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Freilich M, Musikantow DR, Dukkipati S. Ventricular Tachycardia Ablation Through a Recanalized Surgically Plicated Left Ventricular Apical Aneurysm. JACC Case Rep 2024; 29:102299. [PMID: 38601847 PMCID: PMC11002801 DOI: 10.1016/j.jaccas.2024.102299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/17/2024] [Accepted: 02/08/2024] [Indexed: 04/12/2024]
Abstract
Left ventricular apical aneurysms are associated with scar-related ventricular tachycardia (VT) in hypertrophic cardiomyopathy patients. We present a patient with apical hypertrophic cardiomyopathy who underwent combined epicardial and endocardial VT ablation of a left ventricular apical aneurysm, necessitating repeat endocardial VT ablation through a recanalized surgical plication.
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Affiliation(s)
- Michael Freilich
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Daniel R. Musikantow
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Srinivas Dukkipati
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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2
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Jiang Z, Huang J, Ma N, Liu H, Shen SE, Ding F, Wang Y, Tang M, Mei J. Concurrent vs Staged Hybrid Ablation for Long-Standing Persistent Atrial Fibrillation: A Propensity-Matched Cohort Study. JACC Clin Electrophysiol 2024:S2405-500X(24)00160-9. [PMID: 38573292 DOI: 10.1016/j.jacep.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Long-term success rates of catheter ablation (CA) for long-standing persistent atrial fibrillation (LSPAF) are less than satisfactory. Further improvement of ablation methods is crucial for enhancing the treatment of LSPAF. OBJECTIVE This study sought to compare the outcomes of concurrent vs staged minimally invasive surgical-catheter hybrid ablation for LSPAF. METHODS From December 2015 to December 2021, 104 matched patients (concurrent and staged, 1:1) were included in study. In the concurrent group, both left unilateral thoracoscopic epicardial ablation (EA) and CA were performed simultaneously in one procedure. In the staged group, EA was performed at the first hospitalization. If the patients experienced atrial fibrillation (AF) recurrence, CA was performed between 3 months and 1 year after EA. RESULTS In the concurrent group, 4 patients were restored to sinus rhythm after EA, and 41 were patients restored to sinus rhythm during CA; 86.5% (45 of 52) achieved intraprocedural AF termination during concurrent hybrid ablation. In the staged group, all 52 patients underwent staged CA because of the recurrence of AF or atrial tachycardia (AT). Forty-seven (90.4%) patients achieved intraprocedural AF or AT termination during CA. Freedom from AF or AT off antiarrhythmic drugs at 2 years after hybrid ablation was 79.9% ± 5.7% in the concurrent group and 86.0% ± 4.9% in the staged group (P = 0.390). Failure of intraprocedural AF termination (HR: 14.378) was an independent risk factor for AF recurrence after hybrid ablation. CONCLUSIONS Both concurrent and staged hybrid ablation could be safely and effectively applied to treat LSPAF. Improving the intraprocedural AF termination rate predicted better outcomes.
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Affiliation(s)
- Zhaolei Jiang
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Jianbing Huang
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Nan Ma
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Hao Liu
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Sai-E Shen
- Department of Anesthesiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Fangbao Ding
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Yingman Wang
- Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
| | - Min Tang
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China.
| | - Ju Mei
- Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China.
