1
|
Enriquez A, Muser D, Markman TM, Garcia F. Mapping and Ablation of Premature Ventricular Complexes: State of the Art. JACC Clin Electrophysiol 2024:S2405-500X(24)00107-5. [PMID: 38639702 DOI: 10.1016/j.jacep.2024.02.008] [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: 10/25/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/20/2024]
Abstract
Premature ventricular complexes (PVCs) are common arrhythmias in clinical practice. Although benign and asymptomatic in most cases, PVCs may result in disabling symptoms, left ventricular systolic dysfunction, or PVC-induced ventricular fibrillation. Catheter ablation has emerged as a first-line therapy in such cases, with high rates of efficacy and low risk of complications. Significant progress in mapping and ablation technology has been made in the past 2 decades, along with the development of a growing body of knowledge and accumulated experience regarding PVC sites of origin, anatomical relationships, electrocardiographic characterization, and mapping/ablation strategies. This paper provides an overview of the main indications for catheter ablation of PVCs, electrocardiographic features, PVC mapping techniques, and contemporary ablation approaches. The authors also review the most common sites of PVC origin and the main considerations and challenges with ablation in each location.
Collapse
Affiliation(s)
- Andres Enriquez
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Daniele Muser
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Timothy M Markman
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fermin Garcia
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
2
|
Huntrakul A, Yokokawa M, Kovacs B, Ghannam M, Liang JJ, Cochet H, Latchamsetty R, Jongnarangsin K, Morady F, Bogun F. Pleomorphism of premature ventricular complexes originating from papillary muscles and their myocardial connections. Heart Rhythm 2024; 21:36-44. [PMID: 37852565 DOI: 10.1016/j.hrthm.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Patients with arrhythmias originating from papillary muscles (PAPs) often have pleomorphic ventricular arrhythmias (PVAs) that can result in failed ablations. The mechanism of PVAs is unknown. OBJECTIVE The purpose of this study was to assess the prevalence and mechanisms of PVAs and the impact on outcomes in patients with focal left ventricular PAP ventricular arrhythmias (VAs). METHODS The sites of origin (SOOs) of VAs in 43 consecutive patients referred for ablation of focal left ventricular PAP VAs were determined by activation and pacemapping. SOOs were classified as (1) unifocal generating a single VA morphology; (2) unifocal from a deeper-seated origin generating multiple VA morphologies; (3) unifocal located on a PAP branching site; (4) multifocal from a single or multiple PAPs generating multiple VA morphologies; and (5) multifocal from a PAP and a different anatomic source. RESULTS Most patients had multiple morphologies (n = 34 [79%]) and multiple mechanisms (79%) generating the different VA morphologies. Most of the patients with PVAs had multiple SOOs from a single or different PAPs (n = 23 [68%]), followed by patients with SOOs from PAP and non-PAP sites (n = 19 [56%]). In 13 patients (38%), single SOOs accounted for the observed PVAs. The frequent observation (n = 20) of changing QRS morphologies after radiofrequency energy delivery targeting a single VA suggests the presence of a deeper focus with changing sites of preferential conduction. CONCLUSION VA pleomorphism in patients with PAP arrhythmias is most often due to premature ventricular complexes originating from different SOOs. The second most common cause is preferential conduction from a single SOO via PAP branching sites.
Collapse
Affiliation(s)
- Anurut Huntrakul
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan; Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Cardiac Center, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Miki Yokokawa
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Boldizsar Kovacs
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael Ghannam
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jackson J Liang
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Hubert Cochet
- Department of Radiology, University of Bordeaux, Bordeaux, France
| | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Fred Morady
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
| |
Collapse
|
3
|
Chen T, Chang L, Rong B, Zhang K, Fan G, Kong J, Ling M, Kong Q, Maduray K, Zhao C, Zhong J. Combination of Intracardiac Echocardiography and Contact Force Sensing for Left Ventricular Papillary Muscle Arrhythmias. J Clin Med 2023; 12:jcm12093154. [PMID: 37176594 PMCID: PMC10179325 DOI: 10.3390/jcm12093154] [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: 02/24/2023] [Revised: 04/04/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES The catheter ablation of ventricular arrhythmias (VAs) arising from the left ventricular (LV) papillary muscles (PMs) is challenging. This study sought to address whether the combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) can improve the acute and long-term ablation outcomes of left ventricular papillary muscle arrhythmias. METHODS AND RESULTS From May 2015 to August 2022, a total of thirty-three patients underwent catheter ablation for LV PM arrhythmias: VAs were located in anterolateral PMs in 11 and posteromedial PMs in 22. A combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) was used in 21 of the 33 procedures. A mean of 6.93 ± 4.91 for lesions was used per patient, comparable between the CFS/ICE and no ICE/CFS (4.90 ± 2.23 vs. 10.17 ± 5.89; p = 0.011). The mean CF achieved in the ICE/CFS group was 7.52 ± 3.31 g. Less X-ray time was used in the combination group (CFS/ICE: 165.67 ± 47.80 S vs. no ICE/CFS: 365.00 ± 183.73 S; p < 0.001). An acute success rate of 100% was achieved for the ICE/CFS group (n = 22) and 66.67% for the no ICE/CFS group (n = 8). VA recurrence at the 11.21 ± 7.21-month follow-up was 14.2% for the ICE/CFS group and 50% for the no ICE/CFS group (p = 0.04). No severe complications occurred in all patients. CONCLUSIONS The combination of intracardiac echocardiography (ICE) and contact force sensing (CFS) could provide precise geometries of cardiac endocavitary structures and accurate contact information for the catheter during ablation, which improved acute and long-term ablation outcomes. The routine adoption of this strategy should be considered to improve the outcomes of LV PM VA ablation.
Collapse
Affiliation(s)
- Tongshuai Chen
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Lujie Chang
- Department of Pediatric Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Bing Rong
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Kai Zhang
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Guanqi Fan
- Department of Radiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Jing Kong
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Mingying Ling
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Qingyu Kong
- Department of Pediatric Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Kellina Maduray
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Cuifen Zhao
- Department of Pediatric Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Jingquan Zhong
- National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan 250012, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| |
Collapse
|
4
|
Sousa PA, Barra S, Cortez-Dias N, Khoueiry Z, Paulo J, António N, Ferreira A, Pereira M, Lagrange P, de Sousa J, Elvas L, Garcia FC, Gonçalves L. Multielectrode mapping for premature ventricular contraction ablation - A prospective, multicenter study. Int J Cardiol 2023:S0167-5273(23)00598-3. [PMID: 37116756 DOI: 10.1016/j.ijcard.2023.04.044] [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: 01/27/2023] [Revised: 04/01/2023] [Accepted: 04/23/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE We aim to evaluate whether the use of a multielectrode mapping catheter could lead to higher efficacy of premature ventricular contraction (PVC) ablation. METHODS Prospective, multicenter nonrandomized study of consecutive patients referred for PVC ablation from January 2018 to June 2021. Patients were separated into two groups: activation map performed with the PentaRay catheter (Study group) or with the ablation catheter (Control group). PMF software was used in both groups. Procedural endpoints and 1-year freedom from ventricular arrhythmia were assessed. RESULTS During the enrollment period 136 patients (60% males, mean age of 55 ± 17 years, 60% left-sided origin) fulfilled the inclusion criteria - 68 patients in each group. Patients in the Study Group had a sevenfold higher number of acquired activation points (768 ± 728 vs. 110 ± 79, p < 0.01), a shorter mapping time (28 ± 19 min vs. 49 ± 32 min, p < 0.01) and a quicker procedure time (110 ± 33 min vs. 134 ± 50 min, p < 0.01), compared to patients in the Control Group. While there were no significant differences in the acute success (95.6% in the Study Group vs. 90.1% in Control group, p = 0.49), or adverse events (4% in the Study group vs. 7% in the Control group, p = 0.72), patients in the Study group had a higher freedom from ventricular arrhythmia at 1-year (89.7% vs. 70.6%, p = 0.01). The use of the PentaRay catheter was an independent predictor of success (HR = 6.20 [95% CI, 1.08-35.47], p = 0.003). CONCLUSIONS The use of the PentaRay catheter may improve the outcome of PVC ablation while reducing procedure time.
