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Ehdaie A, Ramireddy A, Joshi S, Reyes KR, Aliyari A, Cuk N, Lerner J, Yousefian O, Bresee C, Cingolani E, Braunstein E, Wang X, Chugh SS, Shehata M. Spatial analysis and characteristics of persistent late potentials after ablation of scar-related VT substrate: Implications for late potential elimination as a procedural endpoint with high-resolution mapping. Heart Rhythm 2024:S1547-5271(24)03135-7. [PMID: 39142547 DOI: 10.1016/j.hrthm.2024.08.017] [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: 04/25/2024] [Revised: 07/19/2024] [Accepted: 08/07/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Late potential (LP) elimination has been proposed as a surrogate endpoint for scar-related ventricular tachycardia (VT) ablation procedures. The characteristics, distribution, and predictors of persistent late potentials (pLPs) after ablation have not been studied. OBJECTIVE The purpose of this study was to characterize the spatial distribution and features of pLP after catheter ablation of VT substrate with high-resolution mapping. METHODS Cases of scar-related VT ablation with adequate pre- and postablation electroanatomic maps (EAMs) acquired exclusively using a high-density grid catheter were reviewed from 2021 to 2023. RESULTS A total of 62 EAMs (pre- and postablation) from 31 cases using a high-density grid catheter were reviewed. pLPs were observed in 19 cases (61%) after ablation. New LP, spatially distinct from preablation LP, at the periphery of the ablation area comprised the majority of pLPs (16/19 [84%]). Isolated pLPs were more prevalent than fractionated pLPs, with a median amplitude of 0.26 mV (0.09-0.59 mV). The presence of pLP was associated with a significantly lower left ventricular ejection fraction (LVEF) and septal ablation but not low voltage, LP, or ablation area compared to absence of pLP (22.8% ± 7.8% vs 31.5% ± 8.0%, P = .008 for LVEF; 83% vs 44%, P = .033 for septal ablation). CONCLUSION Formation of spatially distinct new LP after targeted VT ablation is common, especially in patients with lower LVEF and septal substrate independent of ablation burden. This finding highlights the limitations of complete LP elimination as an endpoint to VT ablation procedures.
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Affiliation(s)
- Ashkan Ehdaie
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California.
| | - Archana Ramireddy
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | | | - Klevin R Reyes
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Ayda Aliyari
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Natasha Cuk
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Jonathan Lerner
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Omid Yousefian
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Catherine Bresee
- Biostatistics Shared Resource, Cedars Sinai Medical Center, Los Angeles, California
| | - Eugenio Cingolani
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Eric Braunstein
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Xunzhang Wang
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Sumeet S Chugh
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Michael Shehata
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
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2
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Bisceglia C, Limite LR, Baratto F, D'Angelo G, Cireddu M, Della Bella P. Road-Map to Epicardial Approach for Catheter Ablation of Ventricular Tachycardia in Structural Heart Disease: Results From a 10-Year Tertiary-Center Experience. Circ Arrhythm Electrophysiol 2024; 17:e012181. [PMID: 38836351 DOI: 10.1161/circep.123.012181] [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: 05/31/2023] [Accepted: 05/14/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Epicardial approach in ventricular tachycardia (VT) ablation is still regarded as a second-step strategy, due to the risk of complications. We evaluated the frequency that epicardial ablation targets were identified and ablation performed following pericardial access compared with unnecessary pericardial access for different VT causes and potential markers of epicardial VT. METHODS All VT ablation procedures including epicardial approach over a 10-year period were included. First-line epicardial approach was indicated in arrhythmogenic right ventricular cardiomyopathy (ARVC) and postmyocarditis VT; in patients with idiopathic dilated cardiomyopathy (IDCM) and postmyocardial infarction, indications resulted from available imaging techniques or 12-lead VT morphology. The epicardial approach was considered useful if epicardial ablation was performed after epicardial mapping. Feasibility, complications, and long-term outcome were reported. RESULTS Four hundred and eighty-eight subjects with a median age of 60 years (interquartile range, 47-65) and of left ventricle ejection fraction 41% (interquartile range, 30-55) underwent 626 epicardial VT ablations. Percutaneous access had a success rate of 92.2% and a complication rate of 3.6%. Overall, epicardial approach was, respectively, indicated to 11.8% of postmyocardial infarction patients, 49.5% in IDCM, 94% in myocarditis, and 90.7% in ARVC. Epicardial ablation at the first ablation attempt was performed in 9.3% of postmyocardial infarction patients, 28.8% in IDCM, 86.5% in myocarditis, and 81.3% in patients with ARVC. In first-line epicardial group, ARVC and myocarditis showed the highest odds for epicardial ablation (OR, 4.057 [95% CI, 1.299-8.937]; P=0.007; OR, 3.971 [95% CI, 1.376-11.465]; P=0.005, respectively). IDCM independently predicted unnecessary epicardial approach (OR, 2.7 [95% CI, 1.7-4.3]; P<0.001). After a follow-up of 41 months (interquartile range, 19-64), patients with IDCM experienced higher rate of recurrences and mortality compared with other causes. CONCLUSIONS Epicardial approach is integral part of ablation armamentarium regardless of the VT cause, with high feasibility and low complication rate in experienced centers. Our data support its use at first ablation attempt in VTs related to ARVC and myocarditis.
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Affiliation(s)
- Caterina Bisceglia
- Arrhythmia Unit and EP laboratories, San Raffaele Hospital, Milan, Italy
| | - Luca R Limite
- Arrhythmia Unit and EP laboratories, San Raffaele Hospital, Milan, Italy
| | - Francesca Baratto
- Arrhythmia Unit and EP laboratories, San Raffaele Hospital, Milan, Italy
| | - Giuseppe D'Angelo
- Arrhythmia Unit and EP laboratories, San Raffaele Hospital, Milan, Italy
| | - Manuela Cireddu
- Arrhythmia Unit and EP laboratories, San Raffaele Hospital, Milan, Italy
| | - Paolo Della Bella
- Arrhythmia Unit and EP laboratories, San Raffaele Hospital, Milan, Italy
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Guichard JB, Regany-Closa M, Vázquez-Calvo S, Zazu B, Pellicer Sendra B, Serrano-Campaner J, Molero-Pereira S, Borràs R, Ortiz JT, Falzone PV, Eulogio F, Reventos-Presmanes J, Garre P, Arbelo E, Althoff TF, Guasch E, Tolosana JM, Brugada J, Mont L, Porta-Sánchez A, Roca-Luque I. Substrate Mapping for Ventricular Tachycardia Ablation Through High-Density Whole-Chamber Double Extra Stimuli: The S3 Protocol. JACC Clin Electrophysiol 2024; 10:1534-1547. [PMID: 38819348 DOI: 10.1016/j.jacep.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND A partial delineation of targets for ablation of ventricular tachycardia (VT) during a stable rhythm is likely responsible for a suboptimal success rate. The abnormal low-voltage near-field functional components may be hidden within the high-amplitude far-field signal. OBJECTIVES The aim of this study was to evaluate the benefit and feasibility of functional substrate mapping using a full-ventricle S3 protocol and to assess its colocalization with arrhythmogenic conducting channels (CCs) on late gadolinium enhancement cardiac magnetic resonance. METHODS An S3 mapping protocol with a drive train of S1 followed by S2 (effective refractory period + 30 ms) and S3 (effective refractory period + 50 ms) from the right ventricular apex was performed in 40 consecutive patients undergoing scar-related VT ablation. Deceleration zones (DZs) and areas of late potentials (LPs) were identified for all maps. A preprocedural noninvasive substrate assessment was done using late gadolinium enhancement cardiac magnetic resonance and postprocessing with automated CC identification. RESULTS The S3 protocol was completed in 34 of the 40 procedures (85.0%). The S3 protocol enhanced the identification of VT isthmus on the basis of DZ (89% vs 62%; P < 0.01) and LP (93% vs 78%; P = 0.04) assessment. The percentage of CCs unmasked by DZs and LPs using S3 maps was significantly higher than the ones using S2 and S1 maps (78%, 65%, and 48% [P < 0.001] and 88%, 81%, and 68% [P < 0.01], respectively). The functional substrate identified during S3 activation mapping was significantly more extensive than the one identified using S2 and S1, including a greater number of DZs (2.94, 2.47, and 1.82, respectively; P < 0.001) and a wider area of LPs (44.1, 38.2, and 29.4 cm2, respectively; P < 0.001). After VT ablation, 77.9% of patients have been VT free during a median follow-up period of 13.6 months. CONCLUSIONS The S3 protocol was feasible in 85% of patients, allows a better identification of targets for ablation, and might improve VT ablation results.
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Affiliation(s)
- Jean-Baptiste Guichard
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain; INSERM, SAINBIOSE U1059, University Hospital of Saint-Étienne, Saint-Étienne, France; Cardiology Department, University Hospital of Saint-Étienne, Saint-Étienne, France
| | - Mariona Regany-Closa
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sara Vázquez-Calvo
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Blanca Zazu
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Berta Pellicer Sendra
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jaume Serrano-Campaner
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sílvia Molero-Pereira
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Roger Borràs
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red e Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - José Tomás Ortiz
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Pasquale Valerio Falzone
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Frida Eulogio
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jana Reventos-Presmanes
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; ITACA Institute, Universitat Politècnica de València, Valencia, Spain
| | - Paz Garre
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Elena Arbelo
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Till F Althoff
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Eduard Guasch
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Jose María Tolosana
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Josep Brugada
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Lluís Mont
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Andreu Porta-Sánchez
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Ivo Roca-Luque
- Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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4
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Santangeli P, Higuchi K, Sroubek J. Ventricular Tachycardia Ablation Endpoints: Moving Beyond Noninducibility. JACC Clin Electrophysiol 2024; 10:981-999. [PMID: 38385913 DOI: 10.1016/j.jacep.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/08/2023] [Accepted: 12/30/2023] [Indexed: 02/23/2024]
Abstract
In patients with structural heart disease and ventricular tachycardia (VT) undergoing catheter ablation, the response to programmed electrical stimulation (PES) at the end of the procedure has been traditionally used to evaluate the acute success and predict long-term outcomes. Although noninducibility at PES has been extensively investigated and validated in clinical trials and large multicenter registries, its performance in predicting long-term freedom from VT is suboptimal. In addition, PES has inherent limitations related to the influence of background antiarrhythmic drug therapy, periprocedural use of anesthesia, and the heterogeneity in PES protocols. The increased utilization of substrate-based ablation approaches that focus on ablation of abnormal electrograms identified with mapping in sinus or paced rhythm has been paralleled by a need for additional procedural endpoints beyond VT noninducibility at PES. This article critically appraises the relative merits and limitations of different procedural endpoints according to different ablation techniques for catheter ablation of scar-related VT.
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Affiliation(s)
- Pasquale Santangeli
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Koji Higuchi
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jakub Sroubek
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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5
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Sławiński G, Hawryszko M, Dyda-Kristowska J, Królak T, Kempa M, Świetlik D, Kozłowski D, Daniłowicz-Szymanowicz L, Lewicka E. Clinical and Laboratory Predictors of Long-Term Outcomes after Catheter Ablation for a Ventricular Electrical Storm. J Interv Cardiol 2024; 2024:5524668. [PMID: 38352195 PMCID: PMC10861284 DOI: 10.1155/2024/5524668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/28/2023] [Accepted: 12/08/2023] [Indexed: 02/16/2024] Open
Abstract
Background Ventricular electrical storm (VES) is characterized by the occurrence of multiple episodes of sustained ventricular arrhythmias (VA) over a short period of time. Radiofrequency ablation (RFA) has been reported as an effective treatment in patients with ventricular tachycardia (VT). Objective The aim of the present study was to indicate the short-term and long-term predictors of recurrent VA after RFA was performed due to VES. Methods A retrospective, single-centre study included patients, who had undergone RFA due to VT between 2012 and 2021. In terms of the short-term (at the end of RFA) effectiveness of RFA, the following scenarios were distinguished: complete success: inability to induce any VT; partial success: absence of clinical VT; failure: inducible clinical VT. In terms of the long-term (12 months) effectiveness of RFA, the following scenarios were distinguished: effective ablation: no recurrence of any VT; partially successful ablation: VT recurrence; ineffective ablation: VES recurrence. Results The study included 62 patients. Complete short-term RFA success was obtained in 77.4% of patients. The estimated cumulative VT-free survival and VES-free survival were, respectively, 28% and 33% at the 12-month follow-up. Ischemic cardiomyopathy and complete short-term RFA success were predictors of long-term RFA efficacy. Neutrophil to lymphocyte ratio (NLR) and GFR <60 mL/min/1.73 m2 were associated with VES recurrence. NLR ≥2.95 predicted VT and/or VES recurrence with a sensitivity of 66.7% and specificity of 72.2%. Conclusion Ischemic cardiomyopathy and short-term complete success of RFA were predictors of no VES recurrence during the 12-month follow-up, while NLR and GFR <60 ml/min/1.73 m2 were associated with VES relapse.
