Contemporary Outcomes of Supraventricular Tachycardia Ablation in Congenital Heart Disease: A Single-Center Experience in 116 Patients (original) (raw)
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Journal of Interventional Cardiac Electrophysiology, 2019
Background First experiences using a 64-electrode mini-basket catheter (BC) paired with an automatic mapping system (Rhythmia™) for catheter ablation (CA) of ventricular ectopy (VE) and ventricular tachycardia (VT) have been reported. Objectives We aimed to evaluate (1) differences in ventricular access for the BC and (2) benefit of this technology in the setting of standard clinical practice. Methods Patients (pts) undergoing CA for VE or VT using the Intellamap Orion™ paired with the Rhythmia™ automatedmapping system were included in this study. For LV access, transseptal and retrograde access were compared. Results All 32 pts (29 men, age 63 ± 15 years) underwent CA for VE (17 pts) or VT (15 pts). For mapping of VE originating from the left ventricle (LV) in 10 out of 13 pts, a transaortic access was feasible. The predominant access for CA of VT was transaortic (5/7). Feasibility and safety seem to be equal. The total procedure time was 179.1 ± 21.2 min for VE ablation and 212.0 ± 71.7 min for VT ablation (p = 0.177). For VE, an acquisition of 1602 ± 1672 map points and annotation of 140 ± 98 automated mapping points sufficed to abolish VE in all pts. During a 6-month follow-up (FU) after CA for VE, a VE burden reduction from 18.5 ± 2.1% to 2.8 ± 2.2% (p = 0.019) was achieved. In VT pts, one patient showed recurrence of sustained VT episodes during FU. Conclusion Use of a high-resolution mapping system for VE/VT CA potentially facilitates revelation of VE origin and VT circuits in the setting of standard clinical practice. Feasibility and safety of a venous, transaortic, transseptal, or a combined approach seem to be equal.
Journal of Interventional Cardiac Electrophysiology, 2008
Background Anatomical guided atrial fibrillation (AF) catheter ablation relies on the assumption that the left atrium reconstruction anatomy (LARA) using a 3D mapping system precisely matches the patient’s CT scan anatomy (real anatomy). This study investigates whether this postulation is accurate using CT scan image integration. Patients and methods Thirty consecutive patients (23 men, mean age = 51.9 ± 9.9 years) with symptomatic drug-refractory paroxysmal (n = 21) or persistent (n = 9) AF underwent a circumferential, 2 × 2, pulmonary vein (PV) radiofrequency (RF) ablation using the CARTOMERGE system. Left atrium (LA) anatomy was first reconstructed and RF design lines drawn on this LARA. After a CT-scan image of the LA was integrated into the 3D system, RF lesions were deployed 10 ± 5 mm outside the PV ostia (PVO) onto the CT-scan LA surface. The match between the actual RF lines and the RF design lines was analyzed off-line after catheter withdrawal. Results Circumferential RF design lines were divided into four segments encircling both the right and left PVs. Design segments matched the actual RF segments in a proportion varying from 23% up to 83%. A mean of 2.8 ± 1.6 segments per patient were inaccurately designed that extended a mean of 3.8 ± 2.3mm inside the adjacent PV or 6.7 ± 1.8mm inside the left atrial appendage (LAA). Seven patients (23%) had four or more segments incorrectly designed. Conclusions Our study reveals the inaccuracy of 3D anatomic guided RF ablation with respect to the LA anatomical structures that could be possibly improved when combined with CT-scan image integration.
Circulation, 2006
Background-New ablation strategies for atrial fibrillation or nonidiopathic ventricular tachycardia are increasingly based on anatomic consideration and require the placement of ablation lesions at the correct anatomic locations. This study sought to evaluate the accuracy of the first clinically available image integration system for catheter ablation on 3-dimensional (3D) computed tomography (CT) images in real time. Methods and Results-After midline sternotomy, 2.3-mm CT fiducial markers were attached to the epicardial surface of each cardiac chamber in 9 mongrel dogs. Detailed 3D cardiac anatomy was reconstructed from contrast-enhanced, high-resolution CT images and registered to the electroanatomic maps of each cardiac chamber. To assess accuracy, targeted ablations were performed at each of the fiducial markers guided only by the reconstructed 3D images. At autopsy, the position error was 1.9Ϯ0.9 mm for the right atrium, 2.7Ϯ1.2 mm for the right ventricle, 1.8Ϯ1.0 mm for the left atrium, and 2.3Ϯ1.1 mm for the left ventricle. To evaluate the system's guidance of more complex clinical ablation strategies, ablations of the cavotricuspid isthmus (nϭ4), fossa ovalis (nϭ4), and pulmonary veins (nϭ6) were performed, which resulted in position errors of 1.8Ϯ1.5, 2.2Ϯ1.3, and 2.1Ϯ1.2 mm, respectively. Retrospective analysis revealed that a combination of landmark registration and the target chamber surface registration resulted in Ͻ3 mm accuracy in all 4 cardiac chambers.