Collapse
Affiliation(s)
- Pedro A Sousa
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Coimbra, Portugal.
| | - Sérgio Barra
- Cardiology Department, Hospital da Luz Arrábida, V. N. Gaia, Portugal
| | - Nuno Cortez-Dias
- Arrhythmia Unit, Cardiology Department, Santa Maria University Hospital, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Ziad Khoueiry
- Cardiology Department, Clinique Saint Pierre, Perpignan, France
| | - José Paulo
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Coimbra, Portugal
| | - Natália António
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Coimbra, Portugal; ICBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Afonso Ferreira
- Arrhythmia Unit, Cardiology Department, Santa Maria University Hospital, Lisbon Academic Medical Center, Lisbon, Portugal
| | | | | | - Joao de Sousa
- Arrhythmia Unit, Cardiology Department, Santa Maria University Hospital, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Luís Elvas
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Coimbra, Portugal
| | - Fermin C Garcia
- Section of Cardiac Electrophysiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Lino Gonçalves
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Coimbra, Portugal; ICBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| |
Collapse
|
5
|
Arceluz MR, Thind M, Garcia FC, Guandalini GS, Santangeli P, Hyman M, Deo R, Frankel DS, Supple GE, Schaller RD, Callans DJ, Nazarian S, Dixit S, Kumareswaran R, Zado ES, Marchlinski FE. Sinus Rhythm Electrocardiographic Abnormalities, Sites of Origin, and Ablation Outcomes of Ventricular Premature Depolarizations Initiating Ventricular Fibrillation. Heart Rhythm 2023; 20:844-852. [PMID: 36958413 DOI: 10.1016/j.hrthm.2023.03.019] [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: 09/26/2022] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Ventricular fibrillation (VF) can be initiated by ventricular premature depolarizations (VPDs) in the absence of obvious structural abnormalities. OBJECTIVE To determine the prevalence of 12-lead ECG sinus rhythm reduced QRS amplitude, QRS fractionation (QRSf) and early repolarization (ER) pattern, and the outcome of catheter ablation and VPD anatomic distribution in patients with VPDs initiating VF. METHODS We compared a cohort with no apparent structural heart disease and VPDs initiating VF (Group 1, n=42) to a reference cohort (Group 2, n=61) of patients with no structural heart disease and symptomatic unifocal VPDs. RESULTS A reduced QRS amplitude (<.55 mV) in aVF (59 % vs 10%, p<0.001), QRSf in ≥2 contiguous leads (50% vs 16%, p<0.001) and early repolarization pattern (21.4% vs 1.6%, p=0.01) were more common in Group 1 vs Group 2. At least one abnormal ECG finding was present in 34 (81%) Group 1 vs 17 (28%) Group 2 patients, (p<0.001). VPD origin included RV and LV distal Purkinje system and moderator band/ papillary muscles, in 83% Group 1 vs 18% Group 2 patients, p<0.001. VF was eliminated with single ablation procedure in 77% of Group 1 patients with at least 2 years of follow-up. CONCLUSIONS A reduced QRS amplitude (<.55 mV) in aVF, QRS fractionation in ≥2 contiguous leads and/or an early repolarization pattern are frequently observed in patients with VPDs initiating VF. VPDs initiating VF typically originate from the distal Purkinje system and papillary muscles and can be successfully eliminated with catheter ablation.
Collapse
Affiliation(s)
- Martín R Arceluz
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Munveer Thind
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fermin C Garcia
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gustavo S Guandalini
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew Hyman
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rajat Deo
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David S Frankel
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory E Supple
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert D Schaller
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Callans
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saman Nazarian
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay Dixit
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ramanan Kumareswaran
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica S Zado
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
6
|
Idiopathic Ventricular Tachycardia. J Clin Med 2023; 12:jcm12030930. [PMID: 36769578 PMCID: PMC9918172 DOI: 10.3390/jcm12030930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
Idiopathic ventricular tachycardia (VT) is an important cause of morbidity and less commonly, mortality in patients with structurally normal hearts. Appropriate diagnosis and management are predicated on an understanding of the mechanism, relevant cardiac anatomy, and associated ECG signatures. Catheter ablation is a viable strategy to adequately treat and potentially provide a cure in patients that are intolerant to medications or when these are ineffective. In this review, we discuss special approaches and considerations for effective and safe ablation of VT arising from the right ventricular outflow tract, left ventricular outflow tract, left ventricular fascicles, papillary muscles, and moderator band.
Collapse
|
7
|
Muser D, Santangeli P, Liang JJ. Mechanisms of Ventricular Arrhythmias and Implications for Catheter Ablation. Card Electrophysiol Clin 2022; 14:547-558. [PMID: 36396177 DOI: 10.1016/j.ccep.2022.07.006] [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] [Indexed: 06/16/2023]
Abstract
Ventricular arrhythmias present with a wide spectrum of clinical manifestations, from mildly symptomatic frequent premature ventricular contractions to life-threatening events. Pathophysiologically, idiopathic ventricular arrhythmias occur in the absence of structural heart disease or ion channelopathies. Ventricular arrhythmias in the context of structural heart disease are usually determined by scar-related reentry and are associated with increased mortality. Catheter ablation is safe and highly effective in treating ventricular arrhythmias. The proper characterization of the arrhythmogenic substrate is essential for accurate procedural planning. We provide an overview on the main mechanisms of ventricular arrhythmias and their implications for catheter ablation.
