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Adewumi J, Mann J, Tzou WS, Sandhu A, Aleong RG. Bipolar Ablation From the Anterior Interventricular Vein to the Left Ventricle. JACC Case Rep 2024; 29:102457. [PMID: 39295813 PMCID: PMC11405968 DOI: 10.1016/j.jaccas.2024.102457] [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: 11/13/2023] [Revised: 04/22/2024] [Accepted: 05/02/2024] [Indexed: 09/21/2024]
Abstract
Ventricular tachycardia from the left ventricular summit can be challenging for catheter ablation due to difficult accessibility and proximity to coronary arteries. This paper presents a case of premature ventricular contraction-induced ventricular tachycardia from the left ventricular summit that was ablated using bipolar radiofrequency ablation from the anterior interventricular vein and adjacent left ventricular endocardium.
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Affiliation(s)
- Joseph Adewumi
- Division of Electrophysiology, University of Colorado Hospital, Aurora, Colorado, USA
| | - James Mann
- Division of Electrophysiology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Wendy S Tzou
- Division of Electrophysiology, University of Colorado Hospital, Aurora, Colorado, USA
| | - Amneet Sandhu
- Division of Electrophysiology, University of Colorado Hospital, Aurora, Colorado, USA
| | - Ryan G Aleong
- Division of Electrophysiology, University of Colorado Hospital, Aurora, Colorado, USA
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Tian N, Ma L, Ma Y, Yang Z. Case of idiopathic left ventricular summit premature ventricular contractions successfully treated by catheter ablation. Clin Case Rep 2024; 12:e9273. [PMID: 39130814 PMCID: PMC11310408 DOI: 10.1002/ccr3.9273] [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: 06/05/2024] [Revised: 07/15/2024] [Accepted: 07/24/2024] [Indexed: 08/13/2024] Open
Abstract
Key Clinical Message CA of LVS premature beats complexes is difficult due to anatomical limitations. We report a patient with PVCs originating from the LVS region who was successfully ablated by ablation. Abstract Catheter ablation (CA) of premature ventricular contractions (PVCs) arising from the left ventricular summit (LVS) presents technical challenges due to the regional anatomy and frequently intramural site of origin. Herein, we demonstrated a case of a successful CA, originating from the LVS region. We further discussed the detailed anatomical background and clinical feasibility of CA as an alternative ablation route for PVCs originating from the LVS.
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Affiliation(s)
- Na Tian
- Institute of Medical Sciences General Hospital of Ningxia Medical University Yinchuan Ningxia China
| | - Like Ma
- Institute of Medical Sciences General Hospital of Ningxia Medical University Yinchuan Ningxia China
| | - Yinjiao Ma
- Institute of Medical Sciences General Hospital of Ningxia Medical University Yinchuan Ningxia China
| | - Zhen Yang
- Institute of Medical Sciences General Hospital of Ningxia Medical University Yinchuan Ningxia China
- Institute of Cardiovascular Medicine General Hospital of Ningxia Medical University Ningxia China
- Department of Cardiology General Hospital of Ningxia Medical University Ningxia Medical University Ningxia China
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Mi LJ, Weng SX, Sun Q, Zhang HD, Ding L, Zhang AK, Tang M. Activation pattern of the coronary sinus facilitates the differentiation for ventricular outflow tract arrhythmias. J Cardiovasc Electrophysiol 2024; 35:1440-1449. [PMID: 38757370 DOI: 10.1111/jce.16310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/22/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION The accuracy of surface ECG algorithms for predicting the origin of outflow tract ventricular arrhythmias (OT-VAs) might be questioned. Intracardiac electrograms recorded at anatomic landmarks could provide new predictive insights. We aim to evaluate the efficacy of a novel criterion utilizing the activation pattern of the coronary sinus (CS) in localizing OT-VAs, including VAs originating from the right ventricular outflow tract (RVOT), endocardial left ventricular outflow tract (Endo-LVOT), and epicardial left ventricular outflow tract (Epi-LVOT). METHODS We measured the ventricular activation time of the mitral annulus (MA) from the onset of the earliest QRS complex of VAs to the initial deflection over the isoelectric line at local signals, namely the QRS-MA interval. The activation at 3 and 12 o'clock of the MA was recorded as the QRS-MA3 and QRS-MA12 intervals, respectively. Their predictive values were compared to previous ECG algorithms. RESULTS A total of 68 patients with OT-VAs were enrolled (51 for development and 17 for validation). From early to late, the ventricular activation sequences at MA12 were as follows: Epi-LVOT, Endo-LVOT, and RVOT. In LBBB morphology OT-VAs, the QRS-MA12 interval was significantly earlier for LVOT origins than RVOT origins. In the combined cohort of development and validation cohort, a cut-off value of ≤10 ms predicted the LVOT origin with a sensitivity of 100% and specificity of 78%. The QRS-MA12 interval ≤ -24 ms additionally predicted epicardial LVOT sites of origin. CONCLUSIONS The QRS-MA interval could accurately differentiate the OT-VAs localization.
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Affiliation(s)
- Li-Jie Mi
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Si-Xian Weng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- College of Life Science, University of Chinese Academy of Sciences, Beijing, China
- Department of Cardiology, Beijing Anzhen Hospital, Affiliated to Capital Medical University, Beijing, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Da Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Ding
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ai-Kai Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Tang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Liu Q, Tian Y, Jiang Z, Tian L, Huang J, Yang Y, Yang L. Electrophysiological characteristics and catheter ablation of ventricular arrhythmias arising from the superior septal left ventricle. BMC Cardiovasc Disord 2024; 24:316. [PMID: 38910261 PMCID: PMC11194864 DOI: 10.1186/s12872-024-03979-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 06/14/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND AND AIMS Electrophysiological characteristics and radiofrequency catheter ablation (RFCA) of premature ventricular contractions (PVCs) originating from the superior septal left ventricle (SSLV) have not yet been fully characterized. METHODS AND RESULTS This study included 247 patients who underwent RFCA for PVCs arising from the ventricular outflow tract between February 2020 and August 2022. The successful ablation site was on the SSLV in 37 of the 247 patients. In 12 (32.4%) of those 37 patients, a low amplitude and high frequency spiky potential (SP) was recognized. Five patients showed a narrow QRS duration (86.8 ± 4.6 ms), with a discrete SP observed in PVCs and sinus rhythm, which showed an isoelectric line with the ventricular electrogram at the earliest activation site. Seven patients showed a wide QRS duration (131.6 ± 4.5 ms), with SP observed in PVCs without an isoelectric line with the ventricular electrogram. RFCA was successful at the site of the earliest SP in all 12 patients. The time from SP onset at the successful ablation site to the QRS onset (local activation time) was 30 ± 12 ms, which differed significantly from that for the remaining 25 patients withoutSP(22.1 ± 7.1 ms, P < 0.05). CONCLUSIONS SPs were recorded in 12 (32.4%) of the 37 patients with PVCs originating from the SSLV. The morphology of the PVCs may show a narrow or wide QRS duration and the target site for successful ablation should be identified by the earliest SP.
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Affiliation(s)
- Qifang Liu
- Department of Cardiology, Guizhou Provincial People's Hospital, 83 ZhongShan East Street, Guiyang, China
| | - Ye Tian
- Department of Cardiology, Guizhou Provincial People's Hospital, 83 ZhongShan East Street, Guiyang, China
| | - Zhi Jiang
- Department of Cardiology, Guizhou Provincial People's Hospital, 83 ZhongShan East Street, Guiyang, China
| | - Longhai Tian
- Department of Cardiology, Guizhou Provincial People's Hospital, 83 ZhongShan East Street, Guiyang, China
| | - Jing Huang
- Department of Cardiology, Guizhou Provincial People's Hospital, 83 ZhongShan East Street, Guiyang, China
| | - Ying Yang
- Department of Cardiology, Guizhou Provincial People's Hospital, 83 ZhongShan East Street, Guiyang, China
| | - Long Yang
- Department of Cardiology, Guizhou Provincial People's Hospital, 83 ZhongShan East Street, Guiyang, China.
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Aguilera J, Cabrera J, Saenz LC, Santangeli P. Catheter Ablation of Idiopathic Epicardial Outflow Tract Premature Ventricular Contractions: A Case Report and Review of the Literature. Card Electrophysiol Clin 2024; 16:187-193. [PMID: 38749640 DOI: 10.1016/j.ccep.2023.10.005] [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: 05/26/2024]
Abstract
The epicardial outflow tract can be a site of origin of idiopathic ventricular arrhythmias. These arrhythmias are most commonly perivalvular and can be targeted from within the coronary venous system or from other adjacent structures, such as the right ventricular and left ventricular outflow tracts or the coronary cusp region. The authors report a case of an epicardial idiopathic outflow tract premature ventricular contraction originating from the midseptal epicardial left ventricle. In this case, direct epicardial access was crucial to identify early local activation and achieve successful catheter ablation.
