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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Kawamura M, Gerstenfeld EP, Vedantham V, Rodrigues DM, Burkhardt JD, Kobayashi Y, Hsia HH, Marcus GM, Marchlinski FE, Scheinman MM, Badhwar N. Idiopathic Ventricular Arrhythmia Originating From the Cardiac Crux or Inferior Septum. Circ Arrhythm Electrophysiol 2014; 7:1152-8. [DOI: 10.1161/circep.114.001704] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Idiopathic ventricular arrhythmia (VA) can arise from the epicardium near the posteroseptal region (cardiac crux). There are only 2 prior reports describing idiopathic VA from the cardiac crux. The purpose of this study was to characterize the clinical and the electrocardiographic features of idiopathic crux VA.
Methods and Results—
Crux VA was identified in 18 patients undergoing catheter ablation. We divided patients into 2 groups, those with VA originating from the apical crux (n=9) and the basal crux (n=9). We described the clinical and electrocardiographic characteristics of crux VA as well as the ablation results. Furthermore, we compared clinical features of crux VA with other sites of idiopathic VA. Fifteen crux VA patients (83%) had sustained ventricular tachycardia and 3 patients required implantable cardioverter defibrillator implantation because of syncope. All patients had a left superior axis and 16 patients had R>S wave in V2. In apical crux VA, all patients had a deep S wave in V6 and 8 patients (89%) had R>S wave in aVR. All apical crux patients underwent attempted ablation in the middle cardiac vein without success. In 4 of these patients, epicardial ablation with subxiphoid approach was performed successfully. All basal crux VA patients had either negative or isoelectric pattern in V1 and had R>S in V6. Patients had successful ablation within the middle cardiac vein.
Conclusions—
Apical versus basal crux VA is identified as a new category of idiopathic VA with distinctive electrocardiographic characteristics; ablation via the middle cardiac vein is effective for eliminating basal crux VA, whereas apical crux VA often requires a subxiphoid epicardial approach.
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Affiliation(s)
- Mitsuharu Kawamura
- From the Division of Cardiac Electrophysiology, University of California, San Francisco (M.K., E.P.G., V.V., H.H.H., G.M.M., M.M.S., N.B.); Overlake Medical Center, Bellevue, WA (D.M.R.); Texas Cardiac Arrhythmia Institute, Austin (J.D.B.); Division of Cardiology, Showa University School of Medicine, Tokyo, Japan (Y.K.); and Cardiovascular Division, University of Pennsylvania, Philadelphia (F.E.M.)
| | - Edward P. Gerstenfeld
- From the Division of Cardiac Electrophysiology, University of California, San Francisco (M.K., E.P.G., V.V., H.H.H., G.M.M., M.M.S., N.B.); Overlake Medical Center, Bellevue, WA (D.M.R.); Texas Cardiac Arrhythmia Institute, Austin (J.D.B.); Division of Cardiology, Showa University School of Medicine, Tokyo, Japan (Y.K.); and Cardiovascular Division, University of Pennsylvania, Philadelphia (F.E.M.)
| | - Vasanth Vedantham
- From the Division of Cardiac Electrophysiology, University of California, San Francisco (M.K., E.P.G., V.V., H.H.H., G.M.M., M.M.S., N.B.); Overlake Medical Center, Bellevue, WA (D.M.R.); Texas Cardiac Arrhythmia Institute, Austin (J.D.B.); Division of Cardiology, Showa University School of Medicine, Tokyo, Japan (Y.K.); and Cardiovascular Division, University of Pennsylvania, Philadelphia (F.E.M.)
| | - Derek M. Rodrigues
- From the Division of Cardiac Electrophysiology, University of California, San Francisco (M.K., E.P.G., V.V., H.H.H., G.M.M., M.M.S., N.B.); Overlake Medical Center, Bellevue, WA (D.M.R.); Texas Cardiac Arrhythmia Institute, Austin (J.D.B.); Division of Cardiology, Showa University School of Medicine, Tokyo, Japan (Y.K.); and Cardiovascular Division, University of Pennsylvania, Philadelphia (F.E.M.)
| | - J. David Burkhardt
- From the Division of Cardiac Electrophysiology, University of California, San Francisco (M.K., E.P.G., V.V., H.H.H., G.M.M., M.M.S., N.B.); Overlake Medical Center, Bellevue, WA (D.M.R.); Texas Cardiac Arrhythmia Institute, Austin (J.D.B.); Division of Cardiology, Showa University School of Medicine, Tokyo, Japan (Y.K.); and Cardiovascular Division, University of Pennsylvania, Philadelphia (F.E.M.)
| | - Youichi Kobayashi
- From the Division of Cardiac Electrophysiology, University of California, San Francisco (M.K., E.P.G., V.V., H.H.H., G.M.M., M.M.S., N.B.); Overlake Medical Center, Bellevue, WA (D.M.R.); Texas Cardiac Arrhythmia Institute, Austin (J.D.B.); Division of Cardiology, Showa University School of Medicine, Tokyo, Japan (Y.K.); and Cardiovascular Division, University of Pennsylvania, Philadelphia (F.E.M.)
| | - Henry H. Hsia
- From the Division of Cardiac Electrophysiology, University of California, San Francisco (M.K., E.P.G., V.V., H.H.H., G.M.M., M.M.S., N.B.); Overlake Medical Center, Bellevue, WA (D.M.R.); Texas Cardiac Arrhythmia Institute, Austin (J.D.B.); Division of Cardiology, Showa University School of Medicine, Tokyo, Japan (Y.K.); and Cardiovascular Division, University of Pennsylvania, Philadelphia (F.E.M.)