Collapse
Affiliation(s)
- Daniele Muser
- Cardiothoracic Department, Udine University Hospital, Udine 33100, Italy; Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Pasquale Santangeli
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Jackson J Liang
- Electrophysiology Section, Division of Cardiology, University of Michigan, Frankel Cardiovascular Center, 1425 E. Ann Street, Ann Arbor, MI 48109, USA.
| |
Collapse
|
8
|
Shi L, Wang C, Chen H, Yang G, Gu K, Li M, Chu M, Liu H, Wang Z, Ju W, Chen M. Ventricular arrhythmias originating from the basal septum of the ventricle: Clinical and electrophysiological characteristics and a systematic ablation approach. Front Cardiovasc Med 2022; 9:879381. [DOI: 10.3389/fcvm.2022.879381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 11/01/2022] [Indexed: 11/22/2022] Open
Abstract
BackgroundThere is a paucity of data about VAs clustered at the vicinity of the basal septum of the ventricle. We aimed to report and characterize the clinical and electrophysiological features of basal septum VAs and explore the systematic ablation approach.MethodsA consecutive series of 51 patients who had their VAs successfully ablated at the basal septum of the ventricle was enrolled in this study. The basal septum was defined as the area 2 cm away from the septal annulus, the upper boundary was the site of the left or right His-Purkinje system, and the lower boundary was the borderline that separated away from the septum. RFCA was performed based on detailed activation mapping or pace mapping. Patients who underwent VA ablation from other areas of the tricuspid annulus (TA) and mitral annulus (MA) during the same period were enrolled as the control group.ResultsThe patients with basal septum VAs were significantly older (p < 0.01) and had more comorbidities (hypertension and coronary artery disease) (p < 0.01). Meanwhile, the precordial R wave transition was significantly different in right side, left side and intramural foci group (p < 0.001). Acute procedural success was achieved in 44 patients (86.3%) in the study group and in 63 patients (95.5%) in the control group. After a median of 12 (6–36) months of follow-up, compared with VA recurrence in the control group (2 cases), 11 patients with basal septum VAs had recurrences (p = 0.002), while a delayed cure was observed in 3 in intramural foci group.ConclusionBased on the unique anatomical and electrophysiological characteristics, a systematic approach for VAs originating from the basal septal area is warranted. Moreover, the follow-up data seemed to show a relative high recurrence rate for basal septal VAs during a period of time.
Collapse
|
9
|
Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 686] [Impact Index Per Article: 343.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
10
|
Turnbull S, Kumar S, Campbell T. Surgical Cryoablation of Malignant Papillary Muscle Arrhythmias During Mitral Valve Prolapse Surgery - Putting a Freeze on Sudden Cardiac Death. Heart Lung Circ 2022; 31:1318-1320. [PMID: 36162874 DOI: 10.1016/j.hlc.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Samual Turnbull
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
11
|
Arrhythmic Mitral Valve Prolapse and Mitral Annular Disjunction: Clinical Features, Pathophysiology, Risk Stratification, and Management. J Cardiovasc Dev Dis 2022; 9:jcdd9020061. [PMID: 35200714 PMCID: PMC8879620 DOI: 10.3390/jcdd9020061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 02/05/2023] Open
Abstract
Mitral valve prolapse (MVP) is a common cause of valvular heart disease. Although many patients with MVP have a benign course, there is increasing recognition of an arrhythmic phenotype associated with ventricular arrhythmias and sudden cardiac death (SCD). Pathophysiologic mechanisms associated with arrhythmias include cardiac fibrosis, mechanical stress induced changes in ventricular refractory periods, as well as electrophysiologic changes in Purkinje fibers. Clinically, a variety of risk factors including demographic, electrocardiographic, and imaging characteristics help to identify patients with MVP at the highest at risk of SCD and arrhythmias. Once identified, recent advances in treatment including device therapy, catheter ablation, and surgical interventions show promising outcomes. In this review, we will summarize the incidence of ventricular arrhythmias and SCD in patients with MVP, the association with mitral annular disjunction, mechanisms of arrhythmogenesis, methods for arrhythmic and SCD risk stratification including findings with multimodality imaging, and treatments for the primary and secondary prevention of SCD.
Collapse
|
12
|
Nussinovitch U, Wang P, Narayan S, Viswanathan M, Badhwar N, Zheng L, Sauer WH, Nguyen DT. Perpendicular Catheter Orientation During Papillary Muscle Ablation Results in Larger, Deeper Lesions. J Cardiovasc Electrophysiol 2022; 33:690-695. [PMID: 35133050 DOI: 10.1111/jce.15408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/29/2021] [Accepted: 01/01/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Ablation of papillary muscles (PM) for refractory ventricular arrhythmias can often be challenging. The catheter approach and orientation during ablation may affect optimal radiofrequency (RF) delivery. Yet, no previous study investigated the association between catheter orientation and PM lesion size. We evaluated ablation lesion characteristics with various catheter orientations relative to the PM tissue during open irrigated ablation, using a standardized, experimental setting. METHODS Viable bovine PM was positioned on a load cell in a circulating saline bath. RF ablation was performed over PM tissue at 50W, with the open irrigated catheter positioned either perpendicular or parallel to the PM surface. Applied force was 10 grams. Ablation lesions were sectioned and underwent quantitative morphometric analysis. RESULTS A catheter position oriented directly perpendicular to the PM tissue resulted in the largest ablation lesion volumes and depths compared to ablation with the catheter parallel to PM tissue (75.26±8.40 mm3 vs. 34.04±2.91 mm3 , p<0.001) and (3.33±0.18 mm vs. 2.24±0.10 mm, p<0.001), respectively. There were no significant differences in initial impedance, peak voltage, peak current, or overall decrease in impedance among groups. Parallel catheter orientation resulted in higher peak temperature (41.33±0.28°C vs. 40.28±0.24°C, p=0.003), yet, there were no steam pops in either group. CONCLUSION For PM ablation, catheter orientation perpendicular to the PM tissue achieves more effective and larger ablation lesions, with greater lesion depth. This may have implications for the chosen ventricular access approach, the type of catheter used, consideration for remote navigation, and steerable sheaths. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Udi Nussinovitch
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Paul Wang
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Sanjiv Narayan
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Mohan Viswanathan
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Nitish Badhwar
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Lijun Zheng
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado
| | - William H Sauer
- Section of Cardiac Electrophysiology, Division of Cardiology, Brigham and Women's Hospital, Boston, MA
| | - Duy T Nguyen
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| |
Collapse
|
13
|
Tschabrunn CM, Santangeli P. Maximizing papillary muscle radiofrequency ablation size: Importance of catheter orientation. J Cardiovasc Electrophysiol 2022; 33:696-697. [PMID: 35132708 DOI: 10.1111/jce.15403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Cory M Tschabrunn
- Division of Cardiovascular Medicine, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Division of Cardiovascular Medicine, Cardiac Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
14
|
Hasegawa Y, Izumi D, Kashimura T, Minamino T. Life-threatening ventricular arrhythmia and left ventricular dysfunction associated with anti-mitochondrial antibody-positive myositis: a case report. Eur Heart J Case Rep 2021; 5:ytab469. [PMID: 35047730 PMCID: PMC8759524 DOI: 10.1093/ehjcr/ytab469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/17/2021] [Accepted: 10/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anti-mitochondrial antibody (AMA)-positive myositis is an atypical inflammatory myopathy characterized by chronic progression of muscle atrophy and cardiac involvement. Few detailed reports have shown the clinical course of the cardiac complications of AMA-positive myositis. CASE SUMMARY A 47-year-old man presented with shortness of breath on exertion. Cardiac dilatation was visible on chest X-ray, and echocardiography demonstrated diffuse hypokinesis with a reduced left ventricular (LV) ejection fraction of 30%. He had mild muscle weakness in the bilateral iliopsoas muscles, and his creatine kinase (CK) and anti-mitochondrial M2 antibody levels were elevated. A liver biopsy showed no findings of primary biliary cholangitis. Coronary angiography revealed normal coronary arteries. An endomyocardial biopsy showed interstitial fibrosis and marked degeneration of the mitochondria. Fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography showed circumferential abnormal accumulation in the LV myocardium, and he was diagnosed with cardiomyopathy associated with AMA-positive myositis. Optimal drug therapy for heart failure was started, and a cardiac resynchronization therapy-defibrillator was implanted. However, his cardiac function did not improve, and he was hospitalized due to ventricular tachycardia storm 5 years after the diagnosis. Ventricular tachycardia was terminated by radiofrequency catheter ablation on the LV-anterior papillary muscle. Steroid therapy was initiated and resulted in a decreased uptake of FDG and a normalized CK level at 3 months after his second discharge; however, LV systolic dysfunction remained 1 year later. DISCUSSION Anti-mitochondrial antibody-positive myositis can affect the myocardium and cause severe LV dysfunction and life-threatening ventricular arrhythmia over time. KEYWORDS Anti-mitochondrial antibody-positive myositis • Endomyocardial biopsy • Ventricular tachycardia • Left ventricular dysfunction • Case report • Magnetic resonance imaging • Near-infrared spectroscopy-intravascular ultrasound.
