Late elimination of challenging idiopathic ventricular arrhythmias originating from left ventricular summit by anatomical ablation (original) (raw)
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Heart Rhythm, 2013
BACKGROUND The right ventricular outflow tract (RVOT) is the most common site of origin of ventricular arrhythmias (VAs) in patients with idiopathic VAs. A left bundle branch block, inferior axis morphology arrhythmia is the hallmark of RVOT arrhythmias. VAs from other sites of origin can mimic RVOT VAs, and ablation in the RVOT typically fails for these VAs. OBJECTIVE To analyze reasons for failed ablations of RVOTlike VAs. METHODS Among a consecutive series of 197 patients with an RVOT-like electrocardiographic (ECG) morphology who were referred for ablation, 38 patients (13 men; age 46 Ϯ 14 years; left ventricular ejection fraction 47% Ϯ 14%) in whom a prior procedure failed within the RVOT underwent a second ablation procedure. ECG characteristics of the VA were compared to a consecutive series of 50 patients with RVOT VAs. RESULTS The origin of the VA was identified in 95% of the patients. In 28 of 38 (74%) patients, the arrhythmia origin was not in the RVOT. The VA originated from intramural sites (n ¼ 8, 21%), the pulmonary arteries (n ¼ 7, 18%), the aortic cusps (n ¼ 6, 16%), and the epicardium (n ¼ 5, 13%). The origin was within the RVOT in 10 (26%) patients. In 2 (5%) patients, the origin could not be identified despite biventricular, aortic, and epicardial mapping. The VA was eliminated in 34 of 38 (89%) patients with repeat procedures. The ECG features of patients with failed RVOT-like arrhythmias were different from the characteristics of RVOT arrhythmias. CONCLUSIONS In patients in whom ablation of a VA with an RVOTlike appearance fails, mapping of the pulmonary artery, the aortic cusps, the epicardium, the left ventricular outflow tract, and the aortic cusps will help identify the correct site of origin. The 12-lead ECG is helpful in differentiating these VAs from RVOT VAs.
Heart Rhythm, 2020
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Heart Rhythm, 2018
Background: The optimal site of ablation of idiopathic left ventricular outflow tract (LVOT) ventricular arrhythmias (VAs) is challenging as activation mapping can reveal similar activation times suggesting an intramural origin. Objective: We sought to assess whether in patients with intramural VAs and with multiple early activation sites (AS), sequential ablation of all the early AS could improve acute and long term outcomes. Methods: A total of 116 patients undergoing ablation for symptomatic LVOT VAs were enrolled in this study. Thirty-nine patients (34%) were referred for a redo procedure, whereas the remaining presented for a first procedure. Mapping was performed manually in 86 cases (74%) and with a magnetic robotic system (Stereotaxis) in the remainder of the cases. Results: Out of the 116 patients, 15 (13%) were found to have multiple sites of equally early AS.. In patients with multiple early AS, the mean pre-QRS activation time was significantly less when compared to patients with a single early site (-26 ± 3 msec vs-38 ± 6 msec p < 0.005). Sequential ablation of all the early AS was possible in 14 patients (93%), resulting in complete arrhythmia suppression. After a mean follow up of 21±5 months, all patients with successful ablation of all multiple early AS remained free from clinical VAs. Conclusions: Intramural LVOT VAs manifesting with multiple early AS require ablation at all sites to achieve acute and long-term success, particularly if none of the early sites is greater than-30 ms pre-QRS.
Radiofrequency Ablation of Symptomatic but Benign Ventricular Arrhythmias
Pacing and Clinical Electrophysiology, 1992
GURSOY, S., ET AL.: Radiofrequency Ablation of Symptomatic but Benign Ventricular Arrhythmias. Two cases are presented where ablation of severely symptomatic ventricular arrhythmias not responding to medical therapy was accomplished with radiofrequency current application. After a routine programmed stimulation protocol, a quadripolar ablation catheter with a 4-mm tip was advanced percutaneously into the left ventricle in one case and into the right ventricle in the second case; and after precise pace mapping, the arrhythmogenic focus was successfully ablated using radiofrequency current. The postablation ambulatory recording revealed virtual eradication of ventricular ectopy in both cases. In conclusion, in severely symptomatic cases of "benign" ventricular arrhythmias, radiofrequency ablation offers an effective therapeutic alternative. (PACE, Vol. 15, May 1992) radiofrequency, ablation, ventricular Address for reprints: Sinan Gursoy, M.D., Cardiovascular Center, OLV Hospital, 9300 Aalst, Belgium. Fax: 53 724587.
