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Santangeli P, Higuchi K, Sroubek J. Ventricular Tachycardia Ablation Endpoints: Moving Beyond Noninducibility. JACC Clin Electrophysiol 2024; 10:981-999. [PMID: 38385913 DOI: 10.1016/j.jacep.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/08/2023] [Accepted: 12/30/2023] [Indexed: 02/23/2024]
Abstract
In patients with structural heart disease and ventricular tachycardia (VT) undergoing catheter ablation, the response to programmed electrical stimulation (PES) at the end of the procedure has been traditionally used to evaluate the acute success and predict long-term outcomes. Although noninducibility at PES has been extensively investigated and validated in clinical trials and large multicenter registries, its performance in predicting long-term freedom from VT is suboptimal. In addition, PES has inherent limitations related to the influence of background antiarrhythmic drug therapy, periprocedural use of anesthesia, and the heterogeneity in PES protocols. The increased utilization of substrate-based ablation approaches that focus on ablation of abnormal electrograms identified with mapping in sinus or paced rhythm has been paralleled by a need for additional procedural endpoints beyond VT noninducibility at PES. This article critically appraises the relative merits and limitations of different procedural endpoints according to different ablation techniques for catheter ablation of scar-related VT.
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Affiliation(s)
- Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Koji Higuchi
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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2
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Markman TM, Marchlinski FE, Callans DJ, Frankel DS. Programmed Ventricular Stimulation: Risk Stratification and Guiding Antiarrhythmic Therapies. JACC Clin Electrophysiol 2024:S2405-500X(24)00182-8. [PMID: 38661601 DOI: 10.1016/j.jacep.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/13/2024] [Indexed: 04/26/2024]
Abstract
Electrophysiologic testing with programmed ventricular stimulation (PVS) has been utilized to induce ventricular tachycardia (VT), thereby improving risk stratification for patients with ischemic and nonischemic cardiomyopathies and determining the effectiveness of antiarrhythmic therapies, especially catheter ablation. A variety of procedural aspects can be modified during PVS in order to alter the sensitivity and specificity of the test including the addition of multiple baseline pacing cycle lengths, extrastimuli, and pacing locations. The definition of a positive result is also critically important, which has varied from exclusively sustained monomorphic VT (>30 seconds) to any ventricular arrhythmia regardless of morphology. In this review, we discuss the history of PVS and evaluate its role in sudden cardiac death risk stratification in a variety of patient populations. We propose an approach to future investigations that will capitalize on the unique ability to vary the sensitivity and specificity of this test. We then discuss the application of PVS during and following catheter ablation. The strategies that have been utilized to improve the efficacy of intraprocedural PVS are highlighted during a discussion of the limitations of this probabilistic strategy. The role of noninvasive programmed stimulation is also reviewed in predicting recurrent VT and informing management decisions including repeat ablations, modifications in antiarrhythmic drugs, and implantable cardioverter-defibrillator programming. Based on the available evidence and guidelines, we propose an approach to future investigations that will allow clinicians to optimize the use of PVS for risk stratification and assessment of therapeutic efficacy.
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Affiliation(s)
- Timothy M Markman
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Callans
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David S Frankel
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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3
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Benali K, Zei PC, Lloyd M, Kautzner J, Guenancia C, Ninni S, Rigal L, Simon A, Bellec J, Vlachos K, Sacher F, Hammache N, Sellal JM, de Crevoisier R, Da Costa A, Martins R. One-year mortality and causes of death after stereotactic radiation therapy for refractory ventricular arrhythmias: A systematic review and pooled analysis. Trends Cardiovasc Med 2024:S1050-1738(23)00122-6. [PMID: 38191005 DOI: 10.1016/j.tcm.2023.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/25/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Abstract
Patients treated with cardiac stereotactic body radiation therapy (radioablation) for refractory ventricular arrhythmias are patients with advanced structural heart disease and significant comorbidities. However, data regarding 1-year mortality after the procedure are scarce. This systematic review and pooled analysis aimed at determining 1-year mortality after cardiac radioablation for refractory ventricular arrhythmias and investigating leading causes of death in this population. MEDLINE/EMBASE databases were searched up to January 2023 for studies including patients undergoing cardiac radioablation for the treatment of refractory ventricular arrhythmias. Quality of included trials was assessed using the NIH Tool for Case Series Studies (PROSPERO CRD42022379713). A total of 1,151 references were retrieved and evaluated for relevance. Data were extracted from 16 studies, with a total of 157 patients undergoing cardiac radioablation for refractory ventricular arrhythmias. Pooled 1-year mortality was 32 % (95 %CI: 23-41), with almost half of the deaths occurring within three months after treatment. Among the 157 patients, 46 died within the year following cardiac radioablation. Worsening heart failure appeared to be the leading cause of death (52 %), although non-cardiac mortality remained substantial (41 %) in this population. Age≥70yo was associated with a significantly higher 12-month all-cause mortality (p<0.022). Neither target volume size nor radiotherapy device appeared to be associated with 1-year mortality (p = 0.465 and p = 0.199, respectively). About one-third of patients undergoing cardiac stereotactic body radiation therapy for refractory ventricular arrhythmias die within the first year after the procedure. Worsening heart failure appears to be the leading cause of death in this population.
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Affiliation(s)
- Karim Benali
- Section of Cardiac Electrophysiology, Saint-Etienne University, Saint-Etienne, France; IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France; INSERM-LTSI, U1099 Rennes, France.
| | - Paul C Zei
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, United States
| | - Michael Lloyd
- Section of Cardiac Electrophysiology, Emory University, Atlanta, United States
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Charles Guenancia
- Section of Cardiac Electrophysiology, Dijon University, Dijon, France
| | - Sandro Ninni
- Heart and Lung Institute, Lille University, Lille, France
| | | | | | - Julien Bellec
- Department of Radiation Oncology, Centre Eugène Marquis, Rennes, France
| | | | - Frederic Sacher
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Nefissa Hammache
- Section of Cardiac Electrophysiology, Nancy University, Nancy, France
| | - Jean-Marc Sellal
- Section of Cardiac Electrophysiology, Nancy University, Nancy, France
| | | | - Antoine Da Costa
- Section of Cardiac Electrophysiology, Saint-Etienne University, Saint-Etienne, France
| | - Raphael Martins
- INSERM-LTSI, U1099 Rennes, France; Section of Cardiac Electrophysiology, Rennes University, Rennes, France
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4
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Nissan J, Sabbag A, Beinart R, Nof E. Inducibility of Multiple Ventricular Tachycardia's during a Successful Ablation Procedure Is a Marker of Ventricular Tachycardia Recurrence. J Clin Med 2023; 12:jcm12113660. [PMID: 37297854 DOI: 10.3390/jcm12113660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Even after a successful ventricular tachycardia ablation (VTA), some patients have recurrent ventricular tachycardia (VT) during their follow-up. We assessed the long-term predictors of recurrent VT after having a successful VTA. The patients who underwent a successful VTA (defined as the non-inducibility of any VT at the procedure's end) in 2014-2021 at our center in Israel were retrospectively analyzed. A total of 111 successful VTAs were evaluated. Out of them, 31 (27.9%) had a recurrent event of VT after the procedure during a median follow-up time of 264 days. The mean left ventricular ejection fraction (LVEF) was significantly lower among patients with recurrent VT events (28.9 ± 12.67 vs. 23.53 ± 12.224, p = 0.048). A high number of induced VTs (>two) during the procedure was found to be a significant predictor of VT recurrence (24.69% vs. 56.67%, 20 vs. 17, p = 0.002). In a multivariate analysis, a lower LVEF (HR, 0.964; p = 0.037) and a high number of induced VTs (HR, 2.15; p = 0.039) were independent predictors of arrhythmia recurrence. The inducibility of more than two VTs during a VTA procedure remains a predictor of VT recurrence even after a successful VT ablation. This group of patients remains at high risk for VT and should be followed up with and treated more vigorously.
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Affiliation(s)
- Johnatan Nissan
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Avi Sabbag
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Roy Beinart
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Eyal Nof
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan 52621, Israel
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Lim S, Leach SB. ECG of the Month. J Am Vet Med Assoc 2022; 260:1-4. [PMID: 35482561 DOI: 10.2460/javma.21.01.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Stacey B Leach
- 1BluePearl Pet Hospital, New Braunfels, TX.,2Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO
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Ciaccio EJ, Anter E, Coromilas J, Wan EY, Yarmohammadi H, Wit AL, Peters NS, Garan H. Structure and function of the ventricular tachycardia isthmus. Heart Rhythm 2022; 19:137-153. [PMID: 34371192 DOI: 10.1016/j.hrthm.2021.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/22/2021] [Accepted: 08/01/2021] [Indexed: 12/24/2022]
Abstract
Catheter ablation of postinfarction reentrant ventricular tachycardia (VT) has received renewed interest owing to the increased availability of high-resolution electroanatomic mapping systems that can describe the VT circuits in greater detail, and the emergence and need to target noninvasive external beam radioablation. These recent advancements provide optimism for improving the clinical outcome of VT ablation in patients with postinfarction and potentially other scar-related VTs. The combination of analyses gleaned from studies in swine and canine models of postinfarction reentrant VT, and in human studies, suggests the existence of common electroanatomic properties for reentrant VT circuits. Characterizing these properties may be useful for increasing the specificity of substrate mapping techniques and for noninvasive identification to guide ablation. Herein, we describe properties of reentrant VT circuits that may assist in elucidating the mechanisms of onset and maintenance, as well as a means to localize and delineate optimal catheter ablation targets.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom.
| | - Elad Anter
- Department of Cardiovascular Medicine, Cardiac Electrophysiology, Cleveland Clinic, Cleveland, Ohio
| | - James Coromilas
- Department of Medicine, Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, New Jersey
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Hirad Yarmohammadi
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Andrew L Wit
- Department of Pharmacology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom
| | - Hasan Garan
- Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
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Deveci B, Kara M, Korkmaz A, Ozeke O, Cay S, Ozcan F, Topaloglu S, Aras D. A Wide QRS Tachycardia with Three Distinct Left Bundle Branch Block Morphologies in a Patient with Sinus Rhythm with Left Bundle Branch Block: What Is the Mechanism? J Innov Card Rhythm Manag 2021; 12:4744-4748. [PMID: 34712509 PMCID: PMC8545438 DOI: 10.19102/icrm.2021.121007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/31/2021] [Indexed: 11/06/2022] Open
Abstract
The differential diagnosis for a wide complex tachycardia includes all causes of supraventricular tachycardia (SVT) with bundle branch block or all causes of SVT with antegrade pre-excitation by bystander involvement of any accessory pathways, myocardial or bundle brunch ventricular tachycardia, and antidromic (atriofascicular or nodofascicular/nodoventricular) and other pre-excited reciprocating tachycardias. We present a case of wide complex QRS tachycardia with a left bundle branch block QRS morphology.