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Affiliation(s)
- Jose Aguilera
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Juan Cabrera
- Section of Electrophysiology, Fundación Cardioinfantil, Bogotá, Colombia
| | - Luis Carlos Saenz
- Section of Electrophysiology, Fundación Cardioinfantil, Bogotá, Colombia
| | - Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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Yamada T, Litovsky S, Neal Kay G. Prevalence and electrocardiographic and electrophysiological characteristics of idiopathic ventricular arrhythmias originating from the septal left ventricular summit. J Cardiovasc Electrophysiol 2024; 35:1174-1184. [PMID: 38867544 DOI: 10.1111/jce.16270] [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: 01/14/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION The left ventricular summit (LVS) is the highest point on the epicardial surface of the left ventricle. A part of the LVS that is located between the left coronary arteries (lateral-LVS) is one of the major sites of idiopathic ventricular arrhythmia (VA) origins. Some idiopathic epicardial VAs can be ablated at endocardial sites adjacent to the epicardial area septal to the lateral-LVS (septal-LVS). This study examined the prevalence and electrocardiographic and electrophysiological characteristics of septal-LVS VAs. METHODS We studied consecutive patients with idiopathic VAs originating from the LVS (67 patients) and aortic root (93 patients). RESULTS Based on the ablation results, among 67 LVS VAs, 54 were classified as lateral and 13 as septal-LVS VAs. As compared with the lateral-LVS VAs, the septal-LVS VAs were characterized by a greater prevalence of left bundle branch block with left inferior-axis QRS pattern, later precordial transition, lower R-wave amplitude ratio in leads III to II, lower Q-wave amplitude ratio in leads aVL to aVR, and later local ventricular activation time relative to the QRS onset during VAs (V-QRS) in the great cardiac vein. The electrocardiographic and electrophysiological characteristics of the septal-LVS VAs were similar to those of the aortic root VAs. However, the V-QRS at the successful ablation site was significantly later during the septal-LVS VAs than aortic root VAs (p < .0001). The precordial transition was significantly later during the septal-LVS VAs than aortic root VAs (p < .05). CONCLUSIONS Septal-LVS VAs are considered a distinct subgroup of idiopathic VAs originating from the left ventricular outflow tract.
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Affiliation(s)
- Takumi Yamada
- Cardiovascular Division, University of Minnesota, Minneapolis, Minnesota, USA
| | - Silvio Litovsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - George Neal Kay
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Lampert R, Chung EH, Ackerman MJ, Arroyo AR, Darden D, Deo R, Dolan J, Etheridge SP, Gray BR, Harmon KG, James CA, Kim JH, Krahn AD, La Gerche A, Link MS, MacIntyre C, Mont L, Salerno JC, Shah MJ. 2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play. Heart Rhythm 2024:S1547-5271(24)02560-8. [PMID: 38763377 DOI: 10.1016/j.hrthm.2024.05.018] [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: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
Youth and adult participation in sports continues to increase, and athletes may be diagnosed with potentially arrhythmogenic cardiac conditions. This international multidisciplinary document is intended to guide electrophysiologists, sports cardiologists, and associated health care team members in the diagnosis, treatment, and management of arrhythmic conditions in the athlete with the goal of facilitating return to sport and avoiding the harm caused by restriction. Expert, disease-specific risk assessment in the context of athlete symptoms and diagnoses is emphasized throughout the document. After appropriate risk assessment, management of arrhythmias geared toward return to play when possible is addressed. Other topics include shared decision-making and emergency action planning. The goal of this document is to provide evidence-based recommendations impacting all areas in the care of athletes with arrhythmic conditions. Areas in need of further study are also discussed.
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Affiliation(s)
- Rachel Lampert
- Yale University School of Medicine, New Haven, Connecticut
| | - Eugene H Chung
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Rajat Deo
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Joe Dolan
- University of Utah, Salt Lake City, Utah
| | | | - Belinda R Gray
- University of Sydney, Camperdown, New South Wales, Australia
| | | | | | | | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | | | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jack C Salerno
- University of Washington School of Medicine, Seattle, Washington
| | - Maully J Shah
- Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
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De Smet MAJ, Tavernier R, Duytschaever M, Knecht S, le Polain de Waroux JB. Rescue retrograde coronary venous ethanol ablation of ventricular tachycardia storm in a patient with Lamin A/C cardiomyopathy: a case report. Eur Heart J Case Rep 2024; 8:ytae235. [PMID: 38756545 PMCID: PMC11098039 DOI: 10.1093/ehjcr/ytae235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/22/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024]
Abstract
Background Left ventricular (LV) summit arrhythmias account for up to 14% of LV arrhythmias. The ablation of LV summit arrhythmias is challenging, as testified by the fact that radiofrequency (RF) catheter ablation failure is frequent. Retrograde coronary venous ethanol infusion has been proposed as an alternative approach for the ablation of LV summit arrhythmias. Case summary A 47-year-old man with Lamin A/C cardiomyopathy was referred for the ablation of a pleiomorphic ventricular tachycardia (VT) storm, with dominant morphology compatible with LV summit origin. He first received a combined endo- and epicardial RF ablation with the elimination of three clinically relevant VTs. However, the dominant VT could not be ablated due to the proximity of the coronary vasculature and phrenic nerve and remained inducible. Accordingly, an urgent rescue redo procedure consisting of retrograde coronary venous ethanol ablation was performed. Based on the best pace-match and precocity, the first septal, retro-pulmonary branch and the first diagonal branch were infused with ethanol with immediate cessation of the tachycardia and non-inducibility. Anti-arrhythmic drugs were withdrawn, while guideline-directed medical therapy for heart failure was continued. No complications occurred. After 3 months, the patient remained free from any arrythmias. Discussion Ablation of LV summit arrythmias is challenging, especially in the context of an electrical storm or in patients with structural heart disease. In such a situation, rescue ablation with retrograde coronary venous ethanol infusion represents an attractive alternative ablation modality.
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Affiliation(s)
- Maarten A J De Smet
- Department of Cardiology, AZ Sint-Jan Hospital, Ruddershove 10, 8000 Brugge, Belgium
| | - Rene Tavernier
- Department of Cardiology, AZ Sint-Jan Hospital, Ruddershove 10, 8000 Brugge, Belgium
| | - Mattias Duytschaever
- Department of Cardiology, AZ Sint-Jan Hospital, Ruddershove 10, 8000 Brugge, Belgium
| | - Sébastien Knecht
- Department of Cardiology, AZ Sint-Jan Hospital, Ruddershove 10, 8000 Brugge, Belgium
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Yamada T, Kay GN. Trends Favoring an Anatomical Approach to Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating From the Left Ventricular Summit. Circ Arrhythm Electrophysiol 2024; 17:e012548. [PMID: 38629301 DOI: 10.1161/circep.123.012548] [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: 10/12/2023] [Accepted: 03/26/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Epicardial radiofrequency catheter ablation (RFCA) of idiopathic ventricular arrhythmias (VAs) originating from the left ventricular summit (LVS) is challenging because of the anatomic barriers. On the other hand, RFCA at the endocardial sites near the earliest epicardial activation site of LVS-VAs (anatomic approach) has proven successful. The evolving trends in the approaches and outcomes of RFCA of LVS-VAs at a single center were evaluated. METHODS We studied 88 consecutive patients with idiopathic LVS-VAs at our institute from 2009 to 2019. These patients were divided into 3 periods: 2009 to 2012 (early), 2013 to 2015 (middle), and 2016 to 2019 (recent). The data were compared among the 3 periods. RESULTS The RFCA success rate did not significantly change from the early to middle period but significantly increased from the middle to recent period (P=0.0315). The transpericardial approach usage significantly decreased over the 3 periods. The anatomic approach usage significantly increased over the 3 periods. The use of the transpericardial approach did not affect the RFCA outcomes over the 3 periods. The success rate of the anatomic RFCA tended to increase from the early to middle period and significantly increased from the middle to recent period (P=0.0412). The number of endocardial locations where RFCA was successful increased over the 3 periods. CONCLUSIONS Over the 10-year period, the transpericardial approach became decreasingly performed, whereas the anatomic approach became increasingly performed with a satisfactory improvement in the RFCA outcomes of LVS-VAs. The anatomic RFCA became more successful by identifying more and various endocardial locations as target sites.
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Affiliation(s)
- Takumi Yamada
- Cardiovascular Division, University of Minnesota, Minneapolis (T.Y.)
| | - George Neal Kay
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL (G.N.K.)
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10
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Halaby RN, Bruce CG, Kolandaivelu A, Bhatia NK, Rogers T, Khan JM, Yildirim DK, Jaimes AE, O'Brien K, Babaliaros VC, Greenbaum AB, Lederman RJ. Ventricular Intramyocardial Navigation for Tachycardia Ablation Guided by Electrograms (VINTAGE): Deep Ablation in Inaccessible Targets. JACC Clin Electrophysiol 2024; 10:814-825. [PMID: 38811066 PMCID: PMC11372842 DOI: 10.1016/j.jacep.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Deep intramural ventricular tachycardia substrate targets are difficult to access, map, and ablate from endocardial and epicardial surfaces, resulting in high recurrence rates. OBJECTIVES In this study, the authors introduce a novel approach called ventricular intramyocardial navigation for tachycardia ablation guided by electrograms (VINTAGE) to access and ablate anatomically challenging ventricular tachycardia from within the myocardium. METHODS Guidewire/microcatheter combinations were navigated deep throughout the extravascular myocardium, accessed directly from the right ventricle cavity, in Yorkshire swine (6 naive, 1 infarcted). Devices were steered to various intramyocardial targets including the left ventricle summit, guided by fluoroscopy, unipolar electrograms, and/or electroanatomic mapping. Radiofrequency ablations were performed to characterize ablation parameters and reproducibility. Intramyocardial saline irrigation began 1 minute before ablation and continued throughout. Lesions were analyzed on cardiac magnetic resonance and necropsy. RESULTS VINTAGE was feasible in all animals within naive and infarcted myocardium. Forty-three lesions were created, using various guidewires and power settings. Forty-one (95%) lesions were detected on cardiac magnetic resonance and 38 (88%) on necropsy; all undetected lesions resulted from intentionally subtherapeutic ablation energy (10 W). Larger-diameter guidewires yielded larger size lesions. Lesion volumes on necropsy were significantly larger at 20 W than 10 W (178 mm3 [Q1-Q3: 104-382 mm3] vs 49 mm3 [Q1-Q3: 35-93 mm3]; P = 0.02). Higher power (30 W) did not create larger lesions. Median impedance dropped with preablation irrigation by 12 Ω (Q1-Q3: 8-17 Ω), followed by a further 15-Ω (Q1-Q3: 11-19 Ω) drop during ablation. Intramyocardial navigation, ablation, and irrigation were not associated with any complications. CONCLUSIONS VINTAGE was safe and effective at creating intramural ablation lesions in targets traditionally considered inaccessible from the endocardium and epicardium, both naive and infarcted. Intramyocardial guidewire irrigation and ablation at 20 W creates reproducibly large intramural lesions.