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Affiliation(s)
- Grzegorz Sławiński
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Smoluchowskiego 17 Street, 80-214 Gdańsk, Poland
| | - Maja Hawryszko
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Smoluchowskiego 17 Street, 80-214 Gdańsk, Poland
| | - Julia Dyda-Kristowska
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Smoluchowskiego 17 Street, 80-214 Gdańsk, Poland
| | - Tomasz Królak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Smoluchowskiego 17 Street, 80-214 Gdańsk, Poland
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Smoluchowskiego 17 Street, 80-214 Gdańsk, Poland
| | - Dariusz Świetlik
- Division of Biostatistics and Neural Networks, Medical University of Gdańsk, Dębinki 1 Street, 80-211 Gdansk, Poland
| | - Dariusz Kozłowski
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Smoluchowskiego 17 Street, 80-214 Gdańsk, Poland
| | - Ludmiła Daniłowicz-Szymanowicz
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Smoluchowskiego 17 Street, 80-214 Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Smoluchowskiego 17 Street, 80-214 Gdańsk, Poland
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6
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Kasai Y, Kitai T, Morita J, Okada T, Kasai J, Fujita T. Successful, urgent, single-stage endo-epicardial catheter ablation with a surgically subxiphoid pericardial window for a drug-resistant ventricular tachycardia storm in an extremely old hemodialysis patient with ischemic cardiomyopathy. HeartRhythm Case Rep 2023; 9:736-740. [PMID: 38047188 PMCID: PMC10691947 DOI: 10.1016/j.hrcr.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- Yuhei Kasai
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Takayuki Kitai
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Junji Morita
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Takuya Okada
- Department of Clinical Engineering, Sapporo Cardiovascular Clinic, Sapporo, Japan
| | - Jungo Kasai
- Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, Washington
| | - Tsutomu Fujita
- Department of Cardiology, Sapporo Cardiovascular Clinic, Sapporo, Japan
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7
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Marashly Q, Najjar SN, Hahn J, Rector GJ, Khawaja M, Chelu MG. Innovations in ventricular tachycardia ablation. J Interv Card Electrophysiol 2023; 66:1499-1518. [PMID: 35879516 DOI: 10.1007/s10840-022-01311-z] [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: 02/21/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
Catheter ablation of ventricular arrhythmias (VAs) has evolved significantly over the past decade and is currently a well-established therapeutic option. Technological advances and improved understanding of VA mechanisms have led to tremendous innovations in VA ablation. The purpose of this review article is to provide an overview of current innovations in VA ablation. Mapping techniques, such as ultra-high density mapping, isochronal late activation mapping, and ripple mapping, have provided improved arrhythmogenic substrate delineation and potential procedural success while limiting duration of ablation procedure and potential hemodynamic compromise. Besides, more advanced mapping and ablation techniques such as epicardial and intramyocardial ablation approaches have allowed operators to more precisely target arrhythmogenic substrate. Moreover, advances in alternate energy sources, such as electroporation, as well as stereotactic radiation therapy have been proposed to be effective and safe. New catheters, such as the lattice and the saline-enhanced radiofrequency catheters, have been designed to provide deeper and more durable tissue ablation lesions compared to conventional catheters. Contact force optimization and baseline impedance modulation are important tools to optimize VT radiofrequency ablation and improve procedural success. Furthermore, advances in cardiac imaging, specifically cardiac MRI, have great potential in identifying arrhythmogenic substrate and evaluating ablation success. Overall, VA ablation has undergone significant advances over the past years. Innovations in VA mapping techniques, alternate energy source, new catheters, and utilization of cardiac imaging have great potential to improve overall procedural safety, hemodynamic stability, and procedural success.
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Affiliation(s)
- Qussay Marashly
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Salim N Najjar
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA
| | - Joshua Hahn
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA
| | - Graham J Rector
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA
| | - Muzamil Khawaja
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA
| | - Mihail G Chelu
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA.
- Baylor St. Luke's Medical Center, Houston, USA.
- Texas Heart Institute, Houston, USA.
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8
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Rossi P, Cauti FM, Niscola M, Magnocavallo M, Polselli M, Capone S, Della Rocca DG, Rodriguez-Garrido J, Piccirillo G, Anguera I, Dallaglio P, Bianchi S. Ventricular Electrograms Duration Map to Detect Ventricular Arrhythmia Substrate: the VEDUM Project Study. Circ Arrhythm Electrophysiol 2023; 16:447-455. [PMID: 37485678 PMCID: PMC10786440 DOI: 10.1161/circep.122.011729] [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: 11/22/2022] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The analysis of the wave-front activation patterns is crucial for the comprehension and treatment of ventricular tachycardia (VT). The ventricular electrograms duration map (VEDUM) is a potential method to identify areas (VEDUM area) with slow and inhomogeneous activation. There is no available data on the characteristics and the arrhythmogenic role of VEDUM areas identified during sinus/paced rhythm. METHODS Patients referred for VT ablation were enrolled at 3 different centers. VEDUM maps during sinus/paced rhythm as well as substrate and functional maps were created; activation mapping was performed for all hemodynamically tolerated VT. RESULTS Thirty-two patients (mean age:70.1±9.4 years; males 93.8%) were enrolled. The VEDUM approach was achieved in all patients and the mean size of the VEDUM area was 12.1±6.9 cm2 (interquartile range, 7.8-14.9 cm2). A significative difference was observed between the electrogram duration in the VEDUM area and the normal tissue (163.7 ms [interquartile range, 142.3-199.2 ms]; versus 65.5 ms [interquartile range, 59.5-76.2 ms]; P<0.001). The VEDUM area was visualized in a dense scar (<0.5 mV) in 19 (59.4%) patients. A deceleration zone and late potentials were recorded inside the VEDUM area in 56.3% and 81.3%, respectively. When a complete VT activation mapping was available, the isthmus projected in the VEDUM area in 93.5% of patients; 8 of them had multiple VTs mapped and in the 87.5% all VT isthmuses were included in the VEDUM area. CONCLUSIONS VEDUM maps allow the identification of discrete areas of inhomogeneous and slow conduction. They represent a potential target for VT ablation, including patients with multiple morphologies.
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Affiliation(s)
- Pietro Rossi
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Filippo Maria Cauti
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Marta Niscola
- Abbott Medical Italy, Sesto San Giovanni, Milan, Italy (M.N.)
| | - Michele Magnocavallo
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Marco Polselli
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Silvia Capone
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (D.G.D.R.)
| | | | - Gianfranco Piccirillo
- University of Rome “Sapienza,” Department of Science of Internal Clinics, Anestesiologists & Cardiovasculars, Policlinico Umberto I, Rome, Italy (G.P.)
| | - Ignasi Anguera
- Arrhythmias Unit, Cardiology Department, Bellvitge University Hospital & Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Unstitute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain (I.A., P.D.)
| | - Paolo Dallaglio
- Arrhythmias Unit, Cardiology Department, Bellvitge University Hospital & Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Unstitute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain (I.A., P.D.)
| | - Stefano Bianchi
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy (P.R., F.M.C., M.M., M.P., S.C., S.B.)
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9
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Marin-Neto JA, Rassi A, Oliveira GMM, Correia LCL, Ramos Júnior AN, Luquetti AO, Hasslocher-Moreno AM, Sousa ASD, Paola AAVD, Sousa ACS, Ribeiro ALP, Correia Filho D, Souza DDSMD, Cunha-Neto E, Ramires FJA, Bacal F, Nunes MDCP, Martinelli Filho M, Scanavacca MI, Saraiva RM, Oliveira Júnior WAD, Lorga-Filho AM, Guimarães ADJBDA, Braga ALL, Oliveira ASD, Sarabanda AVL, Pinto AYDN, Carmo AALD, Schmidt A, Costa ARD, Ianni BM, Markman Filho B, Rochitte CE, Macêdo CT, Mady C, Chevillard C, Virgens CMBD, Castro CND, Britto CFDPDC, Pisani C, Rassi DDC, Sobral Filho DC, Almeida DRD, Bocchi EA, Mesquita ET, Mendes FDSNS, Gondim FTP, Silva GMSD, Peixoto GDL, Lima GGD, Veloso HH, Moreira HT, Lopes HB, Pinto IMF, Ferreira JMBB, Nunes JPS, Barreto-Filho JAS, Saraiva JFK, Lannes-Vieira J, Oliveira JLM, Armaganijan LV, Martins LC, Sangenis LHC, Barbosa MPT, Almeida-Santos MA, Simões MV, Yasuda MAS, Moreira MDCV, Higuchi MDL, Monteiro MRDCC, Mediano MFF, Lima MM, Oliveira MTD, Romano MMD, Araujo NNSLD, Medeiros PDTJ, Alves RV, Teixeira RA, Pedrosa RC, Aras Junior R, Torres RM, Povoa RMDS, Rassi SG, Alves SMM, Tavares SBDN, Palmeira SL, Silva Júnior TLD, Rodrigues TDR, Madrini Junior V, Brant VMDC, Dutra WO, Dias JCP. SBC Guideline on the Diagnosis and Treatment of Patients with Cardiomyopathy of Chagas Disease - 2023. Arq Bras Cardiol 2023; 120:e20230269. [PMID: 37377258 PMCID: PMC10344417 DOI: 10.36660/abc.20230269] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- José Antonio Marin-Neto
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Anis Rassi
- Hospital do Coração Anis Rassi , Goiânia , GO - Brasil
| | | | | | | | - Alejandro Ostermayer Luquetti
- Centro de Estudos da Doença de Chagas , Hospital das Clínicas da Universidade Federal de Goiás , Goiânia , GO - Brasil
| | | | - Andréa Silvestre de Sousa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe , São Cristóvão , SE - Brasil
- Hospital São Lucas , Rede D`Or São Luiz , Aracaju , SE - Brasil
| | | | | | | | - Edecio Cunha-Neto
- Universidade de São Paulo , Faculdade de Medicina da Universidade, São Paulo , SP - Brasil
| | - Felix Jose Alvarez Ramires
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Fernando Bacal
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Martino Martinelli Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Maurício Ibrahim Scanavacca
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Magalhães Saraiva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Adalberto Menezes Lorga-Filho
- Instituto de Moléstias Cardiovasculares , São José do Rio Preto , SP - Brasil
- Hospital de Base de Rio Preto , São José do Rio Preto , SP - Brasil
| | | | | | - Adriana Sarmento de Oliveira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Ana Yecê das Neves Pinto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Andre Schmidt
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Andréa Rodrigues da Costa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Barbara Maria Ianni
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Carlos Eduardo Rochitte
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Hcor , Associação Beneficente Síria , São Paulo , SP - Brasil
| | | | - Charles Mady
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Christophe Chevillard
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Marselha - França
| | | | | | | | - Cristiano Pisani
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | - Edimar Alcides Bocchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Evandro Tinoco Mesquita
- Hospital Universitário Antônio Pedro da Faculdade Federal Fluminense , Niterói , RJ - Brasil
| | | | | | | | | | | | - Henrique Horta Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Henrique Turin Moreira
- Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP - Brasil
| | | | | | | | - João Paulo Silva Nunes
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Fundação Zerbini, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | | | | | - Luiz Cláudio Martins
- Universidade Estadual de Campinas , Faculdade de Ciências Médicas , Campinas , SP - Brasil
| | | | | | | | - Marcos Vinicius Simões
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | | | | | - Maria de Lourdes Higuchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Mauro Felippe Felix Mediano
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
| | - Mayara Maia Lima
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | | | | | - Renato Vieira Alves
- Instituto René Rachou , Fundação Oswaldo Cruz , Belo Horizonte , MG - Brasil
| | - Ricardo Alkmim Teixeira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Coury Pedrosa
- Hospital Universitário Clementino Fraga Filho , Instituto do Coração Edson Saad - Universidade Federal do Rio de Janeiro , RJ - Brasil
| | | | | | | | | | - Silvia Marinho Martins Alves
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico Universitário da Universidade de Pernambuco (PROCAPE/UPE), Recife , PE - Brasil
| | | | - Swamy Lima Palmeira
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | - Vagner Madrini Junior
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | - João Carlos Pinto Dias
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
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10
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Nissan J, Sabbag A, Beinart R, Nof E. Inducibility of Multiple Ventricular Tachycardia's during a Successful Ablation Procedure Is a Marker of Ventricular Tachycardia Recurrence. J Clin Med 2023; 12:jcm12113660. [PMID: 37297854 DOI: 10.3390/jcm12113660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Even after a successful ventricular tachycardia ablation (VTA), some patients have recurrent ventricular tachycardia (VT) during their follow-up. We assessed the long-term predictors of recurrent VT after having a successful VTA. The patients who underwent a successful VTA (defined as the non-inducibility of any VT at the procedure's end) in 2014-2021 at our center in Israel were retrospectively analyzed. A total of 111 successful VTAs were evaluated. Out of them, 31 (27.9%) had a recurrent event of VT after the procedure during a median follow-up time of 264 days. The mean left ventricular ejection fraction (LVEF) was significantly lower among patients with recurrent VT events (28.9 ± 12.67 vs. 23.53 ± 12.224, p = 0.048). A high number of induced VTs (>two) during the procedure was found to be a significant predictor of VT recurrence (24.69% vs. 56.67%, 20 vs. 17, p = 0.002). In a multivariate analysis, a lower LVEF (HR, 0.964; p = 0.037) and a high number of induced VTs (HR, 2.15; p = 0.039) were independent predictors of arrhythmia recurrence. The inducibility of more than two VTs during a VTA procedure remains a predictor of VT recurrence even after a successful VT ablation. This group of patients remains at high risk for VT and should be followed up with and treated more vigorously.
