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Di Cori A, Pistelli L, Parollo M, Zaurino N, Segreti L, Zucchelli G. Approaching Ventricular Tachycardia Ablation in 2024: An Update on Mapping and Ablation Strategies, Timing, and Future Directions. J Clin Med 2024; 13:5017. [PMID: 39274230 PMCID: PMC11396273 DOI: 10.3390/jcm13175017] [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: 06/06/2024] [Revised: 08/01/2024] [Accepted: 08/22/2024] [Indexed: 09/16/2024] Open
Abstract
This review provides insights into mapping and ablation strategies for VT, offering a comprehensive overview of contemporary approaches and future perspectives in the field. The strengths and limitations of classical mapping strategies, namely activation mapping, pace mapping, entrainment mapping, and substrate mapping, are deeply discussed. The increasing pivotal relevance of CMR and MDCT in substrate definition is highlighted, particularly in defining the border zone, tissue channels, and fat. The integration of CMR and MDCT images with EAM is explored, with a special focus on their role in enhancing effectiveness and procedure safety. The abstract concludes by illustrating the Pisa workflow for the VT ablation procedure.
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Affiliation(s)
- Andrea Di Cori
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy
| | - Lorenzo Pistelli
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy
| | - Matteo Parollo
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy
| | - Nicola Zaurino
- Biosense Webster, Johnson & Johnson Medial SpA, 00071 Pomezia, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy
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Bencardino G, Narducci ML, Scacciavillani R, Gabrielli FA, Pelargonio G, Massetti M, Crea F, Lanza GA. Characteristics and Outcome of Patients with or without Previous Implantable Cardioverter Defibrillator Interventions Undergoing Ablation for Ventricular Tachycardia. J Clin Med 2024; 13:4958. [PMID: 39201099 PMCID: PMC11355858 DOI: 10.3390/jcm13164958] [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: 07/19/2024] [Revised: 08/17/2024] [Accepted: 08/20/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Catheter ablation (CA) is a well-established treatment in patients with ventricular tachycardia and appropriate implantable cardioverter defibrillator (ICD) therapies. Methods: We enrolled 57 consecutive carriers of ICD undergoing CA for electrical storm (ES). Our aim was to investigate differences in clinical, device-related, and electroanatomic features among patients who had history of appropriate ICD interventions before the ES compared to those who had not. The primary endpoint was a composite of death from any cause and recurrences of sustained VT, ventricular fibrillation, appropriate ICD therapy, or ES. Results: During a median follow up of 39 months, 28 patients (49%) met the primary endpoint. Those with previous ICD interventions had a higher prevalence of late potentials and a greater unipolar low-voltage area at electroanatomic mapping. Patients who met the primary endpoint had a higher prevalence of ATP/shock episodes preceding the ES event. At Cox regression analysis, non-ischemic dilated cardiomyopathy (NIDCM), QRS duration, and previous ATP and/or shock before the ES were associated with arrhythmic recurrences and/or death. At multivariate analysis, NIDCM and previous shock were associated with arrhythmic recurrences and/or death. Conclusions: A history of recurrent ICD therapies predicts worse outcomes when CA is needed because of ES. Although more studies are needed to definitively address this question, our data speak in support of an early referral for CA of ES.
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Affiliation(s)
- Gianluigi Bencardino
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (R.S.); (F.A.G.); (G.P.); (M.M.); (F.C.); (G.A.L.)
| | - Maria Lucia Narducci
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (R.S.); (F.A.G.); (G.P.); (M.M.); (F.C.); (G.A.L.)
| | - Roberto Scacciavillani
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (R.S.); (F.A.G.); (G.P.); (M.M.); (F.C.); (G.A.L.)
- Cardiology Institute, Catholic University of Sacred Heart, 00136 Rome, Italy
| | - Francesca Augusta Gabrielli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (R.S.); (F.A.G.); (G.P.); (M.M.); (F.C.); (G.A.L.)
| | - Gemma Pelargonio
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (R.S.); (F.A.G.); (G.P.); (M.M.); (F.C.); (G.A.L.)
- Cardiology Institute, Catholic University of Sacred Heart, 00136 Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (R.S.); (F.A.G.); (G.P.); (M.M.); (F.C.); (G.A.L.)
- Cardiology Institute, Catholic University of Sacred Heart, 00136 Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (R.S.); (F.A.G.); (G.P.); (M.M.); (F.C.); (G.A.L.)
- Cardiology Institute, Catholic University of Sacred Heart, 00136 Rome, Italy
| | - Gaetano Antonio Lanza
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.L.N.); (R.S.); (F.A.G.); (G.P.); (M.M.); (F.C.); (G.A.L.)
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3
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Müller J, Chakarov I, Nentwich K, Berkovitz A, Barth S, Ausbüttel F, Wächter C, Lehrmann H, Deneke T. Prognostic value of non-invasive programmed ventricular stimulation after VT ablation to predict VT recurrences. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01883-y. [PMID: 39150657 DOI: 10.1007/s10840-024-01883-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/15/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND The prognostic value of (non)-invasive programmed ventricular stimulation (NIPS) to predict recurrences of ventricular tachycardia (VT) is under discussion. Optimal endpoints of VT ablation are not well defined, and optimal timepoint of NIPS is unknown. The goal of this study was to evaluate the ability of programmed ventricular stimulation at the end of the VT ablation procedure (PVS) and NIPS after VT ablation to identify patients at high risk for VT recurrence. METHODS Between January 2016 and February 2022, consecutive patients with VT and structural heart disease undergoing first VT ablation and consecutive NIPS were included. In total, 138 patients were included. All patients underwent NIPS through their implanted ICDs after a median of 3 (1-5) days after ablation (at least 2 drive cycle lengths (500 and 400 ms) and up to four right ventricular extrastimuli until refractoriness). Clinical VT was defined by comparison with 12-lead electrocardiograms and stored ICD electrograms from spontaneous VT episodes. Patients were followed for a median of 37 (13-61) months. RESULTS Of the 138 patients, 104 were non-inducible (75%), 27 were inducible for non-clinical VTs (20%), and 7 for clinical VT (5%). In 107 patients (78%), concordant results of PVS and NIPS were observed. After 37 ± 20 months, the recurrence rate for any ventricular arrhythmia was 40% (normal NIPS 29% vs. inducible VT during NIPS 66%; log-rank p = 0.001) and for clinical VT was 3% (normal NIPS 1% vs. inducible VT during NIPS 9%; log-rank p = 0.045). Positive predictive value (PPV) and negative predictive value (NPV) of NIPS were higher compared to PVS (PPV: 65% vs. 46% and NPV: 68% vs. 61%). NIPS revealed the highest NPV among patients with ICM and LVEF > 35%. Patients with inducible VT during NIPS had the highest VT recurrences and overall mortality. Patients with both negative PVS and NIPS had the lowest any VT recurrence rates with 32%. Early re-ablation of patients with recurrent VTs during index hospitalization was feasible but did not reveal better long-term VT-free survival. CONCLUSIONS In patients after VT ablation and structural heart disease, NIPS is superior to post-ablation PVS to stratify the risk of VT recurrences. The PPV and NPV of NIPS at day 3 were superior compared to PVS at the end of the procedure to predict recurrent VT, especially in patients with ICM.