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Affiliation(s)
- Bulent Deveci
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Meryem Kara
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ahmet Korkmaz
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Firat Ozcan
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Dursun Aras
- Department of Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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8
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Ciaccio EJ, Coromilas J, Wan EY, Yarmohammadi H, Saluja DS, Biviano AB, Wit AL, Peters NS, Garan H. Slow uniform electrical activation during sinus rhythm is an indicator of reentrant VT isthmus location and orientation in an experimental model of myocardial infarction. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 196:105666. [PMID: 32717622 DOI: 10.1016/j.cmpb.2020.105666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND To validate the predictability of reentrant circuit isthmus locations without ventricular tachycardia (VT) induction during high-definition mapping, we used computer methods to analyse sinus rhythm activation in experiments where isthmus location was subsequently verified by mapping reentrant VT circuits. METHOD In 21 experiments using a canine postinfarction model, bipolar electrograms were obtained from 196-312 recordings with 4mm spacing in the epicardial border zone during sinus rhythm and during VT. From computerized electrical activation maps of the reentrant circuit, areas of conduction block were determined and the isthmus was localized. A linear regression was computed at three different locations about the reentry isthmus using sinus rhythm electrogram activation data. From the regression analysis, the uniformity, a measure of the constancy at which the wavefront propagates, and the activation gradient, a measure that may approximate wavefront speed, were computed. The purpose was to test the hypothesis that the isthmus locates in a region of slow uniform activation bounded by areas of electrical discontinuity. RESULTS Based on the regression parameters, sinus rhythm activation along the isthmus near its exit proceeded uniformly (mean r2= 0.95±0.05) and with a low magnitude gradient (mean 0.37±0.10mm/ms). Perpendicular to the isthmus long-axis across its boundaries, the activation wavefront propagated much less uniformly (mean r2= 0.76±0.24) although of similar gradient (mean 0.38±0.23mm/ms). In the opposite direction from the exit, at the isthmus entrance, there was also less uniformity (mean r2= 0.80±0.22) but a larger magnitude gradient (mean 0.50±0.25mm/ms). A theoretical ablation line drawn perpendicular to the last sinus rhythm activation site along the isthmus long-axis was predicted to prevent VT reinduction. Anatomical conduction block occurred in 7/21 experiments, but comprised only small portions of the isthmus lateral boundaries; thus detection of sinus rhythm conduction block alone was insufficient to entirely define the VT isthmus. CONCLUSIONS Uniform activation with a low magnitude gradient during sinus rhythm is present at the VT isthmus exit location but there is less uniformity across the isthmus lateral boundaries and at isthmus entrance locations. These factors may be useful to verify any proposed VT isthmus location, reducing the need for VT induction to ablate the isthmus. Measured computerized values similar to those determined herein could therefore be assistive to sharpen specificity when applying sinus rhythm mapping to localize EP catheter ablation sites.
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Affiliation(s)
- Edward J Ciaccio
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK.
| | - James Coromilas
- Department of Medicine - Division of Cardiovascular Disease and Hypertension, Rutgers University, New Brunswick, NJ, USA
| | - Elaine Y Wan
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Hirad Yarmohammadi
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Deepak S Saluja
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Angelo B Biviano
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Andrew L Wit
- Department of Pharmacology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Nicholas S Peters
- ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, UK
| | - Hasan Garan
- Department of Medicine - Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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Kanagasundram AN, John RM, Stevenson WG. Ventricular tachycardia induced by antitachycardia pacing for ventricular tachycardia: Not so pain-free? Heart Rhythm 2018; 16:551-552. [PMID: 30465904 DOI: 10.1016/j.hrthm.2018.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Arvindh N Kanagasundram
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Roy M John
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William G Stevenson
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
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10
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Guler TE, Yalin K, Aksu T, Golcuk E, Sanli S, Kaya Bilge A, Adalet K. Prognostic value role of radiofrequency lesion size by cardiac magnetic resonance imaging on outcomes of ablation in patients with ischemic scar-related ventricular tachycardia: A single center pilot study. Medicine (Baltimore) 2018; 97:e12955. [PMID: 30431569 PMCID: PMC6257390 DOI: 10.1097/md.0000000000012955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Inadequate ablation lesion formation may be responsible for post-ablation ventricular tachycardia (VT) recurrences.We aimed to evaluate whether visualisation of radiofrequency (RF) lesion size by cardiac magnetic resonance imaging (CMR) has any role in predicting adequacy of lesion and in estimating outcome.Retrospective pilot studyNine consecutive patients (8 male, age 60 ± 13 years) underwent ablation for sustained VT because of ischemic scar were evaluated for pre- and post-procedure scar tissue by CMR to characterize ablation lesions. Microvascular obstruction (MVO) surrounded by late gadolinium enhancement was defined as irreversible RF lesion. All patients were followed for at least 6 months for recurrences.Five of the patients had previous inferior myocardial infarction (MI), whereas remaining 4 had anterior MI. Acute procedural success, as defined by termination of the arrhythmia without recurrence in 30 minutes, was attained in all patients. Contrast enhancement and wall motion abnormality in presumed infarction area were confirmed by pre-ablation CMR images. MVO was detected at the reported ablation site in 6/9 patients, all arrhythmia- and symptom-free at median 24 months (range 8-38 months) follow-up. In remaining 3 patients who had VT recurrence (clinical VT in 2, sustain VT with a new morphology in 1), MVO was not detected despite achievement of acute procedural success. There was no correlation with pre-ablation scar size and clinical arrhythmia recurrence.CMR is a useful imaging modality to guide ablation procedures by detecting scar tissue. Additionally MVO seen by post-procedural imaging may be related to adequacy of RF ablation lesions and may correlate with clinical outcome.
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Affiliation(s)
- Tümer Erdem Guler
- University of Health Sciences, Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli
| | - Kivanç Yalin
- Usak University, Faculty of Medicine, Department of Cardiology, Usak
| | - Tolga Aksu
- University of Health Sciences, Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli
| | - Ebru Golcuk
- Balikesir University, Faculty of Medicine, Department of Cardiology, Balikesir
| | | | - Ahmet Kaya Bilge
- Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Kamil Adalet
- Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
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11
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Essebag V, Joza J, Nery PB, Doucette S, Nault I, Rivard L, Gula L, Deyell M, Raymond JM, Lane C, Sapp JL. Prognostic Value of Noninducibility on Outcomes of Ventricular Tachycardia Ablation: A VANISH Substudy. JACC Clin Electrophysiol 2018; 4:911-919. [PMID: 30025692 DOI: 10.1016/j.jacep.2018.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/19/2018] [Accepted: 03/21/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study sought to evaluate the predictive value of noninducibility on long-term outcomes. BACKGROUND The traditional endpoint for catheter ablation of ventricular tachycardia (VT) is noninducibility of VT by programmed stimulation; however, the definition of inducibility remains variable and its prognostic value limited by nonstandardized periprocedural antiarrhythmic drug therapy and implantable cardioverter-defibrillator programming in prior observational studies. The VANISH trial randomized patients with prior myocardial infarction and VT to ablation (with an endpoint of noninducibility of VT ≥300 ms after ablation) versus antiarrhythmic drug escalation. METHODS Patients enrolled in the VANISH study randomized to catheter ablation were included. The relationship between post-ablation inducibility and the primary composite endpoint (death, VT storm >30 days, or appropriate implantable cardioverter-defibrillator shock >30 days) was assessed using a time-to-event analysis, adjusting for other clinical and procedural characteristics. RESULTS A total of 129 patients from the ablation arm were included in the primary analysis, of which 51 were noninducible post-ablation compared with 78 who had inducible VT or in whom inducibility testing was not performed. There were no significant baseline characteristic or procedural differences except for increased implantable cardioverter-defibrillator shocks before randomization in the noninducible group. In multivariate analysis, inducibility significantly increased the risk of death, appropriate shock, or VT storm after 30 days (HR: 1.87; p = 0.017). CONCLUSIONS Inducibility of any VT post-ablation was associated with an increased risk of the composite endpoint in the VANISH trial. A randomized trial is required to confirm whether more aggressive ablation targeting faster induced VTs (<300 ms) can improve outcomes.
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Affiliation(s)
- Vidal Essebag
- McGill University Health Centre Research Institute, Montreal, Canada; Hôpital Sacré-Coeur de Montréal, Montreal, Canada.
| | - Jacqueline Joza
- McGill University Health Centre Research Institute, Montreal, Canada
| | - Pablo B Nery
- Research Methods Unit, University of Ottawa Heart Institute, Ottawa, Canada
| | - Steve Doucette
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Isabelle Nault
- Institute Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec, Canada
| | | | | | | | | | - Chris Lane
- Royal Jubilee Hospital, Victoria, Canada
| | - John L Sapp
- Department of Medicine, QEII Health Sciences Centre and Dalhousie University, Halifax, Canada
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12
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Tilz RR, Lin T, Eckardt L, Deneke T, Andresen D, Wieneke H, Brachmann J, Kääb S, Chun KRJ, Münkler P, Lewalter T, Hochadel M, Senges J, Kuck KH. Ablation Outcomes and Predictors of Mortality Following Catheter Ablation for Ventricular Tachycardia: Data From the German Multicenter Ablation Registry. J Am Heart Assoc 2018; 7:JAHA.117.007045. [PMID: 29572321 PMCID: PMC5907539 DOI: 10.1161/jaha.117.007045] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Ventricular tachycardia (VT) causes significant morbidity and mortality. Implantable cardioverter‐defibrillator shocks terminate VT but confer a significant morbidity and mortality risk. Therefore, VT ablation is increasingly common. Patients with structural heart disease (SHD) and patients with structurally normal hearts as well as the subgroup with and without ischemic heart disease were assessed for predictors of mortality and nonfatal VT recurrence. We present the first multicenter, prospective German VT registry. Methods and Results In 334 patients, 118 structurally normal hearts and 216 SHD (74.5% ischemic heart disease), referred for VT ablation in 38 centers, long‐term follow‐up was assessed for a minimum of 12 months and analyzed for factors predicting VT recurrence rates and mortality. The VTs in SHD patients were more frequently hemodynamically unstable (34.7% versus 12.7%, P<0.0001) or incessant (9.7% versus 2.7%, P<0.05). More SHD patients underwent substrate modification than patients with structurally normal hearts who had more focal ablations. Ablation failure was 9% in both groups. Two‐year mortality was higher in patients with SHD (18.7% versus 3.5%, P<0.001). Predictors of mortality include age >60 years, incessant VT, left ventricular ejection fraction ≤30%, procedural failure, and Class I and III anti‐arrhythmic drug use at discharge. Only procedural failure is a predictor of nonfatal VT recurrence. Conclusions Procedural failure was the sole independent predictor for nonfatal VT recurrence for our study cohort. This emphasizes the importance of a successful ablation procedure in experienced hands to reduce long‐term mortality and nonfatal VT recurrence.