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Affiliation(s)
- Johnatan Nissan
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Avi Sabbag
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Roy Beinart
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Eyal Nof
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Ramat Gan 52621, Israel
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11
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de la Guía-Galipienso F, Ugedo-Alzaga K, Grazioli G, Quesada-Ocete FJ, Feliu-Rey E, Perez MV, Quesada-Dorador A, Sanchis-Gomar F. Arrhythmogenic Cardiomyopathy and Athletes - A Dangerous Relationship. Curr Probl Cardiol 2023:101799. [PMID: 37172878 DOI: 10.1016/j.cpcardiol.2023.101799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a disease characterized by a progressive replacement of myocardium by fibro-adipose material, predisposing to ventricular arrhythmias (VA) and sudden cardiac death (SCD). Its prevalence is estimated at 1:2000 to 1:5000, with a higher incidence in males, and clinical onset is usually between the 2nd and 4th decade of life. The prevalence of ACM in SCD victims is relatively high, making it one of the most common etiologies in young patients with SCD, especially if they are athletes. Cardiac events occur more frequently in individuals with ACM who participate in competitive sports and/or high-intensity training. In effect, exercise activity can worsen RV function in cases of hereditary ACM. Estimating the incidence of SCD caused by ACM in athletes remains challenging, being reported frequency ranging from 3-20%. Here, we review the potential implications of exercising on the clinical course of the classical genetic form of ACM, as well as the diagnostic tools, risk stratification, and the different therapeutic tools available for managing ACM.
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Affiliation(s)
- Fernando de la Guía-Galipienso
- From the Glorieta Policlinic, Denia, Alicante, Spain; REMA-Sports Cardiology Clinic, Denia, Alicante, Spain; Cardiology Service, Hospital HCB Benidorm, Alicante, Spain; School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain.
| | | | | | - Francisco Javier Quesada-Ocete
- School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain; Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Eloísa Feliu-Rey
- Magnetic Resonance Unit, Inscanner, General University Hospital of Alicante, Alicante, Spain
| | - Marco V Perez
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Aurelio Quesada-Dorador
- School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain; Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Fabian Sanchis-Gomar
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA..
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12
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Baldazzi G, Orrù M, Viola G, Pani D. Computer-aided detection of arrhythmogenic sites in post-ischemic ventricular tachycardia. Sci Rep 2023; 13:6906. [PMID: 37106017 PMCID: PMC10140038 DOI: 10.1038/s41598-023-33866-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Nowadays, catheter-based ablation in patients with post-ischemic ventricular tachycardia (VT) is performed in arrhythmogenic sites identified by electrophysiologists by visual inspection during electroanatomic mapping. This work aims to present the development of machine learning tools aiming at supporting clinicians in the identification of arrhythmogenic sites by exploiting innovative features that belong to different domains. This study included 1584 bipolar electrograms from nine patients affected by post-ischemic VT. Different features were extracted in the time, time scale, frequency, and spatial domains and used to train different supervised classifiers. Classification results showed high performance, revealing robustness across the different classifiers in terms of accuracy, true positive, and false positive rates. The combination of multi-domain features with the ensemble tree is the most effective solution, exhibiting accuracies above 93% in the 10-time 10-fold cross-validation and 84% in the leave-one-subject-out validation. Results confirmed the effectiveness of the proposed features and their potential use in a computer-aided system for the detection of arrhythmogenic sites. This work demonstrates for the first time the usefulness of supervised machine learning for the detection of arrhythmogenic sites in post-ischemic VT patients, thus enabling the development of computer-aided systems to reduce operator dependence and errors, thereby possibly improving clinical outcomes.
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Affiliation(s)
- Giulia Baldazzi
- Medical Devices and Signal Processing (MeDSP) Lab, Department of Electrical and Electronic Engineering (DIEE), University of Cagliari, Cagliari, Italy.
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy.
| | - Marco Orrù
- Medical Devices and Signal Processing (MeDSP) Lab, Department of Electrical and Electronic Engineering (DIEE), University of Cagliari, Cagliari, Italy
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Graziana Viola
- Department of Cardiology, Santissima Annunziata Hospital, Sassari, Italy
| | - Danilo Pani
- Medical Devices and Signal Processing (MeDSP) Lab, Department of Electrical and Electronic Engineering (DIEE), University of Cagliari, Cagliari, Italy
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13
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Temma T, Lux RL, Yoshie K, Hayase J, Bradfield JS, Shivkumar K, Ajijola OA. The derivative of tissue activation as a marker of arrhythmogenic myocardium. Heart Rhythm 2023; 20:261-271. [PMID: 36270579 DOI: 10.1016/j.hrthm.2022.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Mapping techniques to identify diseased myocardial substrate during ventricular tachycardia ablation procedures remain limited. OBJECTIVE We hypothesized that tissue derivative of the voltage with respect to time (dV/dt), the slope of the unipolar ventricular electrogram registered by local ventricular activation, represents a unique parameter for identifying potential arrhythmogenic tissue in the ischemic scar border zone. METHODS Using high-resolution electrical mapping, we examined dV/dt characteristics in the border zone of animals after chronic myocardial infarction (MI). RESULTS Minimum dV/dt (dV/dtmin) in MI animals was less than that in control animals (-344.7 ± 68.7 in controls vs -174.2 ± 104.5 in MI; P < .001) and related to ventricular fibrosis. In MI animals, dV/dtmin values were divided into high (≤-200 μV/ms) and low (>-200 μV/ms) dV/dtmin. Low dV/dtmin regions harbored arrhythmogenic substrates that were characterized by (1) high responsiveness to sympathetic stimulation, (2) presence of late potentials, and (3) lower unipolar and bipolar voltage amplitudes. CONCLUSION Our data indicate that dV/dtmin is a unique parameter for identifying arrhythmogenic myocardium and may add a useful metric to conventional mapping strategies.
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Affiliation(s)
- Taro Temma
- UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California
| | - Robert L Lux
- Cardiovascular Research and Training Institute, University of Utah, Salt Lake, Utah
| | - Koji Yoshie
- UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California; Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Justin Hayase
- UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Program of Excellence, University of California, Los Angeles, California.
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14
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Nakasone K, Fukuzawa K, Kiuchi K, Takami M, Sakai J, Nakamura T, Yatomi A, Sonoda Y, Takahara H, Yamamoto K, Suzuki Y, Tani K, Iwai H, Nakanishi Y, Hirata K. Predictors of recurrence in patients without non-inducibility of ventricular tachycardia at the end of ablation. J Arrhythm 2023; 39:52-60. [PMID: 36733320 PMCID: PMC9885314 DOI: 10.1002/joa3.12796] [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: 07/15/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background Ventricular tachycardia (VT) non-inducibility at the end of ablation is associated with a less likely VT recurrence. However, it is not clear whether we should use VT non-inducibility as a routine end point of VT ablation. The aim of this study was to evaluate VT recurrence in patients in whom VT non-inducibility was not achieved at the end of the radiofrequency (RF) ablation and the factors attributing to the VT recurrence. Methods We analyzed that 62 patients in whom VT non-inducibility was not achieved at the end of the RF ablation were studied. Results Over 2 years, 22 (35%) of the cases had VT recurrences. A multivariate analysis showed that an LVEF ≥35% (HR: 0.19; 95% CI: 0.06-0.49; p < .01) and elimination of the clinical VT as an acute ablation efficacy (HR: 0.23; 95% CI: 0.04-0.81; p = .02) were independent predictors of fewer VT recurrences. RF ablation was associated with a 91.1% reduction in VT episodes. Conclusion Even if VT non-inducibility was not achieved, patients with an LVEF ≥35% or in whom the clinical VT could be eliminated might be prevented from having VT recurrences. The validity of the VT non-inducibility of any VT should be evaluated considering each patient's background and the results of the procedure.
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Affiliation(s)
- Kazutaka Nakasone
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Koji Fukuzawa
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Kunihiko Kiuchi
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
- Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Mitsuru Takami
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Jun Sakai
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Toshihiro Nakamura
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Atsusuke Yatomi
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yusuke Sonoda
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Hiroyuki Takahara
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Kyoko Yamamoto
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yuya Suzuki
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Ken‐ichi Tani
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Hidehiro Iwai
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yusuke Nakanishi
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Ken‐ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
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15
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Accuracy of standard bipolar amplitude voltage thresholds to identify late potential channels in ventricular tachycardia ablation. J Interv Card Electrophysiol 2023; 66:15-25. [PMID: 35195814 PMCID: PMC9931851 DOI: 10.1007/s10840-022-01148-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Ventricular tachycardia (VT) is caused by the presence of a slow conduction channel (CC) of border zone (BZ) tissue inside the scar-core tissue. Electroanatomic mapping can depict this tissue by voltage mapping. Areas of slow conduction can be detected as late potentials (LPs) and their abolition is the most accepted ablation endpoint. In the current guidelines, bipolar voltage thresholds for BZ and core scar are 1.5 and 0.5 mV respectively. The performance of these values is controversial. The aim of the study is to analyze the diagnostic yield of current amplitude thresholds in voltage map to define VT substrate in terms of CCs of LPs. Predictors of usefulness of current thresholds will be analyzed. METHODS All patients with structural heart disease who underwent VT ablation in Hospital Clinic in 2016-2017 were included. Maps with delineation of CCs based on LPs were created with contact force sensor catheter. Thresholds were adjusted for every patient based on CCs. Diagnostic yield and predictors of performance of conventional thresholds were analyzed. RESULTS During study period, 57 consecutive patients were included (age: 60.4 ± 8.5; 50.2% ischemic cardiomyopathy, LVEF 39.8 ± 13.5%). Cutoff voltages that better identified the scar and BZ according to the LP channels were 0.32 (0.02-2 mV) and 1.84 (0.3-6 mV) respectively. Current voltage thresholds identified correctly core and BZ in 87.7% and 42.1% of the patients respectively. Accuracy was worse in non-ischemic cardiomyopathy (NICM) especially for BZ (28.6% vs 55.2%, p = 0.042). CONCLUSIONS Accuracy of standard voltage thresholds for scar and BZ is poor in terms of LPs detection. Diagnostic yield is worse in NICM patients specially for border zone.
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16
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Nakahara S. Catheter ablation of ventricular tachycardia associated with structural heart disease: Current status and perspectives. J Cardiol 2023; 81:57-62. [PMID: 36174816 DOI: 10.1016/j.jjcc.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022]
Abstract
Catheter ablation is an effective and safe treatment for ventricular tachycardia attributable to structural heart disease, reducing the risk of recurrent arrhythmias and defibrillator shock therapy. Advances in medical technology and an accumulation of data have led to the development of detailed guidelines. Successful ablation requires accurate identification of the arrhythmia substrate and effective delivery of radiofrequency energy to the target tissue. Modern practice requires use of traditional electrophysiological mapping processes such as entrainment mapping and three-dimensional activation sequence mapping in combination with newer functional mapping techniques for which there is growing support. Thorough non-invasive preoperative assessment is also necessary before an invasive procedure is undertaken. In this review, we summarize contemporary practice and recent randomized controlled trials underpinning the latest developments in mapping and ablation and discuss potential future developments in this field.
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Affiliation(s)
- Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan.
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17
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Sex differences on outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease: A real-world systematic review and meta-analysis. Heart Rhythm O2 2022; 3:847-856. [PMID: 36588991 PMCID: PMC9795314 DOI: 10.1016/j.hroo.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Sex differences have diversely affected cardiac diseases. Little is known whether these differences impact outcomes of catheter ablation of ventricular tachycardia (VT). Objectives To assess the impact of sex differences on outcomes of catheter ablation of VT. Methods Databases were searched from inception through December 2021. Effect estimates from individual studies were extracted and combined using the random-effects, generic inverse variance method of DerSimonian and Laird. The outcomes of interest included VT recurrence rates, all-cause mortality, and composite outcomes of mortality, left ventricular assistant device use, and heart transplantation following VT ablation. Results Our analysis included 22 observational studies. There were 10,206 patients, of which 12.8% were women. We found no statistical difference between sexes for VT recurrence rate (pooled hazard ratio [HR] 1.04, P = .57, I 2 = 14.9%). Similarly, there was statistical difference in neither all-cause mortality nor composite outcomes (pooled HR 0.93, P = .75, I 2 = 59.1% and pooled HR 0.9, P = .33, I 2 = 0%, respectively). There was a trend toward an increase in women undergoing VT ablation in the recent registries (P = .071). Conclusion Our contemporary analysis suggests that sex may have no impact on clinical outcomes of catheter ablation of VT in patients with structural heart disease, though women are the underrepresented. However, recent VT ablation registries have involved more women in their studies. Future studies with a higher proportion of women are encouraged to verify the current perception.
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18
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Radinovic A, Peretto G, Sgarito G, Cauti FM, Castro A, Narducci ML, Mantovan R, Scaglione M, Solimene F, Scopinaro A, Tondo C, Filippini G, Bianco E, Bonso A, Calzolari V, Ferraris F, Zardini M, Piacenti M, D'Angelo G, Bosica F, Della Bella P. Matching Ablation Endpoints to Long-Term Outcome: The Prospective Multicenter Italian Ventricular Tachycardia Ablation Registry. JACC Clin Electrophysiol 2022:S2405-500X(22)01046-5. [PMID: 36752462 DOI: 10.1016/j.jacep.2022.10.038] [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: 08/08/2022] [Revised: 10/06/2022] [Accepted: 10/19/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Multicenter ventricular tachycardia (VT) ablation studies have shown poorer outcomes compared with single-center experiences. This difference could be related to heterogeneous mapping and ablation strategies. OBJECTIVES This study evaluated a homogenous simplified catheter ablation strategy for different substrates and compared the results with those of a single referral center. METHODS This was a multicenter prospective VT ablation registry of patients with the following 4 causes of VT: previous myocardial infarction; previous myocarditis; arrhythmogenic right ventricular dysplasia; or idiopathic dilated cardiomyopathy. The procedural protocol included precise mapping and ablation steps with the combined endpoint of late potential (LP) abolition and noninducibility of VT. The long-term primary efficacy endpoint was freedom from VT. RESULTS A total of 309 patients were enrolled. LPs were present in 70% of patients and were abolished in 83%. At the end of the procedure 74% of LPs were noninducible. The primary combined endpoint of LP abolition and noninducibility was achieved in 64% of patients with LPs at baseline. Freedom from VT at 12 months was observed in 67% of patients. In the overall study group, VT inducibility was the only predictor of freedom from VT (P = 0.013). In patients with LPs, the VT recurrence rate was lower both for patients with complete LP abolition (P = 0.040) and for patients meeting the composite endpoint (P = 0.035). CONCLUSIONS A standardized VT mapping and ablation technique reproduced the procedural outcomes of a single referral center in a multicenter prospective study. LP abolition and noninducibility were effective in reducing VT recurrences in patients with 4 causes of cardiomyopathy. (Ventricular Tachycardia Ablation Registry; NCT03649022).