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Affiliation(s)
- Rim N Halaby
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher G Bruce
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA; Emory University Hospital, Atlanta, Georgia, USA
| | - Aravindan Kolandaivelu
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Toby Rogers
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA; MedStar Washington Hospital Center, Washington, DC, USA
| | - Jaffar M Khan
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA; St Francis Hospital, Roslyn, New York, USA
| | - D Korel Yildirim
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Andi E Jaimes
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kendall O'Brien
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
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11
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Peters CJ, Marchlinski FE. Left Ventricular Summit Arrhythmias: Have We Reached the Peak of Ablation Success or Just a Higher Plateau? Circ Arrhythm Electrophysiol 2024; 17:e012969. [PMID: 38716652 DOI: 10.1161/circep.124.012969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Affiliation(s)
- Carli J Peters
- Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Francis E Marchlinski
- Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
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Batko J, Jakiel R, Krawczyk-Ożóg A, Litwinowicz R, Hołda J, Bartuś S, Bartuś K, Hołda MK, Konieczyńska M. Definition and anatomical description of the left atrial appendage neck. Clin Anat 2024; 37:201-209. [PMID: 38031393 DOI: 10.1002/ca.24125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/05/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023]
Abstract
The left atrial appendage (LAA) is well known as a source of cardiac thrombus formation. Despite its clinical importance, the LAA neck is still anatomically poorly defined. Therefore, this study aimed to define the LAA neck and determine its morphometric characteristics. We performed three-dimensional reconstructions of the heart chambers based on contrast-enhanced electrocardiography-gated computed tomography scans of 200 patients (47% females, 66.5 ± 13.6 years old). The LAA neck was defined as a truncated cone-shaped canal bounded proximally by the LAA orifice and distally by the lobe origin and was present in 98.0% of cases. The central axis of the LAA neck was 14.7 ± 2.3 mm. The mean area of the LAA neck walls was 856.6 ± 316.7 mm2 . The LAA neck can be divided into aortic, arterial (the smallest), venous (the largest), and free surfaces. All areas have a trapezoidal shape with a broader proximal base. There were no statistically significant differences in the morphometric characteristics of the LAA neck between LAA types. Statistically significant differences between the sexes in the main morphometric parameters of the LAA neck were found in the central axis length and the LAA neck wall area. The LAA neck can be evaluated from computed tomography scans and their three-dimensional reconstructions. The current study provides a complex morphometric analysis of the LAA neck. The precise definition and morphometric details of the LAA neck presented in this study may influence the effectiveness and safety of LAA exclusion procedures.
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Affiliation(s)
- Jakub Batko
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
- CAROL-Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Rafał Jakiel
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Agata Krawczyk-Ożóg
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
- Department of Cardiology and Cardiovascular Interventions, University Hospital in Cracow, Krakow, Poland
| | - Radosław Litwinowicz
- CAROL-Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Cardiac Surgery, Regional Specialist Hospital, Grudziądz, Poland
| | - Jakub Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital in Cracow, Krakow, Poland
| | - Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz K Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
- Department of Diagnostic Medicine, John Paul II Hospital in Kraków, Krakow, Poland
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Małgorzata Konieczyńska
- Department of Diagnostic Medicine, John Paul II Hospital in Kraków, Krakow, Poland
- Department of Thromboembolic Diseases, Jagiellonian University Medical College, Cracow, Poland
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13
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Zhou ZX, Zheng C, Hu YD, Lin JF. Mapping and ablation of ventricular arrhythmias arising from the left ventricular summit. Pacing Clin Electrophysiol 2024; 47:242-252. [PMID: 38291856 DOI: 10.1111/pace.14932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
The left ventricular summit (LVS) refers to the highest portion of the left ventricular outflow tract (LVOT). It is an epicardially delimited triangular area by the left coronary arteries and the coronary venous circulation. Its deep myocardium correlates closely with the left coronary cusp, aortic-mitral continuity, and right ventricular outflow tract (RVOT), complicating the anatomical relationship. Ventricular arrhythmias (VAs) originating from this area are common, accounting for 14.5% of all VAs origin from left ventricle. Specific electrocardiogram (ECG) characteristics may assist in locating LVS-VAs pre-procedure and facilitate procedure planning. However, catheter ablation of LVS-VAs remains challenging because of anatomical constraints. This paper reviews the recent understanding of LVS anatomy, concludes ECG characteristics, and summarizes current mapping and ablation methods for LVS-VAs.
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Affiliation(s)
- Zhi-Xiang Zhou
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Cheng Zheng
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - You-Dong Hu
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jia Feng Lin
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Yamagami S, Mori S, Nishiuchi S, Akiyama M, Nakano Y, Kondo H, Fukuzawa K, Tamura T. Successful Supravalvular Radiofrequency Catheter Ablation of Premature Ventricular Contractions Originating From the Left Ventricular Summit. JACC Clin Electrophysiol 2024; 10:405-413. [PMID: 37999677 DOI: 10.1016/j.jacep.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 11/25/2023]
Affiliation(s)
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - Masaya Akiyama
- Department of Clinical Engineering, Tenri Hospital, Tenri, Nara, Japan
| | - Yuta Nakano
- Department of Clinical Engineering, Tenri Hospital, Tenri, Nara, Japan
| | - Hirokazu Kondo
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
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Mori S, Bradfield JS, Fukuzawa K, Shivkumar K. Comprehensive Anatomy of the Summit of the Left Ventricle. JACC Clin Electrophysiol 2024; 10:168-184. [PMID: 37999670 DOI: 10.1016/j.jacep.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/07/2023] [Accepted: 09/19/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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16
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Enriquez A, Hanson M, Nazer B, Gibson DN, Cano O, Tokioka S, Fukamizu S, Sanchez Millan P, Hoyos C, Matos C, Sauer WH, Tedrow U, Romero J, Neira V, Futyma M, Futyma P. Bipolar ablation involving coronary venous system for refractory left ventricular summit arrhythmias. Heart Rhythm O2 2024; 5:24-33. [PMID: 38312200 PMCID: PMC10837170 DOI: 10.1016/j.hroo.2023.11.015] [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] [Indexed: 02/06/2024] Open
Abstract
Background Catheter ablation of premature ventricular complexes (PVCs) and ventricular tachycardia (VT) from the left ventricular summit (LVS) may require advanced ablation techniques. Bipolar ablation from the coronary veins and adjacent endocardial structures can be effective for refractory LVS arrhythmias. Objective The aim of this study was to investigate the outcomes of bipolar ablation performed between the coronary venous system and adjacent endocardial left ventricular outflow tract (LVOT) or right ventricular outflow tract (RVOT). Methods This multicenter study included consecutive patients with LVS PVC/VT who underwent bipolar ablation between the anterior interventricular vein (AIV) or great cardiac vein (GCV) and the endocardial LVOT/RVOT after failed unipolar ablation. Ablation was started with powers of 10-20 W and uptitrated to achieve an impedance drop of at least 10%. Angiography was performed in all cases to confirm a safe distance (>5 mm) of the catheter from the major coronary arteries. Results Between 2013 and 2023, bipolar radiofrequency ablation between the AIV/GCV and the adjacent LVOT/RVOT was attempted in 20 patients (4 female; age 57 ± 16 years). Unipolar ablation from sites of early activation (AIV/GCV, LVOT, aortic cusps, RVOT) failed to effectively suppress the PVC/VT in all subjects. Bipolar ablation was delivered with a maximum power of 30 ± 8 W and total duration of 238 ± 217 s and led to acute PVC/VT elimination in all patients. No procedural-related complications occurred. Over a follow-up period of 30 ± 24 months, the freedom from arrhythmia recurrence was 85% (1 recurrence in the VT group and 2 in the PVC group). PVC burden was reduced from 22% ± 10% to 4% ± 8% (P <.001). Conclusion In cases of LVS PVC/VT refractory to unipolar ablation, bipolar ablation between the coronary venous system and adjacent endocardial LVOT/RVOT is safe and effective if careful titration of power and intraprocedural angiography are performed to ensure a safe distance from the coronary arteries.
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Affiliation(s)
- Andres Enriquez
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Matthew Hanson
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Babak Nazer
- Division of Cardiology, University of Washington, Seattle, Washington
| | | | - Oscar Cano
- Division of Cardiology, Hospital Universitari Politècnic La Fe, Valencia, Spain
| | - Sayuri Tokioka
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Pablo Sanchez Millan
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos Matos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William H Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Usha Tedrow
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jorge Romero
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Victor Neira
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Marian Futyma
- Medical College, University of Rzeszów and St. Joseph's Heart Rhythm Center, Rzeszów, Poland
| | - Piotr Futyma
- Medical College, University of Rzeszów and St. Joseph's Heart Rhythm Center, Rzeszów, Poland
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Ballı Ş, Kanlıoğlu P, Akgun G. Experience of left ventricular outflow tract arrhythmia ablation in paediatric patients using limited fluoroscopy and three-dimensional mapping technique. Cardiol Young 2023:1-6. [PMID: 38037860 DOI: 10.1017/s1047951123003955] [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] [Indexed: 12/02/2023]
Abstract
OBJECTIVE The left ventricular outflow tract is an important source of ventricular arrhythmias. Up to one-third of all idiopathic ventricular arrhythmias in patients with structurally normal hearts may arise from this region. We would like to share the results of our left ventricular outflow tract ablation using three-dimensional mapping and limited fluoroscopy. MATERIALS AND METHODS This is a single-centre retrospective cohort study. Forty-six consecutive patients who underwent left ventricular outflow tract ablation procedures between January 2015 and June 2023 were included in the study. The EnSite Precision System (Abbott, St. Paul, MN, USA) was used to facilitate mapping and to reduce or eliminate the need for fluoroscopy. RESULTS The study group comprised 29 males and 17 females, with a mean age of 13.4 ± 4.5 years. The most common location for arrhythmias was the left coronary cusp (n : 21). Other locations, in sequence, included the junction of the right and left coronary commissure (n : 10), right coronary cusp (n : 10), left ventricular outflow tract endocardium (n:4), aorto-mitral junction (n : 1), and great cardiac vein (n : 1). Nine of these patients had previously undergone unsuccessful right ventricular outflow tract ablation at another centre. Cryoablation was performed in three patients, irrigated radiofrequency ablation in three patients, and conventional radiofrequency ablation in the remaining patients. The acute success rate was 100%, and no recurrences were observed. The mean follow-up period was 49.6 ± 24.4 months. All patients were asymptomatic and were being followed without antiarrhythmic medication. CONCLUSION Although left ventricular outflow tract ablations pose a risk for coronary artery and heart valve complications, they can be performed successfully and safely with the guidance of three-dimensional mapping.