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Affiliation(s)
- Roland Richard Tilz
- Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany .,Medical Clinic II, University Schleswig Holstein University Heart Center Lübeck, Lübeck, Germany
| | - Tina Lin
- Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Lars Eckardt
- Rhythmologie Universitätsklinikum Muenster, Muenster, Germany
| | - Thomas Deneke
- Heart Center Bad Neustadt an der Saale, Bad Neustadt a.d. Saale, Germany
| | | | | | | | | | | | | | | | | | - Jochen Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
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[Current strategies in the treatment of ventricular tachycardia by catheter ablation : A review]. Herz 2017; 43:628-632. [PMID: 28884341 DOI: 10.1007/s00059-017-4615-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/21/2017] [Accepted: 08/08/2017] [Indexed: 10/18/2022]
Abstract
The treatment of ventricular tachycardia has recently undergone relevant changes as certain interventional treatment options, such as radiofrequency catheter ablation, have gained in importance. Numerous current publications have demonstrated the advantages of catheter ablation compared to conventional therapy with antiarrhythmic drugs in terms of effectiveness and morbidity. Improving the ablation technique and identifying those patient collectives who are most likely to benefit from ablation are still the objectives of current research. The treatment of ventricular tachycardia in the setting of different cardiac and non-cardiac conditions can be challenging and requires understanding of the current procedures and the recommendations for catheter ablation of ventricular tachycardia. This review succinctly summarizes the current research in this evolving field of interventional cardiology.
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Yamashita S, Cochet H, Sacher F, Mahida S, Berte B, Hooks D, Sellal JM, Al Jefairi N, Frontera A, Komatsu Y, Lim HS, Amraoui S, Denis A, Derval N, Sermesant M, Laurent F, Hocini M, Haïssaguerre M, Montaudon M, Jaïs P. Impact of New Technologies and Approaches for Post-Myocardial Infarction Ventricular Tachycardia Ablation During Long-Term Follow-Up. Circ Arrhythm Electrophysiol 2017; 9:CIRCEP.116.003901. [PMID: 27406604 DOI: 10.1161/circep.116.003901] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 06/14/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND During the past years, many innovations have been introduced to facilitate catheter ablation of post-myocardial infarction ventricular tachycardia. However, the predictors of outcome after ablation were not thoroughly studied. METHODS AND RESULTS From 2009 to 2013, consecutive patients referred for post-myocardial infarction ventricular tachycardia ablation were included. The end point of the procedure was complete elimination of local abnormal ventricular activities (LAVA) and ventricular tachycardia (VT) noninducibility. The predictors of outcome with primary end point of VT recurrence were assessed. A total of 125 patients were included (age: 64±11 years; 7 women) for 142 procedures. The left ventricle was accessed via transseptal, retrograde aortic, and epicardial approaches in 87%, 33%, and 37% of patients, respectively. Three-dimensional electroanatomical mapping system was used in 70%, multipolar catheter in 51%, and real-time image integration in 38% (from magnetic resonance imaging in 39% and multidetector computed tomography in 93%) of patients. Before ablation, VT was inducible in 75%, and endocardial/epicardial LAVA were present in 88%/75%. After ablation, complete LAVA elimination was achieved in 60%, and VT noninducibility in 83%. During a median follow-up of 850 days (interquartile range, 439-1707), VT recurrence was observed in 36%. Multivariable analysis identified 3 independent outcome predictors: the ability to achieve complete LAVA elimination (R(2)=0.29; P<0.0001; risk ratio=0.52 [0.38-0.70]), the use of real-time image integration (R(2)=0.21; P=0.0006; risk ratio=0.49 [0.33-0.74]), and the use of multipolar catheters (R(2)=0.08; P=0.05; risk ratio=0.75 [0.56-1.00]). CONCLUSIONS Achievement of complete LAVA elimination and use of scar integration from imaging and multipolar catheters to focus high-density mapping are independent predictors of VT-free survival after catheter ablation for post-myocardial infarction ventricular tachycardia.
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Affiliation(s)
- Seigo Yamashita
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.).
| | - Hubert Cochet
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - Frédéric Sacher
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - Saagar Mahida
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - Benjamin Berte
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - Darren Hooks
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - Jean-Marc Sellal
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - Nora Al Jefairi
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - Antonio Frontera
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - Yuki Komatsu
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - Han S Lim
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - Sana Amraoui
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - Arnaud Denis
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - Nicolas Derval
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - Maxime Sermesant
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - François Laurent
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - Mélèze Hocini
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - Michel Haïssaguerre
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - Michel Montaudon
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
| | - Pierre Jaïs
- From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.)
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Nayyar S, Kuklik P, Ganesan AN, Sullivan TR, Wilson L, Young GD, Sanders P, Roberts-Thomson KC. Development of Time- and Voltage-Domain Mapping (V-T-Mapping) to Localize Ventricular Tachycardia Channels During Sinus Rhythm. Circ Arrhythm Electrophysiol 2017; 9:CIRCEP.116.004050. [PMID: 27913399 DOI: 10.1161/circep.116.004050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 09/28/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND In ventricular scar, impulse spread is slow because it traverses split and zigzag channels of surviving muscle. We aimed to evaluate scar electrograms to determine their local delay (activation time) and inequality in voltage splitting (entropy), and their relationship to channels. We reasoned that unlike innocuous channels, which are often short with multiple side branches, ventricular tachycardia (VT) supporting channels have very slow impulse spread and possess low entropy because of their longer protected length and relative lack of side-branching. METHODS AND RESULTS Patients with ischemic cardiomyopathy and multiple VT were studied. In initial mapping stage (16 patients and 58 VTs), left ventricular endocardial mapping was performed in sinus rhythm. Detailed pace mapping was used to identify VT channels and confirmed, when feasible, by entrainment. Scar electrograms were analyzed in time and voltage domains to determine mean activation time, dispersion in activation time, and entropy. Predictive performances of these properties to detect VT channels were tested. In the application stage (7 patients and 20 VTs), these properties were prospectively tested to guide catheter ablation. A mean number of 763±203 sampling points were taken. From 1770 pace maps, 47 channels corresponded to VTs. A combination of scar electrograms with the latest mean activation time and minimum entropy, in a high activation dispersion region, accurately recognized regions containing VT channels (κ=0.89, sensitivity=86%, specificity=100%, positive predictive value=93%, and negative predictive value=100%). Finally, focused ablation within 5-mm rim of the prospective channel regions eliminated 18 of 20 inducible VTs. CONCLUSIONS Activation time and entropy mapping in the scar accurately identify VT channels during sinus rhythm. The method integrates principles of reentry formation to recognize VT channels without pace mapping or mapping during VT.
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Affiliation(s)
- Sachin Nayyar
- From the Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Australia (S.N., P.K., A.N.G., L.W., G.D.Y., P.S., K.C.R.-T.); and School of Public Health, University of Adelaide, Australia (T.R.S.)
| | - Pawel Kuklik
- From the Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Australia (S.N., P.K., A.N.G., L.W., G.D.Y., P.S., K.C.R.-T.); and School of Public Health, University of Adelaide, Australia (T.R.S.)
| | - Anand N Ganesan
- From the Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Australia (S.N., P.K., A.N.G., L.W., G.D.Y., P.S., K.C.R.-T.); and School of Public Health, University of Adelaide, Australia (T.R.S.)
| | - Thomas R Sullivan
- From the Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Australia (S.N., P.K., A.N.G., L.W., G.D.Y., P.S., K.C.R.-T.); and School of Public Health, University of Adelaide, Australia (T.R.S.)
| | - Lauren Wilson
- From the Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Australia (S.N., P.K., A.N.G., L.W., G.D.Y., P.S., K.C.R.-T.); and School of Public Health, University of Adelaide, Australia (T.R.S.)
| | - Glenn D Young
- From the Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Australia (S.N., P.K., A.N.G., L.W., G.D.Y., P.S., K.C.R.-T.); and School of Public Health, University of Adelaide, Australia (T.R.S.)
| | - Prashanthan Sanders
- From the Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Australia (S.N., P.K., A.N.G., L.W., G.D.Y., P.S., K.C.R.-T.); and School of Public Health, University of Adelaide, Australia (T.R.S.)
| | - Kurt C Roberts-Thomson
- From the Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Australia (S.N., P.K., A.N.G., L.W., G.D.Y., P.S., K.C.R.-T.); and School of Public Health, University of Adelaide, Australia (T.R.S.).
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16
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John RM, Stevenson W. Current Management of Ventricular Tachycardia: Approaches and Timing. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2016. [DOI: 10.15212/cvia.2015.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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17
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Vakil KP, Roukoz H, Tung R, Levy WC, Anand IS, Shivkumar K, Rector TS, Vaseghi M, Tholakanahalli V. Mortality prediction using a modified Seattle Heart Failure Model may improve patient selection for ventricular tachycardia ablation. Am Heart J 2015; 170:1099-104. [PMID: 26678631 DOI: 10.1016/j.ahj.2015.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 09/09/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Catheter ablation is frequently used as a palliative option to reduce shock burden in patients with ventricular tachycardia (VT). A risk prediction tool that accurately predicts short-term survival could improve patient selection for VT ablation. OBJECTIVE The objective of the study is to assess utility of the Seattle Heart Failure Model (SHFM) to predict 6-month mortality in patients undergoing VT ablation. METHODS Data on patients who underwent VT ablation at 2 tertiary institutions were retrospectively compiled. The SHFM score at the time of ablation, including 2 added VT variables, was used to predict 6-month mortality. The predicted number of deaths was compared to the observed number to assess model calibration. Model discrimination of those who died within 6 months was assessed by both K- and C-statistics. RESULTS Mean age of the 243 patients was 63 ± 12 years; 89% were male. Mean SHFM score for the cohort was 1.3 ± 1.3. The Kaplan-Meier probability of death within 6 months was 14% (34 patients). The number of deaths estimated by the SHFM at 6 months was 31 (13%) giving a predicted to observed ratio of 0.91 (95% CI 0.64-1.30). The K-statistic for 6-month mortality predictions was 0.77 (95% CI 0.73-0.81), whereas the C-statistic was 0.84 (95% CI 0.78-0.92). Patients with an SHFM score ≥4.0 had an estimated positive predictive value of 80% (95% CI 28%-99%) for dying within 6 months of VT ablation. CONCLUSION The SHFM was well calibrated to a sample of patients who underwent VT ablation and provided good discrimination of short-term deaths. This model could be useful as a prognostic tool to improve patient selection for VT ablation.
