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Jiang Z, Guo C, Liu Q, Tian Y, Tian L, Yang Y, Wang J, Chen C, Zheng Y, Li Y, Ou Q, Yang L. Outcomes of single-procedure radiofrequency catheter ablation for idiopathic ventricular arrhythmias: a single-centre retrospective cohort study. BMJ Open 2024; 14:e081815. [PMID: 38382956 PMCID: PMC10882318 DOI: 10.1136/bmjopen-2023-081815] [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] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVES Radiofrequency catheter ablation is the first-line treatment for idiopathic premature ventricular complexes (PVCs) and ventricular tachycardias (VTs). However, the outcomes were less compared among the categories. The study aims to assess the effectiveness and safety of catheter ablation for idiopathic PVC/VTs in a single high-volume centre, using the right ventricular outflow tract (RVOT) as a reference. DESIGN Retrospective cohort study. SETTING Patient data were collected from a tertiary hospital in Guizhou, China. PARTICIPANTS Between September 2013 and September 2022, 1028 patients (male: 41.3%; age: 46.5±15.6 years) who underwent the first catheter ablation for idiopathic monomorphic PVC/VTs were enrolled. OUTCOME MEASURES Acute success, procedure-related complications, and long-term recurrence were assessed. Antiarrhythmic drugs (AADs) were not administrated after procedures unless recurrence was identified. RESULTS The overall acute success rate was 90.3%, with 368 patients (35.8%) experiencing left ventricular PVC/VTs. No cases of third-degree atrioventricular block or death were reported. Complications were more common in patients with left ventricular PVC/VTs than those with right-sided ones (4.6% vs 0.1%, p<0.001). A total of 926 patients (90.1%) were followed up for an average of 9.7±3.7 months, and only the PVC/VTs category was found to be associated with long-term success rates. The RVOT, endocardial left ventricular outflow tract (endoLVOT), tricuspid annulus (TA) free wall, posterior septum and fascicular VT had long-term success rates exceeding 85%. Other types of PVC/VTs showed significantly higher risks of recurrence. CONCLUSIONS Besides RVOT and fascicular VT, single-procedure catheter ablation without AADs is highly effective for endoLVOT, TA-free wall and posterior septum. Patients with left ventricular PVC/VTs have higher complication risks compared with right ones.
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Affiliation(s)
- Zhi Jiang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Chuxian Guo
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Qifang Liu
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Ye Tian
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Longhai Tian
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Ying Yang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Junxian Wang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Chunyan Chen
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Yaxi Zheng
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
| | - Yu Li
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Qiaoqiao Ou
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Long Yang
- Cardiology Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
- Guizhou Provincial Cardiovascular Disease Institute, Guiyang, China
- Guizhou Medical University, Guiyang, Guizhou, China
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Kellnar A, von Falkenhausen AS, Fichtner S, Sinner M, Estner HL, Lackermair K. Effects of contemporary hard- and software mapping and ablation features on acute and long-term success in premature ventricular complex ablation. Int J Cardiol 2023; 390:131269. [PMID: 37591414 DOI: 10.1016/j.ijcard.2023.131269] [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: 07/04/2023] [Revised: 08/04/2023] [Accepted: 08/13/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Current standards of ablation of premature ventricular complexes (PVC) combine modern hard- and software mapping and ablation features like multielectrode mapping catheters (MEC), contact force (CF) guided ablation catheters and pattern matching filters (PMF). Benefits of these individual tools were described for selected patients with PVC, but data on combination of these features in the real world setting is sparse. METHODS Between 2015 and 2021 we retrospectively enrolled 172 consecutive patients undergoing PVC ablation in our center. The utilization of MEC, CF guided ablation catheters and PMF software was analyzed in terms of procedural data, acute and long-term success after 12 months. RESULTS Acute ablation success was reached in 71% of patients (n = 118) with an overall recurrence rate of 34% after 12 months. PMF software was used in 130 patients (78%), MEC in 131 patients (79%) and ablation was guided using CF in 99 patients (60%). PMF significantly reduced procedural duration and time of radiofrequency application (RF, 150 vs. 185 min, p 0.04 and 325 vs. 556 min, p 0.01). CF enabled significantly shorter radiation time (7.9 vs. 12.3 min, p 0.01), whereas MEC did not influence procedural data. Acute and long-term outcomes were not affected by these modern mapping and ablation features, yet, multivariable regression analysis revealed an underlying cardiomyopathy and the respective focus as independent predictors for recurrence. CONCLUSION Contemporary hard- and software mapping and ablation features could reduce procedural, radiation and RF time in PVC ablation. Furthermore, patient characteristics rather than technical factors alter outcome of this all-comer collective.