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Affiliation(s)
- Şevket Ballı
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training & Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Pınar Kanlıoğlu
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training & Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gokmen Akgun
- Department of Pediatric Cardiology, Kocaeli City Hospital, Kocaeli, Turkey
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Limite LR, Laborie G, Constantin J, Maubon A, Arcari L, Hebert C, Bortone A. Left ventricular summit premature ventricular contractions treated by venous ethanol infusion: Scar assessment by magnetic resonance imaging. Pacing Clin Electrophysiol 2023; 46:1235-1238. [PMID: 36811180 DOI: 10.1111/pace.14680] [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: 11/27/2022] [Revised: 01/31/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
Left ventricular (LV) summit premature ventricular contractions (PVCs) are often unresponsive to radiofrequency (RF) ablation. Retrograde venous ethanol infusion (RVEI) can be a valuable alternative in this scenario. A 43-year-old woman without structural heart disease presented with LV summit PVCs unresponsive to RF ablation because of their deep-seated origin. Unipolar pace mapping performed through a wire inserted into a branch of the distal great cardiac vein (GCV) demonstrated 12/12 concordance with the clinical PVCs thus indicating close proximity to PVCs' origin. RVEI abolished the PVCs without complications. Subsequently, magnetic resonance imaging (MRI) evidenced an intramural myocardial scar produced by ethanol ablation. In conclusion, RVEI effectively and safely treated PVC arising from a deep site in the LVS. The scar provoked by chemical damage was well characterized by MRI imaging.
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Affiliation(s)
- Luca Rosario Limite
- Service de Cardiologie, Hôpital Privé Les Franciscaines, ELSAN, Nîmes, France
| | - Guillaume Laborie
- Service de Cardiologie, Hôpital Privé Les Franciscaines, ELSAN, Nîmes, France
| | | | - Antoine Maubon
- Service de Radiologie, Hôpital Privé Les Franciscaines, ELSAN, Nîmes, France
| | - Luca Arcari
- Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Caroline Hebert
- Biosense Webster France, Johnson & Johnson, Issy les Moulineaux, France
| | - Agustín Bortone
- Service de Cardiologie, Hôpital Privé Les Franciscaines, ELSAN, Nîmes, France
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Tsiachris D, Botis M, Doundoulakis I, Bartsioka LI, Tsioufis P, Kordalis A, Antoniou CK, Tsioufis K, Gatzoulis KA. Electrocardiographic Characteristics, Identification, and Management of Frequent Premature Ventricular Contractions. Diagnostics (Basel) 2023; 13:3094. [PMID: 37835837 PMCID: PMC10572222 DOI: 10.3390/diagnostics13193094] [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: 08/17/2023] [Revised: 09/09/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Premature ventricular complexes (PVCs) are frequently encountered in clinical practice. The association of PVCs with adverse cardiovascular outcomes is well established in the context of structural heart disease, yet not so much in the absence of structural heart disease. However, cardiac magnetic resonance (CMR) seems to contribute prognostically in the latter subgroup. PVC-induced myocardial dysfunction refers to the impairment of ventricular function due to PVCs and is mostly associated with a PVC burden > 10%. Surface 12-lead ECG has long been used to localize the anatomic site of origin and multiple algorithms have been developed to differentiate between right ventricular and left ventricular outflow tract (RVOT and LVOT, respectively) origin. Novel algorithms include alternative ECG lead configurations and, lately, sophisticated artificial intelligence methods have been utilized to determine the origins of outflow tract arrhythmias. The decision to therapeutically address PVCs should be made upon the presence of symptoms or the development of PVC-induced myocardial dysfunction. Therapeutic modalities include pharmacological therapy (I-C antiarrhythmic drugs and beta blockers), as well as catheter ablation, which has demonstrated superior efficacy and safety.
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Affiliation(s)
- Dimitris Tsiachris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
- Athens Heart Center, Athens Medical Center, 15125 Athens, Greece
| | - Michail Botis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Ioannis Doundoulakis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Lamprini Iro Bartsioka
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Panagiotis Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Athanasios Kordalis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
- Athens Heart Center, Athens Medical Center, 15125 Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Konstantinos A. Gatzoulis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
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Nitta T, Sakamoto SI, Murata H, Suzuki K, Yamada N, Iwasaki Y, Ishii Y. Surgery for ventricular tachycardia originating from the left ventricular summit. Eur J Cardiothorac Surg 2023; 64:ezad323. [PMID: 37725388 DOI: 10.1093/ejcts/ezad323] [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: 03/16/2023] [Revised: 06/28/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVES Ventricular tachycardia (VT) originating from the left ventricular summit region, the most superior region of the left ventricle surrounded by the major coronary arteries and veins, is frequently refractory to pharmacological therapies and endocardial and epicardial catheter ablation. METHODS Eleven patients with an age from 31 to 79 (median 56) years old, underwent map-guided surgery for left ventricular summit VT. All patients had undergone 1-5 unsuccessful sessions of catheter ablation for incessant VT, preoperatively. Five patients had suffered VT storm and 1 had a history of cardiopulmonary resuscitation. Four patients had implanted with a defibrillator. Epicardium to endocardium transmural cryothermia was applied at the VT origin determined by intraoperative epicardial mapping with electro-anatomical mapping system. Harmonic scalpel was used to remove the epicardial fat and cryothermia was applied directly to the myocardium, avoiding thermal or mechanical injuries to the coronary vessels. Additional endocardial cryothermia at the VT origin was performed by a cryoprobe introduced into the left ventricular cavity through an aortotomy. RESULTS There was no surgical mortality or long-term mortality related to VT during a median follow-up period of 60 months (interquartile range: 34-82). Five-year freedom from preoperatively documented left ventricular summit VT and non-documented VT was 91% and 73%, respectively. All the patients with postoperative VT underwent successful catheter ablation. Other patients were free from VT during the follow-up period. CONCLUSIONS Epicardial to endocardial transmural cryothermia at the VT origin guided by intraoperative electro-anatomical mapping with a close collaboration with electrophysiologists was crucial in successful surgery for left ventricular summit VT.
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Affiliation(s)
- Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | | | | | - Kenji Suzuki
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Naoki Yamada
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Yuki Iwasaki
- Department of Cardiology, Nippon Medical School, Tokyo, Japan
| | - Yosuke Ishii
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
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Ferns SJ, Scheinman M. Adenosine sensitive left ventricular summit ventricular tachycardia in a pre-adolescent: case report. Eur Heart J Case Rep 2023; 7:ytad430. [PMID: 37727150 PMCID: PMC10506732 DOI: 10.1093/ehjcr/ytad430] [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: 12/09/2022] [Revised: 08/10/2023] [Accepted: 08/30/2023] [Indexed: 09/21/2023]
Abstract
Background Sustained forms of tachycardia especially from the left ventricular summit are rare. Adenosine sensitive outflow tachycardias, especially from the left ventricular summit, are rarer still. These arrhythmias may be exercise or stress induced as they are facilitated by catecholamines and characteristically terminate with adenosine, vagal manoeuvres, and beta-blockers. The surface 12-lead electrocardiogram can be used to localize the anatomic site of origin before catheter ablation; however, prediction of the precise origin may still be challenging due to the intimate and complex anatomy of the outflow tracts. Case summary A 12-year-old female presented to an emergency room with frequent runs of wide complex tachycardia that terminated with adenosine but would spontaneously reinitiate. After three additional temporary terminations with adenosine and because of an inability to completely eliminate tachycardia, she was started on an esmolol infusion that resulted in an abrupt termination of tachycardia. At follow-up, she reported breakthrough episodes of tachycardia with exercise, especially associated with beta-blocker non-compliance. The rest of her cardiac testing was normal apart from an anomalous right coronary artery origin from the left coronary sinus. Given the increased frequency of symptomatic palpitations and medication non-compliance, she underwent an electrophysiology study. During the study, a ventricular tachycardia was successfully mapped to an epicardial focus at the left ventricle summit and was successfully ablated. Discussion The response of this patient's ventricular tachycardia to adenosine suggests a triggered mechanism. To our knowledge, this is the first unambiguous example of left ventricular tachycardia due to cAMP-mediated triggered activity in this age group.
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Affiliation(s)
- Sunita J Ferns
- Department of Pediatrics, University of Illinois in Chicago, 420 NE Glen Oak Avenue, Suite 301, Peoria, IL 61603, USA
| | - Melvin Scheinman
- School of Medicine, University of California San Francisco, 400 Parnassus Ave, San Francisco, CA 94122, USA
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22
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Nakasone K, Mori S, Izawa Y, Kiuchi K, Takami M, Hirata KI, Fukuzawa K. Transseptal Supravalvular Far-Field Potential Mapping of Ventricular Premature Contractions Originating Around the Superior Mitral Annulus. JACC Clin Electrophysiol 2023; 9:2034-2039. [PMID: 37498246 DOI: 10.1016/j.jacep.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Kazutaka Nakasone
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Kunihiko Kiuchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Mitsuru Takami
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan; Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Koji Fukuzawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan; Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.