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Fang Z, Li X, Yan S, Si P, Ma F, Zhang W, Zhang B, Zhou T, Yang B. A novel polarity configuration for enhancing ablation depth of pulsed field ablation: Design, modeling, and in vivo validation. Med Phys 2023; 50:5364-5374. [PMID: 37493518 DOI: 10.1002/mp.16621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Pulsed field ablation (PFA) has been increasingly used to cut off the delivery of abnormal electrical signals in the treatment of cardiac arrhythmias. A successful cut off requires forming a layer of transmural damage on the heart wall, and this layer depends on the depth of ablation by PFA. PURPOSE This study aims to propose a novel polarity configuration of PFA to increase the ablation depth in the treatment of cardiac arrhythmias. METHOD A novel polarity configuration was designed for a multi-electrode system, where the number of electrodes is greater than two. The polarity configuration in such multi-electrode system is called the paired-electrode interlaced configuration (PIC). The existing configuration called the single-electrode interlaced configuration (SIC) was used to compare with the PIC. To both the SIC and PIC, a full-SIC or a full-PIC is called when all electrodes (anode, cathode) in a catheter is used otherwise partial-SIC or partial-PIC is called. By the comparison between the full-SIC and full-PIC, the benefit of the PIC was exhibited as opposed to the SIC, but an extra ablation step was added in the PIC in order to form a continuous ablation zone. The other comparative study was taken between a partial-PIC and a partial-SIC with the same number of ablation step. In this study, a rabbit model was built by infusing 0.4% saline solution (at 37°C) into the rabbit's abdominal cavity which surrounds the liver. This model was considered as a biometric environment of the heart, namely cardiac-mimetic model (CMM). RESULT The experimental results have shown that the full-PIC is superior to the full-SIC in the ablation depth, specifically in both the maximum (4.14 ± 0.55 mm vs. 3.35 ± 0.26 mm, p < 0.01) and the minimum (3.18 ± 0.29 mm vs. 2.76 ± 0.28 mm, p < 0.05), and in the ablation width, specifically only in the maximum (8.27 ± 0.76 mm vs. 7.09 ± 0.51 mm, p = 0.019) under an identical ablation time (i.e., 5 s). It is noted that the minimum ablation width did not show a significant difference between the full-PIC and full-SIC (specifically, 5.61 ± 0.86 mm vs. 4.67 ± 0.73 mm, p = 0.069). Considering the lethal electric field threshold (LEFT) to be 600 V/cm for liver tissues, the maximum and minimum ablation depth generated by the full-PIC was found larger than that by the full-SIC (3.90 vs. 3.52 mm, and 3.03 vs. 2.48 mm, respectively) in the simulation. Meanwhile, similar experiment results by comparing the partial-PIC and partial-SIC have been obtained, which shows a significant increase in both the maximum ablation depth (4.81 ± 0.87 mm vs. 3.30 ± 0.73 mm, p < 0.001) and the maximum ablation width (8.19 ± 0.85 mm vs. 6.47 ± 1.13 mm, p = 0.001). CONCLUSIONS (1) The electric field in the PIC is concentrated around the pair of electrodes, and the pattern of the field is a significant factor in the energy delivery along the direction of the depth. (2) The increase of the ablation depth can significantly expand the range of the tissue on the heart, where the PFA can apply, and can therefore readily form a layer of transmural damage on the heart wall at positions at which the wall is thicker.
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Affiliation(s)
- Zheng Fang
- Cardiac Electrophysiology R&D Center, APT Medical Inc., Shanghai, China
- Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, Canada
| | - Xiaorong Li
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shengjie Yan
- Centre for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Peng Si
- Cardiac Electrophysiology R&D Center, APT Medical Inc., Shanghai, China
| | - Fei Ma
- Cardiac Electrophysiology R&D Center, APT Medical Inc., Shanghai, China
| | - Wenjun Zhang
- Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, Canada
| | - Bing Zhang
- Intelligent Energy-based Tumor Ablation Laboratory, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Tuo Zhou
- Cardiac Electrophysiology R&D Center, APT Medical Inc., Shanghai, China
| | - Bing Yang
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Du X, Wang S, He B, Chu H. Coronary Injury Caused by Endocardial Ablation in Midanterior Septum of the Right Ventricle. JACC Case Rep 2022; 4:101628. [PMID: 36684028 PMCID: PMC9847231 DOI: 10.1016/j.jaccas.2022.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
Coronary injury or spasm induced by endocardial radiofrequency catheter ablation in the right ventricle (RV) has been rarely reported. We introduce a case of coronary injury from a young patient who underwent catheter ablation for idiopathic ventricular arrhythmia originating from the RV septum. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Xianfeng Du
- Arrhythmia Center, Ningbo First Hospital, Ningbo City, China
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo City, China
| | - Shiqi Wang
- Arrhythmia Center, Ningbo First Hospital, Ningbo City, China
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo City, China
| | - Bin He
- Arrhythmia Center, Ningbo First Hospital, Ningbo City, China
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo City, China
| | - Huimin Chu
- Arrhythmia Center, Ningbo First Hospital, Ningbo City, China
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo City, China
- Address for correspondence: Dr Huimin Chu, Ningbo First Hospital, Zhejiang University, Arrhythmia Center, 59 Liuting Street, Ningbo City, Zhejiang 315010, China.