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Affiliation(s)
- Antonia Kellnar
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany.
| | - Aenne S von Falkenhausen
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | | | - Moritz Sinner
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Heidi L Estner
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Korbinian Lackermair
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
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Kurtul BE, Kurtul A, Kaypakli O. Impact of catheter ablation procedure on optical coherence tomography angiography findings in patients with ventricular arrhythmia. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230489. [PMID: 37729374 PMCID: PMC10508935 DOI: 10.1590/1806-9282.20230489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/25/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE Catheter ablation procedure may cause retinal complications associated with the risk of thromboembolism. We aimed to evaluate retina and optic disc microvascularity with optical coherence tomography angiography before and after the catheter ablation process in patients with ventricular arrhythmia. METHODS A total of 40 eyes of 21 ventricular arrhythmia patients were included in this cross-sectional study. Demographic characteristics and ophthalmic examination findings of patients were recorded. optical coherence tomography angiography measurements were evaluated before (group 1) and after (group 2) catheter ablation. Optical coherence tomography angiography was applied to all eyes with 6×6 mm sections for the macula and 4.5×4.5 mm sections for the optic nerve head. Foveal retinal thickness, peripapillary retinal nerve fiber layer thickness, vessel density in different parts of the retina, and optic disc were analyzed. RESULTS The mean age of ventricular arrhythmia patients was 53.48±13.02 years. In all, 13 (61.9%) of the patients were males and 8 (38.1%) were females. There was no significant difference between the groups in terms of average, inferior, superior, and temporal retinal nerve fiber layer thicknesses, foveal avascular area, flow areas, superficial and deep vessel densities, and optic disc capillary densities of the optic disc. However, when compared with group 1, significantly lower values in foveal retinal thickness and higher values in nasal retinal nerve fiber layer thickness were observed in group 2 (248.42±20.50 vs. 247.20±20.44, p<0.001 and 94.22±18.43 vs. 96.12±20.18, p=0.044, respectively). CONCLUSION Although foveal retinal thickness and nasal retinal nerve fiber layer thickness are affected in patients undergoing catheter ablation for ventricular arrhythmia, the stable retinal and optic disc vessel densities can be explained by the administration of effective anticoagulants during the procedure.
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Affiliation(s)
- Bengi Ece Kurtul
- Hatay Mustafa Kemal University, Tayfur Ata Sökmen Faculty of Medicine, Department of Ophthalmology – Hatay, Turkey
| | - Alparslan Kurtul
- Hatay Mustafa Kemal University, Tayfur Ata Sökmen Faculty of Medicine, Department of Cardiology – Hatay, Turkey
| | - Onur Kaypakli
- Hatay Mustafa Kemal University, Tayfur Ata Sökmen Faculty of Medicine, Department of Cardiology – Hatay, Turkey
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4
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Subramanian M, Atreya AR, Saggu DK, Yalagudri S, Calambur N. Catheter ablation of ventricular tachycardia: strategies to improve outcomes. Front Cardiovasc Med 2023; 10:966634. [PMID: 37645526 PMCID: PMC10461400 DOI: 10.3389/fcvm.2023.966634] [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: 06/11/2022] [Accepted: 04/24/2023] [Indexed: 08/31/2023] Open
Abstract
Catheter ablation of ventricular arrhythmias has evolved considerably since it was first described more than 3 decades ago. Advancements in understanding the underlying substrate, utilizing pre-procedural imaging, and evolving ablation techniques have improved the outcomes of catheter ablation. Ensuring safety and efficacy during catheter ablation requires adequate planning, including analysis of the 12 lead ECG and appropriate pre-procedural imaging. Defining the underlying arrhythmogenic substrate and disease eitology allow for the developed of tailored ablation strategies, especially for patients with non-ischemic cardiomyopathies. During ablation, the type of anesthesia can affect VT induction, the quality of the electro-anatomic map, and the stability of the catheter during ablation. For high risk patients, appropriate selection of hemodynamic support can increase the success of VT ablation. For patients in whom VT is hemodynamically unstable or difficult to induce, substrate modification strategies can aid in safe and successful ablation. Recently, there has been an several advancements in substrate mapping strategies that can be used to identify and differentiate local late potentials. The incorporation of high-definition mapping and contact-sense technologies have both had incremental benefits on the success of ablation procedures. It is crucial to harness newer technology and ablation strategies with the highest level of peri-procedural safety to achieve optimal long-term outcomes in patients undergoing VT ablation.