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Affiliation(s)
- Kairav P Vakil
- Division of Cardiology, University of Minnesota, Minneapolis, MN; Division of Cardiology, Veterans Affairs Health Care System, Minneapolis, MN.
| | - Henri Roukoz
- Division of Cardiology, University of Minnesota, Minneapolis, MN
| | - Roderick Tung
- Division of Cardiology, University of California, Los Angeles, CA
| | - Wayne C Levy
- Division of Cardiology, University of Washington, Seattle, WA
| | - Inder S Anand
- Division of Cardiology, University of Minnesota, Minneapolis, MN; Division of Cardiology, Veterans Affairs Health Care System, Minneapolis, MN
| | | | - Thomas S Rector
- Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System and Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Marmar Vaseghi
- Division of Cardiology, University of California, Los Angeles, CA
| | - Venkatakrishna Tholakanahalli
- Division of Cardiology, University of Minnesota, Minneapolis, MN; Division of Cardiology, Veterans Affairs Health Care System, Minneapolis, MN
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Tanawuttiwat T, Nazarian S, Calkins H. The role of catheter ablation in the management of ventricular tachycardia. Eur Heart J 2015; 37:594-609. [DOI: 10.1093/eurheartj/ehv421] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/07/2015] [Indexed: 12/11/2022] Open
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Tung R, Vaseghi M, Frankel DS, Vergara P, Di Biase L, Nagashima K, Yu R, Vangala S, Tseng CH, Choi EK, Khurshid S, Patel M, Mathuria N, Nakahara S, Tzou WS, Sauer WH, Vakil K, Tedrow U, Burkhardt JD, Tholakanahalli VN, Saliaris A, Dickfeld T, Weiss JP, Bunch TJ, Reddy M, Kanmanthareddy A, Callans DJ, Lakkireddy D, Natale A, Marchlinski F, Stevenson WG, Della Bella P, Shivkumar K. Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: An International VT Ablation Center Collaborative Group study. Heart Rhythm 2015; 12:1997-2007. [PMID: 26031376 DOI: 10.1016/j.hrthm.2015.05.036] [Citation(s) in RCA: 348] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND The impact of catheter ablation of ventricular tachycardia (VT) on all-cause mortality remains unknown. OBJECTIVE The purpose of this study was to examine the association between VT recurrence after ablation and survival in patients with scar-related VT. METHODS Analysis of 2061 patients with structural heart disease referred for catheter ablation of scar-related VT from 12 international centers was performed. Data on clinical and procedural variables, VT recurrence, and mortality were analyzed. Kaplan-Meier analysis was used to estimate freedom from recurrent VT, transplant, and death. Cox proportional hazards frailty models were used to analyze the effect of risk factors on VT recurrence and mortality. RESULTS One-year freedom from VT recurrence was 70% (72% in ischemic and 68% in nonischemic cardiomyopathy). Fifty-seven patients (3%) underwent cardiac transplantation, and 216 (10%) died during follow-up. At 1 year, the estimated rate of transplant and/or mortality was 15% (same for ischemic and nonischemic cardiomyopathy). Transplant-free survival was significantly higher in patients without VT recurrence than in those with recurrence (90% vs 71%, P<.001). In multivariable analysis, recurrence of VT after ablation showed the highest risk for transplant and/or mortality [hazard ratio 6.9 (95% CI 5.3-9.0), P<.001]. In patients with ejection fraction <30% and across all New York Heart Association functional classes, improved transplant-free survival was seen in those without VT recurrence. CONCLUSION Catheter ablation of VT in patients with structural heart disease results in 70% freedom from VT recurrence, with an overall transplant and/or mortality rate of 15% at 1 year. Freedom from VT recurrence is associated with improved transplant-free survival, independent of heart failure severity.
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Affiliation(s)
- Roderick Tung
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
| | - David S Frankel
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | | | - Ricky Yu
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
| | - Sitaram Vangala
- UCLA Department of Medicine Statistics Core, Los Angeles, California
| | - Chi-Hong Tseng
- UCLA Department of Medicine Statistics Core, Los Angeles, California
| | | | - Shaan Khurshid
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mehul Patel
- Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, Texas
| | - Nilesh Mathuria
- Baylor St. Luke's Medical Center/Texas Heart Institute, Houston, Texas
| | - Shiro Nakahara
- Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | | | | | - Kairav Vakil
- University of Minnesota Medical Center, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - Usha Tedrow
- Brigham and Women's Hospital, Boston, Massachusetts
| | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | | | | | - Timm Dickfeld
- University of Maryland Medical Center, Baltimore, Maryland
| | - J Peter Weiss
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - T Jared Bunch
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Madhu Reddy
- University of Kansas Medical Center, Kansas City, Kansas
| | | | - David J Callans
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | | | | | | | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California.
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Ablation of ventricular tachycardia in the very elderly patient with cardiomyopathy: how old is too old? Can J Cardiol 2014; 31:717-22. [PMID: 25869352 DOI: 10.1016/j.cjca.2014.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/12/2014] [Accepted: 12/13/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Because of the disputable effectiveness of the implantable cardioverter-defibrillator (ICD) in very elderly patients, it is reasonable to consider catheter ablation of scar-related ventricular tachycardia (VT) at an earlier stage of the therapeutic cascade, especially in those who have refused ICD implantation. METHODS Analysis of 53 VT ablations performed in our tertiary centre in patients with ischemic or nonischemic dilated cardiomyopathy who were ≥ 60 years of age. We assessed the safety and acute effectiveness of the procedure in 14 very elderly patients (age ≥ 80 years), follow-up all-cause mortality and rates of ICD therapies during follow-up. Furthermore, we established a comparison between very elderly patients and: (1) 34 patients aged 60-79 years having the same procedure; and (2) 11 octogenarian patients with ischemic or nonischemic cardiomyopathy, documented ventricular fibrillation or sustained VT, subsequent secondary prevention ICD implantation and at least 1 ICD therapy after implantation. RESULTS Complete acute success was achieved in 80% of procedures in very elderly patients vs 91.7% in younger individuals. Three complications occurred in the former, including 1 periprocedural death not directly related to the procedure itself, and 2 were seen in the latter. A 6-month 27.3% occurrence of any ICD therapy was seen in the very elderly group (with only 1 patient who required an ICD shock), and the 6-month incidence of ICD therapies in the younger group was 32%. All 11 control octogenarian ICD patients had further ICD therapies after their first ICD intervention. CONCLUSIONS Ablation of VT in very elderly patients seems relatively safe and as effective as in younger patients.
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Ventricular arrhythmias in patients with heart failure secondary to reduced ejection fraction: a current perspective. Curr Opin Cardiol 2014; 29:152-9. [PMID: 24378634 DOI: 10.1097/hco.0000000000000035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review the management of ventricular arrhythmias in patients with heart failure secondary to reduced ejection fraction (HFrEF). RECENT FINDINGS Recurrent ventricular arrhythmias and automatic implantable cardioverter defibrillator (AICD) shocks are responsible for significant mortality and morbidity in patients with HFrEF. Antiarrhythmic drugs and catheter ablation are the main treatment options. Frequent premature ventricular contractions (PVCs; >10,000-20,000/24-h period) are being recognized as a cause of cardiomyopathy and suboptimal response to cardiac resynchronization therapy (CRT). Patients with ventricular assist devices (VADs) have frequent ventricular tachyarrhythmias resulting in increased morbidity and mortality. Such patients may need continuation of active ICD therapy and adjunctive catheter ablation. SUMMARY There is a pressing need to develop new antiarrhythmic drugs to treat patients with recurrent AICD shocks. The effectiveness of catheter ablation as first-line therapy for preventing ventricular arrhythmias and recurrent AICD shocks needs to be directly compared with amiodarone. Ventricular tachyarrhythmias are common in CRT patients and patients with VADs. Frequent PVCs may result in a reversible form of HFrEF.
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22
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Santangeli P, Frankel DS, Marchlinski FE. End Points for Ablation of Scar-Related Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2014; 7:949-60. [DOI: 10.1161/circep.114.001585] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Pasquale Santangeli
- From the Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
| | - David S. Frankel
- From the Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Francis E. Marchlinski
- From the Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
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23
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Ghanbari H, Baser K, Yokokawa M, Stevenson W, Della Bella P, Vergara P, Deneke T, Kuck KH, Kottkamp H, Fei S, Morady F, Bogun F. Noninducibility in Postinfarction Ventricular Tachycardia as an End Point for Ventricular Tachycardia Ablation and Its Effects on Outcomes. Circ Arrhythm Electrophysiol 2014; 7:677-83. [DOI: 10.1161/circep.113.001404] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Although ventricular tachycardia (VT) ablation is a widely used therapy for patients with VT, the ideal end points for this procedure are not well defined. We performed a meta-analysis of the published literature to assess the predictive value of noninducibility of postinfarction VT for long-term outcomes after VT ablation.
Methods and Results—
We performed a systematic review of MEDLINE (1950–2013), EMBASE (1988–2013), the Cochrane Controlled Trials Register (Fourth Quarter, 2012), and reports presented at scientific meetings (1994–2013). Randomized controlled trials, case–control, and cohort studies of VT ablation were included. Outcomes reported in eligible studies were freedom from VT/ventricular fibrillation and all-cause mortality. Of the 3895 studies evaluated, we identified 8 cohort studies enrolling 928 patients for the meta-analysis. Noninducibility after VT ablation was associated with a significant increase in arrhythmia-free survival compared with partial success (odds ratio, 0.49; 95% confidence interval, 0.29–0.84;
P
=0.009) or failed ablation procedure (odds ratio, 0.10; 95% confidence interval, 0.06–0.18;
P
<0.001). There was also a significant reduction in all-cause mortality if patients were noninducible after VT ablation compared with patients with partial success (odds ratio, 0.59; 95% confidence interval, 0.36–0.98;
P
=0.04) or failed ablation (odds ratio, 0.32; 95% confidence interval, 0.10–0.99;
P
=0.049).
Conclusions—
Noninducibility of VT after VT ablation is associated with improved arrhythmia-free survival and all-cause mortality.
