A New Technique to Perform Epicardial Mapping in the Electrophysiology Laboratory (original) (raw)
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Pace-pacing and Clinical Electrophysiology, 1999
We report a case of a 63-year-old women with Chagas'disease and recurrent, syncopal VT treated by RF catheter ablation in whom endocardial application of RF energy was guided by nonsurgical epicardial mapping. The procedure was undertaken in the electrophysiology laboratory under deep anesthesia. VT was interrupted after 2.4 seconds of application and rendered noninducible afterwards. Two weeks after the procedure, a distinct morphology VT was induced by programmed ventricular stimulation, and the patient was started on amiodarone, remaining asymptomatic 12 months after the procedure.
Journal of Cardiovascular Electrophysiology, 1998
Nonsurgical Epicardial Ablation. Introduction: An epicardial site of origin of ventricular tachycardia (VT) may explain unsuccessful endocardial radiofrequency (RF) catheter ablation. A new technique to map the epicardial surface of the heart through pericardial puncture was presented recently and opened the possibility of using epicardial mapping to guide endocardial ablation or epicardial catheter ablation. We report the efficacy and safety of these two approaches to treat 10 consecutive patients with VT and Chagas’ disease.Methods and Results: Epicardial mapping was carried out with a regular steerable catheter introduced into the pericardial space. An epicardial circuit was found in 14 of 18 mapable VTs induced in 10 patients. Epicardial mapping was used to guide endocardial ablation in 4 patients and epicardial ablation in 6. The epicardial earliest activation site occurred 107 ± 60 msec earlier than the onset of the QRS complex. At the epicardial site used to guide endocardial ablation, earliest activation occurred 75 ± 55 msec before the QRS complex. Epicardial mid-diastolic potentials and/or continuous electrical activity were seen in 7 patients. After 4.8 ± 2.9 seconds of epicardial RF applications, VT was rendered noninducible. Hemopericardium requiring drainage occurred in 1 patient; 3 others developed pericardial friction without hemopericardium. Patients remain asymptomatic 5 to 9 months after the procedure. Interruption during endocardial pulses occurred after 20.2 ± 14 seconds (P = 0.004), hut VT was always reinducible and the patients experienced a poor outcome.Conclusion: Epicardial mapping does not enhance the effectiveness of endocardial pulses of RF. Epicardial applications of RF energy can safely and effectively treat patients with VT and Chagas’ disease.
Circulation. Arrhythmia and electrophysiology, 2017
Chagasic cardiomyopathy (CC) is the most frequent nonischemic substrate causing left ventricular (LV) tachycardia in Latin America. Systematic characterization of the LV epicardial/endocardial scar distribution and density in CC has not been performed. Additionally, the usefulness of unipolar endocardial electroanatomic mapping to identify epicardial scar has not been assessed in this setting. Nineteen patients with CC undergoing detailed epicardial and endocardial LV tachycardia mapping and ablation were included. A total of 8494 epicardial and 6331 endocardial voltage signals and 314 epicardial/endocardial matched pairs of points were analyzed. Basal lateral LV scar involvement was observed in 18 of 19 patients. Bipolar voltage mapping demonstrated larger epicardial than endocardial scar and core-dense (≤0.5 mV) scar areas (28 [20-36] versus 19 [15-26] and 21 [2-49] versus 4 [0-7] cm(2); P=0.049 and P=0.004, respectively). Bipolar epicardial and endocardial voltages within scar we...