2013
BACKGROUND Patients with frequent premature ventricular complexes (PVCs) and PVC-induced cardiomyopathy usually have recovery of left ventricular (LV) dysfunction postablation. The time course of recovery of LV function has not been described. OBJECTIVE To describe the time course and predictors of recovery from LV dysfunction after effective ablation of PVCs in patients with PVC-induced cardiomyopathy. METHODS In a consecutive series of 264 patients with frequent idiopathic PVCs referred for PVC ablation, LV dysfunction was present in 87 patients (mean ejection fraction 40%±10%). The PVC burden was reduced to<20% of the initial PVC burden in 75 patients. In these patients, echocardiography was repeated 3-4 months postablation. If LV function did not normalize after 3-4 months, a repeat echocardiogram was performed every 3 months until there was normalization or stabilization of LV function. RESULTS The ejection fraction normalized at a mean of 5±6 months postablation. The majori...
Heart Rhythm, 2011
BACKGROUND Most idiopathic right ventricular (RV) ventricular tachycardias (VTs) originate from the outflow tract. Data on VT from the lower body of the RV are limited. OBJECTIVE The purpose of this study was to describe a large experience with idiopathic VT detailing the prevalence and characteristics of VT arising from the body of the RV. METHODS The distribution of mapping confirmed VTs within the RV body, ECG characteristics, and results of radiofrequency (RF) ablation were analyzed. RESULTS Among 278 patients who underwent ablation for idiopathic VT or ventricular premature depolarizations (VPDs) arising from the RV, 29 (10%) had VT/VPDs from the lower RV body. Fourteen (48%) patients had VT/VPDs within 2 cm of the tricuspid valve annulus (TVA), 8 (28%) from the basal and 7 (24%) from the apical RV segments. Among the VT/VPDs from the TVA, 8 (57%) originated from the free wall and 6 (43%) from the septum. All but one RV basal or apical VT/VPDs originated from the free wall. All VT/VPDs had a left bundle branch block pattern. VT/VPDs from the free wall had longer QRS duration (P ϭ .0032) and deeper S wave in lead V 2 (P ϭ .042) and V 3 (P ϭ .046) than those from the septum. Apical VT/VPDs more often had precordial R wave transition ՆV 6 (P ϭ .0001) and smaller R wave in lead II (P ϭ .024) and S wave in lead aVR (P ϭ .001) compared to VT/VPDs from basal RV or TVA. RF catheter ablation eliminated VT/VPDs in 96% of patients. No complications were observed. During median follow-up of 27 months (range 4-131 months), 81% of patients had elimination of all symptomatic VT/VPDs. Nineteen percent had rare symptoms (8% without medications, 11% on beta-blocker). CONCLUSION Idiopathic VT/VPDs from the body of RV comprise an important subgroup of idiopathic RV VTs. Although most VTs originate from the RV free wall and nearly 50% from the TVA region, septal and more apical VTs are common. ECG characteristics distinguish free-wall versus septal and more apical origin of VTs, and RF catheter ablation provides good long-term arrhythmia control. KEYWORDS Catheter ablation; Idiopathic ventricular arrhythmia; Right ventricle; Ventricular premature depolarization; Ventricular tachycardia ABBREVIATIONS ARVC/D ϭ arrhythmogenic right ventricular cardiomyopathy/dysplasia; ECG ϭ electrocardiographic; EP ϭ electrophysiology; ICD ϭ implantable cardioverter-defibrillator; ICE ϭ intracardiac echocardiography; LBBB ϭ left bundle branch block; RBBB ϭ right bundle branch block; RF ϭ radiofrequency; RV ϭ right ventricle; RVOT ϭ right ventricular outflow tract; TVA ϭ tricuspid valve annulus; VPD ϭ ventricular premature depolarization; VT ϭ ventricular tachycardia
Radiofrequency Catheter Ablation of Idiopathic Left Ventricular Tachycardia
Journal of Cardiovascular Electrophysiology, 1994
Idiopathic ventricular arrhythmias (VA) consist of various subtypes of VA that occur in the absence of clinically apparent structural heart disease. Affected patients account for approximately 10% of all patients referred for evaluation of ventricular tachycardia (VT). Arrhythmias arising from the outflow tract (OT) are the most common subtype of idiopathic VA and more than 70-80% of idiopathic VTs or premature ventricular contractions (PVCs) originate from the right ventricular (RV) OT. Idiopathic OT arrhythmias are thought to be caused by adenosine-sensitive, cyclic adenosine monophosphate (cAMP) mediated triggered activity and, in general, manifest at a relatively early age. Usually they present as salvos of paroxysmal ventricular ectopic beats and are rarely life-threatening. When highly symptomatic and refractory to antiarrhythmic therapy or causative for ventricular dysfunction, ablation is a recommended treatment with a high success rate and a low risk of complications.