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Affiliation(s)
- Hamid Ghanbari
- From the Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor (H.G., K.B., M.Y., F.M., F.B.); Department of Internal Medicine, Cardiovascular Division, Brigham and Women Hospital, Boston, MA (W.S.); Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Hospital, Milano, Italy (P.D.B., P.V.); Klinik für Kardiologie II, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany (T.D.); Hanseatisches Herzzentrum, Asklepios Klinik St. Georg, Hamburg, Germany (K
| | - Kazim Baser
- From the Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor (H.G., K.B., M.Y., F.M., F.B.); Department of Internal Medicine, Cardiovascular Division, Brigham and Women Hospital, Boston, MA (W.S.); Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Hospital, Milano, Italy (P.D.B., P.V.); Klinik für Kardiologie II, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany (T.D.); Hanseatisches Herzzentrum, Asklepios Klinik St. Georg, Hamburg, Germany (K
| | - Miki Yokokawa
- From the Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor (H.G., K.B., M.Y., F.M., F.B.); Department of Internal Medicine, Cardiovascular Division, Brigham and Women Hospital, Boston, MA (W.S.); Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Hospital, Milano, Italy (P.D.B., P.V.); Klinik für Kardiologie II, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany (T.D.); Hanseatisches Herzzentrum, Asklepios Klinik St. Georg, Hamburg, Germany (K
| | - William Stevenson
- From the Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor (H.G., K.B., M.Y., F.M., F.B.); Department of Internal Medicine, Cardiovascular Division, Brigham and Women Hospital, Boston, MA (W.S.); Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Hospital, Milano, Italy (P.D.B., P.V.); Klinik für Kardiologie II, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany (T.D.); Hanseatisches Herzzentrum, Asklepios Klinik St. Georg, Hamburg, Germany (K
| | - Paolo Della Bella
- From the Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor (H.G., K.B., M.Y., F.M., F.B.); Department of Internal Medicine, Cardiovascular Division, Brigham and Women Hospital, Boston, MA (W.S.); Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Hospital, Milano, Italy (P.D.B., P.V.); Klinik für Kardiologie II, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany (T.D.); Hanseatisches Herzzentrum, Asklepios Klinik St. Georg, Hamburg, Germany (K
| | - Pasquale Vergara
- From the Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor (H.G., K.B., M.Y., F.M., F.B.); Department of Internal Medicine, Cardiovascular Division, Brigham and Women Hospital, Boston, MA (W.S.); Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Hospital, Milano, Italy (P.D.B., P.V.); Klinik für Kardiologie II, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany (T.D.); Hanseatisches Herzzentrum, Asklepios Klinik St. Georg, Hamburg, Germany (K
| | - Thomas Deneke
- From the Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor (H.G., K.B., M.Y., F.M., F.B.); Department of Internal Medicine, Cardiovascular Division, Brigham and Women Hospital, Boston, MA (W.S.); Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Hospital, Milano, Italy (P.D.B., P.V.); Klinik für Kardiologie II, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany (T.D.); Hanseatisches Herzzentrum, Asklepios Klinik St. Georg, Hamburg, Germany (K
| | - Karl-Heinz Kuck
- From the Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor (H.G., K.B., M.Y., F.M., F.B.); Department of Internal Medicine, Cardiovascular Division, Brigham and Women Hospital, Boston, MA (W.S.); Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Hospital, Milano, Italy (P.D.B., P.V.); Klinik für Kardiologie II, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany (T.D.); Hanseatisches Herzzentrum, Asklepios Klinik St. Georg, Hamburg, Germany (K
| | - Hans Kottkamp
- From the Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor (H.G., K.B., M.Y., F.M., F.B.); Department of Internal Medicine, Cardiovascular Division, Brigham and Women Hospital, Boston, MA (W.S.); Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Hospital, Milano, Italy (P.D.B., P.V.); Klinik für Kardiologie II, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany (T.D.); Hanseatisches Herzzentrum, Asklepios Klinik St. Georg, Hamburg, Germany (K
| | - She Fei
- From the Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor (H.G., K.B., M.Y., F.M., F.B.); Department of Internal Medicine, Cardiovascular Division, Brigham and Women Hospital, Boston, MA (W.S.); Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Hospital, Milano, Italy (P.D.B., P.V.); Klinik für Kardiologie II, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany (T.D.); Hanseatisches Herzzentrum, Asklepios Klinik St. Georg, Hamburg, Germany (K
| | - Fred Morady
- From the Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor (H.G., K.B., M.Y., F.M., F.B.); Department of Internal Medicine, Cardiovascular Division, Brigham and Women Hospital, Boston, MA (W.S.); Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Hospital, Milano, Italy (P.D.B., P.V.); Klinik für Kardiologie II, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany (T.D.); Hanseatisches Herzzentrum, Asklepios Klinik St. Georg, Hamburg, Germany (K
| | - Frank Bogun
- From the Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor (H.G., K.B., M.Y., F.M., F.B.); Department of Internal Medicine, Cardiovascular Division, Brigham and Women Hospital, Boston, MA (W.S.); Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Hospital, Milano, Italy (P.D.B., P.V.); Klinik für Kardiologie II, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany (T.D.); Hanseatisches Herzzentrum, Asklepios Klinik St. Georg, Hamburg, Germany (K
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Kumar S, Stevenson WG, John RM. Catheter ablation for premature ventricular contractions and ventricular tachycardia in patients with heart failure. Curr Cardiol Rep 2014; 16:522. [PMID: 25059465 DOI: 10.1007/s11886-014-0522-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ventricular arrhythmias (VA) are a significant contributor to morbidity and mortality in patients with heart failure (HF). Implantable cardioverter defibrillators are effective in reducing mortality, but do not prevent arrhythmia recurrence. There is increasing recognition that frequent premature ventricular contractions or repetitive ventricular tachycardia may also lead to new onset ventricular dysfunction or deterioration of ventricular function in patients with pre-existing HF. Suppression of the arrhythmia may lead to recovery of ventricular function. Catheter ablation has emerged as a safe and effective treatment option for reducing arrhythmia recurrence and for suppression of PVCs but its efficacy is governed by the nature of the arrhythmias, the underlying HF substrate and the accessibility of the arrhythmia substrates to ablation.
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Affiliation(s)
- Saurabh Kumar
- Cardiac Arrhythmia Service, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Lin T, Ouyang F, Kuck KH, Tilz R. THERMOCOOL® SMARTTOUCH® CATHETER - The Evidence So Far for Contact Force Technology and the Role of VISITAG™ MODULE. Arrhythm Electrophysiol Rev 2014; 3:44-7. [PMID: 26835065 DOI: 10.15420/aer.2011.3.1.44] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/31/2014] [Indexed: 11/04/2022] Open
Abstract
Catheter ablation has become an important modality in the treatment of most cardiac arrhythmias. In recent years there has been significant development of new ablation energies and technologies in an attempt to improve clinical outcomes and decrease disease burden. Ablation failure is often associated with inadequate lesion formation, and catheter-to-myocardial contact force (CF) and catheter stability are two of the parameters required to produce effective lesions during radiofrequency energy application. Recently, CF sensing catheters and tagging modules have been developed to give operators realtime data on catheter force and stability. This review describes the novel THERMOCOOL(®) SMARTTOUCH(®) CATHETER (Biosense Webster Inc., CA, US) and VISITAG™ MODULE (Biosense Webster Inc., CA, US) software, and discusses the results of several studies on CF and catheter stability during mapping and ablation of the left atrium and ventricle from our electrophysiology laboratory. We assess the short- and longer-term outcomes during mapping and ablation with and without CF data, as well as the use of the VISITAG MODULE™ software, which allows the evaluation of multiple parameters of lesion formation, then integrates and displays this as automatic tags in a relatively objective way.
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Affiliation(s)
| | | | - Karl-Heinz Kuck
- Director of Cardiology; Electrophysiologist, Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany
| | - Roland Tilz
- Electrophysiologist, Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany
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26
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Rajamani K, Goldberg AS, Wilkoff BL. Shock Avoidance and the Newer Tachycardia Therapy Algorithms. Cardiol Clin 2014; 32:191-200. [DOI: 10.1016/j.ccl.2014.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mørk TJ, Kristensen J, Gerdes JC, Jensen HK, Lukac P, Nielsen JC. Catheter ablation for ventricular tachycardia in ischaemic heart disease; acute success and long-term outcome. SCAND CARDIOVASC J 2014; 48:27-34. [PMID: 24460505 DOI: 10.3109/14017431.2013.877154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We conducted a study to assess the acute procedural success and the long-term effect of radiofrequency ablation (RFA) for ventricular tachycardia (VT) in patients with ischaemic heart disease. DESIGN We included 90 patients with ischaemic heart disease treated with RFA for VT in our institution. Data were obtained from patient files, and implantable cardioverter-defibrillator (ICD) discharges were recorded from in-house and remote follow-up data. Recurrence of VT during follow-up was noted as date of first ICD therapy for VT or first recurrence of symptomatic VT. RESULTS After the initial RFA procedure no VT was inducible in 42 patients (47%), non-clinical VT was inducible in 21 patients (23%), and the clinical VT was still inducible in 14 patients (16%). The procedural success was indefinable in 13 patients (14%). After a median follow-up of 33 months after the latest RFA, 38 patients (42%) stayed free from recurrent VT. The number of ICD shocks/year was significantly reduced from median 1.1 (interquartile range: 0.3-2.8) to 0 (0-0.4) (p < 0.0001). CONCLUSIONS Procedural success rate as well as long-term freedom from recurrent VT is modest after RFA for VT in ischaemic heart disease. However, ICD discharges are significantly reduced after RFA, and a considerable proportion of patients remain free from recurrent VT during the long-term follow-up.
