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Futyma P, Zarębski Ł, Chen S, Enriquez A, Pürerfellner H, Santangeli P. Risk Assessment and Management of Outflow Tract Arrhythmias Refractory to Prior Treatments. CURRENT CARDIOVASCULAR RISK REPORTS 2022. [DOI: 10.1007/s12170-022-00712-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Li GY, Chen YY, Chien KL, Lin YJ, Kuo TT, Chung FP. Clinical Significance of Ventricular Tachyarrhythmias in Patients Undergoing Valve Replacement: A Nationwide Population-Based Study. Front Cardiovasc Med 2021; 8:676897. [PMID: 34336945 PMCID: PMC8319543 DOI: 10.3389/fcvm.2021.676897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The clinical significance and outcomes of ventricular tachyarrhythmias (VTa) in patients undergoing valve replacement have rarely been reported. Objective: This study aimed to investigate the incidence and outcome of VTa after surgical valve replacement. Methods: We conducted a population-based retrospective cohort study using data obtained from the Taiwan National Health Insurance Research Database. In total, 10,212 patients were selected after 1:1 propensity-score matching based on the type of prosthetic valve used (mechanical vs. bioprosthetic). Various outcomes during long-term follow-up were analyzed. Results: After a median follow-up period of 59.6 months, the crude incidence rate of VTa after surgical valve replacement was 4.8/1,000 person-years, and the cumulative incidence of VTa persistently increased after surgery. Furthermore, the occurrences of VTa after valve replacement significantly increased the risk of cardiovascular (CV) death (P < 0.001, HR 1.67, 95% CI 1.41–1.96), stroke- (P < 0.001, HR 1.66, 95% CI 1.37–2.01), atrial fibrillation- (P < 0.001, HR 2.80, 95% CI 2.42–3.24), and congestive heart failure-related hospitalization (P < 0.001, HR 2.61, 95% CI 2.30–2.95). Among patients with VTa, all-cause mortality (P = 0.001, HR 0.49, 95% CI 0.32–0.75) and CV death (P = 0.047, HR 0.58, 95% CI 0.34–0.99) in those with implantable cardioverter-defibrillator (ICD) implantation were lower than those without. Conclusion: The crude incidence rate of VTa after surgical valve replacement was 4.8/1,000 person-years, and the cumulative incidence of VTa persistently increased during follow-up. The presence of VTa after surgical valve replacement increases hospitalization and CV death, while ICD implantation reduced the mortality rate in these patients.
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Affiliation(s)
- Guan-Yi Li
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yun-Yu Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Tzu-Ting Kuo
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
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Aras D, Topaloglu S, Ozeke O, Ozcan F, Cay S, Golbasi Z. Percutaneous Interventricular Septal Access Guided by Subcostal Echocardiography and Fluoroscopy for Ventricular Tachycardia Ablation in a Patient with Aortic and Mitral Mechanical Valves. J Innov Card Rhythm Manag 2020; 10:3719-3721. [PMID: 32477738 PMCID: PMC7252692 DOI: 10.19102/icrm.2019.100702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/04/2018] [Indexed: 01/25/2023] Open
Abstract
Mechanical prosthetic aortic and mitral valves preclude either a retrograde aortic or transseptal approach to the left ventricular (LV) endocardium. Several operators have reported on the application of nonconventional techniques for ventricular tachycardia (VT) ablation including transventricular septal puncture, epicardial approach, transmechanical valve approach, transcoronary venous approach, and transapical approach. Incorporating transventricular access to the LV under intracardiac echocardiography (ICE) guidance has been previously attempted in VT ablation procedures in patients with both aortic and mitral mechanical valves. However, while ICE is readily used in the United States, its use is less common in Europe, since the health insurance agencies largely do not cover the costs of ICE catheters. We therefore herein present a case of VT ablation in the LV using a transventricular approach in a patient who underwent mechanical double valve replacement performed under subcostal echocardiographic and fluoroscopic guidance.