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Affiliation(s)
- Julian Müller
- Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen,, University of Freiburg, Freiburg im Breisgau, Germany.
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an Der Saale, Germany.
| | - Ivaylo Chakarov
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an Der Saale, Germany
| | - Karin Nentwich
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an Der Saale, Germany
- Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Artur Berkovitz
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an Der Saale, Germany
| | - Sebastian Barth
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an Der Saale, Germany
- Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Felix Ausbüttel
- Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Christian Wächter
- Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Heiko Lehrmann
- Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen,, University of Freiburg, Freiburg im Breisgau, Germany
| | - Thomas Deneke
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an Der Saale, Germany
- Clinic for Electrophysiology, University Hospital of the Paracelsus Medical University, Klinikum Nuremberg, Campus South, Nuremberg, Germany
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Askarinejad A, Arya A, Zangiabadian M, Ghahramanipour Z, Hesami H, Farmani D, Ghanbari Mardasi K, Kohansal E, Haghjoo M. Catheter ablation as first-line treatment for ventricular tachycardia in patients with structural heart disease and preserved left ventricular ejection fraction: a systematic review and meta-analysis. Sci Rep 2024; 14:18536. [PMID: 39122752 PMCID: PMC11315916 DOI: 10.1038/s41598-024-69467-4] [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: 09/04/2023] [Accepted: 08/02/2024] [Indexed: 08/12/2024] Open
Abstract
In this systematic review and meta-analysis, we aim to evaluate the efficacy and safety of catheter ablation as the first-line treatment of ventricular tachycardia (VT) in patients with structural heart disease (SHD) and preserved left ventricular ejection fraction (LVEF). Patients with SHD are particularly susceptible to VT, a condition that increases the risk of sudden cardiac death (SCD). Implantable cardioverter-defibrillators (ICDs) can terminate VT and prevent SCD but do not prevent VT recurrence. The efficacy and safety of CA as a first-line treatment in SHD patients with preserved LVEF remain unclear. We searched PubMed/Medline, EMBASE, Web of Science, and Cochrane CENTRAL for studies reporting the outcomes of CA therapy in patients with VT and preserved LVEF, published up to January 19, 2023. The primary outcome was the incidence of SCD following catheter ablation as the first-line treatment of VT in patients with SHD and preserved LVEF. Secondary outcomes included all-cause mortality, VT recurrence, procedural complications, CA success rate, and ICD implantation after catheter ablation. We included seven studies in the meta-analysis, encompassing a total of 920 patients. The pooled success rate of catheter ablation was 84.6% (95% CI 67.2-93.6). Complications occurred in 6.4% (95% CI 4.0-9.9) of patients, and 13.9% (95% CI 10.1-18.8) required ICD implantation after ablation. VT recurrence was observed in 23.2% (95% CI 14.8-34.6) of patients, while the rate of sudden cardiac death (SCD) was 3.1% (95% CI 1.7-5.6). The overall prevalence of all-cause mortality in this population was 5% (95% CI 1.8-13). CA appears promising as a first-line VT treatment in patients with SHD and preserved LVEF, especially for monomorphic hemodynamically tolerated VT. However, due to the lack of direct comparisons with ICDs and anti-arrhythmic drugs, further research is needed to confirm these findings.
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Affiliation(s)
- Amir Askarinejad
- Rajaie Cardiovascular Medical and Research Institue, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Arya
- University Hospital Halle (Saale)Martin-Luther-University, Halle-Wittenberg, Germany
| | - Moein Zangiabadian
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Hamed Hesami
- Rajaie Cardiovascular Medical and Research Institue, Iran University of Medical Sciences, Tehran, Iran
| | - Danial Farmani
- Rajaie Cardiovascular Medical and Research Institue, Iran University of Medical Sciences, Tehran, Iran
| | | | - Erfan Kohansal
- Rajaie Cardiovascular Medical and Research Institue, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Haghjoo
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Institue, Iran University of Medical Sciences, Tehran, Iran.
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Sapp JL, Tang ASL, Parkash R, Stevenson WG, Healey JS, Wells G. A randomized clinical trial of catheter ablation and antiarrhythmic drug therapy for suppression of ventricular tachycardia in ischemic cardiomyopathy: The VANISH2 trial. Am Heart J 2024; 274:1-10. [PMID: 38649085 DOI: 10.1016/j.ahj.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Recurrent ventricular tachycardia (VT) in patients with prior myocardial infarction is associated with adverse quality of life and clinical outcomes, despite the presence of implanted defibrillators (ICDs). Suppression of recurrent VT can be accomplished with antiarrhythmic drug therapy or catheter ablation. The Ventricular Tachycardia Antiarrhythmics or Ablation In Structural Heart Disease 2 (VANISH2) trial is designed to determine whether ablation is superior to antiarrhythmic drug therapy as first line therapy for patients with ischemic cardiomyopathy and VT. METHODS The VANISH2 trial enrolls patients with prior myocardial infarction and VT (with one of: ≥1 ICD shock; ≥3 episodes treated with antitachycardia pacing (ATP) and symptoms; ≥5 episodes treated with ATP regardless of symptoms; ≥3 episodes within 24 hours; or sustained VT treated with electrical cardioversion or pharmacologic conversion). Enrolled patients are classified as either sotalol-eligible, or amiodarone-eligible, and then are randomized to either catheter ablation or to that antiarrhythmic drug therapy, with randomization stratified by drug-eligibility group. Drug therapy, catheter ablation procedures and ICD programming are standardized. All patients will be followed until two years after randomization. The primary endpoint is a composite of mortality at any time, appropriate ICD shock after 14 days, VT storm after 14 days, and treated sustained VT below detection of the ICD after 14 days. The outcomes will be analyzed according to the intention-to-treat principle using survival analysis techniques RESULTS: The results of the VANISH2 trial are intended to provide data to support clinical decisions on how to suppress VT for patients with prior myocardial infarction. CLINICALTRIALS gov registration NCT02830360.