Archives of Medical Science, 2016
Introduction: Ablation of the cavotricuspid isthmus (CTI) in patients with atrial flutter (AFL) and pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) are both common therapies. As the demand for ablative treatments rises, total radiation exposure times of staff increase concomitantly. Here, we report on our first experiences with a new fluoroscopy integrating system (FIS) integrated into a current 3D mapping system (3DMS). Material and methods: The study population consisted of 59 consecutive patients who underwent PVI or CTI ablation (26 and 33 patients with and without FIS respectively). Total procedure time (PT), fluoroscopy exposure time (FT) and dose-area product (DAP) were monitored. Results: All procedures were successfully completed without major complications. Employing FIS in the PVI group, FT and DAP were both significantly reduced after completing a short learning curve of 6 cases (respectively 361.6 ±181 s vs. 530.3 ±156.7 s, p = 0.039; 801.9 ±439.15 cGycm² vs. 1495 ±435.2 cGycm², p = 0.002). Mean PT was not significantly affected (121 ±26.7 min vs. 135.6 ±23.2 min, p = 0.21). The same holds true for CTI ablation: FT (99.29 ±51.4 s vs. 153.9 ±76.6 s, p = 0.022) and DAP (269 ±128.7 cGycm² vs. 524.3 ±288.4 cGycm², p = 0.002) were significantly reduced, leaving PT not significantly affected (29.5 ±10 min vs. 35.2 ±16.3 min, p = 0.23). Conclusions: The introduction of the new FIS with a current 3DMS results in a significant reduction of both the total FT and DAP without affecting PT. The initial learning curve for adopting this method is considerably short.
Journal of Interventional Cardiac Electrophysiology, 2012
Objective Remote magnetic navigation (RMN) is considered to be a solution for mapping and ablation of several arrhythmias. In this systematic review we aimed to assess the safety and efficacy of RMN in ablation of ventricular tachycardia (VT). Methods The National Library of Medicine's PubMed database was searched for articles containing any of a predetermined set of search terms that were published prior to November 1, 2011. Quality of evidence was rated using the GRADE system. Results The database search resulted in 11 relevant articles evaluating the usefulness of RMN. Three groups of VTs were studied: VT in patients with ischemic cardiomyopathy (ICMP), non-ischemic cardiomyopathy (NICMP) and structurally normal hearts (SNH). The use of RMN in patients with ICMP has been associated with success rates ranging from 71 to 80%. RMN has been shown to be a feasible and effective method for ablation of VT in NICMP and SNH patients. Success rates between 50% and 100% have been reported in NICMP populations. Rates ranging from 86% to 100% have been reported for SNH patients. The lowest rates of arrhythmia recurrence are reported for SNH patients (0-17%). In ICMP and NICMP, recurrence rates of 0-30% and 14-50%, respectively, have been reported. One patient experienced total heart block, and one patient experienced a thromboembolic event after RMN catheter ablation procedures. Conclusions RMN has been shown to be an effective and safe method for ablation of VT in various patient populations with low recurrence and complication rates. However, more comparative and randomized studies are necessary, and therefore the true value of RMN for VT ablation remains still unknown.
BioMed Research International
Purpose. 3D nonfluoroscopic mapping systems (NMSs) are generally used in the catheter ablation (CA) of complex ventricular and atrial arrhythmias. The aim of this study was to evaluate the efficacy, safety, and long-term effect of the extended, routine use of NMSs for CA. Methods. Our study involved 1028 patients who underwent CA procedures from 2007 to 2016. Initially, CA procedures were performed mainly with the aid of fluoroscopy. From October 2008, NMSs were used for all procedures. Results. The median fluoroscopy time of the overall CA procedures fell by 71%: from 29.2 min in 2007 to 8.4 min in 2016. Over the same period, total X-ray exposure decreased by 65%: from 58.18 Gy⁎cm2 to 20.19 Gy⁎cm2. This reduction was achieved without prolonging the total procedure time. In AF CA procedures, the median fluoroscopy time fell by 85%, with an 86% reduction in total X-ray exposure. In SVT CA procedures, the median fluoroscopy time fell by 93%, with a 92% reduction in total X-ray exposur...