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23
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Arps K, Barnett AS, Koontz JI, Pokorney SD, Jackson KP, Bahnson TD, Piccini JP, Sun AY. Use of Ripple mapping to enhance localization and ablation of outflow tract premature ventricular contractions. J Cardiovasc Electrophysiol 2023; 34:1552-1560. [PMID: 37293826 DOI: 10.1111/jce.15963] [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: 03/30/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Accurate localization of septal outflow tract premature ventricular contractions (PVCs) is often difficult due to frequent mid-myocardial or protected origin. Compared with traditional activation mapping, CARTO Ripple mapping provides visualization of all captured electrogram data without assignment of a specific local activation time and thus may enhance PVC localization. METHODS Electroanatomic maps for consecutive catheter ablation procedures for septal outflow tract PVCs (July 2018-December 2020) were analyzed. For each PVC, we identified the earliest local activation point (EA), defined by the point of maximal -dV/dt in a simultaneously recorded unipolar electrogram, and the earliest Ripple signal (ERS), defined as the earliest point at which three grouped simultaneous Ripple bars appeared in late diastole. Immediate success was defined as full suppression of the clinical PVC. RESULTS Fifty-seven unique PVCs in 55 procedures were included. When ERS and EA were in the same chamber (RV, LV, or CS), the odds ratio for the successful procedure was 13.1 (95% confidence interval [CI] 2.2-79.9, p = .005). Discordance between sites was associated with a higher likelihood of needing multi-site ablation (odds ratio [OR] 7.9 [1.4-4.6; p = .020]). Median EA-ERS distance in successful versus unsuccessful cases was 4.6 mm (interquartile range 2.9-8.5) versus 12.5 mm (7.8-18.5); (p = .020). CONCLUSION Greater EA-ERS concordance was associated with higher odds of single-site PVC suppression and successful septal outflow tract PVC ablation. Visualization of complex signals via automated Ripple mapping may offer rapid localization information complementary to local activation mapping for PVCs of mid-myocardial origin.
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Affiliation(s)
- Kelly Arps
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Adam S Barnett
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Prisma Health, Greenville, South Carolina, USA
| | - Jason I Koontz
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Durham VA Medical Center, Durham, North Carolina, USA
| | - Sean D Pokorney
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Kevin P Jackson
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Tristram D Bahnson
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jonathan P Piccini
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Albert Y Sun
- Division of Cardiovascular Disease, Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA
- Durham VA Medical Center, Durham, North Carolina, USA
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24
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Yamada T. Predictors of Successful Endocardial Ablation of Epicardial Left Ventricular Summit Arrhythmias. Card Electrophysiol Clin 2023; 15:15-24. [PMID: 36774132 DOI: 10.1016/j.ccep.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Endocardial catheter ablation of ventricular arrhythmias (VAs) originating from the left ventricular summit (LVS) at remote structures adjacent to the LVS may be an alternative (anatomic approach) but may not be so successful. This type of catheter ablation is successful most commonly in the left ventricular outflow tract followed by the aortic cusps and rarely in the right ventricular outflow tract. A right bundle branch block QRS morphology and anatomic distance between the earliest ventricular activation site in the coronary venous system and endocardial ablation site (<13 mm) could be predictors of a successful endocardial catheter ablation of LVS VAs.
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Affiliation(s)
- Takumi Yamada
- Cardiovascular Division, University of Minnesota, 420 Delaware Street Southeast, MMC 508, Minneapolis, MN 55455, USA.
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25
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Te-Rosano ALD, Chung FP, Lin YJ, Chen SA. Outcomes of Catheter Ablation of Left Ventricular Summit Arrhythmias. Card Electrophysiol Clin 2023; 15:85-92. [PMID: 36774140 DOI: 10.1016/j.ccep.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The left ventricular summit (LVS) is the area in the highest portion of the left ventricular epicardium, bounded by the left coronary arteries and the coronary venous circulation, and can be surrounded by thick epicardial fat that may preclude epicardial ablation. Ablation of LVS ventricular arrhythmias (VA) can be achieved from adjacent structures with good success rates. The long-term freedom from LVS VA recurrence remains variable. This article reviews the spatial and anatomic relationship of the structures surrounding the LVS, which provide vantage points for ablation, and the acute and long-term outcomes of different ablation approaches in LVS VA ablation.
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Affiliation(s)
- Abigail Louise D Te-Rosano
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan; HB Calleja Heart and Vascular Institute, St. Luke's Medical Center, 279 E. Rodriguez Sr. Avenue, Quezon City 1112, Philippines
| | - Fa-Po Chung
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan; Department of Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan.
| | - Yenn-Jiang Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan; Department of Medicine, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan; Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
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26
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Romero J, Diaz JC, Gamero M, Alviz I, Lorente M, Gabr M, Toquica CC, Krishnan S, Velasco A, Lin A, Natale A, Zou F, Di Biase L. Fluoroless Catheter Ablation of Left Ventricular Summit Arrhythmias: A Step-by-Step Approach. Card Electrophysiol Clin 2023; 15:75-83. [PMID: 36774139 DOI: 10.1016/j.ccep.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Prolonged use of fluoroscopy during catheter ablation (CA) of arrhythmias is associated with a significant exposure to ionizing radiation and risk of orthopedic injuries given the need for heavy protective equipment. CA of ventricular arrhythmias (VAs) arising from the left ventricular (LV) summit is challenging, requiring a vast knowledge of the intricate cardiac anatomy of this area and careful imaging delineation of the different anatomical structures, which is frequently performed using fluoroscopic guidance. Certain techniques, including pericardial mapping and ablation, use of intracoronary wires, and mapping and ablation inside the coronary venous system have been proposed, further prolonging fluoroscopy time. Fluoroless CA procedures are feasible with currently available technology and appear to have similar safety and efficacy outcomes compared with conventional techniques. To successfully perform fluoroless CA of LV summit arrhythmias, it is important to be fully acquainted with intracardiac echocardiography (ICE) imaging and electroanatomic mapping (EAM). We will describe our approach to perform fluoroless CA in LV summit VAs.
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Affiliation(s)
- Jorge Romero
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Juan Carlos Diaz
- Arrhythmia and electrhophysiology service, Clinica Las Vegas, Grupo Quiron Salud; Universidad CES School of Medicine, Medellin, Colombia, USA
| | - Maria Gamero
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Isabella Alviz
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marta Lorente
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mohamed Gabr
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Suraj Krishnan
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alejandro Velasco
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aung Lin
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Fengwei Zou
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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27
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Mori S, Hayase J, Sridharan A, Fukuzawa K, Shivkumar K, Bradfield JS. Revisiting the Anatomy of the Left Ventricular Summit. Card Electrophysiol Clin 2023; 15:1-8. [PMID: 36774131 DOI: 10.1016/j.ccep.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The left ventricular summit corresponds to the epicardial side of the basal superior free wall, extending from the base of the left coronary aortic sinus. The summit composes the floor of the compartment surrounded by the aortic root, infundibulum, pulmonary root, and left atrial appendage. The compartment is filled with thick adipose tissue, carrying the coronary vessels. Thus, the treatment of ventricular tachycardia originating from the summit is challenging, and three-dimensional understanding of this complicated region is fundamental. We revisit the clinical anatomy of the left ventricular summit with original images from the Wallace A. McAlpine collection.
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Affiliation(s)
- Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, CA, USA.
| | - Justin Hayase
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, CA, USA
| | - Aadhavi Sridharan
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, CA, USA
| | - Koji Fukuzawa
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, CA, USA
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; UCLA Cardiovascular Interventional Programs, Department of Medicine, David Geffen School of Medicine at UCLA & UCLA Health System, Los Angeles, CA, USA
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28
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Left atrial appendage as a vantage point for targeting ventricular arrhythmias originating from the left ventricular summit: "Get to know your neighbors". J Interv Card Electrophysiol 2023; 66:241-242. [PMID: 35318577 DOI: 10.1007/s10840-022-01184-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
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29
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Restrepo AJ, Saenz Morales LC. Preventing Complications During Mapping and Ablation of Left Ventricular Summit Arrhythmias. Card Electrophysiol Clin 2023; 15:93-109. [PMID: 36774142 DOI: 10.1016/j.ccep.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The left ventricular summit is a site of origin for idiopathic ventricular arrhythmias. With advancements in mapping and ablation techniques, sites previously considered inaccessible can now be approached. Anatomical knowledge of the 3-dimensional landmarks of this space is important, as critical structures reside within its boundaries and are potentially liable to collateral injury during ablation. This article reviews reported complications from ablation of ventricular arrhythmias arising from the left ventricular summit and its vicinity and discusses the pros and cons of different ablation technique and the role of an individualized anatomical approach to reduce procedural related complications and improve outcomes.
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Affiliation(s)
- Alejandro Jimenez Restrepo
- Marshfield Clinic Health System, 1000 North Oak Avenue, Marshfield, WI 54449, USA; University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Luis Carlos Saenz Morales
- International Arrhythmia Center, Fundacion CardioInfantil, Bogota, Colombia; Fundacion CardioInfantil, Instituto de Cardiologia, Calle 163 #13b-60, Bogota, Colombia
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30
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Percutaneous Epicardial Ablation of Ventricular Arrhythmias Arising from the Left Ventricular Summit. Card Electrophysiol Clin 2023; 15:25-30. [PMID: 36774133 DOI: 10.1016/j.ccep.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The left ventricular summit (LVS) is the highest point of the left ventricular epicardium, and ventricular arrhythmias originating from this area accounts for 10% to 15% of idiopathic outflow tract ventricular arrhythmias. Direct epicardial ablation of outflow tract ventricular arrhythmias arising from the LVS is successful only in a minority of patients because of close proximity to the coronary artery or thick epicardial fat. Therefore, alternative strategies should be prioritized before performing epicardial approach. When performed, electrocardiogram characteristics suggestive of the site of origin to be the accessible area within the LVS needs be evaluated to avoid ineffective epicardial approach.