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Nayyar S, Wilson L, Ganesan AN, Sullivan T, Kuklik P, Chapman D, Brooks AG, Mahajan R, Baumert M, Young GD, Sanders P, Roberts-Thomson KC. High-density mapping of ventricular scar: a comparison of ventricular tachycardia (VT) supporting channels with channels that do not support VT. Circ Arrhythm Electrophysiol 2014; 7:90-8. [PMID: 24382409 DOI: 10.1161/circep.113.000882] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Surviving myocytes within scar may form channels that support ventricular tachycardia (VT) circuits. There are little data on the properties of channels that comprise VT circuits and those that are non-VT supporting channels. METHODS AND RESULTS In 22 patients with ischemic cardiomyopathy and VT, high-density mapping was performed with the PentaRay catheter and Ensite NavX system during sinus rhythm. A channel was defined as a series of matching pace-maps with a stimulus (S) to QRS time of ≥40 ms. Sites were determined to be part of a VT channel if there were matching pace-maps to the VT morphology. This was confirmed with entrainment mapping when possible. Of the 238 channels identified, 57 channels corresponded to an inducible VT. Channels that were part of a VT circuit were more commonly located within dense scar than non-VT channels (97% versus 82%; P=0.036). VT supporting channels were of greater length (mean±SEM, 53±5 versus 33±4 mm), had higher longest S-QRS (130±12 versus 82±12 ms), longer conduction time (103±14 versus 43±13 ms), and slower conduction velocity (0.87±0.23 versus 1.39±0.21 m/s) than non-VT channels (P<0.001). Of all the fractionated, late, and very late potentials located in scar, only 21%, 26%, and 29%, respectively, were recorded within VT channels. CONCLUSIONS High-density mapping shows substantial differences among channels in ventricular scar. Channels supporting VT are more commonly located in dense scar, longer than non-VT channels, and have slower conduction velocity. Only a minority of scar-related potentials participate in the VT supporting channels.
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Affiliation(s)
- Sachin Nayyar
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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Piers SR, Leong DP, van Taxis CFVH, Tayyebi M, Trines SA, Pijnappels DA, Delgado V, Schalij MJ, Zeppenfeld K. Outcome of Ventricular Tachycardia Ablation in Patients With Nonischemic Cardiomyopathy. Circ Arrhythm Electrophysiol 2013; 6:513-21. [DOI: 10.1161/circep.113.000089] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | - Darryl P. Leong
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Mohammad Tayyebi
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Serge A. Trines
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Daniël A. Pijnappels
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martin J. Schalij
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
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Tokuda M, Kojodjojo P, Tung S, Tedrow UB, Nof E, Inada K, Koplan BA, Michaud GF, John RM, Epstein LM, Stevenson WG. Acute failure of catheter ablation for ventricular tachycardia due to structural heart disease: causes and significance. J Am Heart Assoc 2013; 2:e000072. [PMID: 23727700 PMCID: PMC3698765 DOI: 10.1161/jaha.113.000072] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute end points of catheter ablation for ventricular tachycardia (VT) remain incompletely defined. The aim of this study is to identify causes for failure in patients with structural heart disease and to assess the relation of this acute outcome to longer-term management and outcomes. METHODS AND RESULTS From 2002 to 2010, 518 consecutive patients (84% male, 62 ± 14 years) with structural heart disease underwent a first ablation procedure for sustained VT at our institution. Acute ablation failure was defined as persistent inducibility of a clinical VT. Acute ablation failure was seen in 52 (10%) patients. Causes for failure were: intramural free wall VT in 13 (25%), deep septal VT in 9 (17%), decision not to ablate due to proximity to the bundle of His, left phrenic nerve, or a coronary artery in 3 (6%), and endocardial ablation failure with inability or decision not to attempt to access the epicardium in 27 (52%) patients. In multivariable analysis, ablation failure was an independent predictor of mortality (hazard ratio 2.010, 95% CI 1.147 to 3.239, P=0.004) and VT recurrence (hazard ratio 2.385, 95% CI 1.642 to 3.466, P<0.001). CONCLUSIONS With endocardial or epicardial ablation, or both, acute ablation failure was seen in 10% of patients, largely due to anatomic factors. Persistence of a clinical VT is associated with recurrence and comparatively higher mortality.
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Affiliation(s)
- Michifumi Tokuda
- Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Ghanem MT, Ahmed RS, Abd El Moteleb AM, Zarif JK. Predictors of success in ablation of scar-related ventricular tachycardia. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2013; 7:87-95. [PMID: 23700377 PMCID: PMC3653812 DOI: 10.4137/cmc.s11501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
During ablation of re-entrant ventricular tachycardia (VT) 3-dimensional mapping systems are now used to properly delineate the scar tissue and aid ablation of scar-related VT. The aim of our study was to outline how the mode of ablation predicts success and recurrence in large scar-related VT. When comparing patients with recurrence and patients with no recurrence, univariate analysis showed that number of ablation lesions (28 ± 8 vs. 12 ± 8, P = 0.01) and more linear ablation lesions rather than focal lesions (P = 0.03) were associated with long-term success. We demonstrated that more extensive ablation lesions and creation of linear lesions is associated with better success rate and lower recurrence rate during ablation of large scar-related ventricular tachycardia.
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Affiliation(s)
- Mazen T Ghanem
- Cardiology Department, Ain Shams University, Cairo, Egypt
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Tung R, Shivkumar K. Integrated care for management of ventricular arrhythmias: can a specialized unit and catheter ablation improve mortality? Circulation 2013; 127:1354-6. [PMID: 23547176 DOI: 10.1161/circulationaha.113.001775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pauriah M, Cismaru G, Magnin-Poull I, Andronache M, Sellal JM, Schwartz J, Brembilla-Perrot B, Sadoul N, Aliot E, de Chillou C. A Stepwise Approach to the Management of Postinfarct Ventricular Tachycardia Using Catheter Ablation as the First-Line Treatment. Circ Arrhythm Electrophysiol 2013; 6:351-6. [PMID: 23512203 DOI: 10.1161/circep.113.000261] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maheshwar Pauriah
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Gabriel Cismaru
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Isabelle Magnin-Poull
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Marius Andronache
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Jean-Marc Sellal
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Jérôme Schwartz
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Béatrice Brembilla-Perrot
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Nicolas Sadoul
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Etienne Aliot
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
| | - Christian de Chillou
- From the Department of Cardiology, CHU de Nancy, University Hospital Nancy, Nancy, France (M.P., G.C., I.M.-P., M.A., J.-M.S., J.S., B.B.-P., N.S., E.A., C.d.C.); and IADI—INSERM, U947, Nancy, France (I.M.-P., M.A., C.d.C.)
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DELACRÉTAZ ETIENNE, BRENNER ROMAN, SCHAUMANN ANSELM, ECKARDT LARS, WILLEMS STEPHAN, PITSCHNER HEINZFRIEDRICH, KAUTZNER JOSEF, SCHUMACHER BURGHARD, HANSEN PETERS, KUCK KARLHEINZ. Catheter Ablation of Stable Ventricular Tachycardia Before Defibrillator Implantation in Patients with Coronary Heart Disease (VTACH): An On-Treatment Analysis. J Cardiovasc Electrophysiol 2013; 24:525-9. [DOI: 10.1111/jce.12073] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 11/13/2012] [Accepted: 11/26/2012] [Indexed: 11/27/2022]
Affiliation(s)
| | - ROMAN BRENNER
- Department of Cardiology, University Hospital Bern; Switzerland
| | - ANSELM SCHAUMANN
- Hanseatisches Herzzentrum; Asklepios Klinik St. Georg; Hamburg Germany
| | - LARS ECKARDT
- Division of Electrophysiology; Department of Cardiology/Angiology; University of Münster; Germany
| | | | | | - JOSEF KAUTZNER
- Institute for Clinical and Experimental Medicine, Prague; Czech Republic
| | | | | | - KARL-HEINZ KUCK
- Division of Electrophysiology; Department of Cardiology/Angiology; University of Münster; Germany
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FREEDBERG NAHUMA, FELDMAN ALEXANDER. Prognostic Significance of Implantable Defibrillator Shock: Are All Shocks Created Equal? J Cardiovasc Electrophysiol 2012; 23:741-3. [DOI: 10.1111/j.1540-8167.2012.02299.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wissner E, Stevenson WG, Kuck KH. Catheter ablation of ventricular tachycardia in ischaemic and non-ischaemic cardiomyopathy: where are we today? A clinical review. Eur Heart J 2012; 33:1440-50. [DOI: 10.1093/eurheartj/ehs007] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Tung R, Mathuria N, Michowitz Y, Yu R, Buch E, Bradfield J, Mandapati R, Wiener I, Boyle N, Shivkumar K. Functional pace-mapping responses for identification of targets for catheter ablation of scar-mediated ventricular tachycardia. Circ Arrhythm Electrophysiol 2012; 5:264-72. [PMID: 22333344 DOI: 10.1161/circep.111.967976] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Myocardial scars harbor areas of slow conduction and display abnormal electrograms. Pace-mapping at these sites can generate a 12-lead ECG morphological match to a targeted ventricular tachycardia (VT), and in some instances, multiple exit morphologies can result. At times, this can also result in the initiation of VT, termed pace-mapped induction (PMI). We hypothesized that in patients undergoing catheter ablation of VT, scar substrates with multiple exit sites (MES) identified during pace-mapping have improved freedom from recurrent VT, and PMI of VT predicts successful sites of termination during ablation. METHODS AND RESULTS High-density mapping was performed in all subjects to delineate scar (0.5-1.5 mV). Sites with abnormal electrograms were tagged, stimulated (bipolar 10 mA at 2 ms), and targeted for ablation. MES was defined as >1 QRS morphology from a single pacing site. PMI was defined as initiation of VT during pace-mapping (400-600 ms). In a 2-year period, 44 consecutive patients with scar-mediated VT underwent mapping and ablation. MES were observed during pace-mapping in 25 patients (57%). At 9 months, 74% of patients who exhibited MES during pace-mapping had no recurrence of VT compared with 42% of those without MES observed (P=0.024), with an overall freedom from VT of 61%. Thirteen patients (30%) demonstrated PMI, and termination of VT was seen in 95% (18/19) of sites where ablation was performed. CONCLUSIONS During pace-mapping, electrograms that exhibit MES and PMI may be specific for sites critical to reentry. These functional responses hold promise for identifying important sites for catheter ablation of VT.
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Affiliation(s)
- Roderick Tung
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1679, USA.