Collapse
Affiliation(s)
- Yuki Hasegawa
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-754 Asahimachidori, Niigata 951-8510, Japan
| | - Daisuke Izumi
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-754 Asahimachidori, Niigata 951-8510, Japan
| | - Takeshi Kashimura
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-754 Asahimachidori, Niigata 951-8510, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
15
|
Diagnosis and Treatment of Idiopathic Premature Ventricular Contractions: A Stepwise Approach Based on the Site of Origin. Diagnostics (Basel) 2021; 11:diagnostics11101840. [PMID: 34679539 PMCID: PMC8534438 DOI: 10.3390/diagnostics11101840] [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: 08/05/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 12/30/2022] Open
Abstract
Premature ventricular contractions in the absence of structural heart disease are among the most common arrhythmias in clinical practice, with well-defined sites of origin in the right and left ventricle. In this review, starting from the electrocardiographic localization of premature ventricular contractions, we investigated the mechanisms, prevalence in the general population, diagnostic work-up, prognosis and treatment of premature ventricular contractions, according to current scientific evidence.
Collapse
|
16
|
Yamada T, Akrawinthawong K. Catheter ablation of premature ventricular contractions originating from kissing papillary muscles. Clin Case Rep 2021; 9:e04955. [PMID: 34703601 PMCID: PMC8521274 DOI: 10.1002/ccr3.4955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/25/2021] [Accepted: 09/23/2021] [Indexed: 11/08/2022] Open
Abstract
Very thick left ventricular papillary muscles (PAMs) may kiss each other and premature ventricular contractions (PVCs) can originate from the sides of the PAMs facing each other. In such a setting, mapping of those PVCs is confusing and rendering catheter ablation challenging.
Collapse
Affiliation(s)
- Takumi Yamada
- Cardiovascular DivisionUniversity of MinnesotaMinneapolisMinnesotaUSA
| | | |
Collapse
|
17
|
Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
18
|
Gutierrez ME, Kulkarni AK, Howard TS, Lam WW, Sexson-Tejtel SK, Miyake CY. Ventricular tachycardia as the initial presentation of missed Kawasaki disease in a teenager. HeartRhythm Case Rep 2021; 7:378-381. [PMID: 34194984 PMCID: PMC8226316 DOI: 10.1016/j.hrcr.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Maria Elena Gutierrez
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas
| | - Abhay K Kulkarni
- Section of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Taylor S Howard
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas
| | - Wilson W Lam
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas
| | - S Kristen Sexson-Tejtel
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas
| | - Christina Y Miyake
- The Lillie Frank Abercrombie Section of Cardiology, Department of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas.,The Department of Biophysics and Molecular Physiology, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
19
|
Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: executive summary. Europace 2021; 22:450-495. [PMID: 31995197 DOI: 10.1093/europace/euz332] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
Collapse
Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
| | | | | | | | | | | | | |
Collapse
|
20
|
Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
| | | | | | | |
Collapse
|
21
|
Sink J, Turin A, Cytron J, Green A, Santucci P, Wilber D, Vasaiwala S, Vasaiwala S. The effect of catheter ablation for ventricular arrhythmias originating from the left ventricular papillary muscles on mitral valve function. J Cardiovasc Electrophysiol 2021; 32:1931-1936. [PMID: 33993577 DOI: 10.1111/jce.15104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/08/2021] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ablation of ventricular arrhythmias (VA) originating from the left ventricular (LV) papillary muscles (PM) has the potential to damage the mitral valve apparatus resulting in mitral regurgitation (MR). This study sought to evaluate the effect of radiofrequency (RF) ablation of a PM on MR severity. METHODS Patients with pre- and postablation transthoracic echocardiograms who underwent PM ablation for treatment of VA were retrospectively identified and compared to similar patients who underwent VA ablation at non-PM sites. MR severity was evaluated pre- and postablation in both groups and graded as none/trace (Grade 0); mild/mild-to-moderate (Grade 1); moderate (Grade 2); moderate-to-severe/severe (Grade 3). RESULTS A total of 45 and 49 patients were included in the PM and non-PM groups, respectively. There were no significant baseline demographic differences. The PM group had longer RF ablation times (22.3 vs. 13.3 min, p < .01) compared to the non-PM group. Most patients had low-grade MR in both groups at baseline. Change in pre- versus postablation MR within the PM group was not statistically significant by Wilcoxon rank-sum test (Figure 2, p = .46). MR severity following ablation was also evaluated using logistic regression models. The odds ratio for worsening MR in the PM group compared to non-PM was 0.19 (95% confidence interval: 0.008-4.18, p = .29) after adjusting for comorbidities, LV ejection fraction, and LV internal end-diastolic diameter. CONCLUSION RF ablation of VA originating from PM under intracardiac echocardiography guidance did not result in clinically or statistically significant worsening of MR.
Collapse
Affiliation(s)
- Joshua Sink
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Alexander Turin
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Joseph Cytron
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Alexander Green
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Peter Santucci
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - David Wilber
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Samip Vasaiwala
- Department of Cardiology, Maine Medical Center, Portland, Maine, USA
| | - Smit Vasaiwala
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| |
Collapse
|
22
|
Vergara P, Altizio S, Falasconi G, Pannone L, Gulletta S, Della Bella P. Electrophysiological Substrate in Patients with Barlow's Disease. Arrhythm Electrophysiol Rev 2021; 10:33-37. [PMID: 33936741 PMCID: PMC8076976 DOI: 10.15420/aer.2020.29] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Mitral valve prolapse (MVP) is the most common valvular heart disease, affecting 2-3% of the general population. Barlow's disease is a clinical syndrome characterised by MVP. Initially thought a benign condition, MVP is now recognised as a cause of sudden cardiac death and ventricular arrhythmias. The development of new imaging techniques has contributed recently to the identification of novel risk factors. Catheter ablation of ventricular arrhythmias in patients affected by MVP is traditionally considered challenging. In this review, the authors summarise the evidence on arrhythmogenesis in the context of MVP, along with risk stratification of sudden cardiac death and the available treatment options, including new catheter ablation techniques.