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31
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Futyma P, Sauer WH. Bipolar Radiofrequency Catheter Ablation of Left Ventricular Summit Arrhythmias. Card Electrophysiol Clin 2023; 15:57-62. [PMID: 36774137 DOI: 10.1016/j.ccep.2022.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Challenging anatomic and morphologic conditions of the left ventricular (LV) summit architecture and its surrounding sites may prevent sufficient heating of the targeted area during standard radiofrequency catheter ablation. Bipolar ablation can result in higher likelihood of efficacy for ablation of LV summit arrhythmias from inaccessible regions and increase the chance of achieving a transmural lesion. In this review, the authors describe the present approaches for bipolar ablation of the LV summit arrhythmias refractory to standard approaches.
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Affiliation(s)
- Piotr Futyma
- Medical College, University of Rzeszów and St. Joseph's Heart Rhythm Center, Anny Jagiellonki 17, Rzeszów 35-623, Poland.
| | - William H Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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32
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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.
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Ju W, Zhang J, Shi L, Gu K, Chu M, Chen H, Yang G, Li M, Liu H, Zhang F, Yang B, Chen M. Epicardial catheter ablation of idiopathic ventricular arrhythmias originating from uncommon epicardial sites. J Interv Card Electrophysiol 2023; 66:63-72. [PMID: 35604576 DOI: 10.1007/s10840-022-01149-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 02/02/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Idiopathic epicardial ventricular arrhythmias (VAs) are clustered in the areas of the summit and crux. This study was to report a group of idiopathic epicardial VAs remote from the summit and crux areas. METHODS In total, 9 patients (6 males, mean age 32 ± 13 years) were enrolled. The locations were identified by epicardial mapping and ablation. The electrocardiographic and electrophysiological characteristics were compared to those of 9 patients who had VAs ablated at the opposite endocardial site. RESULTS VAs were identified at the epicardium, with 4 patients had VAs located at the inferior wall, one at the anterior wall, one at the apex and 3 patients had VAs at the lateral wall. A "QS" type at the location-related leads was the only identified surface electrocardiogram indication suggesting epicardial origin (compared to that of the controls, 100% vs 0%, p<0.001). Endocardial and epicardial mapping revealed pre-maturities of -11 ± 4 ms and -25 ± 8 ms, respectively (VS. -28 ± 8 ms revealed by endocardial mapping in control patients, p<0.001 and p=0.389, respectively). All of the study cases demonstrated an "rS" pattern in the endocardial unipolar electrogram. Acute and long-term successful ablation (a median of 11 months of follow-up) was achieved in all patients without complications. CONCLUSIONS A distinct group of idiopathic VAs remote from the summit and crux areas warranting ablation by a subxiphoid approach were identified. Morphological ECG features of a "QS" type among the location-related grouped leads combined with the mapping findings helped in the identification of the epicardial site of origin.
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Affiliation(s)
- Weizhu Ju
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road, Nanjing, 210029, China
| | - Jinlin Zhang
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Linsheng Shi
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road, Nanjing, 210029, China
| | - Kai Gu
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road, Nanjing, 210029, China
| | - Ming Chu
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road, Nanjing, 210029, China
| | - Hongwu Chen
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road, Nanjing, 210029, China
| | - Gang Yang
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road, Nanjing, 210029, China
| | - Mingfang Li
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road, Nanjing, 210029, China
| | - Hailei Liu
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road, Nanjing, 210029, China
| | - Fengxiang Zhang
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road, Nanjing, 210029, China
| | - Bing Yang
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road, Nanjing, 210029, China
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Guangzhou Road, Nanjing, 210029, China.
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34
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Ablation of apparently idiopathic ventricular arrhythmias from atypical epicardial sites of origin: Take a look outside. J Interv Card Electrophysiol 2023; 66:73-74. [PMID: 35262859 DOI: 10.1007/s10840-022-01178-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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35
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Miyamoto S, Okubo Y, Uotani Y, Oguri N, Miyauchi S, Okamura S, Tokuyama T, Nakano Y. Initial experience of novel over the wire type decapolar catheter for ventricular arrhythmias originating from left ventricular summit. JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY : AN INTERNATIONAL JOURNAL OF ARRHYTHMIAS AND PACING 2023; 66:117-124. [PMID: 35960405 DOI: 10.1007/s10840-022-01340-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previously, direct monitoring of local activation at the communicating vein (CV) has been reported to be useful for the ablation of ventricular arrhythmias (VAs) originating from the left ventricular (LV) summit. In this study, we evaluated the performance of the novel over-the-wire (OTW)-type decapolar catheter for VAs originating from the LV summit. METHODS Overall, 17 patients who underwent catheter ablation for idiopathic VAs originating from the LV summit were included in this study. Of these, seven patients underwent mapping of the epicardial LV outflow tract with the novel 2.7 Fr OTW-type decapolar catheter (EPstar FIX AIV), and ten underwent mapping with the standard 2.0 Fr octopolar catheter (EPstar FIX 2F) procedure (AIV group = EPstar FIX AIV and control group = EPstar FIX 2F). RESULTS No significant differences in the baseline characteristics were observed between the two groups. In the AIV group, all patients achieved successful catheter positioning in the target CV, whereas in the control group, two patients failed to achieve the same. The novel catheter not only advanced to the target vessels using a 0.014-in guidewire but it was also used for contrast injection from the catheter lumen, which enabled accurate and safe positioning. As a result, the earliest activation time preceding QRS onset during the VA, recorded at the CV, was significantly earlier when compared with the control group (44.66 ± 11.23 ms vs. 32.16 ± 4.26 ms, P = 0.007). CONCLUSIONS Compared with the conventional electrode catheter, this novel multipolar electrode catheter is more effective for mapping local activation at the CV.
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Affiliation(s)
- Shogo Miyamoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yousaku Okubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Yukimi Uotani
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Naoto Oguri
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shunsuke Miyauchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Sho Okamura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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36
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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.
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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.
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37
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Nitta T. Surgical Ablation of Ventricular Tachycardia. Card Electrophysiol Clin 2022; 14:793-799. [PMID: 36396194 DOI: 10.1016/j.ccep.2022.06.005] [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
Surgery for ventricular tachycardia (VT) is indicated in patients in whom pharmacotherapy or catheter ablation is ineffective or frequent VT attacks are not suppressed or with frequent activation of implantable cardioverter defibrillator. In ischemic VT, resection of fibrous endocardium combined with encircling cryothermia at the border between the infarcted and normal myocardium is performed. In surgery for VT associated with cardiomyopathy, close collaboration between the physician and surgeon is important and intraoperative mapping using electro-anatomic mapping system is helpful. In VT associated with cardiac tumors, cryothermia of the thinned subepicardial myocardium at the edge of the tumor is recommended in addition to resection of tumors.
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Affiliation(s)
- Takashi Nitta
- Hanyu General Hospital, Shimo-iwase 446, Hanyu City, Saitama 348-8505 Japan; Nippon Medical School, Tokyo, Japan.
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38
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Atreya AR, Yalagudri SD, Subramanian M, Rangaswamy VV, Saggu DK, Narasimhan C. Best Practices for the Catheter Ablation of Ventricular Arrhythmias. Card Electrophysiol Clin 2022; 14:571-607. [PMID: 36396179 DOI: 10.1016/j.ccep.2022.08.007] [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
Techniques for catheter ablation have evolved to effectively treat a range of ventricular arrhythmias. Pre-operative electrocardiographic and cardiac imaging data are very useful in understanding the arrhythmogenic substrate and can guide mapping and ablation. In this review, we focus on best practices for catheter ablation, with emphasis on tailoring ablation strategies, based on the presence or absence of structural heart disease, underlying clinical status, and hemodynamic stability of the ventricular arrhythmia. We discuss steps to make ablation safe and prevent complications, and techniques to improve the efficacy of ablation, including optimal use of electroanatomical mapping algorithms, energy delivery, intracardiac echocardiography, and selective use of mechanical circulatory support.
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Affiliation(s)
- Auras R Atreya
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India; Division of Cardiovascular Medicine, Electrophysiology Section, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sachin D Yalagudri
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | - Muthiah Subramanian
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | | | - Daljeet Kaur Saggu
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India
| | - Calambur Narasimhan
- Electrophysiology Section, AIG Hospitals Institute of Cardiac Sciences and Research, Hyderabad, India.
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39
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Yamada T. Techniques for Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating from the Outflow Tract and Left Ventricular Summit. Card Electrophysiol Clin 2022; 14:621-631. [PMID: 36396181 DOI: 10.1016/j.ccep.2022.07.008] [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
Idiopathic ventricular arrhythmias (VAs) most commonly originate from the ventricular outflow tracts. Because the anatomy of this region is complex and some of those VA origins are intramural and epicardial, it may sometimes be difficult to locate the site of the VA origin. Meticulous mapping in multiple different locations such as the right and left ventricular outflow tracts, endocardial and epicardial sites, and above and below the aortic and pulmonic valves may be required to achieve successful catheter ablation of those VAs. Special ablation techniques may be considered to improve the outcome of catheter ablation of intramural and epicardial VAs.
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Affiliation(s)
- Takumi Yamada
- Cardiovascular Division, University of Minnesota, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA.