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Liu E, Josephson ME. Pleomorphic Ventricular Tachycardia and Risk for Sudden Cardiac Death. Circ Arrhythm Electrophysiol 2011; 4:2-4. [DOI: 10.1161/circep.110.960443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Emerson Liu
- From the CardioVascular Institute, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA
| | - Mark E. Josephson
- From the CardioVascular Institute, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA
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Hadid C, Almendral J, Ortiz M, Schwab JO, Janko S, Mischke K, Arribas F, Wolpert C, Ricci R, Adragao P, Cobo E, Navarro X, Quesada A. Incidence, Determinants, and Prognostic Implications of True Pleomorphism of Ventricular Tachycardia in Patients With Implantable Cardioverter-Defribillators. Circ Arrhythm Electrophysiol 2011; 4:33-42. [DOI: 10.1161/circep.110.957068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Claudio Hadid
- From the Hospital Gregorio Marañon (C.H., J.A., M.O.), Madrid, Spain; University of Bonn (J.O.S.), Bonn, Germany; Ludwig-Maximilians-University Munich (S.J.), Munich, Germany; RWTH Aachen University (K.M.), Aachen, Germany; Hospital 12 de Octubre (F.A.), Madrid, Spain; University of Mannheim (C.W.), Mannheim, Germany; Hospital San Filippo Neri (R.R.), Rome, Italy; Hospital Santa Cruz (P.A.), Carnaxide, Portugal; Universidad Politecnica de Cataluña (E.C.), Barcelona, Spain; Medtronic (X.N.),
| | - Jesus Almendral
- From the Hospital Gregorio Marañon (C.H., J.A., M.O.), Madrid, Spain; University of Bonn (J.O.S.), Bonn, Germany; Ludwig-Maximilians-University Munich (S.J.), Munich, Germany; RWTH Aachen University (K.M.), Aachen, Germany; Hospital 12 de Octubre (F.A.), Madrid, Spain; University of Mannheim (C.W.), Mannheim, Germany; Hospital San Filippo Neri (R.R.), Rome, Italy; Hospital Santa Cruz (P.A.), Carnaxide, Portugal; Universidad Politecnica de Cataluña (E.C.), Barcelona, Spain; Medtronic (X.N.),
| | - Mercedes Ortiz
- From the Hospital Gregorio Marañon (C.H., J.A., M.O.), Madrid, Spain; University of Bonn (J.O.S.), Bonn, Germany; Ludwig-Maximilians-University Munich (S.J.), Munich, Germany; RWTH Aachen University (K.M.), Aachen, Germany; Hospital 12 de Octubre (F.A.), Madrid, Spain; University of Mannheim (C.W.), Mannheim, Germany; Hospital San Filippo Neri (R.R.), Rome, Italy; Hospital Santa Cruz (P.A.), Carnaxide, Portugal; Universidad Politecnica de Cataluña (E.C.), Barcelona, Spain; Medtronic (X.N.),
| | - Joerg Otto Schwab
- From the Hospital Gregorio Marañon (C.H., J.A., M.O.), Madrid, Spain; University of Bonn (J.O.S.), Bonn, Germany; Ludwig-Maximilians-University Munich (S.J.), Munich, Germany; RWTH Aachen University (K.M.), Aachen, Germany; Hospital 12 de Octubre (F.A.), Madrid, Spain; University of Mannheim (C.W.), Mannheim, Germany; Hospital San Filippo Neri (R.R.), Rome, Italy; Hospital Santa Cruz (P.A.), Carnaxide, Portugal; Universidad Politecnica de Cataluña (E.C.), Barcelona, Spain; Medtronic (X.N.),
| | - Sabine Janko
- From the Hospital Gregorio Marañon (C.H., J.A., M.O.), Madrid, Spain; University of Bonn (J.O.S.), Bonn, Germany; Ludwig-Maximilians-University Munich (S.J.), Munich, Germany; RWTH Aachen University (K.M.), Aachen, Germany; Hospital 12 de Octubre (F.A.), Madrid, Spain; University of Mannheim (C.W.), Mannheim, Germany; Hospital San Filippo Neri (R.R.), Rome, Italy; Hospital Santa Cruz (P.A.), Carnaxide, Portugal; Universidad Politecnica de Cataluña (E.C.), Barcelona, Spain; Medtronic (X.N.),
| | - Karl Mischke
- From the Hospital Gregorio Marañon (C.H., J.A., M.O.), Madrid, Spain; University of Bonn (J.O.S.), Bonn, Germany; Ludwig-Maximilians-University Munich (S.J.), Munich, Germany; RWTH Aachen University (K.M.), Aachen, Germany; Hospital 12 de Octubre (F.A.), Madrid, Spain; University of Mannheim (C.W.), Mannheim, Germany; Hospital San Filippo Neri (R.R.), Rome, Italy; Hospital Santa Cruz (P.A.), Carnaxide, Portugal; Universidad Politecnica de Cataluña (E.C.), Barcelona, Spain; Medtronic (X.N.),
| | - Fernando Arribas
- From the Hospital Gregorio Marañon (C.H., J.A., M.O.), Madrid, Spain; University of Bonn (J.O.S.), Bonn, Germany; Ludwig-Maximilians-University Munich (S.J.), Munich, Germany; RWTH Aachen University (K.M.), Aachen, Germany; Hospital 12 de Octubre (F.A.), Madrid, Spain; University of Mannheim (C.W.), Mannheim, Germany; Hospital San Filippo Neri (R.R.), Rome, Italy; Hospital Santa Cruz (P.A.), Carnaxide, Portugal; Universidad Politecnica de Cataluña (E.C.), Barcelona, Spain; Medtronic (X.N.),
| | - Christian Wolpert
- From the Hospital Gregorio Marañon (C.H., J.A., M.O.), Madrid, Spain; University of Bonn (J.O.S.), Bonn, Germany; Ludwig-Maximilians-University Munich (S.J.), Munich, Germany; RWTH Aachen University (K.M.), Aachen, Germany; Hospital 12 de Octubre (F.A.), Madrid, Spain; University of Mannheim (C.W.), Mannheim, Germany; Hospital San Filippo Neri (R.R.), Rome, Italy; Hospital Santa Cruz (P.A.), Carnaxide, Portugal; Universidad Politecnica de Cataluña (E.C.), Barcelona, Spain; Medtronic (X.N.),
| | - Renato Ricci
- From the Hospital Gregorio Marañon (C.H., J.A., M.O.), Madrid, Spain; University of Bonn (J.O.S.), Bonn, Germany; Ludwig-Maximilians-University Munich (S.J.), Munich, Germany; RWTH Aachen University (K.M.), Aachen, Germany; Hospital 12 de Octubre (F.A.), Madrid, Spain; University of Mannheim (C.W.), Mannheim, Germany; Hospital San Filippo Neri (R.R.), Rome, Italy; Hospital Santa Cruz (P.A.), Carnaxide, Portugal; Universidad Politecnica de Cataluña (E.C.), Barcelona, Spain; Medtronic (X.N.),
| | - Pedro Adragao
- From the Hospital Gregorio Marañon (C.H., J.A., M.O.), Madrid, Spain; University of Bonn (J.O.S.), Bonn, Germany; Ludwig-Maximilians-University Munich (S.J.), Munich, Germany; RWTH Aachen University (K.M.), Aachen, Germany; Hospital 12 de Octubre (F.A.), Madrid, Spain; University of Mannheim (C.W.), Mannheim, Germany; Hospital San Filippo Neri (R.R.), Rome, Italy; Hospital Santa Cruz (P.A.), Carnaxide, Portugal; Universidad Politecnica de Cataluña (E.C.), Barcelona, Spain; Medtronic (X.N.),
| | - Erik Cobo
- From the Hospital Gregorio Marañon (C.H., J.A., M.O.), Madrid, Spain; University of Bonn (J.O.S.), Bonn, Germany; Ludwig-Maximilians-University Munich (S.J.), Munich, Germany; RWTH Aachen University (K.M.), Aachen, Germany; Hospital 12 de Octubre (F.A.), Madrid, Spain; University of Mannheim (C.W.), Mannheim, Germany; Hospital San Filippo Neri (R.R.), Rome, Italy; Hospital Santa Cruz (P.A.), Carnaxide, Portugal; Universidad Politecnica de Cataluña (E.C.), Barcelona, Spain; Medtronic (X.N.),
| | - Xavier Navarro
- From the Hospital Gregorio Marañon (C.H., J.A., M.O.), Madrid, Spain; University of Bonn (J.O.S.), Bonn, Germany; Ludwig-Maximilians-University Munich (S.J.), Munich, Germany; RWTH Aachen University (K.M.), Aachen, Germany; Hospital 12 de Octubre (F.A.), Madrid, Spain; University of Mannheim (C.W.), Mannheim, Germany; Hospital San Filippo Neri (R.R.), Rome, Italy; Hospital Santa Cruz (P.A.), Carnaxide, Portugal; Universidad Politecnica de Cataluña (E.C.), Barcelona, Spain; Medtronic (X.N.),
| | - Aurelio Quesada
- From the Hospital Gregorio Marañon (C.H., J.A., M.O.), Madrid, Spain; University of Bonn (J.O.S.), Bonn, Germany; Ludwig-Maximilians-University Munich (S.J.), Munich, Germany; RWTH Aachen University (K.M.), Aachen, Germany; Hospital 12 de Octubre (F.A.), Madrid, Spain; University of Mannheim (C.W.), Mannheim, Germany; Hospital San Filippo Neri (R.R.), Rome, Italy; Hospital Santa Cruz (P.A.), Carnaxide, Portugal; Universidad Politecnica de Cataluña (E.C.), Barcelona, Spain; Medtronic (X.N.),
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The role of catheter ablation for ventricular tachycardia in patients with ischemic heart disease. Curr Opin Cardiol 2011; 26:30-9. [DOI: 10.1097/hco.0b013e328341390b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Almendral J, Marchlinski F. Is it the same or a different ventricular tachycardia?: an additional use for defibrillator electrograms. J Am Coll Cardiol 2010; 56:980-2. [PMID: 20828651 DOI: 10.1016/j.jacc.2010.03.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 03/23/2010] [Indexed: 10/19/2022]
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Nakahara S, Tung R, Ramirez RJ, Gima J, Wiener I, Mahajan A, Boyle NG, Shivkumar K. Distribution of late potentials within infarct scars assessed by ultra high-density mapping. Heart Rhythm 2010; 7:1817-24. [PMID: 20682358 DOI: 10.1016/j.hrthm.2010.07.032] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Accepted: 07/25/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Late potential (LP) electrograms represent areas of slow conduction and are often sites critical to reentrant tachycardia circuits. The distribution of LPs within infarct scar is not known. OBJECTIVE The purpose of this study was to delineate infarct heterogeneity using ultra high-density mapping and to determine the location of LPs with respect to scar architecture. METHODS Detailed endocardial (n = 21) and epicardial (n = 8) ultra high-density mapping was performed to delineate the substrate for ventricular tachycardia (VT) in 21 patients with ischemic cardiomyopathy. LP was defined as a low-voltage electrogram (< 1.5 mV) with distinct onset after the QRS. Very late potentials (vLPs) were classified as LPs with onset > 100 ms after the QRS. RESULTS A mean of 787 ± 391 and 810 ± 375 points in the LV endocardium and epicardium were sampled. Multipolar mapping identified heterogeneous islets (HIs) with relatively preserved electrogram amplitudes (≥ 0.51 mv) within dense scar (8.5 ± 4.9/4.5 ± 2.6 HIs per endocardium/epicardium) in all patients. In maps on which putative VT isthmuses were identified (25/29), 57% of vLP were recorded in or adjacent to HI. An LP-targeted ablation strategy combined with pace mapping achieved acute success in all patients (complete success in 52% and partial success in 48%). After 15 ± 7 months, 65% of patients remained free of VT episodes. CONCLUSION Ultra high-density mapping with a multipolar catheter facilitates the delineation of heterogeneous scar architecture at higher resolution. Electrograms within and adjacent to HIs have a higher incidence of vLP, and these sites are frequently critical to reentry. These findings have important implications for substrate-based ablation strategies.