Collapse
Affiliation(s)
- Pasquale Vergara
- Arrhythmia Unit and Electrophysiology Laboratories, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Savino Altizio
- Arrhythmia Unit and Electrophysiology Laboratories, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Giulio Falasconi
- Arrhythmia Unit and Electrophysiology Laboratories, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Luigi Pannone
- Arrhythmia Unit and Electrophysiology Laboratories, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Simone Gulletta
- Arrhythmia Unit and Electrophysiology Laboratories, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Paolo Della Bella
- Arrhythmia Unit and Electrophysiology Laboratories, IRCCS San Raffaele Scientific Institute, Milano, Italy
| |
Collapse
|
23
|
Kim MJ. False Tendon in Cardiovascular Diseases: Friend, Foe, or Bystander? J Cardiovasc Imaging 2021; 29:57-59. [PMID: 33511801 PMCID: PMC7847795 DOI: 10.4250/jcvi.2020.0239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 12/28/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Mi Jeong Kim
- Department of Cardiovascular Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
| |
Collapse
|
24
|
Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 218] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
Collapse
Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Cai C, Wang J, Niu H, Hua W, Chu J, Zhang S. Multipolar mapping for catheter ablation of premature ventricular complexes originating from papillary muscles in the structurally normal heart: a case series. BMC Cardiovasc Disord 2020; 20:464. [PMID: 33115432 PMCID: PMC7594480 DOI: 10.1186/s12872-020-01747-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies on radiofrequency catheter ablation of premature ventricular complexes (PVCs) arising from the left ventricle (LV) papillary muscles (PM) show a modest procedural success rate with higher recurrence rate. Our study sought to explore the utility of using a multipolar mapping with a steerable linear duodecapolar catheter for ablating the PM PVCs. Methods Detailed endocardial multipolar mapping was performed using a steerable linear duodecapolar catheter in 6 consecutive PM PVCs patients with structurally normal heart. The clinical features and procedural data as well as success rate were analysed. Results LV endocardial electroanatomic mapping was performed in all patients via a retrograde aortic approach using a duodecapolar mapping catheter. All patients displayed a PVC burden with 16.2 ± 5.4%. Duodecapolar catheter mapping demonstrated highly efficiency with an average procedure time (95.8 ± 7.4 min) and fluoroscopy time (14.2 ± 1.5 min). The mean number of ablation applications points was 6.8 ± 1.9 with an average overall ablation duration of 6.1 ± 3.0 min. The values of earliest activation time during mapping using duodecapolar catheter were 37.8 ± 7.2 ms. All patients demonstrated acute successful ablation, and the PVC burden in all patients after an average follow-up of 8.5 ± 2.0 months was only 0.7%. There were no complications during the procedures and after follow-up. Conclusions Mapping and ablation of PM PVCs using a duodecapolar catheter facilitated the identification of earliest activation potentials and pace mapping, and demonstrated a high success rate during follow-up.
Collapse
Affiliation(s)
- Chi Cai
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing, 100037, China
| | - Jing Wang
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing, 100037, China.
| | - Hongxia Niu
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing, 100037, China
| | - Wei Hua
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing, 100037, China
| | - Jianmin Chu
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing, 100037, China
| | - Shu Zhang
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing, 100037, China
| |
Collapse
|
26
|
Strategies for Catheter Ablation of Left Ventricular Papillary Muscle Arrhythmias. JACC Clin Electrophysiol 2020; 6:1381-1392. [DOI: 10.1016/j.jacep.2020.06.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/20/2022]
|
27
|
Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: Executive summary. J Interv Card Electrophysiol 2020; 59:81-133. [PMID: 31960344 PMCID: PMC7508755 DOI: 10.1007/s10840-019-00664-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
Collapse
Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
| | | | | | | | | | | | | |
Collapse
|
28
|
Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
Collapse
Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
| | | | | | | | | | | | | |
Collapse
|
29
|
Briceño DF, Santangeli P, Frankel DS, Liang JJ, Shirai Y, Markman T, Enriquez A, Walsh K, Riley MP, Nazarian S, Lin D, Kumareswaran R, Arkles JS, Hyman MC, Deo R, Supple GE, Garcia FC, Dixit S, Epstein AE, Callans DJ, Marchlinski FE, Schaller RD. QRS morphology in lead V 1 for the rapid localization of idiopathic ventricular arrhythmias originating from the left ventricular papillary muscles: A novel electrocardiographic criterion. Heart Rhythm 2020; 17:1711-1718. [PMID: 32454219 DOI: 10.1016/j.hrthm.2020.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Twelve-lead electrocardiogram (ECG) criteria have been developed to identify idiopathic ventricular arrhythmias (VAs) from the left ventricular (LV) papillary muscles (PAPs), but accurate localization remains a challenge. OBJECTIVE The purpose of this study was to develop ECG criteria for accurate localization of LV PAP VAs using lead V1 exclusively. METHODS Consecutive patients undergoing mapping and ablation of VAs from the LV PAPs guided by intracardiac echocardiography from 2007 to 2018 were reviewed (study group). The QRS morphology in lead V1 was compared to patients with VAs with a "right bundle branch block" morphology from other LV locations (reference group). Patients with structural heart disease were excluded. RESULTS One hundred eleven patients with LV PAP VAs (mean age 54 ± 16 years; 65% men) were identified, including 64 (55%) from the posteromedial PAP and 47 (42%) from the anterolateral PAP. The reference group included patients with VAs from the following LV locations: fascicles (n = 21), outflow tract (n = 36), ostium (n = 37), inferobasal segment (n = 12), and apex (5). PAP VAs showed 3 distinct QRS morphologies in lead V1 93% of the time: Rr (53%), R with a slurred downslope (29%), and RR (11%). Sensitivity, specificity, positive predictive value, and negative predictive value for the 3 morphologies combined are 93%, 98%, 98%, and 93%, respectively. The intrinsicoid deflection of PAP VAs in lead V1 was shorter than that of the reference group (63 ± 13 ms vs 79 ± 24 ms; P < .001). An intrinsicoid deflection time of <74 ms best differentiated the 2 groups (sensitivity 79%; specificity 87%). CONCLUSION VAs originating from the LV PAPs manifest unique QRS morphologies in lead V1, which can aid in rapid and accurate localization.