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Barrett C, Tzou WS. Endocardial and Epicardial Scar Homogenization: Is It Time to See the Light? JACC Clin Electrophysiol 2022; 8:462-464. [PMID: 35450600 DOI: 10.1016/j.jacep.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/02/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Christopher Barrett
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Wendy S Tzou
- Cardiac Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
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Mohanty S, Trivedi C, Di Biase L, Burkhardt JD, Della Rocca DG, Gianni C, MacDonald B, Mayedo A, Shetty SS, Zagrodzky W, Baqai F, Bassiouny M, Gallinghouse GJ, Horton R, Al-Ahmad A, Natale A. Endocardial Scar-Homogenization With vs Without Epicardial Ablation in VT Patients With Ischemic Cardiomyopathy. JACC Clin Electrophysiol 2022; 8:453-461. [PMID: 35246406 DOI: 10.1016/j.jacep.2021.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES In this study, the authors investigated the ablation success of scar homogenization with combined (epicardial + endocardial) vs endocardial-only approach for ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) at 5 years of follow-up. BACKGROUND Best ablation approach to achieve long-term success rate in VT patients with ICM is not known yet. METHODS Consecutive ICM patients undergoing VT ablation at our center were classified into group 1: endocardial + epicardial scar homogenization and group 2: endocardial scar homogenization. Patients with previous open heart surgery were excluded. Epicardial ablation was performed despite being noninducible after endocardial ablation in all group 1 patients. All patients underwent bipolar substrate mapping with standard scar settings defined as normal tissue >1.5 mV and severe scar <0.5 mV. Noninducibility of monomorphic VT was the procedural endpoint in both groups. Patients were followed up every 4 months for 5 years with implantable device interrogations. RESULTS A total of 361 patients (group 1: n = 70 and group 2: n = 291) were included in the study. At 5 years, 81.4% (n = 57/70) patients from group 1 and 66.3% (n = 193/291) from group 2 were arrhythmia-free (P = 0.01) Of those patients, 26 of 57 (45.6%) and 172 of 193 (89.1%) from group 1 and group 2 respectively were on anti-arrhythmic drugs (AAD) (log-rank P < 0.001). After adjusting for age, sex, and obstructive sleep apnea, endo-epicardial scar homogenization was associated with a significant reduction in arrhythmia-recurrence (HR: 0.48; 95% CI: 0.27-0.86; P = 0.02). CONCLUSIONS In this series of patients with ICM and VT, epicardial substrate was detected in all group 1 patients despite being noninducible after endocardial ablation. Moreover, combined endo-epicardial scar homogenization was associated with a significantly higher success rate at 5 years of follow-up and a substantially lower need for antiarrhythmic drugs after the procedure compared with the endocardial ablation alone.
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Affiliation(s)
- Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York, USA
| | - John D Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Bryan MacDonald
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Angel Mayedo
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Sai Shishir Shetty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Will Zagrodzky
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Faiz Baqai
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA; Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
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7
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Yammine M, Puskas J, El Moheb M, Lattouf O. The surgical technique of the convergent procedure. J Cardiovasc Electrophysiol 2021; 32:3221-3227. [PMID: 34559431 DOI: 10.1111/jce.15252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
The convergent procedure is a newly developed hybrid ablation procedure that involves extensive epicardial ablation of the posterior left atrial wall followed by endocardial mapping and addition of pulmonary vein isolation. It is a team-based approach that provides a promising option for patients with persistent and permanent atrial fibrillation. In this manuscript, we present a detailed description of the surgical component of this procedure and include potential pitfalls based on our experience in performing it.
