wall. The entire tachycardia cycle length was recorded from the epicardium in 71% of circuits. In all circuits, a large proportion of the tachycardia cycle length was recorded from the epicardium relative to the endocardium. Localized epicardial reentry was observed in 35% of patients (14 mm × 15 mm), which was associated with smaller endocardial low voltage area (39 cm2 vs 104 cm2; P = .002) and preserved right ventricular ejection fraction (35% vs 25%; P = .046) compared with those with larger circuit dimensions. Seventy percent of termination sites were achieved from the epicardium. CONCLUSION High-resolution recordings from both myocardial surfaces confirm a consistent predominance of epicardial participation during reentry in ARVC. Only the perivalvular inflow region of the "triangle of dysplasia" had a strong propensity to harbor VT circuits, with the greatest proportion located in the inferior wall. Localized epicardial reentry may be a manifestation of earlier stage disease with a relative paucity of endocardial substrate.
Collapse
Affiliation(s)
- Ruhong Jiang
- Center for Arrhythmia Care, Pritzker School of Medicine, The University of Chicago Medicine, Chicago, Illinois; Department of Cardiology, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Takuro Nishimura
- Center for Arrhythmia Care, Pritzker School of Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Andrew D Beaser
- Center for Arrhythmia Care, Pritzker School of Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Zaid A Aziz
- Center for Arrhythmia Care, Pritzker School of Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Pritzker School of Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Dalise Y Shatz
- Center for Arrhythmia Care, Pritzker School of Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Hemal M Nayak
- Center for Arrhythmia Care, Pritzker School of Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Hongtao Liao
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xianzhang Zhan
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Fa Po Chung
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yumei Xue
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shulin Wu
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Roderick Tung
- Center for Arrhythmia Care, Pritzker School of Medicine, The University of Chicago Medicine, Chicago, Illinois; Department of Cardiology, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| |
Collapse
|
8
|
Ollitrault P, Champ-Rigot L, Ferchaud V, Pellissier A, Coffin O, Milliez P. Vascular entrapment of a multipolar basket catheter (Orion TM ) during catheter ablation. J Cardiovasc Electrophysiol 2020; 32:545-546. [PMID: 33058383 DOI: 10.1111/jce.14780] [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: 09/12/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/28/2022]
Abstract
The IntellaMap OrionTM (Boston Scientific) is a 64-electrode basket catheter allowing for ultrahigh-density mapping of complex cardiac arrhythmias. We report the case of a basket catheter vascular entrapment, requiring surgical removal.
Collapse
Affiliation(s)
- Pierre Ollitrault
- Department of Cardiology, Regional University Hospital, Caen, France
| | - Laure Champ-Rigot
- Department of Cardiology, Regional University Hospital, Caen, France.,UniCaen, University of Caen Normandy, Caen, France
| | - Virginie Ferchaud
- Department of Cardiology, Regional University Hospital, Caen, France.,UniCaen, University of Caen Normandy, Caen, France
| | - Arnaud Pellissier
- Department of Cardiology, Regional University Hospital, Caen, France
| | - Olivier Coffin
- Department of Vascular Surgery, Regional University Hospital, Caen, France
| | - Paul Milliez
- Department of Cardiology, Regional University Hospital, Caen, France.,UniCaen, University of Caen Normandy, Caen, France
| |
Collapse
|