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Affiliation(s)
- Dursun Aras
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Firat Ozcan
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Serkan Cay
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Zehra Golbasi
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, Ankara, Turkey
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Yamada T. Special considerations in mapping and ablation of focal ventricular arrhythmias originating from the left ventricular outflow tract in patients with a transcatheter aortic valve replacement. J Cardiovasc Electrophysiol 2019; 30:2640-2647. [PMID: 31512333 DOI: 10.1111/jce.14175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/25/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022]
Abstract
Transcatheter aortic valve replacements (TAVRs) have been increasingly performed in high-risk patients with severe aortic stenosis. Focal ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT) can occur after a TAVR, and radiofrequency catheter ablation (RFCA) should be considered as a treatment option when those VAs are drug-refractory. There are specific challenges in the RFCA of LVOT VAs after a TAVR because the tubular structure of the TAVR device sits in the LVOT. However, if the anatomical background of the TAVR and LVOT VAs are well understood and the anatomical relationship between the TAVR device and LVOT is sufficiently evaluated, RFCA of LVOT VAs in patients with a TAVR should be safe and highly successful.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
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Liang JJ, Castro SA, Muser D, Briceno DF, Shirai Y, Enriquez A, Kumareswaran R, Santangeli P, Zado ES, Arkles JS, Schaller RD, Supple GE, Frankel DS, Nazarian S, Riley MP, Garcia FC, Lin D, Dixit S, Callans DJ, Marchlinski FE. Electrophysiologic Substrate, Safety, Procedural Approaches, and Outcomes of Catheter Ablation for Ventricular Tachycardia in Patients After Aortic Valve Replacement. JACC Clin Electrophysiol 2018; 5:28-38. [PMID: 30678784 DOI: 10.1016/j.jacep.2018.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to investigate the substrate, procedural strategies, safety, and outcomes of catheter ablation (CA) for ventricular tachycardia (VT) in patients with aortic valve replacement (AVR). BACKGROUND VT ablation in patients with AVR is challenging, particularly when mapping and ablation in the periaortic region are necessary. METHODS We identified consecutive patients with mechanical, bioprosthetic, and transcatheter AVR who underwent CA for VT refractory to antiarrhythmic drugs and analyzed VT substrate, approach to LV access, complications, and long-term outcomes. RESULTS Overall, 29 patients (87% men, mean age 67.9 ± 9.8 years, left ventricular ejection fraction 39 ± 10%) with prior AVR (13 mechanical, 15 bioprosthetic, 1 transcatheter AVR) underwent 40 ablations from 2004 to 2016. Left-sided mapping/CA was performed in 27 patients (36 procedures). Access was retrograde aortic in 11 procedures (all bioprosthetic), transseptal in 24 (13 mechanical; 10 bioprosthetic; 1 transcatheter AVR), or transventricular septal in 1. Periaortic bipolar or unipolar scar was detected in all 24 patients in whom detailed periaortic mapping was performed. Clinical VT circuit(s) involved the periaortic region in 10 patients (34%), 2 (7%) had bundle branch re-entry VT, and 17 (59%) had substrate unrelated to AVR. There were 2 major complications (both related to vascular access). Only 2 patients (9.1%) had VT recurrence. Over median follow-up of 12.8 months, 11 patients died (none as a result of recurrent VT). CONCLUSIONS Whereas most patients undergoing CA for VT after AVR had VT from substrate unrelated to AVR, periaortic scar is universally present and bundle branch re-entry can be the VT mechanism. CA can be safely performed with excellent long-term VT elimination.