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Affiliation(s)
- Maroun Yammine
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York City, New York, USA
| | - John Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside Hospital, New York City, New York, USA
| | - Mohamad El Moheb
- Department of Surgery, Emory University Hospital, Atlanta, Georgia, USA
| | - Omar Lattouf
- Department of Cardiovascular Surgery, Mount Sinai Morningside Hospital, New York City, New York, USA.,Department of Surgery, Emory University Hospital, Atlanta, Georgia, USA
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8
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De Martino G, Compagnucci P, Mancusi C, Vassallo E, Calvanese C, Della Ratta G, Librera M, Franciulli M, Marino L, Russo AD, Casella M. Stepwise endo-/epicardial catheter ablation for atrial fibrillation: The Mediterranea approach. J Cardiovasc Electrophysiol 2021; 32:2107-2115. [PMID: 34216076 PMCID: PMC8457187 DOI: 10.1111/jce.15151] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/28/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
Background Outcomes of catheter ablation (CA) among patients with nonparoxysmal atrial fibrillation (AF) are largely disappointing. Objective We sought to evaluate the feasibility, effectiveness, and safety of a single‐stage stepwise endo‐/epicardial approach in patients with persistent/longstanding‐persistent AF. Methods We enrolled 25 consecutive patients with symptomatic persistent (n = 4) or longstanding‐persistent (n = 21) AF and at least one prior endocardial procedure, who underwent CA using an endo‐/epicardial approach. Our anatomical stepwise protocol included multiple endocardial as well as epicardial (Bachmann's bundle [BB] and ligament of Marshall ablations) components, and entailed ablation of atrial tachycardias emerging during the procedure. The primary outcome was freedom from any AF/atrial tachycardia episode after a 3‐month blanking period. The secondary outcome was patients' symptom status during follow‐up. Results The stepwise endo‐/epicardial approach allowed sinus rhythm restoration in 72% of patients, either directly (n = 6, 24%) or after AF organization into atrial tachycardia (n = 12, 48%). BB's ablation was commonly implicated in arrhythmia termination. After a median follow‐up of 266 days (interquartile range, 96 days), survival free from AF/atrial tachycardia was 88%. Antiarrhythmic drugs could be discontinued in 22 patients (88%). As compared to baseline, more patients were asymptomatic at 9‐month follow‐up (0% vs. 56%, p = .02). Five patients (20%) developed mild medical complications, whereas one subject (4%) had severe kidney injury requiring dialysis. Conclusion A single‐stage endo‐/epicardial CA resulted in favorable rhythm and symptom outcomes in a cohort of patients with symptomatic persistent/longstanding‐persistent AF and one or more prior endocardial procedures. Epicardial ablation of BB was commonly implicated in procedural success.
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Affiliation(s)
| | - Paolo Compagnucci
- Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Marche Polytechnic University, Ancona, Italy
| | - Carmine Mancusi
- Arrhythmology and Heart Failure Unit, Mediterranea Hospital, Naples, Italy
| | - Enrico Vassallo
- Arrhythmology and Heart Failure Unit, Mediterranea Hospital, Naples, Italy
| | - Claudia Calvanese
- Arrhythmology and Heart Failure Unit, Mediterranea Hospital, Naples, Italy
| | | | | | | | - Luigi Marino
- Cardiac Surgery Unit, Mediterranea Hospital, Naples, Italy
| | - Antonio Dello Russo
- Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Marche Polytechnic University, Ancona, Italy
| | - Michela Casella
- Department of Clinical, Special, and Dental Sciences, Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Marche Polytechnic University, Ancona, Italy
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Romero J, Patel K, Briceno D, Alviz I, Gabr M, Diaz JC, Trivedi C, Mohanty S, Della Rocca D, Al-Ahmad A, Yang R, Rios S, Cerna L, Du X, Tarantino N, Zhang XD, Lakkireddy D, Natale A, Di Biase L. Endo-epicardial ablation vs endocardial ablation for the management of ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2020; 31:2022-2031. [PMID: 32478430 DOI: 10.1111/jce.14593] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/28/2020] [Accepted: 05/25/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The pathologic process of ARVC (arrhythmogenic right ventricular cardiomyopathy) typically originates in the epicardium or subepicardial layers with progression toward endocardium. However, in the most recent ARVC international task force consensus statement, epicardial ventricular tachycardia (VT) ablation is recommended as a Class I indication only in patients with at least one failed endocardial VT ablation attempt. OBJECTIVE The aim of this meta-analysis is to assess the outcomes of ARVC patients undergoing combined endo-epicardial VT ablation, as compared to endocardial ablation alone. METHODS A systematic review of PubMed, Embase, and Cochrane was performed for studies reporting clinical outcomes of endo-epicardial VT ablation vs endocardial-only VT ablation in patients with ARVC. Fixed-Effect model was used if I2 < 25 and the Random-Effects Model was used if I2 ≥ 25%. RESULTS Nine studies consisting of 452 patients were included (mean age 42.3 ± 5.7 years; 70% male). After a mean follow-up of 48.1 ± 21.5 months, endo-epicardial ablation was associated with 42% relative risk reduction in VA recurrence as opposed to endocardial ablation alone (risk ratio [RR], 0.58; 95% confidence interval [CI], 0.45-0.75; P < .0001). No significant differences were noted between endo-epicardial and endocardial VT ablation groups in terms of all-cause mortality (RR, 1.19; 95% CI, 0.03-47.08; P = .93) and acute procedural complications (RR, 5.39; 95% CI, 0.60-48.74; P = .13). CONCLUSIONS Our findings suggest that in patients with ARVC, endo-epicardial VT ablation is associated with a significant reduction in VA recurrence as opposed to endocardial ablation alone, without a significant difference in all-cause mortality or acute procedural complications.