Collapse
Affiliation(s)
- David F Briceño
- Electrophysiology Section, Division of Cardiology, Albert Einstein College of Medicine, Montefiore Hospital, New York, New York
| | - Pasquale Santangeli
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jackson J Liang
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, Michigan
| | - Yasuhiro Shirai
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Timothy Markman
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andres Enriquez
- Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Katie Walsh
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael P Riley
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saman Nazarian
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Lin
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ramanan Kumareswaran
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey S Arkles
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew C Hyman
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rajat Deo
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Supple
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fermin C Garcia
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sanjay Dixit
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew E Epstein
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Callans
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert D Schaller
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
30
|
Barmeda M, Jain R, Gautam S, Mar PL, Devabahktuni SR, Stucky MA, Jain R. Novel electrocardiographic criteria for diagnosis of premature ventricular complexes arising from the base of left ventricle. J Electrocardiol 2020; 60:148-150. [PMID: 32371197 DOI: 10.1016/j.jelectrocard.2020.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/06/2020] [Accepted: 04/21/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE We report new electrocardiographic criteria (ECG) for localizing premature ventricular complexes (PVCs) originating from the base of the left ventricle (LV). METHODS QRS deflection (positive negative or negative positive) in lead aVR and aVL respectively, were evaluated in 41 PVC/VT cases. RESULTS There were a total of 41 patients, age 64 ± 11 years. Twelve patients had QRS deflection in aVR which were completely opposite to the deflection in aVL. If the PVC originated from basal septum, aVR was negative while aVL positive and vice versa when it was from the baso-lateral LV. PVCs from other LV sites had aVR and aVL deflection in the same direction. The ECG criteria had a sensitivity and specificity of 91% and 84%, respectively. CONCLUSION We propose a new ECG criterion to localize PVCs originating from the base of the LV.
Collapse
Affiliation(s)
- Mamta Barmeda
- Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States of America; Indiana University Health, Indianapolis, IN, United States of America.
| | - Rohit Jain
- Pennsylvania State Health Milton S. Hershey Medical Center, United States of America
| | - Shruti Gautam
- Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Philip L Mar
- Department of Cardiology, Indiana University School of Medicine, Indianapolis, IN, United States of America; Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States of America
| | - Subodh R Devabahktuni
- Department of Cardiology, Indiana University School of Medicine, Indianapolis, IN, United States of America; Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States of America
| | - Marcelle A Stucky
- Department of Cardiology, Indiana University School of Medicine, Indianapolis, IN, United States of America; Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States of America
| | - Rahul Jain
- Department of Cardiology, Indiana University School of Medicine, Indianapolis, IN, United States of America; Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States of America
| |
Collapse
|
31
|
Kim Y, Chen S, Ernst S, Guzman CE, Han S, Kalarus Z, Labadet C, Lin Y, Lo L, Nogami A, Saad EB, Sapp J, Sticherling C, Tilz R, Tung R, Kim YG, Stiles MK. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J Arrhythm 2020; 36:215-270. [PMID: 32256872 PMCID: PMC7132207 DOI: 10.1002/joa3.12308] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Young‐Hoon Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
| | - Shih‐Ann Chen
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Sabine Ernst
- Department of CardiologyRoyal Brompton and Harefield HospitalImperial College LondonLondonUK
| | | | - Seongwook Han
- Division of CardiologyDepartment of Internal MedicineKeimyung University School of MedicineDaeguRepublic of Korea
| | - Zbigniew Kalarus
- Department of CardiologyMedical University of SilesiaKatowicePoland
| | - Carlos Labadet
- Cardiology DepartmentArrhythmias and Electrophysiology ServiceClinica y Maternidad Suizo ArgentinaBuenos AiresArgentina
| | - Yenn‐Jian Lin
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Li‐Wei Lo
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Eduardo B. Saad
- Center for Atrial FibrillationHospital Pro‐CardiacoRio de JaneiroBrazil
| | - John Sapp
- Division of CardiologyDepartment of MedicineQEII Health Sciences CentreDalhousie UniversityHalifaxNSCanada
| | | | - Roland Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine)University Hospital Schleswig‐Holstein (UKSH) – Campus LuebeckLuebeckGermany
| | - Roderick Tung
- Center for Arrhythmia CarePritzker School of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Yun Gi Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
| | | |
Collapse
|
32
|
Pollet M, Jenny B, Mehta A, Howard A, Mathuria N. Ablation of Refractory Papillary Muscle Ventricular Tachycardia Warranting Multiple Adjunctive Ablation Techniques: A Combined Approach for Success. J Innov Card Rhythm Manag 2020; 11:3997-4003. [PMID: 32368372 PMCID: PMC7192147 DOI: 10.19102/icrm.2020.110206] [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: 06/20/2019] [Accepted: 08/15/2019] [Indexed: 12/30/2022] Open
Abstract
A 27-year-old male presented to our institution with recurrent unifocal premature ventricular contraction/nonsustained ventricular tachycardia (VT) with associated cardiomyopathy. The patient had undergone three prior ablation procedures with continued arrhythmia. Mapping led to identification of the VT arising from the basal aspect of the left ventricular anterolateral papillary muscle. Conventional ablation techniques were unsuccessful. We incorporated adjunctive ablation techniques in this case that ultimately led to a successful outcome. The present discussion covers the roles of intracardiac echocardiography, induced apnea, and low-ionic irrigation.
Collapse
Affiliation(s)
- Mark Pollet
- Division of Cardiac Electrophysiology, Texas Heart Institute, Houston, TX, USA
| | - Ben Jenny
- Division of Cardiac Electrophysiology, Texas Heart Institute, Houston, TX, USA
| | - Adwait Mehta
- Division of Cardiac Electrophysiology, Texas Heart Institute, Houston, TX, USA
| | - Austin Howard
- Division of Cardiac Electrophysiology, Texas Heart Institute, Houston, TX, USA
| | - Nilesh Mathuria
- Division of Cardiac Electrophysiology, Texas Heart Institute, Houston, TX, USA
| |
Collapse
|
33
|
Successful bipolar radiofrequency catheter ablation of ventricular premature complexes arising from the anterolateral papillary muscle of the left ventricle. HeartRhythm Case Rep 2020; 5:472-475. [PMID: 31934544 PMCID: PMC6951329 DOI: 10.1016/j.hrcr.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
34
|
Raja DC, Rangaswamy VV, Abhilash SP, King K, Pathak RK. Electrophysiological Substrates in Papillary Muscle Arrhythmias – Implications for Catheter Ablation. ACTA ACUST UNITED AC 2020. [DOI: 10.17925/ejae.2020.6.1.32] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
35
|
Wu J, Chen Y, Ji W, Gu B, Shen J, Fu L, Li F. Catheter ablation of ventricular tachycardia in the pediatric patients: A single‐center experience. Pacing Clin Electrophysiol 2019; 43:37-46. [DOI: 10.1111/pace.13835] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 10/10/2019] [Accepted: 11/02/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Jinjin Wu
- Department of Cardiology, Shanghai Children's Medical CenterShanghai Jiaotong University School of Medicine Shanghai China