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Affiliation(s)
- Muthiah Subramanian
- Department of Cardiology, AIG Institute of Cardiac Sciences, Gachibowli, India
| | - Auras R. Atreya
- Department of Cardiology, University of Arkansas Medical Sciences, Little Rock, AR, United States
| | - Daljeet Kaur Saggu
- Department of Cardiology, AIG Institute of Cardiac Sciences, Gachibowli, India
| | - Sachin Yalagudri
- Department of Cardiology, AIG Institute of Cardiac Sciences, Gachibowli, India
| | - Narasimhan Calambur
- Department of Cardiology, AIG Institute of Cardiac Sciences, Gachibowli, India
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Karkowski G, Kuniewicz M, Ząbek A, Koźluk E, Dębski M, Matusik PT, Lelakowski J. Contact Force-Sensing versus Standard Catheters in Non-Fluoroscopic Radiofrequency Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias. J Clin Med 2022; 11:jcm11030593. [PMID: 35160043 PMCID: PMC8836481 DOI: 10.3390/jcm11030593] [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: 12/15/2021] [Revised: 01/10/2022] [Accepted: 01/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Adequate contact between the catheter tip and tissue is important for optimal lesion formation and, in some procedures, it has been associated with improved effectiveness and safety. We evaluated the potential benefits of contact force-sensing (CFS) catheters during non-fluoroscopic radiofrequency catheter ablation (NF-RFCA) of idiopathic ventricular arrhythmias (VAs) originating from outflow tracts (OTs). Methods: A group of 102 patients who underwent NF-RFCA (CARTO, Biosense Webster Inc., Irvine, CA, USA) of VAs from OTs between 2014 to 2018 was retrospectively analyzed. Results: We included 52 (50.9%) patients in whom NF-RFCA was performed using CFS catheters and 50 (49.1%) who were ablated using standard catheters. Arrhythmias were localized in the right and left OT in 70 (68.6%) and 32 (31.4%) patients, respectively. The RFCA acute success rate was 96.1% (n = 98) and long-term success during a minimum 12-month follow-up (mean 51.3 ± 21.6 months) was 85.3% (n = 87), with no difference between CFS and standard catheters. There was no difference in complications rate between CFS (n = 1) and standard catheter (n = 2) ablations. Conclusions: There is no additional advantage of CFS catheters use over standard catheters during NF-RFCA of OT-VAs in terms of procedural effectiveness and safety.
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Affiliation(s)
- Grzegorz Karkowski
- Department of Electrocardiology, The John Paul II Hospital, 31-202 Kraków, Poland; (G.K.); (M.K.); (A.Z.); (J.L.)
| | - Marcin Kuniewicz
- Department of Electrocardiology, The John Paul II Hospital, 31-202 Kraków, Poland; (G.K.); (M.K.); (A.Z.); (J.L.)