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Affiliation(s)
- Jorge Romero
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Kavisha Patel
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - David Briceno
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Isabella Alviz
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Mohamed Gabr
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Juan Carlos Diaz
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Ruike Yang
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.,Division of Cardiology, Department of Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Saul Rios
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Luis Cerna
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Xianfeng Du
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Nicola Tarantino
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Xiao-Dong Zhang
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Luigi Di Biase
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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10
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Khan Z, Hamandi M, Khan H, DiMaio JM, Evans M. Convergent epicardial- endocardial ablation for treatment of long-standing persistent atrial fibrillation: A review of literature. J Card Surg 2020; 35:1306-1313. [PMID: 32333456 DOI: 10.1111/jocs.14562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/26/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIM OF STUDY The convergent procedure (CVP) is a hybrid ablation technique via a subxiphoid incision that has recently emerged as a treatment option for non-paroxysmal atrial fibrillation (npAF). By combining endocardial and epicardial ablation into a simultaneous or staged procedure, the pulmonary vein and posterior left atrium can be isolated with transmural lesion sets while minimizing the risk of proarrhythmic gaps that are a known limitation with endocardial linear lesion sets. We reviewed the 12-month outcomes in patients who underwent CVP compared to those who underwent endocardial catheter ablation (CA) and surgical ablation (SA). METHODS A literature search was conducted using the PubMed database for publications related to CVP. Selected studies included detailed 12-month follow-up of patients, patient characteristics, periprocedural complications, use of antiarrhythmic drugs (AADs), and monitoring method. RESULTS Five studies with 340 patients who underwent CVP between January 2009 and March 2017 were selected for this review. A total of 8.5% of patients had paroxysmal AF (pAF), 42.2% had persistent AF (peAF), and 49.1% had long-standing persistent AF (lspAF). At 12 months, 81.9% of patients were in sinus rhythm, while 54.1% of patients were in sinus rhythm while not taking AADs. The overall complication rate was 10%. CONCLUSION CVP had better 1-year efficacy in eliminating AF when compared to CA. However, SA, specifically the Cox Maze IV, had lower rates of AF recurrence in the npAF patient population. Despite its promising 1-year efficacy rates, the periprocedural complication rate for CVP was significantly higher than both CA and SA.
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Affiliation(s)
- Zoheb Khan
- Cardiovascular Research, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - Mohanad Hamandi
- Cardiovascular Research, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - Hafiza Khan
- Cardiovascular Research, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - John Michael DiMaio
- Cardiovascular Research, Baylor Scott & White The Heart Hospital, Plano, Texas
| | - Matthew Evans
- Electrophysiology, Baylor Scott & White The Heart Hospital, Denton, Texas
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Mehra NS, Goel K, Asirvatham SJ, Rihal CS. Right Ventriculocutaneous Fistula Treated With Radiofrequency Ablation. JACC Cardiovasc Interv 2019; 12:1737-8. [PMID: 31153843 DOI: 10.1016/j.jcin.2019.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/20/2019] [Accepted: 04/02/2019] [Indexed: 10/26/2022]
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Berruezo A, Acosta J. To Reach or Not to Reach the Whole Arrhythmic Substrate?: A Matter of Accessibility. JACC Clin Electrophysiol 2019; 5:25-27. [PMID: 30678783 DOI: 10.1016/j.jacep.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 11/19/2022]
Affiliation(s)
| | - Juan Acosta
- Arrhythmia Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Clive Robinson M, Scierka L, Chiravuri M, Winslow R, Squitieri R, Dimeo A, Feinn R, Tiano JJ, Mcpherson C. Confluent Extended Posterior Left Atrial Wall Ablation: Thinking Inside the Box. J Innov Card Rhythm Manag 2017; 8:2765-2772. [PMID: 32494458 PMCID: PMC7252930 DOI: 10.19102/icrm.2017.080704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/22/2017] [Indexed: 11/06/2022] Open
Abstract
Here, we report intermediate follow-up details after using a technique of confluent posterior left atrial wall epicardial ablation designed to eliminate both existing and future atrial fibrillation (AF) substrates. The method is part of the Convergent hybrid procedure for AF ablation. In this study, multiple confluent epicardial ablations with radiofrequency energy were delivered, spanning the vertical and transverse dimensions of the posterior left atrium, along with facilitated pulmonary vein isolation (PVI). Endocardial mapping and ablation were performed to complete PVI and to ablate the cavotricuspid isthmus. All patients were followed clinically and using two-to-four weeks of continuous monitoring at six, 12, and 24 months, respectively. The average length of follow-up was 488 days. Of the 57 largely unselected patients with persistent or longstanding persistent AF (NPAF), mean duration of AF was 5.6 years. Single procedure freedom from AF through 24 months was 64.5%, and that for all arrhythmias, was 58.9%. Sixty-eight percent of patients were off antiarrhythmic drugs. Four patients (7%) required a second endocardial ablation procedure. A sub-analysis of the observed arrhythmia burden present through follow-up showed this to be small (ie, <1%) in the majority of patients involved in this study. In conclusion, the extended posterior left atrial wall ablation technique discussed here, as part of the Convergent hybrid method, achieved notable single-procedure success in a particularly challenging series of patients with NPAF.