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40
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Gulletta S, Gasperetti A, Schiavone M, Paglino G, Vergara P, Compagnucci P, Bisceglia C, Cireddu M, Fierro N, D’Angelo G, Sala S, Rampa L, Casella M, Mazzone P, Dello Russo A, Forleo GB, Della Bella P. Long-Term Follow-Up of Catheter Ablation for Premature Ventricular Complexes in the Modern Era: The Importance of Localization and Substrate. J Clin Med 2022; 11:jcm11216583. [PMID: 36362811 PMCID: PMC9654324 DOI: 10.3390/jcm11216583] [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: 09/01/2022] [Revised: 10/24/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Large-scale studies evaluating long-term recurrence rates in both idiopathic and non-idiopathic PVC catheter ablation (CA) patients have not been reported. Objective: To evaluate the efficacy and safety of idiopathic and non-idiopathic PVC CA, investigating the predictors of acute and long-term efficacy. Methods: This retrospective multicentric study included 439 patients who underwent PVC CA at three institutions from April-2015 to December-2021. Clinical success at 6 months’ follow-up, defined as a reduction of at least 80% of the pre-procedural PVC burden, was deemed the primary outcome. The secondary aims of the study were: clinical success at the last available follow-up, predictors of arrhythmic recurrences at long-term follow-up, and safety outcomes. Results: The median age was 51 years, with 24.9% patients being affected suffering from structural heart disease. The median pre-procedural PVC burden was 20.1%. PVCs originating from the RVOT were the most common index PVC observed (29.1%), followed by coronary cusp (CC) and non-outflow tract (OT) LV PVCs (23.1% and 19.0%). The primary outcome at 6 months was reached in 85.1% cases, with a significant reduction in the 24 h% PVC burden (−91.4% [−83.4; −96.7], p < 0.001); long-term efficacy was observed in 82.1% of cases at almost 3-year follow-up. The presence of underlying structural heart disease and non-OT LV region origin (aHR 1.77 [1.07−2.93], p = 0.027 and aHR = 1.96 [1.22−3.14], p = 0.005) was independently associated with recurrences. Conclusion: CA of both idiopathic and non-idiopathic PVCs showed a very good acute and long-term procedural success rate, with an overall low complication. Predictors of arrhythmic recurrence at follow-up were underlying structural heart disease and non-OT LV origin.
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Affiliation(s)
- Simone Gulletta
- Department of Arrhythmology, San Raffaele Hospital, 20132 Milan, MI, Italy
- Correspondence:
| | - Alessio Gasperetti
- Cardiology Unit, Luigi Sacco University Hospital, 20157 Milan, MI, Italy
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Marco Schiavone
- Cardiology Unit, Luigi Sacco University Hospital, 20157 Milan, MI, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, RM, Italy
| | - Gabriele Paglino
- Department of Arrhythmology, San Raffaele Hospital, 20132 Milan, MI, Italy
| | - Pasquale Vergara
- Department of Arrhythmology, San Raffaele Hospital, 20132 Milan, MI, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital Umberto-I-Salesi-Lancisi, 60123 Ancona, AN, Italy
| | - Caterina Bisceglia
- Department of Arrhythmology, San Raffaele Hospital, 20132 Milan, MI, Italy
| | - Manuela Cireddu
- Department of Arrhythmology, San Raffaele Hospital, 20132 Milan, MI, Italy
| | - Nicolai Fierro
- Department of Arrhythmology, San Raffaele Hospital, 20132 Milan, MI, Italy
| | - Giuseppe D’Angelo
- Department of Arrhythmology, San Raffaele Hospital, 20132 Milan, MI, Italy
| | - Simone Sala
- Department of Arrhythmology, San Raffaele Hospital, 20132 Milan, MI, Italy
| | - Lorenzo Rampa
- Department of Arrhythmology, San Raffaele Hospital, 20132 Milan, MI, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital Umberto-I-Salesi-Lancisi, 60123 Ancona, AN, Italy
| | - Patrizio Mazzone
- Department of Arrhythmology, San Raffaele Hospital, 20132 Milan, MI, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital Umberto-I-Salesi-Lancisi, 60123 Ancona, AN, Italy
| | | | - Paolo Della Bella
- Department of Arrhythmology, San Raffaele Hospital, 20132 Milan, MI, Italy
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Ma C, Chen T, Chen Y, Ge J, Han W, Wang Q, Zhong J. Understanding the scope of intracardiac echocardiography in catheter ablation of ventricular arrhythmia. Front Cardiovasc Med 2022; 9:1037176. [PMID: 36386380 PMCID: PMC9650380 DOI: 10.3389/fcvm.2022.1037176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/14/2022] [Indexed: 01/03/2024] Open
Abstract
Over the last few decades, catheter ablation has emerged as the first-line treatment for ventricular arrhythmias. However, detailed knowledge of cardiac anatomy during the surgery remains the prerequisite for successful ablation. Intracardiac echocardiography (ICE) is a unique imaging technique, which provides real-time visualization of cardiac structures, and is superior to other imaging modalities in terms of precise display of cardiac tissue characteristics as well as the orientation of anatomical landmarks. This article aimed to introduce the various advantages and limitations of ICE in the ablation of ventricular arrhythmias.
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Affiliation(s)
- Chuanzhen Ma
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tongshuai Chen
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yanbo Chen
- Department of Cardiology, Weifang People’s Hospital, Weifang, China
| | - Junye Ge
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenqiang Han
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qinhong Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jingquan Zhong
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
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Retrograde coronary venous ethanol ablation of ventricular tachycardia in a patient after aortic valve replacement and failed both radiofrequency ablation and stereotactic radiotherapy. HeartRhythm Case Rep 2022; 9:2-5. [PMID: 36685688 PMCID: PMC9845546 DOI: 10.1016/j.hrcr.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Doste R, Lozano M, Jimenez-Perez G, Mont L, Berruezo A, Penela D, Camara O, Sebastian R. Training machine learning models with synthetic data improves the prediction of ventricular origin in outflow tract ventricular arrhythmias. Front Physiol 2022; 13:909372. [PMID: 36035489 PMCID: PMC9412034 DOI: 10.3389/fphys.2022.909372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
In order to determine the site of origin (SOO) in outflow tract ventricular arrhythmias (OTVAs) before an ablation procedure, several algorithms based on manual identification of electrocardiogram (ECG) features, have been developed. However, the reported accuracy decreases when tested with different datasets. Machine learning algorithms can automatize the process and improve generalization, but their performance is hampered by the lack of large enough OTVA databases. We propose the use of detailed electrophysiological simulations of OTVAs to train a machine learning classification model to predict the ventricular origin of the SOO of ectopic beats. We generated a synthetic database of 12-lead ECGs (2,496 signals) by running multiple simulations from the most typical OTVA SOO in 16 patient-specific geometries. Two types of input data were considered in the classification, raw and feature ECG signals. From the simulated raw 12-lead ECG, we analyzed the contribution of each lead in the predictions, keeping the best ones for the training process. For feature-based analysis, we used entropy-based methods to rank the obtained features. A cross-validation process was included to evaluate the machine learning model. Following, two clinical OTVA databases from different hospitals, including ECGs from 365 patients, were used as test-sets to assess the generalization of the proposed approach. The results show that V2 was the best lead for classification. Prediction of the SOO in OTVA, using both raw signals or features for classification, presented high accuracy values (>0.96). Generalization of the network trained on simulated data was good for both patient datasets (accuracy of 0.86 and 0.84, respectively) and presented better values than using exclusively real ECGs for classification (accuracy of 0.84 and 0.76 for each dataset). The use of simulated ECG data for training machine learning-based classification algorithms is critical to obtain good SOO predictions in OTVA compared to real data alone. The fast implementation and generalization of the proposed methodology may contribute towards its application to a clinical routine.