- Department of Anatomy, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Andrzej Ząbek
- Department of Electrocardiology, The John Paul II Hospital, 31-202 Kraków, Poland; (G.K.); (M.K.); (A.Z.); (J.L.)
| | - Edward Koźluk
- Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Maciej Dębski
- Department of Cardiology, Norfolk and Norwich University Hospital, University of East Anglia, Norwich NR4 7TJ, UK;
| | - Paweł T. Matusik
- Department of Electrocardiology, The John Paul II Hospital, 31-202 Kraków, Poland; (G.K.); (M.K.); (A.Z.); (J.L.)
- Department of Electrocardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Kraków, Poland
- Correspondence: ; Tel.: +48-12-614-2277
| | - Jacek Lelakowski
- Department of Electrocardiology, The John Paul II Hospital, 31-202 Kraków, Poland; (G.K.); (M.K.); (A.Z.); (J.L.)
- Department of Electrocardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-008 Kraków, Poland
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6
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Reichlin T, Baldinger SH, Pruvot E, Bisch L, Ammann P, Altmann D, Berte B, Kobza R, Haegeli L, Schlatzer C, Mueller A, Namdar M, Shah D, Burri H, Conte G, Auricchio A, Knecht S, Osswald S, Asatryan B, Seiler J, Roten L, Kühne M, Sticherling C. Impact of contact force sensing technology on outcome of catheter ablation of idiopathic pre-mature ventricular contractions originating from the outflow tracts. Europace 2021; 23:603-609. [PMID: 33207371 DOI: 10.1093/europace/euaa315] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/21/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Catheter ablation of frequent idiopathic pre-mature ventricular contractions (PVC) is increasingly performed. While potential benefits of contact force (CF)-sensing technology for atrial fibrillation ablation have been assessed in several studies, the impact of CF-sensing on ventricular arrhythmia ablation remains unknown. This study aimed to compare outcomes of idiopathic outflow tract PVC ablation when using standard ablation catheters as opposed to CF-sensing catheters. METHODS AND RESULTS In a retrospective multi-centre study, unselected patients undergoing catheter ablation of idiopathic outflow tract PVCs between 2013 and 2016 were enrolled. All procedures were performed using irrigated-tip ablation catheters and a 3D electro-anatomical mapping system. Sustained ablation success was defined as a ≥80% reduction of pre-procedural PVC burden determined by 24 h Holter ECG during follow-up. Overall, 218 patients were enrolled (median age 52 years, 51% males). Baseline and procedural data were similar in the standard ablation (24%) and the CF-sensing group (76%). Overall, the median PVC burden decreased from 21% (IQR 10-30%) before ablation to 0.2% (IQR 0-3.0%) after a median follow-up of 2.3 months (IQR 1.4-3.9 months). The rates of both acute (91% vs. 91%, P = 0.94) and sustained success (79% vs. 74%, P = 0.44) were similar in the standard ablation and the CF-sensing groups. No differences were observed in subgroups according to arrhythmia origin from the RVOT (65%) or LVOT (35%). Complications were rare (1.8%) and evenly distributed between the two groups. CONCLUSION The use of CF-sensing technology is not associated with increased success rate nor decreased complication rate in idiopathic outflow tract PVC ablation.
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Affiliation(s)
- Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.,Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Etienne Pruvot
- Department of Cardiology, University Hospital Lausanne, Lausanne, Switzerland
| | - Laurence Bisch
- Department of Cardiology, University Hospital Lausanne, Lausanne, Switzerland
| | - Peter Ammann
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - David Altmann
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Benjamin Berte
- Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Laurent Haegeli
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.,Department of Cardiology, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Christian Schlatzer
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - Andreas Mueller
- Department of Cardiology, Triemli Hospital, Zurich, Switzerland
| | - Mehdi Namdar
- Department of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | - Dipen Shah
- Department of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | - Haran Burri
- Department of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | - Giulio Conte
- Department of Cardiology, Fundazione Cardiocentro Ticino, Lugano, Switzerland
| | - Angelo Auricchio
- Department of Cardiology, Fundazione Cardiocentro Ticino, Lugano, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
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