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Affiliation(s)
- John L Sapp
- Department of Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, Canada.
| | | | - Ratika Parkash
- Department of Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, Canada
| | - William G Stevenson
- Department of Medicine, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, Canada
| | - George Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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Gupta A, Danaila V, De Silva K, Bhaskaran A, Turnbull S, Wong MS, Campbell TG, Kumar S. The Current Landscape of Ventricular Tachycardia Trials: A Systematic Review of Registered Studies. Heart Lung Circ 2024; 33:1082-1096. [PMID: 38821759 DOI: 10.1016/j.hlc.2024.01.041] [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: 10/10/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Although there are evolving techniques and technologies for treating ventricular tachycardia (VT), the current landscape of clinical trials for managing VT remains understudied. OBJECTIVE The objective of this study was to provide a systematic characterisation of the interventional management of VT through an analysis of the ClinicalTrials.gov, clinicaltrialsregister.eu, anzctr.org.au and chictr.org.cn databases. METHODS We queried all phase II to IV interventional trials registered up to November 2023 that enrolled patients with VT. Published, completed but unpublished, terminated, or ongoing trials were included for final analysis. RESULTS Of the 698 registered studies, 135 were related to VT, with 123 trials included in the final analysis. Among these trials, 25 (20%) have been published, enrolling a median of 35 patients (interquartile range [IQR] 20-132) over a median of 43 months (IQR 19-62). Out of the published trials, 14 (56%) were randomised, and 12 (48%) focused on catheter ablation. Twenty-two (18%) have been completed but remain unpublished, even after a median of 36 months (IQR 15-60). Furthermore, 27 (22%) trials were terminated or withdrawn, with the most common cause being poor enrolment. Currently, 49 (40%) trials are ongoing and novel non-ablative technologies, such as radioablation and autonomic modulation, account for 35% and 8% of ongoing trials, respectively. CONCLUSIONS Our analysis revealed that many registered trials remain unpublished or incomplete, and randomised controlled trial evidence is limited to only a few studies. Furthermore, many ongoing trials are focused on non-catheter ablation-based strategies. Therefore, larger pragmatic trials are needed to create stronger evidence in the future.
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Affiliation(s)
- Anunay Gupta
- Department of Cardiology, Westmead Hospital, NSW, Australia; Westmead Applied Research Centre, University of Sydney, NSW, Australia
| | - Vlad Danaila
- Department of Cardiology, Westmead Hospital, NSW, Australia
| | - Kasun De Silva
- Department of Cardiology, Westmead Hospital, NSW, Australia; Westmead Applied Research Centre, University of Sydney, NSW, Australia
| | - Ashwin Bhaskaran
- Department of Cardiology, Westmead Hospital, NSW, Australia; Westmead Applied Research Centre, University of Sydney, NSW, Australia
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, NSW, Australia; Westmead Applied Research Centre, University of Sydney, NSW, Australia
| | - Mary S Wong
- Department of Cardiology, Westmead Hospital, NSW, Australia; Westmead Applied Research Centre, University of Sydney, NSW, Australia
| | - Timothy G Campbell
- Department of Cardiology, Westmead Hospital, NSW, Australia; Westmead Applied Research Centre, University of Sydney, NSW, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, NSW, Australia.
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7
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Shinoda Y, Komatsu Y, Hattori M, Oda Y, Iioka Y, Hanaki Y, Yamasaki H, Igarashi M, Ishizu T, Nogami A. Optimal cardiac rhythm during substrate mapping in scar-related ventricular tachycardia: Significance of wavefront direction on identifying critical sites. Heart Rhythm 2024; 21:1298-1307. [PMID: 38432425 DOI: 10.1016/j.hrthm.2024.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/11/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND A rotational activation pattern (RAP) around the localized line of a conduction block often correlates with sites specific to the critical zones of ventricular tachycardia (VT). The wavefront direction during substrate mapping affects manifestation of the RAP and line of block. OBJECTIVE The purpose of this study was to investigate the most optimal cardiac rhythm for identifying RAP and line of block in substrate mapping. METHODS We retrospectively evaluated 71 maps (median 3205 points/map) in 46 patients (65 ± 15 years; 33% with ischemic cardiomyopathy) who underwent high-density substrate mapping and ablation of scar-related VT. Appearance of a RAP during sinus, right ventricular (RV)-paced, left ventricular (LV)-paced, and biventricular-paced rhythms was investigated. RESULTS RAP was identified in 24 of 71 maps (34%) in the region where wavefronts from a single direction reached but not in the region where wavefronts from multiple directions centripetally collided. The probability of identifying the RAP depended on scar location; that is, anteroseptal and inferoseptal, inferior and apical, and basal lateral RAPs were likely to be identified during sinus/atrial, RV-paced, and LV-paced rhythms, respectively. In 13 patients, the RAP was not evident in the baseline map but became apparent during remapping in the other rhythm, in which the wavefront reached the site earlier within the entire activation time. CONCLUSION The optimal rhythm for substrate mapping depends on the spatial distribution of the area of interest. A paced rhythm with pacing sites near the scar may facilitate the identification of critical VT zones.