Mapeamento epicárdico da taquicardia ventricular sustentada em cardiopatias não isquêmicas
Arquivos Brasileiros de Cardiologia, 2011
Background: The complexity of reentrant circuits related to ventricular tachycardias decreases the success rate of radiofrequency ablation procedures. Objective: To evaluate whether the epicardial mapping with multiple electrodes carried out simultaneously with the endocardial mapping helps in ablation procedures of sustained ventricular tachycardia (VT) in patients with nonischemic heart disease. Methods: Twenty-six patients with recurrent sustained VT, of which 22 (84.6%) presenting chronic chagasic cardiomyopathy, 2 (7.7%) with idiopathic dilated cardiomyopathy and 2 with right ventricular arrhythmogenic dysplasia (RVAD), were submitted to epicardial mapping with two or three microcatheters, with 8 electrodes each, simultaneously to the conventional endocardial mapping. A catheter with a 4-mm tip was used for the ablation by radiofrequency (RF) carried out during the induced VT. Results: Of the 33 induced VT, 25 were mapped and 20 had their origin defined. Eleven had epicardial and 9 had endocardial origin. The programmed ventricular stimulation did not induce sustained VT in 11 (42.0%) of the 26 patients after the ablation. Events such as VT recurrence and death occurred in 10.0% of the patients submitted to successful ablation and in 59.0% of the unsuccessful cases, during a mean ambulatory follow-up of 357 ± 208 days. Conclusion: Subepicardial circuits are frequent in patients with nonischemic heart disease. The epicardial mapping with multiple catheters carried out simultaneously with the endocardial mapping contributes to the identification of these circuits in a same procedure. (Arq Bras Cardiol 2011; 96(2): 114-120
HeartRhythm Case Reports, 2017
Figure 1 Magnetic resonance images (MRI) and pericardial puncture. A: Frontal axis and B: lateral views of a cardiac MRI display the situs inversus, dextrocardia, apical left ventricle pointing to the right, and the inverted position of the liver and its relation to the heart. C: Electrocardiogram shows the morphology of ventricular tachycardia recorded with right precordial lead position. D: A 45 right anterior oblique view showing a guidewire in the pericardial space encircling the cardiac silhouette (red arrows) through a 16G Tuohy needle (orange arrow). A quadripolar catheter (blue arrow) is positioned in the apex of the right ventricle as a guide for puncturing. E: A 0 anterior-posterior view displaying the catheters positioned in the epicardial space (blue arrows: ablation catheter in the epicardial space through the epicardial sheath), a quadripolar catheter in the right ventricle through the inferior vena cava (orange arrows), and a second ablation catheter in the left ventricular outflow tract through the aortic root (red arrows). The precordial electrocardiogram leads are also positioned in the right aspect (V1 to V5).
International Journal of Cardiology, 2005
Ventricular tachycardia (VT) is common among patients with Chagas' heart disease but the ultimate mechanisms responsible for its sustained and nonsustained forms are not understood. This study aimed at determining which factors differentiate between patients with sustained (S-VT) and nonsustained VT (NS-VT). Fifty-six consecutive chagasic patients with VT were prospectively selected: 28 patients with spontaneous S-VT and 28 patients with NS-VT. The patients underwent clinical, angiographic, electrophysiologic and myocardial perfusion examination. Syncope episodes (S-VT: 43% versus NS-VT: 11%, p=0.007) and induction of S-VT by programmed ventricular stimulation (S-VT: 89% versus NS-VT: 7%, p=0.001) were significantly more frequent in S-VT patients. Evidence of a scarrelated reentry was observed in all 24 S-VT patients who underwent endocardial mapping for attempted radiofrequency ablation of 33 VTs. Overall, 29 VTs arose from the LV (88%) and 4 VTs arose from the RV (12%). Among these, 27 VTs (82%) were related to LV inferolateral scar, 2 VTs (6%) were related to LV apical scar, and 4 VTs (12%) were related to RV scars. A significantly higher prevalence of wall motion abnormalities (S-VT: 82% versus NS-VT: 46%, p=0.005) and myocardial perfusion defects (basal segments, S-VT: 95.5% versus NS-VT: 44%, p=0.001) was documented within the LV inferior and/or posterolateral regions in S-VT patients compared to NS-VT. In conclusion: (a) VT may arise from various regions in both ventricles, but LV inferolateral scar is the main source of S-VT reentrant circuits; (b) there is good topographic correlation between myocardial perfusion, wall motion abnormalities and areas that originate S-VT; (c) although to a lesser extent, wall motion and perfusion defects also occur in a relevant proportion of chagasics with NS-VT.
Epicardial Cryoablation of Ventricular Tachycardia in Chagas Disease: Emergency Hybrid Treatment
Argentine Journal of Cardiology, 2014
Las taquicardias ventriculares asociadas a cardiopatia estructural de origen no isquemico presentan escaras de mayor area en el epicardio, comparadas con el area endocardica 1 . A su vez, la densidad de canales de conduccion lenta dentro de la escara a nivel del epicardio es mayor que en el endocardio 2 . La ablacion combinada (epicardica y endocardica) de taquicardia ventricular (TV) logra mayor tasa de exito y menores recurrencias 3 , sin embargo evitar lesiones de las arterias coronarias durante la ablacion epicardica representa un gran desafio. A continuacion presentamos un caso de enfermedad de Chagas y tormenta electrica, donde se fusiono el mapa de voltaje epicardico y endocardico del ventriculo izquierdo con una angiotomografia cardiaca multicorte (ATCMC), con el fin de visualizar en forma directa la relacion de la escara y las arterias coronarias. Se utilizo un tratamiento hibrido con radiofrecuencia y crioenergia, con el fin de minimizar riesgos.