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Affiliation(s)
- Andrea Radinovic
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Giovanni Peretto
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Antonello Castro
- Cardiology unit Pertini Hospital- Azienda USL Roma B, Rome, Italy
| | | | | | | | | | - Alice Scopinaro
- Alessandria Hospital - SS. Antonio, Biagio, Cesare Arrigo, Alessandria, Italy
| | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS Dipartimento di Scienze Biomediche, Chirurgiche e Odontoiatriche Università degli Studi di Miano, Milan, Italy
| | | | | | | | - Vittorio Calzolari
- Electrophysiology, Division of Cardiology, Neuro-Cardio-Vascular Department, Hospital of Treviso, ULSS 2 "Marca Trevigiana," Treviso, Italy
| | | | - Marco Zardini
- Cardiac Electrophysiology Section, Zenda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Marcello Piacenti
- CNR - Area della Ricerca di Pisa Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Giuseppe D'Angelo
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco Bosica
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Della Bella
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
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Zachariah D, Nakajima K, Limite LR, Zweiker D, Spartalis M, Zirolia D, Musto M, D'Angelo G, Paglino G, Baratto F, Cireddu M, Bisceglia C, Radinovic A, Marzi A, Sala S, Peretto G, Vergara P, Gulletta S, Mazzone P, Della Bella P, Frontera A. Significance of abnormal and late ventricular signals in ventricular tachycardia ablation of ischemic and nonischemic cardiomyopathies. Heart Rhythm 2022; 19:2075-2083. [PMID: 35964871 DOI: 10.1016/j.hrthm.2022.08.008] [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: 04/29/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Abnormal ventricular signals (AVS) are the cornerstone of substrate-based ventricular tachycardia (VT) ablation in sinus rhythm. Signal characterization of AVS in ischemic and nonischemic cardiomyopathies has never been performed. OBJECTIVE The purpose of this study was to describe ventricular signal abnormalities in 3 different pathologies and examine their association with the diastolic component of VT circuits. METHODS A total of 45 patients (15 ischemic cardiomyopathy [ICM], 15 arrhythmogenic cardiomyopathy [ACM], 15 dilated cardiomyopathy [DCM]) who had undergone VT ablation with >50% of the diastolic pathway of the VT circuit recorded were studied. AVS were classified into late potentials (LPs) and continuous fractionated ventricular signals (CFVS), and their characteristics and correlation with the diastolic pathway of VT circuits were analyzed. RESULTS Seventy-five VT circuits were analyzed. Bipolar scars were greatest in ICM endocardially (53 cm2 ICM vs 36 cm2 ACM vs 25 cm2 DCM; P = .010) and in ACM epicardially (98 cm2 ACM vs 25 cm2 ICM vs 24 cm2 DCM; P = .005). Location of the VT diastolic interval coincided with AVS location in 54% of VTs in ICM, 89% in ACM, and 72% in DCM (P = .036). There was a trend toward a greater association of diastolic intervals coinciding with LPs than with CFVS (78% vs 57%; P = .052) (69% diastolic intervals in ICM coincided with LPs, 33% with CFVS; P = .063). All patients (100%) with CFVS in ACM had VT diastolic components arising from CFVS (33% ICM, 64% DCM; P = .049). Positive predictive value for LPs vs CFVS was 77.8% vs 56.7%, and sensitivity was 67.3% vs 32.7%, respectively. CONCLUSION The nature of abnormal signals in different cardiomyopathies reflects underlying pathology. LPs rather than CFVS seem to be more linked to diastolic components of VT circuits, especially in ICM. LPs have greater sensitivity and specificity for VT; however, CFVS may be of more relevance in ACM.
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Affiliation(s)
- Donah Zachariah
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy; Department of Cardiology, University Hospitals of North Midlands, Stoke on Trent, United Kingdom.
| | | | | | - David Zweiker
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michael Spartalis
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Davide Zirolia
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Martina Musto
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giuseppe D'Angelo
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Gabriele Paglino
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesca Baratto
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Manuela Cireddu
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Andrea Radinovic
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessandra Marzi
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Simone Sala
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giovanni Peretto
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Pasquale Vergara
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Simone Gulletta
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Patrizio Mazzone
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Della Bella
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Antonio Frontera
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
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20
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Roca-Luque I, Quinto L, Sanchez-Somonte P, Garre P, Alarcón F, Zaraket F, Vazquez S, Prat-Gonzalez S, Ortiz-Perez JT, Guasch E, Tolosana JM, Arbelo E, Berruezo A, Sitges M, Brugada J, Mont L. Late Potential Abolition in Ventricular Tachycardia Ablation. Am J Cardiol 2022; 174:53-60. [PMID: 35437160 DOI: 10.1016/j.amjcard.2022.02.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/12/2022] [Accepted: 02/18/2022] [Indexed: 11/01/2022]
Abstract
Ventricular tachycardia (VT) substrate-based ablation has become the gold standard treatment for patients with structural heart disease-related VT. VT is linked to re-entry in relation to myocardial scarring, with areas of conduction block (core scar) and of slow conduction (border zone). Slow conduction areas can be detected in sinus rhythm as late potentials (LPs). LP abolition has been shown to be the best end point to avoid long-term recurrences. Our study aimed to analyze the challenges of LP abolition and the predictors of failure. We analyzed 169 consecutive patients with structural heart disease (61% ischemic cardiomyopathy, left ventricular ejection fraction: 37 ± 13%) who underwent VT ablation between 2013 and 2018. A preprocedural clinical evaluation, including cardiac magnetic resonance, was done in 66% of patients. Electroanatomical mapping with the identification of LPs was performed in all patients. Noninducibility was achieved in 71% (119), and complete LP abolition was achieved in 61% (103) of patients. Incomplete LP abolition was a powerful predictor of VT recurrence (67% vs 33%, hazard ratio 3.19 [2.1 to 4.7]; p <0.001). Lack of use of a high-density mapping catheter (odds ratio 6.2, 1.2 to 38.1; p = 0.028), the septal substrate (odds ratio 9.34, 2.27 to 38.4; p = 0.002), and larger left ventricular mass (190 ± 58 g vs 156 ± 46 g, p = 0.002) were predictors of incomplete LP abolition. The main reasons that contributed to unsuccessful LP abolition were anatomic obstacles (such as the conduction system) and large extension of the LP area. In conclusion, incomplete LP abolition is related to VT recurrence. Lack of use of a high-density mapping catheter, the septal substrate, and larger left ventricular mass are related to incomplete LP abolition.
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21
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Maury P, Beneyto M, Mondoly P, Delasnerie H, Rollin A. Ventricular tachycardia ablation as an alternative to implantable cardioverter-defibrillators in patients with preserved ejection fraction: current status and future prospects. Expert Rev Med Devices 2022; 19:423-430. [PMID: 35686666 DOI: 10.1080/17434440.2022.2088354] [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: 11/04/2022]
Abstract
INTRODUCTION The occurrence of a sustained monomorphic ventricular tachycardia in patients with structural heart disease is a class 1 indication for ICD because of the expected relevant risk of sudden death. However, if this concerns selected patients with preserved left ventricular function and well-tolerated arrhythmias is still poorly known. AREAS COVERED In this article, we review the available data about the natural history of nonimplanted patients with structural heart disease and sustained ventricular tachycardia and the possible role of catheter ablation alone in this population. EXPERT OPINION In structural heart disease patients with well-tolerated sustained ventricular tachycardia and preserved LVEF, catheter ablation alone, without ICD implantation, does not seem to carry an important risk of sudden death and the prognosis of these patients is mainly nonarrhythmic. Randomized prospective trials are urgently needed for evaluating the place of first choice ablation without ICD implantation in these populations.
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Affiliation(s)
- Philippe Maury
- Department of Cardiology, University Hospital Toulouse, France
| | - Maxime Beneyto
- Department of Cardiology, University Hospital Toulouse, France
| | - Pierre Mondoly
- Department of Cardiology, University Hospital Toulouse, France
| | | | - Anne Rollin
- Department of Cardiology, University Hospital Toulouse, France
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22
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Wiles BM, Li AC, Waight MC, Saba MM. Contemporary Management of Complex Ventricular Arrhythmias. Arrhythm Electrophysiol Rev 2022; 11:e04. [PMID: 35734144 PMCID: PMC9194914 DOI: 10.15420/aer.2021.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/06/2022] [Indexed: 12/02/2022] Open
Abstract
Percutaneous catheter ablation is an effective and safe therapy that can eliminate ventricular tachycardia, reducing the risks of both recurrent arrhythmia and shock therapies from a defibrillator. Successful ablation requires accurate identification of arrhythmic substrate and the effective delivery of energy to the targeted tissue. A thorough pre-procedural assessment is needed before considered 3D electroanatomical mapping can be performed. In contemporary practice, this must combine traditional electrophysiological techniques, such as activation and entrainment mapping, with more novel physiological mapping techniques for which there is an ever-increasing evidence base. Novel techniques to maximise energy delivery to the tissue must also be considered and balanced against their associated risks of complication. This review provides a comprehensive appraisal of contemporary practice and the evidence base that supports recent developments in mapping and ablation, while also considering potential future developments in the field.
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Affiliation(s)
- Benedict M Wiles
- Advanced Ventricular Arrhythmia Training and Research (AVATAR) Program, St George's University Hospitals NHS Foundation Trust, London, UK
- Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Anthony C Li
- Advanced Ventricular Arrhythmia Training and Research (AVATAR) Program, St George's University Hospitals NHS Foundation Trust, London, UK
- Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Michael C Waight
- Advanced Ventricular Arrhythmia Training and Research (AVATAR) Program, St George's University Hospitals NHS Foundation Trust, London, UK
- Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Magdi M Saba
- Advanced Ventricular Arrhythmia Training and Research (AVATAR) Program, St George's University Hospitals NHS Foundation Trust, London, UK
- Cardiology Clinical Academic Group, St George's University of London, London, UK
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23
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Spectral characterisation of ventricular intracardiac potentials in human post-ischaemic bipolar electrograms. Sci Rep 2022; 12:4782. [PMID: 35314732 PMCID: PMC8938475 DOI: 10.1038/s41598-022-08743-7] [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: 10/07/2021] [Accepted: 03/11/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractAbnormal ventricular potentials (AVPs) are frequently referred to as high-frequency deflections in intracardiac electrograms (EGMs). However, no scientific study performed a deep spectral characterisation of AVPs and physiological potentials in real bipolar intracardiac recordings across the entire frequency range imposed by their sampling frequency. In this work, the power contributions of post-ischaemic physiological potentials and AVPs, along with some spectral features, were evaluated in the frequency domain and then statistically compared to highlight specific spectral signatures for these signals. To this end, 450 bipolar EGMs from seven patients affected by post-ischaemic ventricular tachycardia were retrospectively annotated by an experienced cardiologist. Given the high variability of the morphologies observed, three different sub-classes of AVPs and two sub-categories of post-ischaemic physiological potentials were considered. All signals were acquired by the CARTO® 3 system during substrate-guided catheter ablation procedures. Our findings indicated that the main frequency contributions of physiological and pathological post-ischaemic EGMs are found below 320 Hz. Statistical analyses showed that, when biases due to the signal amplitude influence are eliminated, not only physiological potentials show greater contributions below 20 Hz whereas AVPs demonstrate higher spectral contributions above ~ 40 Hz, but several finer differences may be observed between the different AVP types.
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24
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A novel ECG finding in patients with epicardial infarct-associated ventricular tachycardia: a case series. Herzschrittmacherther Elektrophysiol 2022; 33:217-223. [PMID: 35277790 DOI: 10.1007/s00399-022-00849-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 02/01/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study analyzes the incidence, characteristics, and ECG morphology of ventricular tachycardia (VT) in post-infarction patients undergoing epicardial VT ablation. BACKGROUND Ablation of recurrent VTs in patients with ischemic cardiomyopathy is typically performed endocardially. In rare cases, epicardial access is required to achieve non-inducibility. METHODS AND RESULTS The study evaluated the baseline characteristics, procedural data, and ECG morphology of clinical VT in patients undergoing epicardial VT ablation. From the initial 491 patients with coronary heart disease (CHD) and recurrent VTs undergoing ablation at the Heart Center of Leipzig, Germany, between 2012 and 2020, only 39 patients required an additional epicardial access. In 17 patients, the VTs were associated with infarction scar, while the remaining patients had concomitant CHD without infarction-associated scar and were excluded from the analysis. A propensity match study was performed at a 1:2 ratio for these 17 patients, with 34 patients of the initial cohort as a control group to evaluate the differences in baseline characteristics, procedural data, and ECG morphology of the VTs. The specific VT morphology of negative concordance and superior axis in patients with inferior scar as well as the history of VT ablation were independent predictors of the need for epicardial access. CONCLUSIONS In addition to previous endocardial ablation, VT ECG morphology with negative concordance and superior axis in post-infarction patients with inferior scar predicted the need for epicardial VT ablation.