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Affiliation(s)
- Yasutoshi Shinoda
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuki Komatsu
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Masayuki Hattori
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuka Oda
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuto Iioka
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuichi Hanaki
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiro Yamasaki
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Miyako Igarashi
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoko Ishizu
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akihiko Nogami
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
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8
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Sharma E, Tedrow U. Taming the Tempest: Early Catheter Ablation in Ventricular Electrical Storm. JACC Clin Electrophysiol 2024:S2405-500X(24)00482-1. [PMID: 39066779 DOI: 10.1016/j.jacep.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 06/08/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Esseim Sharma
- Division of Cardiology, Department of Medicine, University Hospitals, Case Western Reserve University Medical School, Cleveland, Ohio, USA
| | - Usha Tedrow
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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9
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Wang NC, Wann DG, McCabe MA, Singh M, Bhonsale A, Kancharla K, Jain SK. Prevalence of atrial fibrillation and/or atrial flutter in multicenter randomized controlled trials for catheter ablation of ventricular tachycardia in structural heart disease: A meta-analysis. Heart Rhythm O2 2024; 5:483-486. [PMID: 39119027 PMCID: PMC11305877 DOI: 10.1016/j.hroo.2024.06.007] [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: 08/10/2024] Open
Affiliation(s)
- Norman C. Wang
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Melina A. McCabe
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Madhurmeet Singh
- UPMC Heart and Vascular Institute, UPMC Hamot, Erie, Pennsylvania
| | - Aditya Bhonsale
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Krishna Kancharla
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sandeep K. Jain
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Enriquez A, Sadek M, Hanson M, Yang J, Matos CD, Neira V, Marchlinski F, Miranda-Arboleda A, Orellana-Cáceres JJ, Alviz I, Hoyos C, Gabr M, Batnyam U, Tedrow UB, Zei PC, Sauer WH, Romero JE. Feasibility, Efficacy, and Safety of Fluoroless Ablation of VT in Patients With Structural Heart Disease. JACC Clin Electrophysiol 2024; 10:1287-1300. [PMID: 38819345 DOI: 10.1016/j.jacep.2024.03.011] [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: 10/23/2023] [Revised: 03/08/2024] [Accepted: 03/09/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Catheter ablation of ventricular tachycardia (VT) typically requires radiation exposure with its potential adverse health effects. A completely fluoroless ablation approach is achievable using a combination of electroanatomical mapping and intracardiac echocardiography. Nonetheless, data in patients undergoing VT ablation are limited. OBJECTIVES This study aimed to determine the feasibility, efficacy, and safety of VT ablation in patients with structural heart disease using a zero-fluoroscopy approach. METHODS This multicenter study included consecutive patients with ischemic and nonischemic cardiomyopathy undergoing fluoroless VT ablation. Patients requiring epicardial access or coronary angiography were excluded. RESULTS Between 2017 and 2023 a total of 198 patients (aged 66.4 ± 13.4 years, 76% male, 48% ischemic) were included. Most patients (95.4%) underwent left ventricular (LV) mapping and/or ablation, which was conducted via transseptal route in 54.5% (n = 103), via retrograde aortic route in 43.4% (n = 82), and using a combined approach in 2.1% (n = 4). Two-thirds of patients had a cardiac device, including a biventricular device in 15%; 2 patients had a LV assist device, and 1 patient had a mechanical aortic valve prosthesis. The mean total procedural time was 211 ± 70 minutes, and the total radiofrequency time was 30 ± 22 minutes. During a follow-up period of 22 ± 18 months, the freedom from VT recurrence was 80%, and 7.6% of patients underwent a repeated ablation. Procedural-related complications occurred in 6 patients (3.0%). CONCLUSIONS Fluoroless ablation of VT in structural heart disease is feasible, effective, and safe when epicardial mapping/ablation is not required.
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Affiliation(s)
- Andres Enriquez
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Cardiology, Queen's University, Kingston, Ontario, Canada.
| | - Mouhannad Sadek
- Division of Cardiology, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Matthew Hanson
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Jaejoon Yang
- Division of Cardiology, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Victor Neira
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Francis Marchlinski
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andres Miranda-Arboleda
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Juan-José Orellana-Cáceres
- Department of Public Health, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile; Centro de Capacitación, Investigación y Gestión para la Salud Basada en Evidencia (CIGES), Temuco, Chile
| | - Isabella Alviz
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohamed Gabr
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Uyanga Batnyam
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Usha B Tedrow
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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11
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Zucchelli G, Parollo M, Di Cori A, Mazzocchetti L, Segreti L, Grifoni G, Torre M, Sbragi S, De Lucia R, Barletta V, Canu A, Viani S, Bongiorni MG. Feasibility of carbon dioxide insufflation and impact on epicardial approach utilization for ventricular tachycardia ablation in a midvolume referral center. Heart Rhythm 2024; 21:1032-1039. [PMID: 38403236 DOI: 10.1016/j.hrthm.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Epicardial access is often crucial for successful ventricular tachycardia (VT) ablation, but it is often burdened by significant procedural risk. Intentional coronary vein exit and intrapericardial CO2 insufflation (EpiCO2) can facilitate subxiphoid pericardial access. OBJECTIVE This prospective study aimed to assess procedural feasibility, safety, and impact of the introduction of intrapericardial CO2 insufflation for epicardial access in a referral center for VT ablation. METHODS All consecutive patients treated with epicardial VT ablation between November 2022 and January 2024 with the EpiCO2 technique at Pisa University Hospital were prospectively enrolled and compared in terms of feasibility, efficiency, and safety with a local retrospective cohort of patients treated with subxiphoid dry puncture between July 2018 and October 2022. RESULTS Twenty-two consecutive patients (90.9% male; mean age, 54.3 years) underwent VT ablation with EpiCO2 during the study period. Epicardial access was achieved in all patients; median time from coronary sinus (CS) cannulation to epicardial access was 33 minutes. Intentional vein exit was successful in all cases, whereas CO2 insufflation was not feasible in 1 patient. There were no major complications and no significant bleeding. Since EpiCO2 introduction, epicardial approach utilization increased from 17.8% to 40% of all VT procedures. Comparison with 20 standard dry approach epicardial ablations showed no significant differences in terms of total procedural duration (322.5 [interquartile range, 296.75-363.75] minutes vs 359 [interquartile range, 323-409] minutes; P = .08). CONCLUSION In our single-center experience, EpiCO2 was feasible and safe and led to significant increase in procedural volume without affecting total procedural time compared with standard dry puncture.
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Affiliation(s)
- Giulio Zucchelli
- Second Division of Cardiology, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy.
| | - Matteo Parollo
- Second Division of Cardiology, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Andrea Di Cori
- Second Division of Cardiology, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Lorenzo Mazzocchetti
- Second Division of Cardiology, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Gino Grifoni
- Second Division of Cardiology, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Marco Torre
- Second Division of Cardiology, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Sara Sbragi
- Second Division of Cardiology, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Raffaele De Lucia
- Second Division of Cardiology, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Valentina Barletta
- Second Division of Cardiology, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Antonio Canu
- Second Division of Cardiology, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Stefano Viani
- Second Division of Cardiology, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy; Heart Rhythm Clinic, San Rossore Hospital, Pisa, Italy
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12
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Deneke T, Pauschinger M, Brinker-Paschke A, Kowalewski C. Ablation of ventricular tachycardia in patients with ischemic cardiomyopathy and without an ICD-for the times they are a-changin'? Heart Rhythm 2024:S1547-5271(24)02677-8. [PMID: 38848861 DOI: 10.1016/j.hrthm.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 06/09/2024]
Affiliation(s)
- Thomas Deneke
- Clinic for Arrhythmology and Electrophysiology, Klinikum Nuremberg, University Hospital of the Paracelsus Medical University, Nuremberg, Germany.