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Affiliation(s)
- M Clive Robinson
- Department of Cardiothoracic Surgery and Department of Cardiology, Bridgeport Hospital, Bridgeport, CT.,Department of Cardiothoracic Surgery and Department of Cardiology, St. Vincent's Medical Center, Bridgeport, CT
| | - Lindsey Scierka
- Department of Cardiothoracic Surgery and Department of Cardiology, St. Vincent's Medical Center, Bridgeport, CT
| | - Murali Chiravuri
- Department of Cardiothoracic Surgery and Department of Cardiology, Bridgeport Hospital, Bridgeport, CT
| | - Robert Winslow
- Department of Cardiothoracic Surgery and Department of Cardiology, Bridgeport Hospital, Bridgeport, CT
| | - Rafael Squitieri
- Department of Cardiothoracic Surgery and Department of Cardiology, St. Vincent's Medical Center, Bridgeport, CT
| | - Albert Dimeo
- Department of Cardiothoracic Surgery and Department of Cardiology, St. Vincent's Medical Center, Bridgeport, CT
| | - Richard Feinn
- Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT
| | - Joseph J Tiano
- Department of Cardiothoracic Surgery and Department of Cardiology, St. Vincent's Medical Center, Bridgeport, CT.,Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT
| | - Craig Mcpherson
- Department of Cardiothoracic Surgery and Department of Cardiology, Bridgeport Hospital, Bridgeport, CT.,Yale New Haven Hospital, New Haven, CT
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Kearney K, Stephenson R, Phan K, Chan WY, Huang MY, Yan TD. A systematic review of surgical ablation versus catheter ablation for atrial fibrillation. Ann Cardiothorac Surg 2014; 3:15-29. [PMID: 24516794 DOI: 10.3978/j.issn.2225-319x.2014.01.03] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 01/08/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is an increasingly prevalent condition in the ageing population, with significantly associated morbidity and mortality. Surgical and catheter ablative strategies both aim to reduce mortality and morbidity through freedom from AF. This review consolidates all currently available comparative data to evaluate these two interventions. METHODS A systematic search was conducted across MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews from January 2000 until August 2013. All studies were critically appraised and only those directly comparing surgical and catheter ablation were included. RESULTS Seven studies were deemed suitable for analysis according to the inclusion criteria. Freedom from AF was significantly higher in the surgical ablation group versus the catheter ablation group at 6-month, 12-month and study endpoint follow-up periods. Subgroup analysis demonstrated similar trends, with higher freedom from AF in the surgical ablation group for paroxysmal AF patients. The incidence of pacemaker implantation was higher, while no difference in stroke or cardiac tamponade was demonstrated for the surgical versus catheter ablation groups. CONCLUSIONS Current evidence suggests that epicardial ablative strategies are associated with higher freedom from AF, higher pacemaker implantation rates and comparable neurological complications and cardiac tamponade incidence to catheter ablative treatment. Other complications and risks were poorly reported, which warrants further randomized controlled trials (RCTs) of adequate power and follow-up duration.
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Affiliation(s)
- Katherine Kearney
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Rowan Stephenson
- St Vincent's Hospital, Sydney, Australia, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Kevin Phan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Wei Yen Chan
- University of Western Sydney, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Min Yin Huang
- University of Western Sydney, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Tristan D Yan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; ; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
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