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25
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Hanaki Y, Komatsu Y, Nogami A, Kowase S, Kurosaki K, Sekiguchi Y, Aonuma K, Ieda M. Combined endo- and epicardial pace-mapping to localize ventricular tachycardia isthmus in ischaemic and non-ischaemic cardiomyopathy. Europace 2021; 24:587-597. [PMID: 34543395 DOI: 10.1093/europace/euab245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/03/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS A high-density pace-mapping can depict an abrupt transition in paced QRS morphology from a poor to excellent match, unmasking the critical component of ventricular tachycardia (VT) isthmus from the entrance to exit. We sought to assess pace-mapping at multiple sites within the endo- and epicardial scars to identify the VT isthmus in patients with ischaemic (ICM) and non-ischaemic cardiomyopathy (NICM). METHODS AND RESULTS Colour-coded maps correlating to the percentage matches between 12-lead electrocardiograms during VT and pace-mapping [referred to as correlation score maps (CSMs)] were analysed. We studied 115 CSMs (80 endo- and 35 epicardial CSMs) in 37 patients (17 ICM, 20 NICM). The CSM with an abrupt change (AC) in pacemap score (AC-type) on the endocardium was more frequently observed in ICM than in NICM [11/39 (28%) vs. 1/41 (2%); P = 0.001]. Among 35 CSMs that were analysed by the combined endo- and epicardial mapping, 10 (29%) CSMs exhibited non-AC-type on the endocardium; however, AC-type was present on the opposite epicardium. Although 24 (69%) CSMs did not show AC-type on both the endocardium and epicardium, 16 of them had either an excellent (>90%) or poor (<0%) correlation score on either side, associated with isthmus exit or entrance, respectively. However, the remaining eight CSMs had neither excellent nor poor scores. CONCLUSION The CSM may provide electrophysiological information to localize the endo- and epicardial VT isthmus. The absence of AC-type CSM on the endocardium, which is frequently observed in NICM, appears to indicate the sub-epicardial or intramural course of the critical isthmus.
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Affiliation(s)
- Yuichi Hanaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Yuki Komatsu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Shinya Kowase
- Department of Heart Rhythm management, Yokohama Rosai Hospital, Yokohama, Japan
| | - Kenji Kurosaki
- Department of Heart Rhythm management, Yokohama Rosai Hospital, Yokohama, Japan
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
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Fernandez-Armenta J, Soto-Iglesias D, Silva E, Penela D, Jáuregui B, Linhart M, Bisbal F, Acosta J, Fernandez M, Borras R, Villuendas R, Cano L, Guasch E, Mont L, Berruezo A. Safety and Outcomes of Ventricular Tachycardia Substrate Ablation During Sinus Rhythm: A Prospective Multicenter Registry. JACC Clin Electrophysiol 2021; 6:1435-1448. [PMID: 33121673 DOI: 10.1016/j.jacep.2020.07.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/16/2020] [Accepted: 07/29/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to analyze safety and outcomes of ventricular tachycardia (VT) substrate ablation during sinus rhythm (SR), without baseline VT induction. BACKGROUND Safety and outcomes after scar-related VT ablation during SR are not well known. Hemodynamic instability and need for electrical cardioversion can compromise safety of VT ablation procedures. METHODS Four hundred twelve consecutive patients with structural heart disease undergoing VT ablation were included in a prospective multicenter registry. Substrate ablation during SR, without baseline VT induction, was the first step of the ablation procedure and the standard protocol. Scar dechanneling was the substrate ablation technique used. VT inducibility was tested after substrate ablation. RESULTS VT induction protocol was negative after substrate ablation in 289 patients (70.1%), completing the procedure in SR. Procedure-related complication rate was 6.5%, including 1 death (0.2%). Thirty-day mortality after first VT ablation procedure was 1.7%. Overall survival was 95.8% and 88.6% at 1 and 3 years of follow-up, respectively. In a multivariable proportional hazards regression model, age ≥70 years (hazard ratio [HR]: 4.95 [2.59 to 9.47]; p < 0.001), chronic obstructive pulmonary disease (HR: 2.37 [1.24 to 4.52]; p = 0.008), left ventricular ejection fraction <30% (HR: 2.43 [1.37 to 4.33]; p = 0.002), and incomplete substrate ablation (HR: 2.37 [1.24 to 4.52]; p = 0.026) were independent predictors of overall mortality. At 12 months' follow-up, VT-free survival was 82.5% after 1 procedure and 87.8% after n procedures CONCLUSIONS: Substrate ablation during SR avoiding multiple VT induction has low procedure-related complications and low early mortality. Age, chronic obstructive pulmonary disease, and reduced left ventricular ejection fraction, but also incomplete substrate elimination, are predictors of mortality.
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Affiliation(s)
- Juan Fernandez-Armenta
- Department of Cardiology, Puerta del Mar University Hospital, Cadiz, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cadiz, Spain
| | - David Soto-Iglesias
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Etel Silva
- Department of Cardiology, Puerta del Mar University Hospital, Cadiz, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cadiz, Spain
| | - Diego Penela
- Heart Institute, Teknon Medical Center, Barcelona, Spain; Department of Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Beatriz Jáuregui
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Markus Linhart
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Felipe Bisbal
- Institut del Cor (iCor), Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Juan Acosta
- Department of Cardiology, Virgen del Rocio University Hospital, Seville, Spain
| | - Marcos Fernandez
- Department of Cardiology, Puerta del Mar University Hospital, Cadiz, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cadiz, Spain
| | - Roger Borras
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Roger Villuendas
- Institut del Cor (iCor), Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Lucas Cano
- Department of Cardiology, Puerta del Mar University Hospital, Cadiz, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Cadiz, Spain
| | - Eduard Guasch
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Lluis Mont
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Antonio Berruezo
- Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain; Heart Institute, Teknon Medical Center, Barcelona, Spain.
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27
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: executive summary. Europace 2021; 22:450-495. [PMID: 31995197 DOI: 10.1093/europace/euz332] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Roca-Luque I, Van Breukelen A, Alarcon F, Garre P, Tolosana JM, Borras R, Sanchez P, Zaraket F, Doltra A, Ortiz-Perez JT, Prat-Gonzalez S, Perea RJ, Guasch E, Arbelo E, Berruezo A, Sitges M, Brugada J, Mont L. Ventricular scar channel entrances identified by new wideband cardiac magnetic resonance sequence to guide ventricular tachycardia ablation in patients with cardiac defibrillators. Europace 2021; 22:598-606. [PMID: 32101605 DOI: 10.1093/europace/euaa021] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/19/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Ventricular tachycardia (VT) substrate-based ablation has become a standard procedure. Electroanatomical mapping (EAM) detects scar tissue heterogeneity and define conduction channels (CCs) that are the ablation target. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is able to depict CCs and increase ablation success. Most patients undergoing VT ablation have an implantable cardioverter-defibrillator (ICD) that can cause image artefacts in LGE-CMR. Recently wideband (WB) LGE-CMR sequence has demonstrated to decrease these artefacts. The aim of this study is to analyse accuracy of WB-LGE-CMR in identifying the CC entrances. METHODS AND RESULTS Thirteen consecutive ICD-patients who underwent VT ablation after WB-LGE-CMR were included. Number and location of CC entrances in three-dimensional EAM and in WB-LGE-CMR reconstruction were compared. Concordance was compared with a historical cohort matched by cardiomyopathy, scar location, and age (26 patients) with LGE-CMR prior to ICD and VT ablation. In WB-CMR group, 101 and 93 CC entrances were identified in EAM and WB-LGE-CMR, respectively. In historical cohort, 179 CC entrances were identified in both EAM and LGE-CMR. The EAM/CMR concordance was 85.1% and 92.2% in the WB and historical group, respectively (P = 0.66). There were no differences in false-positive rate (CC entrances detected in CMR and absent in EAM: 7.5% vs 7.8% in WB vs. conventional CMR, P = 0.92) nor in false-negative rate (CC entrances present in EAM not detected in CMR: 14.9% vs.7.8% in WB vs. conventional CMR, P = 0.23). Epicardial CCs was predictor of poor CMR/EAM concordance (OR 2.15, P = 0.031). CONCLUSION Use of WB-LGE-CMR sequence in ICD-patients allows adequate VT substrate characterization to guide VT ablation with similar accuracy than conventional LGE-CMR in patients without an ICD.
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Affiliation(s)
- Ivo Roca-Luque
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Ana Van Breukelen
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Francisco Alarcon
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Paz Garre
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Jose M Tolosana
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS).,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV)
| | - Roger Borras
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Paula Sanchez
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Fatima Zaraket
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Adelina Doltra
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Jose T Ortiz-Perez
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Susanna Prat-Gonzalez
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Rosario J Perea
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS).,Radiology Department, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain
| | - Eduard Guasch
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS)
| | - Elena Arbelo
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS).,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV)
| | - Antonio Berruezo
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS).,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV)
| | - Marta Sitges
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS).,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV)
| | - Josep Brugada
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS).,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV)
| | - Lluis Mont
- Arrhythmia Unit, Cardiovascular Clinical Institut, Hospital Clínic, Universitat de Barcelona, Villarroel St 170, ZIP code 08036, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS).,Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV)
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Quinto L, Sanchez-Somonte P, Alarcón F, Garre P, Castillo À, San Antonio R, Borras R, Guasch E, Arbelo E, Tolosana JM, Berruezo A, Mont L, Roca-Luque I. Ventricular tachycardia burden reduction after substrate ablation: Predictors of recurrence. Heart Rhythm 2021; 18:896-904. [PMID: 33639298 DOI: 10.1016/j.hrthm.2021.02.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/14/2021] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Substrate-based ventricular tachycardia (VT) ablation is a first-line treatment in patients with structural cardiac disease and sustained VT refractory to medical therapy. Despite technological improvements and increased knowledge of VT substrate, recurrence still is frequent. Published data are lacking on the possible reduction in VT burden after ablation despite recurrence. OBJECTIVE The purpose of this study was to assess VT burden reduction during long-term follow-up after substrate ablation and identify predictors of VT recurrence. METHODS We analyzed 234 consecutive VT ablation procedures in 207 patients (age 63 ± 14.9 years; 92% male; ischemic heart disease in 65%) who underwent substrate ablation in a single center from 2013 to 2018. RESULTS After follow-up of 3.14 ± 1.8 years, the VT recurrence rate was 41.4%. Overall, a 99.6% reduction in VT burden (median VT episodes per year: preprocedural 3.546 [1.347-13.951] vs postprocedural 0.001 [0-0.689]; P = .001) and a 96.3% decrease in implantable cardioverter-defibrillator (ICD) shocks (preprocedural 1.145 [0.118-4.467] vs postprocedural 0.042 [0-0.111] per year; P = .017) were observed. In the subgroup of patients who experienced VT recurrences, VT burden decreased by 69.2% (median VT episodes per year: preprocedural 2.876 [1.105-8.801] vs postprocedural 0.882 [0.505-2.283]; P <.001). Multivariable analysis showed persistence of late potentials (67% vs 19%; hazard ratio 3.18 [2.18-6.65]; P <.001) and lower left ventricular ejection fraction (EF) (30 [25-40] vs 39 [30-50]; P = .022) as predictors of VT recurrence. CONCLUSION Despite a high recurrence rate during long-term follow-up, substrate-based VT ablation is related to a large reduction in VT burden and a decrease in ICD therapies. Lower EF and persistence of late potentials are predictors of recurrence.
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Affiliation(s)
- Levio Quinto
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Paula Sanchez-Somonte
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Francisco Alarcón
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Paz Garre
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Àngel Castillo
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Rodolfo San Antonio
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Roger Borras
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Eduard Guasch
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Elena Arbelo
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José Maria Tolosana
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Antonio Berruezo
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Lluís Mont
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Ivo Roca-Luque
- Department of Cardiology, Cardiovascular Clinical Institute, Arrhythmia Unit, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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Peretto G, Sala S, Basso C, Rizzo S, Radinovic A, Frontera A, Limite LR, Paglino G, Bisceglia C, De Luca G, Campochiaro C, Sartorelli S, Palmisano A, Esposito A, Busnardo E, Villatore A, Baratto F, Cireddu M, Marzi A, D'Angelo G, Gulletta S, Vergara P, De Cobelli F, Dagna L, Mazzone P, Della Bella P. Inflammation as a Predictor of Recurrent Ventricular Tachycardia After Ablation in Patients With Myocarditis. J Am Coll Cardiol 2021; 76:1644-1656. [PMID: 33004129 DOI: 10.1016/j.jacc.2020.08.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/27/2020] [Accepted: 08/07/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Little is known about the risk stratification of patients with myocarditis undergoing ventricular tachycardia (VT) ablation. OBJECTIVES This study sought to describe VT ablation results and identify factors associated with arrhythmia recurrences in a cohort of patients with myocarditis. METHODS The authors enrolled 125 consecutive patients with myocarditis, undergoing VT ablation. Before ablation, disease stage was evaluated, to identify active (AM) versus previous myocarditis (PM). The primary study endpoint was assessment of VT recurrences by 12-month follow-up. Predictors of VT recurrences were retrospectively identified. RESULTS All patients (age 51 ± 14 years, 91% men, left ventricular ejection fraction 52% ± 9%) had history of myocarditis diagnosed by endomyocardial biopsy (59%) and/or cardiac magnetic resonance (90%). Furthermore, all had multiple episodes of drug-refractory VTs. Multimodal pre-procedural staging identified 47 patients with AM (38%) and 78 patients with PM (62%). All patients showed low-voltage areas (LVA) at electroanatomical map (97% epicardial or endoepicardial); of them, 25 (20%) had wide borderzone (WBZ, constituting >50% of the whole LVA). VT recurrences were documented in 25 patients (20%) by 12 months, and in 43 (34%) by last follow-up (median 63 months; interquartile range: 39 to 87). At multivariable analysis, AM stage was the only predictor of VT recurrences by 12 months (hazard ratio: 9.5; 95% confidence interval: 2.6 to 35.3; p < 0.001), whereas both AM stage and WBZ were associated with arrhythmia recurrences anytime during follow-up. No VT episodes were found after redo ablation was performed in 23 patients during PM stage. CONCLUSION Our findings suggest that VT ablation should be avoided during AM, but is often of benefit for recurrent VT after the acute phase of myocarditis.