| | - Yiwei Chen
- Department of Cardiology, Shanghai Children's Medical CenterShanghai Jiaotong University School of Medicine Shanghai China
| | - Wei Ji
- Department of Cardiology, Shanghai Children's Medical CenterShanghai Jiaotong University School of Medicine Shanghai China
| | - Beiyin Gu
- Department of Cardiology, Shanghai Children's Medical CenterShanghai Jiaotong University School of Medicine Shanghai China
| | - Jie Shen
- Department of Cardiology, Shanghai Children's Medical CenterShanghai Jiaotong University School of Medicine Shanghai China
| | - Lijun Fu
- Department of Cardiology, Shanghai Children's Medical CenterShanghai Jiaotong University School of Medicine Shanghai China
| | - Fen Li
- Department of Cardiology, Shanghai Children's Medical CenterShanghai Jiaotong University School of Medicine Shanghai China
| |
Collapse
|
36
|
Edward JA, Zipse MM, Tompkins C, Varosy PD, Sandhu A, Rosenberg M, Aleong R, Tzou WS, Borne RT, Sauer WH, Nguyen DT. Follow-Up After Catheter Ablation of Papillary Muscles and Valve Cusps. JACC Clin Electrophysiol 2019; 5:1185-1196. [DOI: 10.1016/j.jacep.2019.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 11/24/2022]
|
37
|
Abrich VA, Ladia VM, Scott LR. Coexisting fascicular ventricular tachycardia and papillary muscle ventricular tachycardia in the setting of coronary artery disease in a master athlete. J Electrocardiol 2019; 73:137-140. [DOI: 10.1016/j.jelectrocard.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/22/2019] [Accepted: 10/21/2019] [Indexed: 11/26/2022]
|
38
|
Ortmans S, Daval C, Aguilar M, Compagno P, Cadrin-Tourigny J, Dyrda K, Rivard L, Tadros R. Pharmacotherapy in inherited and acquired ventricular arrhythmia in structurally normal adult hearts. Expert Opin Pharmacother 2019; 20:2101-2114. [DOI: 10.1080/14656566.2019.1669561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Staniel Ortmans
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Charline Daval
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Martin Aguilar
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Electrophysiology service, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Pablo Compagno
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Julia Cadrin-Tourigny
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Cardiovascular Genetics Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Katia Dyrda
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Lena Rivard
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Electrophysiology service, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Rafik Tadros
- Electrophysiology service, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Cardiovascular Genetics Center, Montreal Heart Institute, Montreal, Quebec, Canada
- Department of Physiology and Pharmacology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
39
|
Yamada T. Twelve-lead electrocardiographic localization of idiopathic premature ventricular contraction origins. J Cardiovasc Electrophysiol 2019; 30:2603-2617. [PMID: 31502322 DOI: 10.1111/jce.14152] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/16/2019] [Accepted: 08/29/2019] [Indexed: 11/29/2022]
Abstract
The major sites of origins of idiopathic ventricular arrhythmias have been elucidated. Idiopathic ventricular arrhythmias most often present as premature ventricular contractions (PVCs) with a focal mechanism, and commonly occur without structural heart disease. Idiopathic ventricular arrhythmias usually originate from specific anatomical structures, commonly endocardial but sometimes epicardial and exhibit characteristic electrocardiograms (ECGs) based on their anatomical background. There are general and specific ECG characteristics that can localize the site of idiopathic PVC origins. The general ECG characteristics include the bundle branch block pattern, axis, QRS polarity in lead V6, QRS duration, precordial transition, maximal deflection index, and so forth. They can roughly localize the site of idiopathic PVC origins. Several major sites of idiopathic PVC origins are located close to each other, and specific ECG characteristics are helpful for localizing the site of origins more accurately in those PVCs. Twelve-lead surface ECG algorithms usually can localize the site of idiopathic PVC origins with a high accuracy, but their accuracy can be limited by the patients' physique, heart rotation, specific conduction properties, presence of structural heart disease, and so forth. This review describes an overview of the approaches to the 12-lead surface ECG localization of idiopathic PVCs, and also discusses their caveats and limitations.
Collapse
Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
40
|
Possible association of papillary muscle hypertrophy with the genesis of J-waves. J Cardiol 2019; 75:90-96. [PMID: 31327704 DOI: 10.1016/j.jjcc.2019.07.001] [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: 09/13/2018] [Accepted: 11/30/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although J-waves have been known to be associated with vulnerability to ventricular fibrillation, their electrophysiologic mechanism remains to be elucidated. The papillary muscles (PMs) of the left ventricle (LV) have been recognized as the target site of radiofrequency ablation for ventricular arrhythmias. However, the relationship between PM hypertrophy and J-waves has not been investigated. OBJECTIVE To investigate the electrocardiographic characteristics, including the J-waves, in patients with solitary PM hypertrophy. METHODS We studied 101 patients with PM hypertrophy without LV hypertrophy (PMH group) and 159 age- and sex-matched control subjects (control group). The parameters of the 12-lead electrocardiogram and the echocardiogram were compared between the two groups. RESULTS Compared with the control group, the PMH group had significantly higher incidence (15% vs. 33%, p=0.001) and amplitude (0.17±0.06mV vs. 0.28±0.17mV, p<0.01) of J-waves; significantly longer QRS, QTc, and JTc intervals (p=0.0001, p<0.0001, and p<0.05, respectively); significantly greater Sokolow-Lyon index (p<0.001); and significantly greater LV wall thickness and LV mass index (p<0.0001 for each). Multivariate logistic regression analysis showed that only the PM hypertrophy was an independent predictor of the presence of J-waves. CONCLUSION PM hypertrophy was related to the genesis of J-waves.
Collapse
|
41
|
Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: Executive summary. Heart Rhythm 2019; 17:e155-e205. [PMID: 31102616 PMCID: PMC8459311 DOI: 10.1016/j.hrthm.2019.03.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Indexed: 12/16/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
Collapse
Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
| | | | | | | | | | | | | |
Collapse
|
42
|
Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
Collapse
Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
| | | | | | | | | | | | | |
Collapse
|
43
|
Kautzner J, Peichl P. Papillary Muscle Ventricular Tachycardia or Ectopy: Diagnostics, Catheter Ablation and the Role of Intracardiac Echocardiography. Arrhythm Electrophysiol Rev 2019; 8:65-69. [PMID: 30918670 PMCID: PMC6434512 DOI: 10.15420/aer.2018.80.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ventricular arrhythmias originating from the papillary muscle of the left or right ventricle are specific clinical entities. They are usually focal in origin and can be identified by a characteristic ECG pattern. Intracardiac echocardiography appears to be the most suitable imaging method for assessment of the exact location of the focus at papillary muscles in association with activation mapping. We recently confirmed that ectopic foci were located within the distal, mid, or proximal (basal) third of the papillary muscle in 67%, 19%, and 14% of patients, respectively. Radiofrequency ablation has the potential to cure these specific arrhythmias. However, the procedure is usually challenging for catheter instability, despite navigation with intracardiac echocardiography. Cryoablation, which ensures catheter tip stability, could be a viable alternative in cases of the failure of radiofrequency catheter ablation.