Pacing and Clinical Electrophysiology, 2007
Circumferential radiofrequency catheter ablation (RFCA) around the orifices of the pulmonary veins (PV) is a curative catheter-based therapy of paroxysmal, persistent, and permanent atrial fibrillation (AF). Integration of multislice computed tomography into three-dimensional electroanatomic mapping to guide catheter ablation has been shown to be accurate and feasible. This study investigated whether the use of such sophisticated imaging technology translates into better clinical outcomes, procedural efficacy, and safety in comparison with a control group treated with conventional three-dimensional electroanatomic mapping. A total of 100 consecutive patients (85 male, mean age 55 +/- 9 years) with multi-drug-resistant AF underwent RFCA. In this study we used a wide area circumferential approach with confirmed PV isolation (requiring additional ablations at the ostial level) and further lines as needed. Comparison of outcome data between the conventional electroanatomic mapping (Carto XP, Biosense Webster, Diamond Bar, CA, USA) and the image integration technology (Carto MERGE, Biosense Webster) resulted in a significant improvement in procedural success for the image integration group (85.1% vs 67.9%; P = 0.018). No single case of significant PV stenosis occurred in the Carto MERGE group versus three significant stenoses in the conventional group (P = 0.098). Both procedure and fluoroscopy times remained unchanged. Multislice computed tomography image integration into electroanatomic mapping significantly improves the success of wide area circumferential ablation with confirmed isolation of the PV and additional lines. In addition, the safety of radiofrequency ablation with regard to the occurrence of PV stenosis is increased in comparison with a control group using conventional electroanatomic mapping alone. Procedural efficacy remains unchanged.
Authorea (Authorea), 2022
Catheter ablation for tachyarrhythmia via superior approach has been used in patients without possible inferior vena cava access such as in cases of venous occlusion or complex anomaly. Difficulty in catheter manipulation, instability, number of required vascular access, and radiation exposure of operator had been described in the procedure. Application of three-dimensional (3-D) mapping system in catheter ablation via superior approach could navigate the guiding catheter and provide more precise ablation. We reported four cases receiving catheter ablation due to atrioventricular nodal reentry tachycardia, atrial fibrillation and right ventricular arrhythmia via superior approach facilitated by 3-D mapping system with fewer vascular access and catheters.
Radiofrequency ablation without the use of fluoroscopy – in what kind of patients is it feasible
A b s t r a c t Introduction: The aim of the study was to describe the experience in performing ablation without fluoroscopy. Material and methods: From 575 ablation procedures with CARTO performed in the period 2003–2008, 108 (42 M; age 40 ±16 years) were done without fluoroscopy. One patient had ablation using the Localisa system. There was one man with thrombocytopenia and two pregnant women. Results: Right ventricular (RV) outflow tract arrhythmias and other RV arrhythmias were noted in 38 patients (35%) and 17 patients (15%), respectively. There were 5 (4.6%) left ventricular (LV) outflow tract arrhythmias and 19 (17.5%) other LV tachycardias; right accessory pathways in 17 patients (20%), in the middle cardiac vein in 1, Mahaim fibres in 1, and 3 cases of permanent junctional reciprocating tachycardias. One patient with CRT had AV node ablation (Localisa). In 3 patients there were also other arrhythmias treated: slow AV nodal pathway, typical flutter isthmus and right atrial tachycardia. In 2004, 1/96 CARTO procedures was done without fluoroscopy, in 2006 2/97, in 2007 19 (2 in LV) of 93, in 2008 87 (22 in LV) of 204. The percentage of ablations without fluoroscopy in every hundred CARTO procedures was: 1%, 1%, 8%, 23%, 46%, 28% (mean 18%). There were no procedure-related complications. Conclusions: It is feasible to perform ablations within both right and left sides of the heart without fluoroscopy. The number and type of non-fluoroscopic procedures depends on the operator’s experience. Pregnant patients, with malignant history or with hematologic diseases should be ablated without fluoroscopy in centres that specialise in these kinds of procedures.
Journal of Interventional Cardiac Electrophysiology, 2007
Circumferential radiofrequency ablation around the orifices of the pulmonary veins is a curative catheterbased therapy of paroxysmal and persistent atrial fibrillation (AF). Three-dimensional cardiac image integration is a promising new technology to visualize the complex left atrial anatomy and neighbouring structures. This study aimed to validate the accuracy of integrating multislice computed tomography (MSCT) into three-dimensional electroanatomic mapping (EAM) to guide radiofrequency catheter ablation (CA) of AF. Forty consecutive patients (34 male, mean age 56±10 years) with multidrug-resistant AF underwent 16-slice MSCT 1 day before radiofrequency CA. MSCT data were processed and imported to the Carto™ EAM system. Using the CartoMerge™ Image Integration Module, the generated EAM was aligned with the MSCT images. An integrated statistical algorithm provided information about the accuracy of the fusion process. In every single patient, MSCT images could be aligned with the EAM. Mean distance between the EAM points (n=63±14) and the MSCT surface was 1.6±1.2 mm with no difference between sinus rhythm versus AF (p = 0.145) and no distinction between patients in paroxysmal versus persistent/permanent AF despite a significant difference in left atrial diameters. An average of 388±81 radiofrequency ablation points were taken within the procedures resulting in a mean distance of 2.3±1.8 mm between the EAM points and the MSCT image after the ablation procedure. There was a significant difference of alignment accuracy before and after radiofrequency CA (p<0.001). MSCT images can be accurately integrated into three-dimensional EAM. Preinterventional cardiac rhythm does not influence the precision of fusion. Accuracy of fusion deteriorates after radiofrequency CA.