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Affiliation(s)
- Giovanni Peretto
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; San Raffaele Vita-Salute University, Milan, Italy.
| | - Simone Sala
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Basso
- Department of Cardiovascular Pathology, Padua Hospital and University, Padua, Italy
| | - Stefania Rizzo
- Department of Cardiovascular Pathology, Padua Hospital and University, Padua, Italy
| | - Andrea Radinovic
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Frontera
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Rosario Limite
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Paglino
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Bisceglia
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo De Luca
- San Raffaele Vita-Salute University, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Sartorelli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anna Palmisano
- San Raffaele Vita-Salute University, Milan, Italy; Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- San Raffaele Vita-Salute University, Milan, Italy; Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Busnardo
- Nuclear Medicine Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Francesca Baratto
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Manuela Cireddu
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Marzi
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe D'Angelo
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simone Gulletta
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pasquale Vergara
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- San Raffaele Vita-Salute University, Milan, Italy; Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- San Raffaele Vita-Salute University, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizio Mazzone
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; San Raffaele Vita-Salute University, Milan, Italy
| | - Paolo Della Bella
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; San Raffaele Vita-Salute University, Milan, Italy
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Kuo L, Muser D, Shirai Y, Lin A, Liang J, Schaller RD, Hyman M, Kumareswaran R, Arkles J, Supple GE, Frankel DS, Garcia F, Tschabrunn C, Nazarian S, Dixit S, Lin D, Riley MP, Callans DJ, Deo R, Epstein A, Zado ES, Marchlinski FE, Santangeli P. Periprocedural Acute Kidney Injury in Patients With Structural Heart Disease Undergoing Catheter Ablation of VT. JACC Clin Electrophysiol 2020; 7:174-186. [PMID: 33602398 DOI: 10.1016/j.jacep.2020.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to examine the impact of periprocedural acute kidney injury (AKI) in scar-related ventricular tachycardia (VT) patients undergoing radiofrequency catheter ablation (RFCA) on short- and long-term outcomes. BACKGROUND The clinical significance of periprocedural AKI in patients with scar-related VT undergoing RFCA has not been previously investigated. METHODS This study included 317 consecutive patients with scar-related VT undergoing RFCA (age: 64 ± 13 years, mean left ventricular ejection fraction: 33 ± 13%, 55% ischemic cardiomyopathy). Periprocedural AKI was defined as an absolute increase in creatinine of ≥0.3 mg/dl over 48 h or an increase of >1.5× the baseline values within 1 week post-procedure. RESULTS Periprocedural AKI occurred in 31 patients (10%). Independent predictors of AKI included chronic kidney disease (odds ratio [OR]: 3.43; 95% confidence interval [CI]: 1.48 to 7.96; p = 0.004), atrial fibrillation (OR: 2.42; 95% CI: 1.01 to 5.78; p = 0.047), and peri-procedural acute hemodynamic decompensation (OR: 3.98; 95% CI: 1.17 to 13.52; p = 0.003). After a median follow-up of 39 months (interquartile range: 6 to 65 months), 95 patients (30%) died. Periprocedural AKI was associated with increased risk of early mortality (within 30 days; hazard ratio [HR]: 9.91; 95% CI: 2.87 to 34.22; p < 0.001) and late mortality (within 1 year) (HR: 4.57; 95% CI: 2.08 to 10.05; p < 0.001). After multivariable adjustment, AKI remained independently associated with increased risk of early and late mortality (HR: 4.49; 95% CI: 1.1 to 18.36; p = 0.04, and HR: 3.28; 95% CI: 1.43 to 7.49; p = 0.005, respectively). CONCLUSIONS Periprocedural AKI occurs in 10% of patients undergoing RFCA of scar-related VT and is strongly associated with increased risk of early and late post-procedural mortality.
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Affiliation(s)
- Ling Kuo
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniele Muser
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yasuhiro Shirai
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aung Lin
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jackson Liang
- Electrophysiology Section, Cardiovascular Medicine Division, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert D Schaller
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew Hyman
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ramanan Kumareswaran
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey Arkles
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory E Supple
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David S Frankel
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fermin Garcia
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cory Tschabrunn
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saman Nazarian
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay Dixit
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Lin
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael P Riley
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Callans
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rajat Deo
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew Epstein
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica S Zado
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: Executive summary. J Interv Card Electrophysiol 2020; 59:81-133. [PMID: 31960344 PMCID: PMC7508755 DOI: 10.1007/s10840-019-00664-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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34
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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Kewcharoen J, Prasitlumkum N, Titichoatrattana S, Wittayalikit C, Trongtorsak A, Kanitsoraphan C, Putthapiban P, Poonsombudlert K, Rattanawong P, Chung EH. Factors associated with recurrent postinfarction ventricular tachycardia following ablation. Minerva Cardiol Angiol 2020; 69:50-60. [PMID: 32989960 DOI: 10.23736/s2724-5683.20.05128-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Ablation of ventricular tachycardia is the main therapy for patients with drug-refractory ventricular tachycardia (VT). Although evidence suggests that VT ablation could lower the incidence of recurrent VT, many cases still develop VT in follow-up. In this study, we performed a systematic review and meta-analysis to examine risk factors for recurrent VT in patients with postinfarction VT who underwent VT ablation. EVIDENCE ACQUISITION We comprehensively searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were cohort studies, experimental trials, or randomized controlled trials that evaluate the risk of recurrent VT in postinfarction VT patients who underwent VT ablation. Data from each study were combined using random-effects. EVIDENCE SYNTHESIS Thirteen studies involving 1803 postinfarction patients who underwent VT ablation were included. Inducibility after the procedure (pooled HR=1.71, P<0.001), lower baseline left ventricular ejection fraction (LVEF) (pooled HR=0.98, P<0.001) and higher baseline New York Heart Association (NYHA) classification (pooled HR=1.34, P=0.003) were significantly associated with VT recurrence during the follow-up. There was no significant association between age, gender or diabetes mellitus and VT recurrence. CONCLUSIONS Our meta-analysis demonstrated that inducibility after the procedure, lower baseline LVEF and higher baseline NYHA classification were associated with an increased risk of VT recurrence in postinfarction VT patients who underwent VT ablation.
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Affiliation(s)
- Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA -
| | - Narut Prasitlumkum
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | | | | | | | | | | | | | - Pattara Rattanawong
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA.,Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Eugene H Chung
- Department of Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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36
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Hendriks AA, Kis Z, Glisic M, Bramer WM, Szili-Torok T. Pre-procedural image-guided versus non-image-guided ventricular tachycardia ablation-a review. Neth Heart J 2020; 28:573-583. [PMID: 32930978 PMCID: PMC7596120 DOI: 10.1007/s12471-020-01485-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging and computed tomography in patients with ventricular tachycardia (VT) after myocardial infarction (MI) helps to delineate scar from healthy tissue. Image-guided VT ablation has not yet been studied on a large scale. OBJECTIVE The aim of the meta-analysis was to compare the long-term outcome of image-guided VT ablation with a conventional approach for VT after MI. METHODS Eight electronic bibliographic databases were searched to identify all relevant studies from 2012 until 2018. The search for scientific literature was performed for studies that described the outcome of VT ablation in patients with an ischaemic substrate. The outcome of image-guided ablation was compared with the outcome of conventional ablations. RESULTS Of the 2990 citations reviewed for eligibility, 38 articles-enrolling a total of 7748 patients-were included into the meta-analysis. Five articles included patients with image-guided ablation. VT-free survival was 82% [74-90] in the image-guided VT ablation versus 59% [54-64] in the conventional ablation group (p < 0.001) during a mean follow-up of 35 months. Overall survival was 94% [90-98] in the image-guided versus 82% [76-88] in the conventional VT ablation group (p < 0.001). CONCLUSIONS Image-guided VT ablation in ischaemic VT was associated with a significant benefit in VT-free and overall survival as compared with conventional VT ablation. Visualising myocardial scar facilitates substrate-guided ablation procedures, pre-procedurally and by integrating imaging during the procedure, and may consequently improve long-term outcome.
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Affiliation(s)
- A A Hendriks
- Department of Electrophysiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Z Kis
- Department of Electrophysiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M Glisic
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - T Szili-Torok
- Department of Electrophysiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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37
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Campbell T, Bennett RG, Garikapati K, Turnbull S, Bhaskaran A, De Silva K, Kumar S. Prognostic significance of extensive versus limited induction protocol during catheter ablation of scar-related ventricular tachycardia. J Cardiovasc Electrophysiol 2020; 31:2909-2919. [PMID: 32905634 DOI: 10.1111/jce.14740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Testing for inducible ventricular tachycardia (VT) pre- and postablation forms the cornerstone of contemporary scar-related VT ablation procedures. There is significant heterogeneity in reported VT induction protocols. We examined the utility of an extensive induction protocol (up to 4 extra-stimuli [ES] ± burst ventricular pacing) compared to the current guideline-recommended protocol (up to 3ES, defined as limited induction protocol) in patients with scar-related VT. METHODS AND RESULTS Sixty-two patients (age: 64 ± 14 years; left ventricular ejection fraction: 37 ± 13%, ischemic cardiomyopathy: 31, nonischemic cardiomyopathy: 31) with at least one inducible VT were included. An extensive testing protocol induced 11%-17% more VTs, compared to the limited induction protocol before, and after the final ablation. VT recurred in 48% of patients during a mean follow up of 566 ± 428 days. Patients who were noninducible for any VT using the limited induction protocol had worse ventricular arrhythmia (VA)-free survival (12 months, 43% vs. 82%; p = .03) and worse survival free of VA, transplantation and mortality (12 months 46% vs. 82%; p = .02), compared to patients who were noninducible for any VT using the extensive induction protocol. CONCLUSIONS Between 11% and 17% of inducible VTs may be missed if 4ES and burst pacing are not performed in induction protocols before and after ablation. Noninducibility for any VT after an extensive induction protocol after the final ablation portends more favorable prognostic outcomes when compared with the current guideline-recommended induction protocol of up to 3ES. This data suggests that the adoption of an extensive induction protocol is of prognostic benefit after VT ablation.
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Affiliation(s)
- Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Kasun De Silva
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
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38
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Shah K, Turagam M, Patel B, Natale A, Lakkireddy D, Garg J. Prophylactic Catheter Ablation of Ventricular Tachycardia in Ischemic Cardiomyopathy: a systematic review and meta-analysis of randomized controlled trials Electrophysiology Collaborative Consortium for Metaanalysis - ELECTRAM Investigators. J Atr Fibrillation 2020; 13:2371. [PMID: 34950297 DOI: 10.4022/jafib.2371] [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: 06/26/2020] [Revised: 06/29/2020] [Accepted: 07/30/2020] [Indexed: 11/10/2022]
Abstract
Aims Catheter ablation is an effective strategy for drug-refractory ventricular tachycardia (VT) in ischemic cardiomyopathy. We aimed to perform a systematic review and meta-analysis of outcomes of prophylactic catheter ablation (PCA) of Ventricular Tachycardia (VT) in ischemic cardiomyopathy patients. Methods We performed a comprehensive literature search through February 10, 2020, for all eligible randomized controlled trials that compared "PCA" versus "No PCA" for VT. Primary efficacy outcomes included - appropriate ICD therapy (composite of anti-tachycardia pacing and ICD shock), appropriate ICD shocks, electrical storm, cardiac mortality, and all-cause mortality. The primary safety outcome was any adverse events. Results Four randomized controlled trials (N = 505) met inclusion criteria. Prophylactic catheter ablation was associated significant reduction in appropriate ICD therapies (RR 0.70; 95% CI 0.55 - 0.89, p = 0.004), appropriate ICD shocks (RR 0.57 95% CI 0.40 - 0.80, p = 0.001) with a trend towards reduced risk of electrical storm (RR 0.64; CI 0.39 - 1.05; p = 0.075) compared to "No PCA". There was no significant difference in cardiac mortality (RR 0.66, 95% CI 0.31 - 1.43, p = 0.29) and all-cause mortality (RR 0.98, 95% CI 0.52 - 1.82, p = 0.94) with similar adverse events (RR 1.46, 95% CI 0.73 - 2.95, p = 0.29) between two groups. Conclusions Prophylactic catheter ablation in ischemic cardiomyopathy patients was associated with a lower risk of ICD therapies, including ICD shocks and VT storm with no difference in cardiac and all-cause mortality.
