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Gardziejczyk P, Piotrowski R, Kryński T, Sikorska A, Kułakowski P, Baran J. Bipolar catheter ablation with dedicated radiofrequency system for highly refractory ventricular arrhythmia-Does the rate of success depend on arrhythmia origin? J Cardiovasc Electrophysiol 2024; 35:667-674. [PMID: 38293729 DOI: 10.1111/jce.16186] [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: 11/28/2023] [Accepted: 01/06/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Despite rapid technological progress, some arrhythmias are still resistant to standard unipolar ablation. These include arrhythmias arising from the base of the heart, cardiac crux, or epicardium. Bipolar radiofrequency ablation (B-RFA) may be useful in some cases, however, data on the efficacy of this approach in various arrhythmia localizations are scarce. The aim of this study was to assess the efficacy of B-RFA in patients with ventricular arrhythmias originating from various locations, occurring refractory to standard unipolar ablation approaches. METHODS An observational, single center study was conducted over a 30-month period. B-RFA were performed using dedicated radio frequency (RF) generator and electroanatomic mapping system. RESULTS Twenty-four procedures, in 23 patients with a median (range) of 1 (1-2) previously failed unipolar ablation procedures, were included in the final analysis. There were 12 ablations of ventricular arrhythmias originating from interventricular septum with an acute success rate of 75%, and 12 from left ventricular (LV) summit with an acute success rate of 58%. The midterm success rate (median interquartile range follow-up of 205 days [188-338]) was 66% and 50%, respectively. CONCLUSIONS B-RFA is a promising method of catheter ablation for refractory cardiac arrhythmias. A higher success rate was observed in ablation for difficult ventricular arrhythmias originating from interventricular septal region than LV summit.
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Affiliation(s)
- Piotr Gardziejczyk
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Roman Piotrowski
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Tomasz Kryński
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Agnieszka Sikorska
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Piotr Kułakowski
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Jakub Baran
- Division of Clinical Electrophysiology, Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
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Atreya AR, Yalagudri SD, Subramanian M, Rangaswamy VV, Saggu DK, Narasimhan C. Best Practices for the Catheter Ablation of Ventricular Arrhythmias. Card Electrophysiol Clin 2022; 14:571-607. [PMID: 36396179 DOI: 10.1016/j.ccep.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Techniques for catheter ablation have evolved to effectively treat a range of ventricular arrhythmias. Pre-operative electrocardiographic and cardiac imaging data are very useful in understanding the arrhythmogenic substrate and can guide mapping and ablation. In this review, we focus on best practices for catheter ablation, with emphasis on tailoring ablation strategies, based on the presence or absence of structural heart disease, underlying clinical status, and hemodynamic stability of the ventricular arrhythmia. We discuss steps to make ablation safe and prevent complications, and techniques to improve the efficacy of ablation, including optimal use of electroanatomical mapping algorithms, energy delivery, intracardiac echocardiography, and selective use of mechanical circulatory support.
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Affiliation(s)
- Auras R Atreya
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India; Division of Cardiovascular Medicine, Electrophysiology Section, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sachin D Yalagudri
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | - Muthiah Subramanian
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | | | - Daljeet Kaur Saggu
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | - Calambur Narasimhan
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India.
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Bennett RG, Campbell T, Sood A, Bhaskaran A, De Silva K, Davis L, Qian P, Sivagangabalan G, Cooper MJ, Chow CK, Thiagalingam A, Denniss AR, Thomas SP, Kizana E, Kumar S. Remote magnetic navigation compared to contemporary manual techniques for the catheter ablation of ventricular arrhythmias in structural heart disease. Heliyon 2021; 7:e08538. [PMID: 34917813 PMCID: PMC8666643 DOI: 10.1016/j.heliyon.2021.e08538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 12/05/2022] Open
Abstract
Background There are limited data comparing remote magnetic navigation (RMN) to contemporary techniques of manual-guided ventricular arrhythmia (VA) catheter ablation. Objectives We compared acute and long-term outcomes of VA ablation guided by either RMN or contemporary manual techniques in patients with structural heart disease. Methods From 2010–2019, 192 consecutive patients, with ischemic cardiomyopathy (ICM) or non-ischemic cardiomyopathy (NICM) underwent catheter ablation for sustained ventricular tachycardia (VT) or premature ventricular complexes (PVCs), using either RMN (n = 60) or manual (n = 132) guided techniques. Acute success and VA-free survival were compared. Results In ICM, acute procedural success was comparable between the 2 techniques (manual 43.5% vs. RMN 29%, P = 0.11), as was VA-free survival (manual 83% vs. RMN 74%, P = 0.88), and survival free from cardiac transplantation and all-cause mortality (manual 88% vs. RMN 87%, P = 0.47), both at 12-months after final ablation. In NICM, manual compared to RMN guided, had superior acute procedural success (manual 46% vs. RMN 19%, P = 0.003) and VA-free survival 12-months after final ablation (manual 79% vs. RMN 41%, P = 0.004), but comparable survival free from cardiac transplantation and all-cause mortality 12-months after final ablation (manual 95% vs. RMN 90%, P = 0.52). Procedural duration was shorter in both subgroups undergoing manual guided ablation, whereas fluoroscopy dose and complication rates were comparable. Conclusion RMN provides similar outcomes to manual ablation in patients with ICM. In NICM however, acute success, and long-term VA-free survival was better with manual ablation. Prospective, multi-centre randomised trials comparing contemporary manual and RMN systems for VA catheter ablation are needed.