| | - Gregory M. Marcus
- From the Division of Cardiac Electrophysiology, University of California, San Francisco (M.K., E.P.G., V.V., H.H.H., G.M.M., M.M.S., N.B.); Overlake Medical Center, Bellevue, WA (D.M.R.); Texas Cardiac Arrhythmia Institute, Austin (J.D.B.); Division of Cardiology, Showa University School of Medicine, Tokyo, Japan (Y.K.); and Cardiovascular Division, University of Pennsylvania, Philadelphia (F.E.M.)
| | - Francis E. Marchlinski
- From the Division of Cardiac Electrophysiology, University of California, San Francisco (M.K., E.P.G., V.V., H.H.H., G.M.M., M.M.S., N.B.); Overlake Medical Center, Bellevue, WA (D.M.R.); Texas Cardiac Arrhythmia Institute, Austin (J.D.B.); Division of Cardiology, Showa University School of Medicine, Tokyo, Japan (Y.K.); and Cardiovascular Division, University of Pennsylvania, Philadelphia (F.E.M.)
| | - Melvin M. Scheinman
- From the Division of Cardiac Electrophysiology, University of California, San Francisco (M.K., E.P.G., V.V., H.H.H., G.M.M., M.M.S., N.B.); Overlake Medical Center, Bellevue, WA (D.M.R.); Texas Cardiac Arrhythmia Institute, Austin (J.D.B.); Division of Cardiology, Showa University School of Medicine, Tokyo, Japan (Y.K.); and Cardiovascular Division, University of Pennsylvania, Philadelphia (F.E.M.)
| | - Nitish Badhwar
- From the Division of Cardiac Electrophysiology, University of California, San Francisco (M.K., E.P.G., V.V., H.H.H., G.M.M., M.M.S., N.B.); Overlake Medical Center, Bellevue, WA (D.M.R.); Texas Cardiac Arrhythmia Institute, Austin (J.D.B.); Division of Cardiology, Showa University School of Medicine, Tokyo, Japan (Y.K.); and Cardiovascular Division, University of Pennsylvania, Philadelphia (F.E.M.)
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Noninvasive cardiac arrhythmia therapy using High-Intensity Focused Ultrasound (HIFU) ablation. Int J Cardiol 2013; 166:e28-30. [DOI: 10.1016/j.ijcard.2013.01.235] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 01/16/2013] [Indexed: 11/17/2022]
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6
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Garikipati NV, Paruchuri V, Mittal S. How to Learn Epicardial Intervention Techniques in Electrophysiology. Card Electrophysiol Clin 2010; 2:35-43. [PMID: 28770734 DOI: 10.1016/j.ccep.2009.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article outlines an approach to begin an epicardial ablation program in the electrophysiology laboratory. There are some logistical hurdles in getting this program up and running, so this is a good opportunity to review the indications, the risks that are inherent in the procedure, and the infrastructure necessary in the electrophysiology laboratory and institution to perform the procedure safely and effectively.
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Affiliation(s)
- Naga Vamsi Garikipati
- Clinical Electrophysiology, The Al-Sabah Arrhythmia Institute, The St Luke's and Roosevelt Hospitals Center, Columbia University College of Physicians & Surgeons, 1111 Amsterdam Avenue, New York, NY 10025, USA
| | - Vijayapraveena Paruchuri
- Clinical Electrophysiology, The Al-Sabah Arrhythmia Institute, The St Luke's and Roosevelt Hospitals Center, Columbia University College of Physicians & Surgeons, 1111 Amsterdam Avenue, New York, NY 10025, USA
| | - Suneet Mittal
- Electrophysiology Laboratory, The Al-Sabah Arrhythmia Institute, The St Luke's and Roosevelt Hospitals Center, Columbia University College of Physicians & Surgeons, 1111 Amsterdam Avenue, New York, NY 10025, USA
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7
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Natale A, Raviele A, Al-Ahmad A, Alfieri O, Aliot E, Almendral J, Breithardt G, Brugada J, Calkins H, Callans D, Cappato R, Camm JA, Della Bella P, Guiraudon GM, Haïssaguerre M, Hindricks G, Ho SY, Kuck KH, Marchlinski F, Packer DL, Prystowsky EN, Reddy VY, Ruskin JN, Scanavacca M, Shivkumar K, Soejima K, Stevenson WJ, Themistoclakis S, Verma A, Wilber D. Venice Chart International Consensus document on ventricular tachycardia/ventricular fibrillation ablation. J Cardiovasc Electrophysiol 2010; 21:339-79. [PMID: 20082650 DOI: 10.1111/j.1540-8167.2009.01686.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
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8
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Hashimoto K, Watanabe I, Okumura Y, Ohkubo K, Ashino S, Kofune M, Nakai T, Kunimoto S, Kasamaki Y, Hirayama A. Comparison of Endocardial and Epicardial Lesion Size Following Large-Tip and Extra-Large-Tip Transcatheter Cryoablation. Circ J 2009; 73:1619-26. [DOI: 10.1253/circj.cj-08-1211] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kenichi Hashimoto
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Ichiro Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Sonoko Ashino
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Masayoshi Kofune
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Satoshi Kunimoto
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yuji Kasamaki
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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