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Affiliation(s)
- Kuldeep Shah
- Division of Cardiology, West Virginia University, Morgantown, WV
| | - Mohit Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Brijesh Patel
- Division of Cardiology, West Virginia University, Morgantown, WV
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, KS.,D.L and J.G are co-senior authors
| | - Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service, Medical College of Wisconsin, Milwaukee, WI.,D.L and J.G are co-senior authors
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Hadjis A, Frontera A, Limite LR, Bisceglia C, Bognoni L, Foppoli L, Lipartiti F, Paglino G, Radinovic A, Tsitsinakis G, Calore F, Della Bella P. Complete Electroanatomic Imaging of the Diastolic Pathway Is Associated With Improved Freedom From Ventricular Tachycardia Recurrence. Circ Arrhythm Electrophysiol 2020; 13:e008651. [PMID: 32755381 PMCID: PMC7495983 DOI: 10.1161/circep.120.008651] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. The development of multielectrode mapping catheters has expanded the spectrum of mappable ventricular tachycardias (VTs). Full diastolic pathway recording has been associated with a high rate of VT termination during radiofrequency ablation as well as noninducibility at study end. However, the role of diastolic pathway mapping on VT recurrence has yet to be clearly elucidated. We aimed to explore the role of complete diastolic pathway activation mapping on VT recurrence.
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Affiliation(s)
- Alexios Hadjis
- Arrhythmology Department (A.H., A.F., L.R.L., C.B., L.F., F.L., G.P, A.R., G.T., P.D.B.), IRCCS San Raffaele Hospital, Milan, Italy.,Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Quebec, Canada (A.H.)
| | - Antonio Frontera
- Arrhythmology Department (A.H., A.F., L.R.L., C.B., L.F., F.L., G.P, A.R., G.T., P.D.B.), IRCCS San Raffaele Hospital, Milan, Italy
| | - Luca Rosario Limite
- Arrhythmology Department (A.H., A.F., L.R.L., C.B., L.F., F.L., G.P, A.R., G.T., P.D.B.), IRCCS San Raffaele Hospital, Milan, Italy
| | - Caterina Bisceglia
- Arrhythmology Department (A.H., A.F., L.R.L., C.B., L.F., F.L., G.P, A.R., G.T., P.D.B.), IRCCS San Raffaele Hospital, Milan, Italy
| | - Ludovica Bognoni
- University of Medicine (L.B.), IRCCS San Raffaele Hospital, Milan, Italy
| | - Luca Foppoli
- Arrhythmology Department (A.H., A.F., L.R.L., C.B., L.F., F.L., G.P, A.R., G.T., P.D.B.), IRCCS San Raffaele Hospital, Milan, Italy
| | - Felicia Lipartiti
- Arrhythmology Department (A.H., A.F., L.R.L., C.B., L.F., F.L., G.P, A.R., G.T., P.D.B.), IRCCS San Raffaele Hospital, Milan, Italy
| | - Gabriele Paglino
- Arrhythmology Department (A.H., A.F., L.R.L., C.B., L.F., F.L., G.P, A.R., G.T., P.D.B.), IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Radinovic
- Arrhythmology Department (A.H., A.F., L.R.L., C.B., L.F., F.L., G.P, A.R., G.T., P.D.B.), IRCCS San Raffaele Hospital, Milan, Italy
| | - Georgio Tsitsinakis
- Arrhythmology Department (A.H., A.F., L.R.L., C.B., L.F., F.L., G.P, A.R., G.T., P.D.B.), IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Paolo Della Bella
- Arrhythmology Department (A.H., A.F., L.R.L., C.B., L.F., F.L., G.P, A.R., G.T., P.D.B.), IRCCS San Raffaele Hospital, Milan, Italy
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40
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Okubo K, Gigli L, Trevisi N, Foppoli L, Radinovic A, Bisceglia C, Frontera A, D'Angelo G, Cireddu M, Paglino G, Mazzone P, Della Bella P. Long-Term Outcome After Ventricular Tachycardia Ablation in Nonischemic Cardiomyopathy: Late Potential Abolition and VT Noninducibility. Circ Arrhythm Electrophysiol 2020; 13:e008307. [PMID: 32657137 DOI: 10.1161/circep.119.008307] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with an ischemic cardiomyopathy (ICM), the combination of late potential (LP) abolition and postprocedural ventricular tachycardia (VT) noninducibility is known to be the desirable end point for a successful long-term outcome after VT ablation. We investigated whether LP abolition and VT noninducibilty have a similar impact on the outcomes of patients with non-ICMs (NICM) undergoing VT ablation. METHODS A total of 403 patients with NICM (523 procedures) who underwent a VT ablation from 2010 to 2016 were included. The procedure end points were the LP abolition (if the LPs were absent, other ablation strategies were undertaken) and the VT noninducibilty. RESULTS The underlying structural heart disease consisted of dilated cardiomyopathy (DCM, 49%), arrhythmogenic right ventricular dysplasia (ARVD, 17%), postmyocarditis (14%), valvular heart disease (8%), congenital heart disease (2%), hypertrophic cardiomyopathy (2%), and others (5%). The epicardial access was performed in 57% of the patients. At baseline, the LPs were present in 60% of the patients and a VT was either inducible or sustained/incessant in 85% of the cases. At the end of the procedure, the LP abolition was achieved in 79% of the cases and VT noninducibility in 80%. After a multivariable analysis, the combination of LP abolition and VT noninducibilty was independently associated with free survival from VT (hazard ratio, 0.45 [95% CI, 0.29-0.69], P=0.0002) and cardiac death (hazard ratio, 0.38 [95% CI, 0.18-0.74], P=0.005). The benefit of the LP abolition on preventing the VT recurrence in patients with ARVD and postmyocarditis appeared superior to that observed for those with DCM. CONCLUSIONS In patients with NICM undergoing VT ablation, the strategy of LP abolition and VT noninducibilty were associated with better outcomes in terms of long-term VT recurrences and cardiac survival. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Kenji Okubo
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Lorenzo Gigli
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Nicola Trevisi
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Luca Foppoli
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Andrea Radinovic
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Caterina Bisceglia
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Antonio Frontera
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Giuseppe D'Angelo
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Manuela Cireddu
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Gabriele Paglino
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Patrizio Mazzone
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
| | - Paolo Della Bella
- Arrhythmia Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milan, Italy
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Frontera A, Melillo F, Baldetti L, Radinovic A, Bisceglia C, D'Angelo G, Foppoli L, Gigli L, Peretto G, Cireddu M, Sala S, Mazzone P, Della Bella P. High-Density Characterization of the Ventricular Electrical Substrate During Sinus Rhythm in Post-Myocardial Infarction Patients. JACC Clin Electrophysiol 2020; 6:799-811. [PMID: 32703562 DOI: 10.1016/j.jacep.2020.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this study was to characterize, during sinus rhythm, the electric activation abnormalities in post-myocardial infarction patients undergoing ablation of ventricular tachycardia (VT) in order to identify specific signatures of those abnormal electrograms (EGMs). BACKGROUND In the setting of VT ablation, substrate characterization hinges on the identification of local abnormal ventricular activity (LAVA) and late potentials (LPs) that are considered to be related to the VT circuit. METHODS Patients scheduled for VT ablation underwent high-density ventricular substrate mapping. The substrate map during sinus rhythm was then compared with the activation maps of the clinical VT. Abnormal EGMs (LAVA and LPs) during sinus rhythm were characterized according to their configuration, duration, and amplitude and distinguished as belonging to bystander region or to the re-entrant circuit. Underlying electrophysiological mechanisms (wave-front collision, slow conduction) were identified on the activation maps and assigned to corresponding EGMs. RESULTS Ten patients satisfied the criteria to be enrolled in the study. A mean of 5 ± 1 slow-conduction areas and 4 ± 2 wave-front collisions were identified. LAVA was due to slow conduction in 60.5%, followed by wave-front collision (17.5%). LPs were caused by slow conduction in 52% of cases and by wave-front collision in 43% of cases. During sinus rhythm, entrance and exit sites were characterized by LAVA, while at the VT isthmus, only LPs were identified. Cutoff values of duration <24.5 ms (95% sensitivity and 99% specificity) and amplitude <0.14 mV (90% sensitivity and 48.1% specificity) discriminated those LPs belonging to the circuit from those playing a bystander role. CONCLUSIONS In the setting of post-myocardial infarction cardiomyopathy, specific EGM signatures are expressions of distinct electrophysiological phenomena. LAVA and LPs may play a bystander or an active role in the VT circuit, but only LPs with low amplitude and short duration predicted the VT isthmus.
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Affiliation(s)
- Antonio Frontera
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Francesco Melillo
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Luca Baldetti
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Radinovic
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Giuseppe D'Angelo
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Luca Foppoli
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Lorenzo Gigli
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giovanni Peretto
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Manuela Cireddu
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Simone Sala
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Patrizio Mazzone
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Paolo Della Bella
- Department of Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
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42
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Baszko A, Kochman K, Królak T, Kałmucki P, Telec W, Ożegowski S, Szyszka A. Long-term results of irrigated bipolar radiofrequency ablation in patients with recurrent arrhythmia after failed unipolar ablation. Medicine (Baltimore) 2020; 99:e19970. [PMID: 32481260 PMCID: PMC7250050 DOI: 10.1097/md.0000000000019970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The RF ablation of ventricular tachycardia (VT) or atrial flutter (AFl) can be unsuccessful due to lack of lesion transmurality. Bipolar ablation (BA) is more successful than unipolar ablation (UA). The purpose of our study was to investigate the long-term effect of BA ablation in patients after failed UA. METHODS Patients with septal VT (5) or AFL (2) after 2 to 5 unsuccessful UA were prospectively analysed after BA. All patients presented with heart failure or had ICD interventions. RESULTS BA was successful in 5 patients (1 failure each in the AFL and VT group). The follow-up duration was 10 to 26 months. In AFL group, BA was successful in 1 patient, unidirectional cavotricuspid block in was achieved in the other patient. All patients were asymptomatic for 12 months, but 1 had atrial fibrillation and the other had AFL reablation 19 months after BA. In VT group, all patients had several forms of septal VT. BA was successful in 4 patients. In 2 patients with high septal VT BA resulted in complete atrioventricular block. During follow-up, 1 patient had VT recurrence 26 months after BA and died after an unsuccessful reablation. Three patients had VT recurrences of different morphologies, which required reablation (UA in 2 and alcohol septal ablation in the other patient). CONCLUSION BA was successful in patients with AFL and septal VT resistant to standard ablation. Relapses of clinical arrhythmia are rare; however, long-term follow-up is complicated by recurrences of different arrhythmias related to complex arrhythmogenic substrate.
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Affiliation(s)
- Artur Baszko
- Department of Cardiology, Poznań University of Medical Sciences
| | - Karol Kochman
- Department of Cardiology, Poznań University of Medical Sciences
| | - Tomasz Królak
- Department of Cardiology, Medical University of Gdańsk, Poland
| | - Piotr Kałmucki
- Department of Cardiology, Poznań University of Medical Sciences
| | - Wojciech Telec
- Department of Cardiology, Poznań University of Medical Sciences
| | | | - Andrzej Szyszka
- Department of Cardiology, Poznań University of Medical Sciences
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43
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Ghannam M, Siontis KC, Cochet H, Jais P, Juhoor M, Attili A, Sharaf-Dabbagh G, Latchamsetty R, Jongnarangsin K, Morady F, Bogun F. Risk stratification in patients with nonischemic cardiomyopathy and ventricular arrhythmias based on quantification of intramural delayed enhancement on cardiac magnetic resonance imaging. J Cardiovasc Electrophysiol 2020; 31:1762-1769. [PMID: 32329161 DOI: 10.1111/jce.14514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/19/2020] [Accepted: 03/28/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Intramural scarring is a risk factor for sudden cardiac death. The objective of this study was to determine the value of scar quantification for risk stratification in patients with nonischemic cardiomyopathy (NICM) undergoing ablation procedures for ventricular arrhythmias (VA). METHODS AND RESULTS Cardiac late gadolinium-enhanced magnetic resonance imaging was performed in patients with NICM referred for ablation of premature ventricular complexes or ventricular tachycardia (VT). Only patients with intramural delayed enhancement were included. Scar volume was measured and correlated with immediate and long-term outcomes. Receiver operator curves, Wilcoxon signed-rank testing, and logistic regression were used to compare patient characteristics. The study consisted of 99 patients (74 males, mean age: 59.6 [54.0-68.1] years, ejection fraction [EF]: 46.0 [35.0-60.0]%). Patients without clinical VT or inducible VT had smaller total and core scar size compared to patients with a history of VT or inducible VT (total scar 1.12 [0.74-1.79] cm3 vs 7.45 [4.16-12.21] cm3 , P < .001). A total scar volume of greater than or equal to 2.78 cm3 was associated with inducibility of VT (AUC 0.94, 95% CI [0.89-0.98], sensitivity 85%, specificity 90%). Scar volume was associated with VT inducibility independent of a prior history of VT or the preprocedure EF (adjusted OR 1.67 [1.24-2.24]/cm3 , P < .01). CONCLUSION Quantification of scar size in patients with intramural scarring is useful for risk stratification in patients with NICM and VA independent of the EF or a prior history of VT. Scar characteristics of patients without a history of VT who have inducible VT are similar to patients with a history of VT.
