Modern mapping and ablation techniques to treat ventricular arrhythmias from the left ventricular summit and interventricular septum (original) (raw)
Related papers
Ablation strategies for intramural ventricular arrhythmias
Heart Rhythm, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Indian Pacing and Electrophysiology Journal, 2019
Ablation of premature ventricular complexes (PVCs) originating from left ventricular outflow tract (LVOT)/left ventricular summit (LVS) is challenging with considerable rate of failure. Recently, in a novel approach to ablation of these arrythmias, application of radiofrequency energy to anatomically opposite sites of presumed origin of arrythmia, has been associated with moderate procedure success. Although late elimination of PVCs that are persistent following an ablation procedure has been previously reported, this observation has not been studied sufficiently. In this report, firstly, we present three cases of lately eliminated LVS PVCs, then, we discuss possible mechanism of this observation and conclude that after an initial failed attempt of anatomic ablation, operators may choose a period of watchful waiting before attempting a redo procedure.
Treatment of ventricular tachycardia: consider ablation sooner
F1000 medicine reports, 2009
Ventricular tachycardia (VT) is a leading cause of morbidity and mortality for many patients, with a significant emotional and economic burden caused by implantable cardioverter-defibrillator (ICD) shocks and the requirement of medication with significant side effects. Additionally, 10% of VT occurs in patients with no structural heart disease. Until quite recently, ablation for VT has been reserved as the procedure of last hope for those who have ongoing recurrences despite maximal medical therapy and who are traumatized by multiple ICD shocks [1]. However, recent advances in imaging technology and three-dimensional intracardiac mapping systems have significantly improved the safety and efficacy of VT ablation procedures. Thus, ablation for VT should no longer be reserved as a last-resort bailout procedure and should move into the realm of routine electrophysiology treatment.
Acta Cardiologica Sinica, 2018
Epicardial catheter ablation has been shown to be an effective strategy for treating ventricular arrhythmias (VA). We investigated the efficacy and safety from a tertiary referral center in Taiwan. From 2010 to 2016, patients undergoing epicardial ablation for VAs were consecutively enrolled. The clinical characteristics, disease entity, electrophysiological studies, and ablation outcome were extracted for further analysis. A total of 80 patients were eligible, including 34 patients for arrhythmogenic right ventricular cardiomyopathy (ARVC), 16 for Brugada syndrome (BrS), 13 for idiopathic VAs, 11 for idiopathic dilated cardiomyopathy (IDCM), 2 for ischemic cardiomyopathy, and 4 for other nonischemic cardiomyopathies (NICM). Epicardial ablation rendering VAs non-inducible was achieved in 78 patients (97.5%). There were no procedure-related deaths. Major complications were reported in 8 (10.0%) patients, including an acute hemopericardium in 5 (6.3%), delayed tamponade in 1 (1.3%), h...
2011
Background-In patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy, freedom from ventricular arrhythmias (VAs) after endocardial ablation is limited. We compared the long-term freedom from recurrent VAs by using endocardial-alone ablation versus endo-epicardial substrate-based ablation. Methods and Results-Forty-nine patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy undergoing ablation of ventricular tachycardia (VT) were divided into 2 groups: endocardial-alone ablation (group 1, nϭ23) and endo-epicardial ablation (group 2, nϭ26). All patients had an implantable cardioverter-defibrillator (ICD). Conventional and 3D mappings were used to determine the mechanism of induced VTs and to identify area of "scar" or "abnormal" myocardium. All critical sites responsible for VTs and points with "abnormal" potential were targeted for ablation from endocardium (group 1) or from both endocardium and epicardium (group 2). The procedural end point was noninducibility of sustained, monomorphic VT with isoproterenol. The presence of frequent premature ventricular contractions at the end of ablation was recorded. Patients were followed up by ECG, Holter, and ICD interrogation. After a follow-up of at least 3 years, freedom from VAs or ICD therapy was 52.2% (12/23) in group 1 and 84.6% (22/26) in group 2 (Pϭ0.029), with 21.7% (5/23) and 69.2% (18/26) patients off antiarrhythmic drugs (PϽ0.001), respectively. Compared with patients with no premature ventricular contractions after ablation, patients with frequent premature ventricular contractions after ablation were more likely to have VA recurrence/ICD therapy [3/33 (9%) versus 12/16 (75%); log-rank PϽ0.001]. Conclusions-An endo-epicardial-based ablation strategy achieves higher long-term freedom from recurrent VAs off antiarrhythmic therapy in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy when compared with endocardial-alone ablation. The presence of Ն10 premature ventricular contractions per minute after ablation is associated with more VA recurrence. (Circ Arrhythm Electrophysiol. 2011;4:478-485.) Key Words: arrhythmogenic right ventricular dysplasia Ⅲ cardiomyopathy Ⅲ ventricular tachycardia Ⅲ ablation Ⅲ epicardial Ⅲ premature ventricular contraction A rrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is characterized by ventricular arrhythmias (VAs) or even sudden cardiac death secondary to fibro-fatty replacement of the right ventricular (RV) myocardium. It is a genetically determined myocardial disease in which the pathological lesions are believed to progress over time from the epicardium to the endocardium and with diffuse involvement of the RV and the left ventricle (LV) in rare cases. 1,2
Predictors of ventricular ablation’s success: Viability, innervation, or mismatch?
Journal of Nuclear Cardiology, 2019
Aims. Sympathetic dys-innervation may play an important role in the development of postischemic ventricular arrhythmias (VA). Aim of this study was to prove that perfusion/innervation mismatch (PIM) evaluated by SPECT can identify areas of local abnormal ventricular activities (LAVA) on electroanatomic mapping (EAM). Methods. Sixteen patients referred to post-ischemic VA catheter ablation underwent preprocedural and 1-month post-ablation 123 I-MIBG/ 99m Tc-tetrofosmin rest SPECT myocardial imaging. PIM was defined according to the segmental distributions of 99mTc-tetrofosmin and 123I-MIBG. A 17-segment LV analysis was used for either SPECT or LV EAM voltage map. All patients were followed up clinically for at least 1 year. Results. Before ablation, the mean voltage in the PIM segments was higher than in the scarred ones but lower than in the normal regions. The presence of PIM in a specific LV zone was an independent predictor of LAVA. After ablation, PIM value was significantly reduced, mainly due to an increase in perfusion summed rest score, in particular in patients that were responders to ablation. Conclusions. PIM may associate with VA substrate expressed by LAVA and might provide a novel guide for substrate ablation. A significant reduction of PIM could predict a positive clinical response to ablation. (J Nucl Cardiol 2018) Key Words: Intervention tracers AE image-guided application AE diagnostic and prognostic application AE cardiac innervation AE multimodality Abbreviations IHD Ischemic heart disease VA Ventricular arrhythmias ICD Implantable cardioverter-defibrillator EAM Electro-anatomical mapping VT Ventricular tachycardia LAVA Local abnormal ventricular activities SNS Sympathetic nervous system 123 I-MIBG 123 I-metaiodobenzylguanigine PIM Perfusion/innervations mismatch Electronic supplementary material The online version of this article (