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Affiliation(s)
- Jackson J Liang
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Simon A Castro
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniele Muser
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David F Briceno
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yasuhiro Shirai
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andres Enriquez
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ramanan Kumareswaran
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pasquale Santangeli
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica S Zado
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey S Arkles
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert D Schaller
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Supple
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saman Nazarian
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael P Riley
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fermin C Garcia
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Lin
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sanjay Dixit
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Callans
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Srivatsa UN, Nordsieck EJ, Pezeshkian N, Yang Y, Southard J. Ablation of ventricular tachycardia from the aortic root after transcatheter aortic valve replacement. HeartRhythm Case Rep 2018; 4:201-203. [PMID: 29922576 PMCID: PMC6006421 DOI: 10.1016/j.hrcr.2017.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | | | - Yingbo Yang
- University of California, Davis, Davis, California
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Ozeke O, Cay S, Ozcan F, Topaloglu S, Aras D. The reentry circuit and route in no entry left ventricle situations for ventricular tachycardia ablations. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:678. [PMID: 29656452 DOI: 10.1111/pace.13348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Ozcan Ozeke
- Department of Electrophysiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Serkan Cay
- Department of Electrophysiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Firat Ozcan
- Department of Electrophysiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Serkan Topaloglu
- Department of Electrophysiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Dursun Aras
- Department of Electrophysiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Science University, Ankara, Turkey
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Chen J, Hoff PI, Rossvoll O, De Bortoli A, Solheim E, Sun L, Schuster P, Larsen T, Ohm OJ. Ventricular arrhythmias originating from the aortomitral continuity: an uncommon variant of left ventricular outflow tract tachycardia. Europace 2011; 14:388-95. [PMID: 21979993 DOI: 10.1093/europace/eur318] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Ventricular arrhythmias arising from the fibrous rings have been demonstrated, but knowledge about the aortomitral continuity (AMC) as a source of the arrhytmias is still limited. The objective is to describe the characteristics of ventricular arrhythmias originating from the AMC in patients without structural heart disease. METHODS AND RESULTS Ten patients with ventricular tachycardia (VT) and/or premature ventricular contractions, who had been successfully treated by catheter ablation at the AMC beneath the aortic valve, were enrolled. Clinical data and electrocardiographic characteristics were analysed. Three of the 10 patients had previously registered episodes of supraventricular tachycardia and had undergone catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT). In four patients with anterior AMC location, early R/S wave transition was found in the precordial leads, with equal R and S amplitudes in V2, rS in V1, and R in V3. In six patients whose VT arose from the middle part of the AMC, we demonstrated a special ('rebound') transition pattern, with which equal R and S amplitudes occurred in V2, and high R waves in V1 and V3. In the anterior AMC location, the S/R ratios in leads V1 and V2 were >1 and statistically significantly higher than those located in the middle (V1: 1.59 vs. 0.23, P< 0.001; V2: 1.52 vs. 0.41, P< 0.01). CONCLUSIONS We report a series of ventricular arrhythmias arising from the AMC with different R/S wave transition patterns in the precordial leads on the electrocardiogram. There may be a relationship between ventricular arrhythmias from AMC and AVNRT.
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Affiliation(s)
- Jian Chen
- Department of Heart Disease, Haukeland University Hospital, Institute of Medicine, University of Bergen, N-5021 Bergen, Norway.
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Transaortic ablation of incessant ventricular tachycardia after aortic valve replacement by a mechanical prosthesis. COR ET VASA 2010. [DOI: 10.33678/cor.2010.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pluta S, Lenarczyk R, Pruszkowska-Skrzep P, Kowalski O, Sokal A, Sredniawa B, Mazurek M, Kalarus Z. Transseptal versus transaortic approach for radiofrequency ablation in patients with cardioverter-defibrillator and electrical storm. J Interv Card Electrophysiol 2010; 28:45-50. [PMID: 20180007 DOI: 10.1007/s10840-009-9464-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Accepted: 12/08/2009] [Indexed: 01/06/2023]
Abstract
PURPOSE Radiofrequency current ablation (RFCA) of ventricular tachycardia (VT) is usually performed using a retrograde transaortic approach. We compared the mapping accuracy, procedural course, safety, and results of VT ablation using transseptal and transaortic route. METHODS Twenty-one consecutive patients with ischemic cardiomyopathy and history of electrical storm underwent RFCA with electro-anatomic mapping system. In six patients, ablation was performed with transseptal approach (transseptal group); in 15, retrograde approach to the left ventricle was used (retrograde group). RESULTS The endocardial surface of the left ventricle was similarly accessible in both methods. Less detailed maps of interventricular septum were constructed with the use of transseptal approach. The RFCA success rate was similar in the transseptal and retrograde groups (83 vs. 80%, p = NS). The median procedural time was 112 min in transseptal vs. 145 min in the retrograde group; radiation exposure was 200 vs. 67 mGy, respectively (both p < 0.05), and fluoroscopy time was 22 vs.16 min (p = NS). During the 3-month follow-up, VT recurrence occurred in one patient in the transseptal group and in three patients in the retrograde group (p = NS). CONCLUSIONS Transseptal approach is an accurate, safe, feasible, and effective method of RF ablation in patients with malignant, recurrent ventricular arrhythmias. However, limited access to the septal regions with the use of this method has to be remembered. Transseptal approach may be considered as an alternative to the transaortic route in patients with contraindication to the latter.
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Affiliation(s)
- Slawomir Pluta
- 1st Department of Cardiology, Silesian Medical University, Silesian Center of Heart Diseases, Ul. Szpitalna 2, 41-800, Zabrze, Poland
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