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Affiliation(s)
- Michael Ghannam
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Konstantinos C Siontis
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Hubert Cochet
- Department of Radiology and Division of Cardiology, University of Bordeaux, Bordeaux, France
| | - Pierre Jais
- Department of Radiology and Division of Cardiology, University of Bordeaux, Bordeaux, France
| | - Mehdi Juhoor
- Department of Radiology and Division of Cardiology, University of Bordeaux, Bordeaux, France
| | - Anil Attili
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Ghaith Sharaf-Dabbagh
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Fred Morady
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
| | - Frank Bogun
- Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan
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44
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Ladas TP, Sugrue A, Nan J, Vaidya VR, Padmanabhan D, Venkatachalam KL, Asirvatham SJ. Fundamentals of Cardiac Mapping. Card Electrophysiol Clin 2020; 11:433-448. [PMID: 31400868 DOI: 10.1016/j.ccep.2019.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
To characterize cardiac activity and arrhythmias, electrophysiologists can record the electrical activity of the heart in relation to its anatomy through a process called cardiac mapping (electroanatomic mapping, EAM). A solid understanding of the basic cardiac biopotentials, called electrograms, is imperative to construct and interpret the cardiac EAM correctly. There are several mapping approaches available to the electrophysiologist, each optimized for specific arrhythmia mechanisms. This article provides an overview of the fundamentals of EAM.
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Affiliation(s)
- Thomas P Ladas
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Alan Sugrue
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - John Nan
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Vaibhav R Vaidya
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - Deepak Padmanabhan
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
| | - K L Venkatachalam
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Jacksonville, Florida, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA; Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA; Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
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45
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Dinov B, Schramm L, Koenig S, Oebel S, Bollmann A, Hindricks G, Arya A, Bode K. Dynamic changes in the signal-averaged electrocardiogram are associated with the long-term outcomes after ablation of ischemic ventricular tachycardia. J Interv Card Electrophysiol 2020; 60:125-134. [PMID: 32124150 PMCID: PMC8325669 DOI: 10.1007/s10840-020-00708-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/09/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Signal-averaged ECG (SAECG) can detect inhomogeneous myocardial conduction in patients presenting with ventricular tachycardia (VT) after myocardial infarction. Radiofrequency ablation (RFCA) aims at elimination of the endocardial late potentials and non-inducibility of VT. Previously, we demonstrated that abnormal SAECG at baseline can return to normal after a successful VT ablation. The present research investigates the post-ablation changes in SAECG after RFCA of VT and their relation to the procedural long-term outcomes. METHODS Thirty-three patients (31 male; age 68 ± 9 years; EF 36 ± 12%) with ischemic VT were prospectively enrolled to receive RFCA. One VT (range 1-7) per patient was ablated using substrate-guided RFCA and complete success was achieved in 28 (85%) cases. SAECG was performed before (t1), immediately after (t2), and at least 6 months (t3) after the RFCA. RESULTS After RFCA, the amount of patients showing abnormal SAECG decreased from 82% initially (t1) to 57.6% post-interventionally (t2); P = 0.008; and remained unchanged thereafter in 57% (t3). Patients who experienced VT recurrence (VT+) during the follow-up period had broader averaged QRS (t2): (VT+) 150 ± 26 vs. (VT-) 129 ± 21 ms; P = 0.015, as well as longer LAS40 (t2): (VT+) 60 ± 26 vs. (VT-) 43 ± 18 ms; P = 0.03. Abnormal SAECG (t2) was a strong predictor for VT recurrence: HR 5.4; 95% CI 1.5-21. SAECG detected more late potentials in patients with inferior than in those with anterior scars: 95% vs. 58%; P = 0.016. CONCLUSIONS RFCA of VT in the left ventricle can improve an abnormal SAECG in some patients after myocardial infarction. Normal SAECG after RFCA of VT is associated with a lower risk for VT recurrence and death.
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Affiliation(s)
- Borislav Dinov
- Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Lisa Schramm
- Medical Faculty, University of Leipzig, Leipzig, Germany.
- Department of Anesthesiology, University Hospital Erlangen, Erlangen, Germany.
| | - Sebastian Koenig
- Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Sabrina Oebel
- Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Arash Arya
- Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Kerstin Bode
- Department of Cardiac Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
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46
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Oxigenador extracorpóreo de membrana como asistencia hemodinámica para la ablación de la taquicardia ventricular: experiencia de dos centros. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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47
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Dallaglio PD, Oyarzabal Rabanal L, Alegre Canals O, Osorio Higa K, Rivas Gandara N, Anguera I. Extracorporeal membrane oxygenation for hemodynamic support of ventricular tachycardia ablation: a 2-center experience. ACTA ACUST UNITED AC 2019; 73:264-265. [PMID: 31740277 DOI: 10.1016/j.rec.2019.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/15/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Paolo D Dallaglio
- Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Loreto Oyarzabal Rabanal
- Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Alegre Canals
- Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Karina Osorio Higa
- Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria Rivas Gandara
- Área de Enfermedades del Corazón, Unidad de Arritmias y Electrofisiología, Hospital Vall d'Hebrón, Barcelona, Spain
| | - Ignasi Anguera
- Área de Enfermedades del Corazón, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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Okubo K, Frontera A, Bisceglia C, Paglino G, Radinovic A, Foppoli L, Calore F, Della Bella P. Grid Mapping Catheter for Ventricular Tachycardia Ablation. Circ Arrhythm Electrophysiol 2019; 12:e007500. [DOI: 10.1161/circep.119.007500] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
A new grid mapping catheter (GMC)—allowing for bipolar recordings of the electrograms in each orthogonal direction—became available. The aim of the current study is to evaluate the utility of the GMC in creating substrate and ventricular tachycardia (VT) activation maps during VT ablation procedures.
Methods:
From December 2017 to July 2018, 41 consecutive patients undergoing a VT ablation procedure using a GMC were studied. During the substrate mapping, 3 different maps were created using the 3 GMC bipolar configurations (along the spline, across the spline, HD wave solution); the low voltage area and late potential areas were compared. In case of inducible VTs, the GMC was used to create the VT activation maps focusing on the diastolic interval. The relation between diastolic activities during VT and substrate abnormality during sinus rhythm was also investigated.
Results:
The median low-voltage area drawn by the HD wave configuration was 28.9 cm
2
, 13% and 15% smaller than the low-voltage areas identified by the along and across configuration, respectively (33.1 and 33.9 cm
2
;
P
<0.0001). The late potential areas obtained with the 3 GMC configuration did not differ (
P
>0.05). VT activation mappings using the GMC were performed in 40 VTs, visualizing the full diastolic pathway in 22 (55%) of them. While the latest late potential areas were included in VT diastolic pathway in 17 VTs, the other 6 VTs showed mismatching of them. Identifying the full diastolic pathway led to a higher ongoing VT termination rate during the ablation than in case of partial recordings (88% versus 45%;
P
=0.03); furthermore, in the former situation, the noninducibility of the targeted VTs was achieved in all cases.
Conclusions:
The GMC is a useful tool for performing substrate and VT activation mappings during the VT ablation procedure, precisely identifying the low-voltage areas and quickly visualizing the diastolic pathways.
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Affiliation(s)
- Kenji Okubo
- Arrhythmology Unit, San Raffaele Hospital, Milan, Italy (K.O, A.F., C.B., G.P., A.R., L.F., P.D.B.)
| | - Antonio Frontera
- Arrhythmology Unit, San Raffaele Hospital, Milan, Italy (K.O, A.F., C.B., G.P., A.R., L.F., P.D.B.)
| | - Caterina Bisceglia
- Arrhythmology Unit, San Raffaele Hospital, Milan, Italy (K.O, A.F., C.B., G.P., A.R., L.F., P.D.B.)
| | - Gabriele Paglino
- Arrhythmology Unit, San Raffaele Hospital, Milan, Italy (K.O, A.F., C.B., G.P., A.R., L.F., P.D.B.)
| | - Andrea Radinovic
- Arrhythmology Unit, San Raffaele Hospital, Milan, Italy (K.O, A.F., C.B., G.P., A.R., L.F., P.D.B.)
| | - Luca Foppoli
- Arrhythmology Unit, San Raffaele Hospital, Milan, Italy (K.O, A.F., C.B., G.P., A.R., L.F., P.D.B.)
| | - Federico Calore
- Abbott Medical Italy, Sesto San Giovanni, Milano, Italy (F.C)
| | - Paolo Della Bella
- Arrhythmology Unit, San Raffaele Hospital, Milan, Italy (K.O, A.F., C.B., G.P., A.R., L.F., P.D.B.)
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Takigawa M, Relan J, Kitamura T, Martin CA, Kim S, Martin R, Cheniti G, Vlachos K, Massoullié G, Frontera A, Thompson N, Wolf M, Bourier F, Lam A, Duchateau J, Pambrun T, Denis A, Derval N, Pillois X, Magat J, Naulin J, Merle M, Collot F, Quesson B, Cochet H, Hocini M, Haïssaguerre M, Sacher F, Jaïs P. Impact of Spacing and Orientation on the Scar Threshold With a High-Density Grid Catheter. Circ Arrhythm Electrophysiol 2019; 12:e007158. [PMID: 31446771 DOI: 10.1161/circep.119.007158] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multipolar catheters are increasingly used for high-density mapping. However, the threshold to define scar areas has not been well described for each configuration. We sought to elucidate the impact of bipolar spacing and orientation on the optimal threshold to match magnetic resonance imaging-defined scar. METHOD The HD-Grid catheter uniquely allows for different spatially stable bipolar configurations to be tested. We analyzed the electrograms with settings of HD-16 (3 mm spacing in both along and across bipoles) and HD-32 (1 mm spacing in along bipoles and 3 mm spacing in across bipoles) and determined the optimal cutoff for scar detection in 6 infarcted sheep. RESULTS From 456 total acquisition sites (mean 76±12 per case), 14 750 points with the HD-16 and 32286 points with the HD-32 configuration for bipolar electrograms were analyzed. For bipolar voltages, the optimal cutoff value to detect the magnetic resonance imaging-defined scar based on the Youden's Index, and the area under the receiver operating characteristic curve (AUROC) differed depending on the spacing and orientation of bipoles; across 0.84 mV (AUROC, 0.920; 95% CI, 0.911-0.928), along 0.76 mV (AUROC, 0.903; 95% CI, 0.893-0.912), north-east direction 0.95 mV (AUROC, 0.923; 95% CI, 0.913-0.932), and south-east direction, 0.87 mV (AUROC, 0.906; 95% CI, 0.895-0.917) in HD-16; and across 0.83 mV (AUROC, 0.917; 95% CI, 0.911-0.924), along 0.46 mV (AUROC, 0.890; 95% CI, 0.883-0.897), north-east direction 0.89 mV (AUROC, 0.923; 95% CI, 0.917-0.929), and south-east direction 0.83 mV (AUROC, 0.913; 95% CI, 0.906-0.920) in HD-32. Significant differences in AUROC were seen between HD-16 along versus across (P=0.002), HD-16 north-east direction versus south-east direction (P=0.01), HD-32 north-east direction versus south-east direction (P<0.0001), and HD-16 along versus HD-32 along (P=0.006). The AUROC was significantly larger (P<0.01) when only the best points on each given site were selected for analysis, compared with when all points were used. CONCLUSIONS Spacing and orientation of bipoles impacts the accuracy of scar detection. Optimal threshold specific to each bipolar configuration should be determined. Selecting one best voltage point among multiple points projected on the same surface is also critical on the Ensite-system to increase the accuracy of scar-mapping.
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Affiliation(s)
- Masateru Takigawa
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.).,Heart Rhythm Center, Tokyo Medical and Dental University, Japan (M.T.)
| | - Jatin Relan
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.).,Abbott, Minneapolis, MN (J.R., S.K.)
| | - Takeshi Kitamura
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Claire A Martin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.).,Royal Papworth Hospital, Cambridge (C.A.M.)
| | - Steven Kim
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.).,Abbott, Minneapolis, MN (J.R., S.K.)
| | - Ruairidh Martin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.).,Institute of Genetic Medicine, Newcastle University, United Kingdom (R.M.)
| | - Ghassen Cheniti
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Konstantinos Vlachos
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Grégoire Massoullié
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Antonio Frontera
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Nathaniel Thompson
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Michael Wolf
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Felix Bourier
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Anna Lam
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Thomas Pambrun
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Arnaud Denis
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Nicolas Derval
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Xavier Pillois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Julie Magat
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Jerome Naulin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Mathilde Merle
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Florent Collot
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Bruno Quesson
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Hubert Cochet
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Mélèze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Frederic Sacher
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
| | - Pierre Jaïs
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, University of Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, France/Pessac-Bordeaux, France (M.T., J.R., T.K., C.A.M., S.K., R.M., G.C., K.V., G.M., A.F., N.T., M.W., F.B., A.L., J.D., T.P., A.D., N.D., X.P., J.M., J.N., M.M., F.C., B.Q., H.C., M. Hocini, M. Haïssaguerre, F.S., P.J.)
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Chang TY, Lin CY, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Chen SA. Role of catheter ablation in patients with ischemic ventricular tachycardia: From basic to clinical practice. J Chin Med Assoc 2019; 82:609-615. [PMID: 31305344 DOI: 10.1097/jcma.0000000000000137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Catheter ablation provides a therapeutic option for decreasing episodes of ventricular tachycardia in patients with coronary artery disease. Clinical studies show improvement with catheter ablation in reducing arrhythmia recurrence and therapy from implantable defibrillators, but not in decreasing mortality. Ablation can be an important tool for patients with electrical storm. Overall, complication rates of catheter ablation are acceptable, but recurrence rates are still significant. Advances in mapping and ablation technologies could be expected to improve the success rates and reduce the mortality.
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Affiliation(s)
- Ting-Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chin-Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Fa-Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shih-Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Li-Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
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