| | - Matthias Pauschinger
- Clinic for Arrhythmology and Electrophysiology, Klinikum Nuremberg, University Hospital of the Paracelsus Medical University, Nuremberg, Germany
| | - Andrea Brinker-Paschke
- Clinic for Arrhythmology and Electrophysiology, Klinikum Nuremberg, University Hospital of the Paracelsus Medical University, Nuremberg, Germany
| | - Christopher Kowalewski
- Clinic for Arrhythmology and Electrophysiology, Klinikum Nuremberg, University Hospital of the Paracelsus Medical University, Nuremberg, Germany
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13
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Tereshchenko LG, Waks JW, Tompkins C, Rogers AJ, Ehdaie A, Henrikson CA, Dalouk K, Raitt M, Kewalramani S, Kattan MW, Santangeli P, Wilkoff BW, Kapadia SR, Narayan SM, Chugh SS. Competing risks of monomorphic vs. non-monomorphic ventricular arrhythmias in primary prevention implantable cardioverter-defibrillator recipients: Global Electrical Heterogeneity and Clinical Outcomes (GEHCO) study. Europace 2024; 26:euae127. [PMID: 38703375 PMCID: PMC11167666 DOI: 10.1093/europace/euae127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/09/2024] [Accepted: 03/29/2024] [Indexed: 05/06/2024] Open
Abstract
AIMS Ablation of monomorphic ventricular tachycardia (MMVT) has been shown to reduce shock frequency and improve survival. We aimed to compare cause-specific risk factors for MMVT and polymorphic ventricular tachycardia (PVT)/ventricular fibrillation (VF) and to develop predictive models. METHODS AND RESULTS The multicentre retrospective cohort study included 2668 patients (age 63.1 ± 13.0 years; 23% female; 78% white; 43% non-ischaemic cardiomyopathy; left ventricular ejection fraction 28.2 ± 11.1%). Cox models were adjusted for demographic characteristics, heart failure severity and treatment, device programming, and electrocardiogram metrics. Global electrical heterogeneity was measured by spatial QRS-T angle (QRSTa), spatial ventricular gradient elevation (SVGel), azimuth, magnitude (SVGmag), and sum absolute QRST integral (SAIQRST). We compared the out-of-sample performance of the lasso and elastic net for Cox proportional hazards and the Fine-Gray competing risk model. During a median follow-up of 4 years, 359 patients experienced their first sustained MMVT with appropriate implantable cardioverter-defibrillator (ICD) therapy, and 129 patients had their first PVT/VF with appropriate ICD shock. The risk of MMVT was associated with wider QRSTa [hazard ratio (HR) 1.16; 95% confidence interval (CI) 1.01-1.34], larger SVGel (HR 1.17; 95% CI 1.05-1.30), and smaller SVGmag (HR 0.74; 95% CI 0.63-0.86) and SAIQRST (HR 0.84; 95% CI 0.71-0.99). The best-performing 3-year competing risk Fine-Gray model for MMVT [time-dependent area under the receiver operating characteristic curve (ROC(t)AUC) 0.728; 95% CI 0.668-0.788] identified high-risk (> 50%) patients with 75% sensitivity and 65% specificity, and PVT/VF prediction model had ROC(t)AUC 0.915 (95% CI 0.868-0.962), both satisfactory calibration. CONCLUSION We developed and validated models to predict the competing risks of MMVT or PVT/VF that could inform procedural planning and future randomized controlled trials of prophylactic ventricular tachycardia ablation. CLINICAL TRIAL REGISTRATION URL:www.clinicaltrials.gov Unique identifier:NCT03210883.
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Affiliation(s)
- Larisa G Tereshchenko
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, JJN3-01, Cleveland, OH, USA
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jonathan W Waks
- Department of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Christine Tompkins
- Department of Cardiovascular Medicine, University of Colorado, Aurora, CO, USA
| | - Albert J Rogers
- Department of Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA
| | - Ashkan Ehdaie
- Department of Cardiovascular Medicine, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Charles A Henrikson
- Department of Cardiovascular Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Khidir Dalouk
- Department of Cardiovascular Medicine, VA Portland Health Care System, OR, USA
| | - Merritt Raitt
- Department of Cardiovascular Medicine, VA Portland Health Care System, OR, USA
| | - Shivangi Kewalramani
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, JJN3-01, Cleveland, OH, USA
| | - Michael W Kattan
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, JJN3-01, Cleveland, OH, USA
| | - Pasquale Santangeli
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce W Wilkoff
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sanjiv M Narayan
- Department of Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA
| | - Sumeet S Chugh
- Department of Cardiovascular Medicine, Cedars-Sinai Health System, Los Angeles, CA, USA
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14
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Zabel M, Friede T. Electrocardiographic risk stratification in patients with a primary prophylactic implantable cardioverter defibrillator: can future arrhythmias correlating with sudden cardiac death be predicted? Europace 2024; 26:euae133. [PMID: 38758091 PMCID: PMC11167662 DOI: 10.1093/europace/euae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 05/14/2024] [Indexed: 05/18/2024] Open
Affiliation(s)
- Markus Zabel
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Tim Friede
- DZHK (German Center for Cardiovascular Research), Partner Site Lower Saxony, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073 Göttingen, Germany
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15
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Gomes DA, Sousa Paiva M, Matos D, Bello AR, Rodrigues G, Carmo J, Ferreira J, Moscoso Costa F, Galvão Santos P, Carmo P, Cavaco D, Bello Morgado F, Adragão P. Outcomes of ventricular tachycardia ablation in patients with ischemic and non-ischemic cardiomyopathy: A propensity-score matched analysis. Rev Port Cardiol 2024; 43:341-349. [PMID: 38615878 DOI: 10.1016/j.repc.2024.04.002] [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: 02/27/2024] [Revised: 03/21/2024] [Accepted: 04/09/2024] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Catheter ablation (CA) is effective in the treatment of ventricular tachycardia (VT). Although some observational data suggest patients with non-ischemic cardiomyopathy (NICM) have less favorable outcomes when compared to those with an ischemic etiology (ICM), direct comparisons are rarely reported. We aimed to compare the outcomes of VT ablation in a propensity-score matched population of ICM or NICM patients. METHODS Single-center retrospective study of consecutive patients undergoing VT ablation from 2012 to 2023. A propensity score (PS) was used to match ICM and NICM patients in a 1:1 fashion according to age, sex, left ventricular ejection fraction (LVEF), NYHA class, electrical storm (ES) at presentation, and previous endocardial ablation. The outcomes of interest were VT-free survival and all-cause mortality. RESULTS The PS yielded two groups of 71 patients each (mean age 63±10 years, 92% male, mean LVEF 35±10%, 36% with ES at presentation, and 23% with previous ablation), well matched for baseline characteristics. During a median follow-up of 2.3 (interquartile range IQR 1.3-3.8) years, patients with NICM had a significantly lower VT-free survival (53.5% vs. 69.0%, log-rank p=0.037), although there were no differences regarding all-cause mortality (22.5% vs. 16.9%, log-rank p=0.245). Multivariate analysis identified NICM (HR 2.34 [95% CI 1.32-4.14], p=0.004), NYHA class III/IV (HR 2.11 [95% CI 1.11-4.04], p=0.024), and chronic kidney disease (HR 2.23 [95% CI 1.25-3.96], p=0.006), as independent predictors of VT recurrence. CONCLUSION Non-ischemic cardiomyopathy patients were at increased risk of VT recurrence after ablation, although long-term mortality did not differ.