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Affiliation(s)
- Shiro Nakahara
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1679, USA
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Abstract
Sudden cardiac death due to ventricular arrhythmias remains the most common cause of death in developed nations. Implantable cardioverter defibrillators have been shown to improve mortality in high-risk groups for ventricular tachyarrhythmias, but they are not curative, with the risk of arrhythmia recurrence remaining unaltered. It is also important to remember that ventricular tachycardia (VT) in the setting of a structurally normal heart is often not associated with an increased risk of sudden death and catheter ablation is a potentially curative procedure in this cohort. Recent advances in catheter ablation for VT have increased the efficacy in creating adequate lesions, accurate three-dimensional maps and mapping haemodynamically unstable VT, all of which have increased the utility of this modality in the treatment of ventricular arrhythmias. In this article, we review the recent advances that have fuelled renewed interest in catheter ablation of VT, its clinical utility and who should be referred.
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Affiliation(s)
- H S Lim
- Department of Cardiovascular Medicine, Flinders Medical Centre, Cardiovascular Research Centre, Department of Cardiology, Royal Adelaide Hospital and the Discipline of Physiology, School of Molecular and Biomedical Science, University of Adelaide and School of Medicine, Flinders University, Adelaide, South Australia, Australia
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Tedrow U, Stevenson WG. Epicardial Ablation of Ischemic Ventricular Tachycardia. Card Electrophysiol Clin 2010; 2:69-79. [PMID: 28770737 DOI: 10.1016/j.ccep.2009.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Endocardial catheter ablation for ventricular arrhythmias in patients with ischemic cardiomyopathy decreases ventricular tachycardia (VT) episodes, and painful implantable defibrillator shocks and can be lifesaving in the context of VT storm. Unfortunately, up to approximately one-third of postinfarction VTs are not accessible for ablation from the endocardium. Percutaneous access to the epicardial space has allowed ablation of a portion of these circuits, although anatomic barriers, such as the phrenic nerve, coronary arteries, and intramural circuits, still limit success in some cases. Adhesions, most often due to prior cardiac surgery, frequently necessitate a surgical approach to the pericardial space.
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Affiliation(s)
- Usha Tedrow
- The Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Inada K, Roberts-Thomson KC, Seiler J, Steven D, Tedrow UB, Koplan BA, Stevenson WG. Mortality and safety of catheter ablation for antiarrhythmic drug-refractory ventricular tachycardia in elderly patients with coronary artery disease. Heart Rhythm 2010; 7:740-4. [PMID: 20167290 DOI: 10.1016/j.hrthm.2010.02.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 02/10/2010] [Indexed: 12/01/2022]
Abstract
BACKGROUND As the population ages, recurrent ventricular tachycardia (VT) is increasingly encountered in elderly patients with ischemic heart disease. Radiofrequency catheter ablation is useful for reducing VT therapy in patients with an implantable defibrillator. The utility of radiofrequency catheter ablation in the elderly is not well defined. OBJECTIVE The purpose of this study was to evaluate the prognosis and safety of radiofrequency catheter ablation of postinfarct VT in elderly patients. METHODS Radiofrequency catheter ablation was performed in 285 consecutive patients with recurrent postinfarct VT refractory to antiarrhythmic drugs. Mortality and outcomes were compared for an elderly group (age >or=75 years, n = 72) and a younger group (age <75 years, n = 213). RESULTS The groups were similar with regard to baseline characteristics, except for a greater number of females in the elderly group (20.8% vs 10.8%, P = .03). Inducible VTs were abolished or modified in 79.2% of the elderly group and 87.8% of the younger group (P = .12). Major complications occurred in 5.6% of elderly patients and 2.3% of younger patients (P = .48). Periprocedural mortality was similar between both groups (2/72 in elderly and 9/213 in younger group, P = .74). During mean follow-up of 42 +/- 33 months, 50.0% of the elderly group and 35.2% of the younger group died (P = .08). No VT was observed in 63.9% of the elderly patients and 60.1% of the younger patients, respectively (mean follow-up 18 +/- 24 months, P = .80). CONCLUSION Outcomes of catheter ablation are similar for selected elderly and younger patients. Advanced age should not preclude ablation when recurrent VT is adversely affecting quality of life in elderly patients who otherwise have a reasonable expectation for survival.
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Affiliation(s)
- Keiichi Inada
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Tung R, Josephson ME, Reddy V, Reynolds MR. Influence of clinical and procedural predictors on ventricular tachycardia ablation outcomes: an analysis from the substrate mapping and ablation in Sinus Rhythm to Halt Ventricular Tachycardia Trial (SMASH-VT). J Cardiovasc Electrophysiol 2010; 21:799-803. [PMID: 20132389 DOI: 10.1111/j.1540-8167.2009.01705.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Substrate Mapping and Ablation in Sinus Rhythm to Halt Ventricular Tachycardia (SMASH-VT) trial is the largest randomized trial in substrate-based ablation. We performed a retrospective analysis of patients randomized to prophylactic ablation of ventricular tachycardia to determine the predictive value of clinical and procedural variables on outcomes. METHODS In patients treated with catheter ablation, we examined predictors of ICD-therapy free survival using Cox proportional hazards models. Procedural variables tested included the scar location, number of VT morphologies (VTs) induced, tachycardia cycle length, catheter irrigation, catheter approach, procedural duration, and VT inducibility after ablation. Clinical variables including age, index arrhythmia, NYHA class, ejection fraction, prior revascularization, and baseline medication use were also analyzed. RESULTS Among 64 patients randomized to ablation, 61 received the assigned therapy and complete procedural data were available for 54 patients. Thirteen percent (7 of 54) experienced ICD therapies during 2-year follow-up. Patients with subsequent ICD therapies had significantly more VTs induced during the ablation procedure than those without (3.9 +/- 2.1 vs 1.9 +/- 1.8, P = 0.05). The hazard ratio for each additional VT induced was 1.51 (95% CI 1.07-2.13, P = 0.02). Two-year Kaplan-Meier event-free survival rates were 96% for 0-1 VTs induced, and 78% for two or more. The use of irrigated catheters was not predictive of ablation success. CONCLUSION In this small retrospective analysis, the number of VTs induced during the procedure was predictive of 2-year outcomes. This likely reflects a more complex arrhythmia substrate in patients who fail ablation.
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Kuck KH, Schaumann A, Eckardt L, Willems S, Ventura R, Delacrétaz E, Pitschner HF, Kautzner J, Schumacher B, Hansen PS. Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial. Lancet 2010; 375:31-40. [PMID: 20109864 DOI: 10.1016/s0140-6736(09)61755-4] [Citation(s) in RCA: 533] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In patients with ventricular tachycardia (VT) and a history of myocardial infarction, intervention with an implantable cardioverter defibrillator (ICD) can prevent sudden cardiac death and thereby reduce total mortality. However, ICD shocks are painful and do not provide complete protection against sudden cardiac death. We assessed the potential benefit of catheter ablation before implantation of a cardioverter defibrillator. METHODS The Ventricular Tachycardia Ablation in Coronary Heart Disease (VTACH) study was a prospective, open, randomised controlled trial, undertaken in 16 centres in four European countries. Patients aged 18-80 years were eligible for enrolment if they had stable VT, previous myocardial infarction, and reduced left-ventricular ejection fraction (LVEF; <or=50%). 110 patients were randomly allocated in a 1:1 ratio to receive catheter ablation and an ICD (ablation group, n=54) or ICD alone (control group, n=56). Randomisation was done by computer-generated randomly permuted blocks and stratified by centre and LVEF (<or=30% or >30%). Patients were followed up for at least 1 year. The primary endpoint was the time to first recurrence of VT or ventricular fibrillation (VF). Analysis was by intention to treat (ITT). This study is registered with ClinicalTrials.gov, number NCT00919373. FINDINGS 107 patients were included in the ITT population (ablation group, n=52; control group, n=55). Two patients (one in each group) withdrew consent immediately after randomisation without any follow-up data and one patient (ablation group) was excluded because of a protocol violaton. Mean follow-up was 22.5 months (SD 9.0). Time to recurrence of VT or VF was longer in the ablation group (median 18.6 months [lower quartile 2.4, upper quartile not determinable]) than in the control group (5.9 months [IQR 0.8-26.7]). At 2 years, estimates for survival free from VT or VF were 47% in the ablation group and 29% in the control group (hazard ratio 0.61; 95% CI 0.37-0.99; p=0.045). Complications related to the ablation procedure occurred in two patients; no deaths occurred within 30 days after ablation. 15 device-related complications requiring surgical intervention occurred in 13 patients (ablation group, four; control group, nine). Nine patients died during the study (ablation group, five; control group, four). INTERPRETATION Prophylactic VT ablation before defibrillator implantation seemed to prolong time to recurrence of VT in patients with stable VT, previous myocardial infarction, and reduced LVEF. Prophylactic catheter ablation should therefore be considered before implantation of a cardioverter defibrillator in such patients. FUNDING St Jude Medical.
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Affiliation(s)
- Karl-Heinz Kuck
- Hanseatisches Herzzentrum, Asklepios Klinik St Georg, Hamburg, Germany.
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Kuck KH. Should Catheter Ablation be the Preferred Therapy for Reducing ICD Shocks? Circ Arrhythm Electrophysiol 2009; 2:713-20; discussion 720. [DOI: 10.1161/circep.109.896571] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Karl-Heinz Kuck
- From the Hanseatisches Herzzentrum, Asklepios Klinik St Georg, Hamburg, Germany
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PRATOLA CLAUDIO, BALDO ELISA, TOSELLI TIZIANO, NOTARSTEFANO PASQUALE, PAOLO ARTALE, FERRARI ROBERTO. Contact versus Noncontact Mapping for Ablation of Ventricular Tachycardia in Patients with Previous Myocardial Infarction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:842-50. [DOI: 10.1111/j.1540-8159.2009.02398.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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