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Affiliation(s)
- Richard G. Bennett
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ashish Sood
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Kasun De Silva
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Lloyd Davis
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Pierre Qian
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | | | - Mark J. Cooper
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Clara K. Chow
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Stuart P. Thomas
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Eddy Kizana
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Institute of Medical Research, Westmead, Sydney, New South Wales, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
- Corresponding author.
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Bennett R, Campbell T, Kotake Y, Turnbull S, Bhaskaran A, De Silva K, Lee G, Kalman J, Kumar S. Catheter ablation of idiopathic outflow tract ventricular arrhythmias with low intraprocedural burden guided by pace mapping. Heart Rhythm O2 2021; 2:355-364. [PMID: 34430941 PMCID: PMC8369296 DOI: 10.1016/j.hroo.2021.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background There are limited data comparing ablation outcomes in patients with low intraprocedural burden of ventricular arrhythmias (VA) undergoing a pace mapping (PM)–guided strategy vs those with high burden guided by standard activation mapping strategy (non-PM). Objective We sought to determine if catheter ablation–guided by PM of low-intraprocedural-burden idiopathic outflow tract VA would be noninferior compared to non-PM-guided ablation. Methods Outcomes of catheter ablation of idiopathic outflow tract VA in 22 patients with a low burden of intraprocedural VA using PM-guided ablation were compared to 44 patients with a high burden of intraprocedural VA undergoing ablation using standard techniques. Results Sixty-six patients were included (age 46.5 ± 14.8 years; 68% female, left ventricular ejection fraction 59% ± 5%). Within the PM group, 24-hour preprocedure premature ventricular complex (PVC) burden was 9.5% (interquartile range [IQR] 4%–13.8%), number of pace maps 33.6 ± 18.5, surface area of ≥95% pace map correlation 1.9 ± 1.2 cm2, with best pace map correlation 96% (IQR 92%–97%). Within the non-PM group, 24-hour preprocedure PVC burden was 13.5% (IQR 6.6%–30%), earliest activation time -33.7 ± 9.9 ms. Procedural duration, general anesthesia administration, fluoroscopy dose, and complications were all comparable. Following final procedure, 24-hour VA burden (PM 0% [IQR 0–2.4%] vs non-PM 0% [IQR 0–4.2%], P = .98), along with VA-free survival at 6-month follow-up (PM 77% vs non-PM 71%, P = .77), were both comparable. Conclusion In patients with low intraprocedural burden of outflow tract VA, PM-guided catheter ablation can accurately identify the VA site of origin, leading to outcomes comparable to those achieved with standard ablation techniques.
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Affiliation(s)
- Richard Bennett
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Westmead, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Westmead, Australia
| | - Yasuhito Kotake
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Westmead, Australia
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Westmead, Australia
| | - Ashwin Bhaskaran
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Westmead, Australia
| | - Kasun De Silva
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Westmead, Australia
| | - Geoffrey Lee
- Department of Cardiology, The Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
| | - Jonathan Kalman
- Department of Cardiology, The Royal Melbourne Hospital, University of Melbourne, Victoria, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Westmead, Australia
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Qian PC, Tedrow UB. Intracardiac Echocardiography to Guide Catheter Ablation of Ventricular Arrhythmias in Ischemic Cardiomyopathy. Card Electrophysiol Clin 2021; 13:285-292. [PMID: 33990267 DOI: 10.1016/j.ccep.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intracardiac echocardiography (ICE) allows intraprocedural assessment of cardiac anatomy and identification of ischemic myocardial scar and is useful for guidance of the ablation catheter and monitoring for complications. In this review, the authors discuss and provide examples of how ICE can be used to obtain additional information to understand arrhythmia mechanisms and facilitate catheter ablation therapy for ventricular arrhythmias arising from ischemic scar substrates.
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Affiliation(s)
- Pierre C Qian
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Usha B Tedrow
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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