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Affiliation(s)
- Daniel A Gomes
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal.
| | - Mariana Sousa Paiva
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Daniel Matos
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal; Department of Cardiology, Hospital da Luz, Lisbon, Portugal
| | - Ana Rita Bello
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Gustavo Rodrigues
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal; Department of Cardiology, Hospital dos Lusíadas, Lisbon, Portugal
| | - João Carmo
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal; Department of Cardiology, Hospital da Luz, Lisbon, Portugal
| | - Jorge Ferreira
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Francisco Moscoso Costa
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal; Department of Cardiology, Hospital da Luz, Lisbon, Portugal
| | - Pedro Galvão Santos
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal; Department of Cardiology, Hospital da Luz, Lisbon, Portugal
| | - Pedro Carmo
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal; Department of Cardiology, Hospital da Luz, Lisbon, Portugal
| | - Diogo Cavaco
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal; Department of Cardiology, Hospital da Luz, Lisbon, Portugal
| | - Francisco Bello Morgado
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal; Department of Cardiology, Hospital dos Lusíadas, Lisbon, Portugal
| | - Pedro Adragão
- Department of Cardiology, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal; Department of Cardiology, Hospital da Luz, Lisbon, Portugal
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16
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Radinovic A, Giacopelli D, Bisceglia C, Paglino G, Gargaro A, Della Bella P. Active Arrhythmia Pattern: A Novel Predictor of ICD Shocks-A Subanalysis From the PARTITA Study. Circ Arrhythm Electrophysiol 2024; 17:e012523. [PMID: 38690665 DOI: 10.1161/circep.123.012523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND In the PARTITA trial (Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator?), antitachycardia pacing (ATP) predicted the occurrence of implantable cardioverter defibrillator (ICD) shocks. Catheter ablation of ventricular tachycardia after the first shock reduced the risk of death or worsening heart failure. A threshold of ATPs that might warrant an ablation procedure before ICD shocks is unknown. Our aim was to identify a threshold of ATPs and clinical features that predict the occurrence of shocks and cardiovascular events. METHODS We analyzed data from 517 patients in phase A of the PARTITA study. We used classification and regression tree analysis to develop and test a risk stratification model based on arrhythmia patterns and clinical data to predict ICD shocks. Secondary end points were worsening heart failure and cardiovascular hospitalization. RESULTS Classification and regression tree classified patients into 6 leaves by increasing shock probability. Patients treated with ≥5 ATPs in 6 months (active arrhythmia pattern) had the highest risk of ICD shocks (93% and 86%, training and testing samples, respectively). Patients without ATPs had the lowest (1% and 2%). Other predictors included left ventricle ejection fraction<35%, age of <60 years, and obesity. Survival analysis revealed a higher risk of worsening heart failure (hazard ratio, 5.45 [95% CI, 1.62-18.4]; P=0.006) and cardiovascular hospitalization (hazard ratio, 7.29 [95% CI, 3.66-14.5]; P<0.001) for patients with an active arrhythmia pattern compared with those without ATPs. CONCLUSIONS Patients with an active arrhythmia pattern (≥5 ATPs in 6 months) are associated with an increased risk of ICD shocks, as well as heart failure hospitalization and cardiovascular hospitalization. These data suggest that additional treatments may be helpful to this high-risk group as a preventive strategy to reduce the incidence of major events. Further prospective randomized trials are needed to confirm the benefits of early ventricular tachycardia ablation in this setting.
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Affiliation(s)
- Andrea Radinovic
- Department of Cardiac Arrhythmia and Electrophysiology, San Raffaele University-Hospital, Milan, Italy (A.R., C.B., G.P., A.G., P.D.B.)
| | | | - Caterina Bisceglia
- Department of Cardiac Arrhythmia and Electrophysiology, San Raffaele University-Hospital, Milan, Italy (A.R., C.B., G.P., A.G., P.D.B.)
| | - Gabriele Paglino
- Department of Cardiac Arrhythmia and Electrophysiology, San Raffaele University-Hospital, Milan, Italy (A.R., C.B., G.P., A.G., P.D.B.)
| | - Alessio Gargaro
- Department of Cardiac Arrhythmia and Electrophysiology, San Raffaele University-Hospital, Milan, Italy (A.R., C.B., G.P., A.G., P.D.B.)
| | - Paolo Della Bella
- Department of Cardiac Arrhythmia and Electrophysiology, San Raffaele University-Hospital, Milan, Italy (A.R., C.B., G.P., A.G., P.D.B.)
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17
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Falzone PV, Vazquez-Calvo S, Roca-Luque I. Catheter Ablation of Ventricular Tachycardia in Ischemic Heart Disease: What Is Known and New Perspectives. Curr Heart Fail Rep 2024; 21:174-185. [PMID: 38536648 DOI: 10.1007/s11897-024-00656-y] [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] [Accepted: 03/04/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE OF THE REVIEW This review aims to evaluate current evidence regarding ventricular tachycardia ablation in patients with ischemic heart disease and explore novel approaches currently developing to improve procedural and long-term outcomes. RECENT FINDINGS Recently published trials (PARTITA, PAUSE-SCD, and SURVIVE-VT) have demonstrated the prognostic benefit of prophylactic ventricular tachycardia ablation compared to current clinical practice. Advanced cardiac imaging provides a valuable pre-procedural evaluation of the arrhythmogenic substrate, identifying ablation targets non-invasively. Advanced cardiac mapping techniques allow to better characterize arrhythmogenic substrate during ablation procedure. Emerging technologies like pulsed field ablation and ultra-low temperature cryoablation show promise in ventricular tachycardia ablation. Advancements in mapping techniques, ablation technologies, and pre-procedural cardiac imaging offer promise for improving ventricular tachycardia ablation outcomes in ischemic heart disease.