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Affiliation(s)
- Ruben Doste
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Miguel Lozano
- Computational Multiscale Simulation Lab (CoMMLab), Department of Computer Science, Universitat de Valencia, Valencia, Spain
| | - Guillermo Jimenez-Perez
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Lluis Mont
- Arrhythmia Section, Cardiology Department, Cardiovascular Clinical Institute, Hospital Clínic, Universitat de Barcelona - IDIBAPS, Barcelona, Spain
| | - Antonio Berruezo
- Cardiology Department, Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Diego Penela
- Cardiology Department, Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Oscar Camara
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Rafael Sebastian
- Computational Multiscale Simulation Lab (CoMMLab), Department of Computer Science, Universitat de Valencia, Valencia, Spain
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Shirai Y, Goya M, Sasaki T, Nagasawa R, Toya C, Hayasaka K, Sugiyama K, Shimizu S, Yamamoto T, Nishimura T, Tao S, Takigawa M, Miyazaki S, Sasano T. Usefulness of the over-the-wire microelectrodes catheter in treatment of ventricular arrhythmia arising from the left ventricular summit. Pacing Clin Electrophysiol 2022; 45:1141-1150. [PMID: 35665518 DOI: 10.1111/pace.14542] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/23/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study was aimed to investigate efficacy of the over-the-wire (OTW) microelectrodes catheter in coronary venous system (CVS) mapping and treatment of outflow tract ventricular arrhythmia (OTVA) arising from the vicinity of the left ventricular summit (LVS). METHODS Consecutive 62 patients with idiopathic OTVA in whom the OTW microelectrodes catheter was routinely used for CVS mapping were analyzed. CVS mapping was performed for both main trunk (from great cardiac vein to anterior interventricular vein) and branches including annular branch or septal branch. RESULTS The earliest activation site (EAS) was within the CVS in 21 patients. Among them, the EAS was within the main trunk of the CVS in 7 (33%) and within the branch of the CVS in 14 (67%) patients. Radiofrequency catheter ablation was started at an anatomically adjacent site to the EAS, which eliminated OTVA in 16 (76%) patients (the endocardial LVOT in 10 and the aortic sinus of Valsalva in 6 patients). For the remaining 5 patients with unsuccessful catheter ablation at an anatomically adjacent site, targeted OTVA was eliminated by catheter ablation at the EAS within the CVS in 2 patients and by chemical ablation with ethanol injection in 1 patient, resulting in overall success rate of 90% (19/21). CONCLUSION The OTW microelectrodes-guided ablation of OTVA from the vicinity of the LVS was effective. In maximizing the efficacy of ablation, CVS branch mapping is important since the earliest activation was commonly recorded not in the main trunk but within the branch of the CVS. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yasuhiro Shirai
- Department of Cardiology, National Disaster Medical Center, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Sasaki
- Department of Cardiology, National Disaster Medical Center, Tokyo, Japan
| | - Ryo Nagasawa
- Department of Cardiology, National Disaster Medical Center, Tokyo, Japan
| | - Chisashi Toya
- Department of Cardiology, National Disaster Medical Center, Tokyo, Japan
| | - Kazuto Hayasaka
- Department of Cardiology, National Disaster Medical Center, Tokyo, Japan
| | - Koji Sugiyama
- Department of Cardiology, National Disaster Medical Center, Tokyo, Japan
| | - Shigeo Shimizu
- Department of Cardiology, National Disaster Medical Center, Tokyo, Japan
| | - Tasuku Yamamoto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuro Nishimura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Susumu Tao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masateru Takigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Chang TY, Chen KW, Liu CM, Chang SL, Lin YJ, Lo LW, Hu YF, Chung FP, Lin CY, Kuo L, Chen SA. A High-Precision Deep Learning Algorithm to Localize Idiopathic Ventricular Arrhythmias. J Pers Med 2022; 12:jpm12050764. [PMID: 35629186 PMCID: PMC9145898 DOI: 10.3390/jpm12050764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/30/2022] [Accepted: 05/06/2022] [Indexed: 12/04/2022] Open
Abstract
Background: An accurate prediction of ventricular arrhythmia (VA) origins can optimize the strategy of ablation, and facilitate the procedure. Objective: This study aimed to develop a machine learning model from surface ECG to predict VA origins. Methods: We obtained 3628 waves of ventricular premature complex (VPC) from 731 patients. We chose to include all signal information from 12 ECG leads for model input. A model is composed of two groups of convolutional neural network (CNN) layers. We chose around 13% of all the data for model testing and 10% for validation. Results: In the first step, we trained a model for binary classification of VA source from the left or right side of the chamber with an area under the curve (AUC) of 0.963. With a threshold of 0.739, the sensitivity and specification are 90.7% and 92.3% for identifying left side VA. Then, we obtained the second model for predicting VA from the LV summit with AUC is 0.998. With a threshold of 0.739, the sensitivity and specificity are 100% and 98% for the LV summit. Conclusions: Our machine learning algorithm of surface ECG facilitates the localization of VPC, especially for the LV summit, which might optimize the ablation strategy.
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Affiliation(s)
- Ting-Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan
| | - Ke-Wei Chen
- Department of BioMedical Engineering, National Cheng Kung University, Tainan City 701401, Taiwan;
| | - Chih-Min Liu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Correspondence: ; Tel.: +886-2-7735-3832; Fax: +886-2-2872-4082
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Ling Kuo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (T.-Y.C.); (C.-M.L.); (Y.-J.L.); (L.-W.L.); (Y.-F.H.); (F.-P.C.); (C.-Y.L.); (L.K.); (S.-A.C.)
- Institute of Cardiovascular Research, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan
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This was…outflow tract ventricular arrhythmia non-contact balloon guided ablation. Rev Port Cardiol 2022; 41:495-497. [DOI: 10.1016/j.repc.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Garg L, Daubert T, Lin A, Dhakal B, Santangeli P, Schaller R, Hyman MC, Kumareswaran R, Arkles J, Nazarian S, Lin D, Riley MP, Supple GE, Frankel DS, Zado E, Callans DJ, Marchlinski FE, Dixit S. Utility of Prolonged Duration Endocardial Ablation for Ventricular Arrhythmias Originating From the Left Ventricular Summit. JACC Clin Electrophysiol 2022; 8:465-476. [PMID: 35450601 DOI: 10.1016/j.jacep.2021.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/02/2021] [Accepted: 12/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study sought to explore whether prolonged duration (PD) radiofrequency ablation (RFA) from adjacent endocardial locations can improve catheter ablation (CA) outcomes of left ventricular summit (LVS) ventricular arrhythmias (Vas). BACKGROUND CA of VAs originating from the LVS region can be challenging. METHODS Patients undergoing CA of LVS VAs from January 1, 2015, to December 31, 2019, were included. Standard RFA approach involved incremental power titration (20-45 W) over 60-120 seconds with irrigated tip catheter to achieve 10%-12% impedance drop. Prolonged duration RFA involved similar power titration; however, lesion application was extended beyond 120 seconds (maximum 5 minutes). Lesions were confined to lowest aspect of aortic cusps and/or subvalvular LV outflow tract region (≤0.5 cm from the valve). Procedural success was defined as suppression of VA ≥30 minutes postablation and clinical success as no arrhythmia symptoms on follow-up and >80% reduction of VA burden on postprocedure monitor. RESULTS This study included 102 patients (60±14 years old, 62% male): standard RFA in 80 and PD RFA in 38. Procedural success was achieved in 54 patients with standard and 32 patients with PD RFA (68% vs 84%; P = 0.05). Short-term clinical success was achieved in 48 patients (60%) with standard and 30 patients (79%) with PD RFA (P = 0.04). Two pericardial effusions occurred (1 in each group) and no steam pops were noted. Patients in whom standard RFA was successful were more likely to have R/S ratio >1 or absence of qS in lead I (odds ratio: 3.35; 95% CI: 1.20-9.35; P = 0.03). CONCLUSIONS Prolonged duration RFA from adjacent endocardial locations is a safe and effective technique for successfully targeting challenging LVS VAs that fail standard RFA.
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Affiliation(s)
- Lohit Garg
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas Daubert
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aung Lin
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Bishnu Dhakal
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert Schaller
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew C Hyman
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ramanan Kumareswaran
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey Arkles
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saman Nazarian
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Lin
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael P Riley
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory E Supple
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David S Frankel
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica Zado
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Callans
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay Dixit
- Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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It Takes Perseverance to Reach the Summit. JACC Clin Electrophysiol 2022; 8:477-479. [PMID: 35450602 DOI: 10.1016/j.jacep.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/20/2022]
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Guandalini GS, Santangeli P, Schaller R, Pothineni NVK, Briceño DF, Enriquez A, Razminia P, Tung R, Marchlinski FE, Garcia FC. Intramyocardial mapping of ventricular premature depolarizations via septal venous perforators: Differentiating the superior intraseptal region from left ventricular summit origins. Heart Rhythm 2022; 19:1475-1483. [DOI: 10.1016/j.hrthm.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 02/25/2022] [Accepted: 03/04/2022] [Indexed: 11/04/2022]
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Larsen T, Winterfield J, Ravi V, Du-Fey-de-Lavallaz JM, Wasserlauf J, Trohman RG, Sharma PS, Huang HD. Comparison of Radiofrequency Ablation from the Coronary Cusps and Endocardial Left Ventricular Outflow Tract for Left Ventricular Summit Ventricular Arrhythmias in a Porcine and Infrared Thermal Model. J Cardiovasc Electrophysiol 2022; 33:551-556. [PMID: 35032079 DOI: 10.1111/jce.15360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/27/2021] [Accepted: 11/28/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The coronary cusps (CCs) are utilized as an alternative vantage point for radiofrequency catheter ablation (RFCA) of left ventricular (LV) summit ventricular arrhythmias (VA) but is sometimes a challenge despite favorable activation timing and pace mapping. METHODS Ex-vivo experiments were performed in 12 intact porcine hearts submerged in a 37o C saline bath. RF applications were delivered with an irrigated contact force sensing catheter oriented 45o to the endocardial LVOT surface and nadir of the CCs using different dosing parameters. Sections were stained in 2% triphenyltetrazolium chloride and lesion dimensions were measured. Thermal infrared imaging analysis was used to compare time-to-lethal tissue temperature and depth/area of lethal isotherms. RESULTS A total of 60 RF applications were performed under different dosing parameters for (1) 30, 40, and 50 Watts (W) x 30 seconds and (2) 40W x 30, 45, and 60 seconds. Lesion depth was greater with RFCA from LVOT than from the CCs (maximum depth 6.11 mm vs 2.68 mm). Longer RF duration led to larger lesion volume in the CC group (40Wx30 sec: 8.1±0.4 vs. 40Wx60 sec: 10.1±0.96 mm; p=0.002). One steam pop occurred in both the LVOT (50Wx30 seconds) and CC groups (40Wx60 seconds). Time-to-reach lethal temperature of 58 o C was longer in the CC group than the LVOT group (4.7 vs. 11.3 seconds; p=0.02) CONCLUSIONS: RFCA from the CC led comparatively to shallower lesion depth than from the LVOT. Longer RF duration led to an increase in lesion volume during ablation from CCs. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Timothy Larsen
- Department of Cardiology, Section of Electrophysiology, Rush University Medical Center, Chicago, IL
| | - Jeffrey Winterfield
- Department of Cardiology, Section of Electrophysiology, Medical University of South Carolina, Charleston, SC
| | - Venkatesh Ravi
- Department of Cardiology, Section of Electrophysiology, Rush University Medical Center, Chicago, IL
| | | | - Jeremiah Wasserlauf
- Department of Cardiology, Section of Electrophysiology, Rush University Medical Center, Chicago, IL
| | - Richard G Trohman
- Department of Cardiology, Section of Electrophysiology, Rush University Medical Center, Chicago, IL
| | - Parikshit S Sharma
- Department of Cardiology, Section of Electrophysiology, Rush University Medical Center, Chicago, IL
| | - Henry D Huang
- Department of Cardiology, Section of Electrophysiology, Rush University Medical Center, Chicago, IL
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