Collapse
Affiliation(s)
- Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM) Prague, Czech Republic
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM) Prague, Czech Republic
| |
Collapse
|
44
|
Rivera S, Tomas L, Ricapito MDLP, Nicolas V, Reinoso M, Caro M, Mondragon I, Albina G, Giniger A, Scazzuso F. Updated results on catheter ablation of ventricular arrhythmias arising from the papillary muscles of the left ventricle. J Arrhythm 2019; 35:99-108. [PMID: 30805050 PMCID: PMC6373649 DOI: 10.1002/joa3.12137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/19/2018] [Accepted: 10/09/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Catheter ablation of ventricular arrhythmias (VAs) arising from the left ventricle`s (LV) papillary muscles (PM) is challenging. In this study we present results of catheter ablation using multiple energy sources and image-based approaches. METHODS Fifty-three patients (49 ± 17 years old; 34% females; median LV ejection fraction 53 ± 11%) underwent catheter cryoablation or radiofrequency (RF) ablation with non-contact force sensing (Non-CFS) catheters and cardiac computed tomography integration (CTII) into the electroanatomical mapping system or contact force sensing RF (CFS RF) ablation catheters and intracardiac echo-facilitated 3D electroanatomical mapping. Ventricular arrhythmias foci were mapped at either the anterolateral (ALPM) or posteromedial papillary muscles (PMPM). Ablation was performed using an 8-mm cryoablation catheter (CRYO); a Non-CFS 4-mm open-irrigated RF catheter; or a CFS RF 3.5-mm open-irrigated tip catheter, via transmitral or transaortic approach. RESULTS Acute success rate was 83% for Non-CFS RF/CTII; 100% for CRYO/CTII (n = 16) and CFS RF/ICE3D (n = 14) (P = 0.03). Catheter stability was achieved in all patients treated with Cryo/CTII. VA recurrence at 12 months follow-up was 48% (n = 11) for Non-CFS RF/CTII; 19% (n = 3) for CRYO/CTII; and 7% (n = 1) for CFS RF/ICE3D (P = 0.02). CONCLUSIONS Non-CFS/CTII was associated with an increased risk of recurrence of the clinical arrhythmia. Ablation with either CFS RF/ICE3D or CRYO/CTII showed high acute success rates and low recurrence rates during follow-up. Cryoablation provided stable contact and was less arrhythmogenic.
Collapse
Affiliation(s)
- Santiago Rivera
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Leandro Tomas
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Maria de la Paz Ricapito
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Vecchio Nicolas
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Marcelo Reinoso
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Milagros Caro
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Ignacio Mondragon
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Gaston Albina
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Alberto Giniger
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| | - Fernando Scazzuso
- Cardiovascular Institute of Buenos Aires (ICBA)Ciudad Autonoma de Buenos AiresBuenos AiresArgentina
| |
Collapse
|
45
|
Lee A, Walters TE, Gerstenfeld EP, Haqqani HM. Frequent Ventricular Ectopy: Implications and Outcomes. Heart Lung Circ 2019; 28:178-190. [DOI: 10.1016/j.hlc.2018.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 11/29/2022]
|
46
|
Rivera S, Vecchio N, Ricapito P. Anatomical Connections Between the Papillary Muscles and the Ventricular Myocardium. Circ Arrhythm Electrophysiol 2019; 12:e007004. [DOI: 10.1161/circep.118.007004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Santiago Rivera
- Buenos Aires Cardiovascular Institute (ICBA), Ciudad Autónoma de Buenos Aires, Argentina
| | - Nicolás Vecchio
- Buenos Aires Cardiovascular Institute (ICBA), Ciudad Autónoma de Buenos Aires, Argentina
| | - Paz Ricapito
- Buenos Aires Cardiovascular Institute (ICBA), Ciudad Autónoma de Buenos Aires, Argentina
| |
Collapse
|
47
|
Leftheriotis D, Flevari P, Stassinos V, Ikonomidis I. Transthoracic 3D echocardiography used as a low-cost and precise technique to facilitate ablation of ventricular tachycardia from the left posteromedial papillary muscle. Hellenic J Cardiol 2018; 60:261-263. [PMID: 30448620 DOI: 10.1016/j.hjc.2018.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/26/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
| | - Panayota Flevari
- Department of Cardiology, Attikon University Hospital of Athens, Greece
| | | | | |
Collapse
|
48
|
Pathak RK, Ariyarathna N, Garcia FC, Sanders P, Marchlinski FE. Catheter Ablation of Idiopathic Ventricular Arrhythmias. Heart Lung Circ 2018; 28:102-109. [PMID: 30554597 DOI: 10.1016/j.hlc.2018.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Abstract
Ventricular arrhythmias (VA) are observed in the setting of structural heart disease. However, in a proportion of patients presenting with VT, the routine diagnostic modalities fail to demonstrate overt myocardial abnormality. These arrhythmias have been called idiopathic VAs. They consist of various subtypes that have been defined by their anatomic location of origin within the heart and/or their underlying mechanism. While the majority of patients are asymptomatic, some experience debilitating symptoms and may develop reversible ventricular dysfunction. Catheter ablation has been traditionally reserved for patients with incapacitating symptoms or progressive ventricular dysfunction. However, as many patients are young, and catheter ablation can be curative in >90% of cases with a low risk (<1%) of serious complications, it is increasingly being offered as a first-line treatment in symptomatic patients. The approach to arrhythmia mapping is guided by the 12-lead electrocardiograph (ECG) morphology of the ventricular tachycardia (VT). Use of three dimensional (3D) electroanatomic mapping systems and intra-cardiac echocardiography are helpful in localising sites for successful ablation.
Collapse
Affiliation(s)
- Rajeev K Pathak
- Canberra Hospital, Australian National University, Canberra, ACT, Australia.
| | | | - Fermin C Garcia
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Francis E Marchlinski
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
49
|
Sohinki DA, Mathew ST. Ventricular Arrhythmias in the Patient with a Structurally Normal Heart. J Innov Card Rhythm Manag 2018; 9:3338-3353. [PMID: 32477784 PMCID: PMC7252725 DOI: 10.19102/icrm.2018.091004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/04/2018] [Indexed: 11/24/2022] Open
Abstract
Ventricular arrhythmias (VAs) are among the most common cardiac rhythm disturbances encountered in clinical practice. Patients presenting with frequent ventricular ectopy or sustained ventricular tachycardia represent a challenging and worrisome clinical scenario for many practitioners because of concerning symptoms, frequent associated acute hemodynamic compromise, and the adverse prognostic implications inherent to these cases. While an underlying structural or functional cardiac abnormality, metabolic derangement, or medication toxicity is often readily apparent, many patients have no obvious underlying condition, despite a comprehensive diagnostic evaluation. Such patients are diagnosed as having an idiopathic VA, which is a label with specific implications regarding arrhythmia origin, prognosis, and potential for pharmacologic and invasive management. Further, a subset of patients with otherwise benign idiopathic ventricular ectopy can present with polymorphic ventricular tachycardia and ventricular fibrillation, adding a layer of complexity to a clinical syndrome previously felt to have a benign clinical course. Thus, this review seeks to highlight the most common types of idiopathic VAs with a focus on their prognostic implications, underlying electrophysiologic mechanisms, unique electrocardiographic signatures, and considerations for invasive electrophysiologic study and catheter ablation. We further address some of the data regarding idiopathic ventricular fibrillation with respect to the heterogeneous nature of this diagnosis.
Collapse
Affiliation(s)
- Daniel A Sohinki
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sunil T Mathew
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
50
|
2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm 2018; 15:e73-e189. [DOI: 10.1016/j.hrthm.2017.10.036] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 02/07/2023]
|