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Affiliation(s)
- Pasquale Valerio Falzone
- Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Sara Vazquez-Calvo
- Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Ivo Roca-Luque
- Institut Clinic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Carrer de Villaroel 170, 08036, Barcelona, Catalonia, Spain.
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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18
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Dong Y, Song X, Bo D, Wang H, Yang B, Yadav N, Chen Q, Xu R, Chen H, Ju W, Cao K, Chen M, Zhang F. Catheter ablation versus antiarrhythmic drug therapy for sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy. BMC Cardiovasc Disord 2024; 24:255. [PMID: 38755595 PMCID: PMC11097463 DOI: 10.1186/s12872-024-03924-w] [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: 11/08/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Ventricular tachycardia (VT) is the primary cause of sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, the strategy for VT treatment in HCM patients remains unclear. This study is aimed to compare the effectiveness of catheter ablation versus antiarrhythmic drug (AAD) therapy for sustained VT in patients with HCM. METHODS A total of 28 HCM patients with sustained VT at 4 different centers between December 2012 and December 2021 were enrolled. Twelve underwent catheter ablation (ablation group) and sixteen received AAD therapy (AAD group). The primary outcome was VT recurrence during follow-up. RESULTS Baseline characteristics were comparable between two groups. After a mean follow-up of 31.4 ± 17.5 months, the primary outcome occurred in 35.7% of the ablation group and 90.6% of the AAD group (hazard ratio [HR], 0.29 [95%CI, 0.10-0.89]; P = 0.021). No differences in hospital admission due to cardiovascular cause (25.0% vs. 71.0%; P = 0.138) and cardiovascular cause-related mortality/heart transplantation (9.1% vs. 50.6%; P = 0.551) were observed. However, there was a significant reduction in the composite endpoint of VT recurrence, hospital admission due to cardiovascular cause, cardiovascular cause-related mortality, or heart transplantation in ablation group as compared to that of AAD group (42.9% vs. 93.7%; HR, 0.34 [95% CI, 0.12-0.95]; P = 0.029). CONCLUSIONS In HCM patients with sustained VT, catheter ablation reduced the VT recurrence, and the composite endpoint of VT recurrence, hospital admission due to cardiovascular cause, cardiovascular cause-related mortality, or heart transplantation as compared to AAD.
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MESH Headings
- Humans
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/physiopathology
- Tachycardia, Ventricular/mortality
- Tachycardia, Ventricular/therapy
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/surgery
- Anti-Arrhythmia Agents/therapeutic use
- Anti-Arrhythmia Agents/adverse effects
- Catheter Ablation/adverse effects
- Catheter Ablation/mortality
- Male
- Female
- Middle Aged
- Cardiomyopathy, Hypertrophic/mortality
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/physiopathology
- Cardiomyopathy, Hypertrophic/surgery
- Cardiomyopathy, Hypertrophic/therapy
- Treatment Outcome
- Recurrence
- Time Factors
- Adult
- Retrospective Studies
- Risk Factors
- Aged
- Heart Rate
- China
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Affiliation(s)
- Yan Dong
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Xudong Song
- Department of Cardiology, ZhuJiang Hospital of Southern Medical University, Guangzhou, China
| | - Dan Bo
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Hongtao Wang
- Department of Cardiology, the Second Affiliated Hospital of Xi'an JiaoTong University, Xi'an, China
| | - Bo Yang
- Department of Cardiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Nishant Yadav
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Qiushi Chen
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Ruochen Xu
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Hongwu Chen
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Weizhu Ju
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Kejiang Cao
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Minglong Chen
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Fengxiang Zhang
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029.
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19
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Li L, Ding L, Wu L, Zheng L, Zhou L, Zhang Z, Xiong Y, Zhang Z, Yao Y. Efficacy of catheter ablation for ventricular tachycardia in ischemic cardiomyopathy patients without an ICD implantation. Heart Rhythm 2024:S1547-5271(24)02553-0. [PMID: 38734226 DOI: 10.1016/j.hrthm.2024.05.011] [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: 03/17/2024] [Revised: 04/27/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND The implantable cardioverter-defibrillator (ICD) prevents sudden cardiac death in patients with ischemic cardiomyopathy (ICM). Catheter ablation has been shown to effectively reduce ventricular tachycardia (VT) recurrence, yet its efficacy in patients without an ICD implantation remains uncertain. OBJECTIVE We aimed to investigate the outcomes of ablation for VT in patients with ICM without a backup ICD. METHODS Patients with ICM who received ablation for VT without an ICD implantation were included in this study. Ablation was guided by either activation mapping or substrate mapping. Endocardial ablation was the primary strategy; epicardial access was considered when endocardial ablation failed. The primary end point was VT recurrence during follow-up; secondary end points included cardiovascular rehospitalization, all-cause mortality, and a composite of these events. RESULTS A total of 114 patients were included, with the mean age of 58.2 ± 11.1 years, 102 of whom (89.5%) were male. Twelve patients (10.5%) underwent endo-epicardial ablation, whereas the rest received endocardial ablation. With a median follow-up of 53.8 months (24.8-84.2 months), VT recurred in 45 patients (39.5%), and 6 patients (5.3%) died, including 2 sudden cardiac deaths. The recurrence rate of VT was significantly lower in patients undergoing endo-epicardial ablation than in those with endocardial ablation only (8.3% vs 43.1%; log-rank P = .032). After multivariate adjustment, epicardial ablation remained associated with a reduced risk of VT recurrence (hazard ratio, 0.14; 95% confidential interval, 0.02-0.98; P = .048). CONCLUSION Patients with ICM undergoing VT ablation without a backup ICD experienced a notably low rate of arrhythmic death. Most recurrences proved nonlethal.
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Affiliation(s)
- Le Li
- Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ligang Ding
- Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Lingmin Wu
- Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Lihui Zheng
- Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Likun Zhou
- Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhenhao Zhang
- Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yulong Xiong
- Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhuxin Zhang
- Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yan Yao
- Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
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20
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Tonko JB, Lambiase P. Exploring the Full Potential of Radiofrequency Technology: A Practical Guide to Advanced Radiofrequency Ablation for Complex Ventricular Arrhythmias. Curr Cardiol Rep 2024; 26:269-282. [PMID: 38700597 PMCID: PMC11136806 DOI: 10.1007/s11886-024-02048-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] [Accepted: 03/19/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW Percutaneous radiofrequency (RF) catheter ablation is an established strategy to prevent ventricular tachycardia (VT) recurrence and ICD shocks. Yet delivery of durable lesion sets by means of traditional unipolar radiofrequency ablation remains challenging, and left ventricular transmurality is rarely achieved. Failure to ablate and eliminate functionally relevant areas is particularly common in deep intramyocardial substrates, e.g. septal VT and cardiomyopathies. Here, we aim to give a practical-orientated overview of advanced and emerging RF ablation technologies to target these complex VT substrates. We summarize recent evidence in support of these technologies and share experiences from a tertiary VT centre to highlight important "hands-on" considerations for operators new to advanced RF ablation strategies. RECENT FINDINGS A number of innovative and modified radiofrequency ablation approaches have been proposed to increase energy delivery to the myocardium and maximize RF lesion dimensions and depth. These include measures of impedance modulation, combinations of simultaneous unipolar ablations or true bipolar ablation, intramyocardial RF delivery via wires or extendable RF needles and investigational linear or spherical catheter designs. Recent new clinical evidence for the efficacy and safety of these investigational technologies and strategies merits a re-evaluation of their role and clinic application for percutaneous VT ablations. Complexity of substrates targeted with percutaneous VT ablation is increasing and requires detailed preprocedural imaging to characterize the substrate to inform the procedural approach and selection of ablation technology. Depending on local experience, options for additional and/or complementary interventional treatments should be considered upfront in challenging substrates to improve the success rates of index procedures. Advanced RF technologies available for clinical VT ablations include impedance modulation via hypotonic irrigation or additional dispersive patches and simultaneous unipolar as well as true bipolar ablation. Promising investigational RF technologies involve an extendable needle RF catheter, intramyocardial RF delivery over intentionally perforated wires as well as a variety of innovative ablation catheter designs including multipolar linear, spherical and partially insulated ablation catheters.
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Affiliation(s)
- J B Tonko
- Institute of Cardiovascular Science, University College London, 62 Huntley St, London, WC1E 6DD, UK.
- Bartholomew s Hospital, W Smithfield, London, UK.
| | - P Lambiase
- Institute of Cardiovascular Science, University College London, 62 Huntley St, London, WC1E 6DD, UK
- Bartholomew s Hospital, W Smithfield, London, UK
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21
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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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22
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Scarà A, Palamà Z, Robles AG, Dei LL, Borrelli A, Zanin F, Pignalosa L, Romano S, Sciarra L. Non-Pharmacological Treatment of Heart Failure-From Physical Activity to Electrical Therapies: A Literature Review. J Cardiovasc Dev Dis 2024; 11:122. [PMID: 38667740 PMCID: PMC11050051 DOI: 10.3390/jcdd11040122] [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: 03/14/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Heart failure (HF) represents a significant global health challenge that is still responsible for increasing morbidity and mortality despite advancements in pharmacological treatments. This review investigates the effectiveness of non-pharmacological interventions in the management of HF, examining lifestyle measures, physical activity, and the role of some electrical therapies such as catheter ablation, cardiac resynchronization therapy (CRT), and cardiac contractility modulation (CCM). Structured exercise training is a cornerstone in this field, demonstrating terrific improvements in functional status, quality of life, and mortality risk reduction, particularly in patients with HF with reduced ejection fraction (HFrEF). Catheter ablation for atrial fibrillation, premature ventricular beats, and ventricular tachycardia aids in improving left ventricular function by reducing arrhythmic burden. CRT remains a key intervention for selected HF patients, helping achieve left ventricular reverse remodeling and improving symptoms. Additionally, the emerging therapy of CCM provides a novel opportunity for patients who do not meet CRT criteria or are non-responders. Integrating non-pharmacological interventions such as digital health alongside specific medications is key for optimizing outcomes in HF management. It is imperative to tailor approaches to individual patients in this diverse patient population to maximize benefits. Further research is warranted to improve treatment strategies and enhance patient outcomes in HF management.
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Affiliation(s)
- Antonio Scarà
- San Carlo di Nancy Hospital—GVM, 00165 Roma, Italy; (A.B.); (F.Z.); (L.P.)
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (Z.P.); (A.G.R.); (L.-L.D.); (S.R.); (L.S.)
| | - Zefferino Palamà
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (Z.P.); (A.G.R.); (L.-L.D.); (S.R.); (L.S.)
- Electrophysiology Unit “Casa di Cura Villa Verde”, 74121 Taranto, Italy
| | - Antonio Gianluca Robles
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (Z.P.); (A.G.R.); (L.-L.D.); (S.R.); (L.S.)
- Electrophysiology Unit “Casa di Cura Villa Verde”, 74121 Taranto, Italy
- Department of Cardiology, “L. Bonomo” Hospital, 76123 Andria, Italy
| | - Lorenzo-Lupo Dei
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (Z.P.); (A.G.R.); (L.-L.D.); (S.R.); (L.S.)
| | - Alessio Borrelli
- San Carlo di Nancy Hospital—GVM, 00165 Roma, Italy; (A.B.); (F.Z.); (L.P.)
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (Z.P.); (A.G.R.); (L.-L.D.); (S.R.); (L.S.)
| | - Federico Zanin
- San Carlo di Nancy Hospital—GVM, 00165 Roma, Italy; (A.B.); (F.Z.); (L.P.)
| | - Leonardo Pignalosa
- San Carlo di Nancy Hospital—GVM, 00165 Roma, Italy; (A.B.); (F.Z.); (L.P.)
| | - Silvio Romano
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (Z.P.); (A.G.R.); (L.-L.D.); (S.R.); (L.S.)
| | - Luigi Sciarra
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (Z.P.); (A.G.R.); (L.-L.D.); (S.R.); (L.S.)
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23
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Tan MC, Ang QX, Yeo YH, Deshmukh A, Scott LR, Hussein AA, Sroubek J, Santangeli P, Wazni OM, Lee JZ. Thirty-day readmission after catheter ablation for ventricular tachycardia: associated factors and outcomes. J Interv Card Electrophysiol 2024; 67:513-521. [PMID: 37530968 DOI: 10.1007/s10840-023-01614-9] [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: 07/23/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Patients with ventricular tachycardia (VT) who require VT ablation are at high risk for readmission. This study aimed to identify the causes and outcomes of 30-day readmission after VT ablation and to analyze the predictors of recurrent VT that required rehospitalization. METHODS Using the Nationwide Readmission Database, our study included patients aged ≥ 18 years who underwent VT catheter ablation between 2017 and 2020. Based on the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), we identified the causes of 30-day readmission by organ systems and analyzed their outcomes. Additional analysis was performed to determine the independent predictors of 30-day readmission for recurrent VT. RESULTS Of the 4228 patients who underwent VT ablation, 14.2% were readmitted within 30 days of the procedure. The most common cause of readmission was cardiac events (73.6%). Among the cardiac-related readmissions, recurrent VT (47.7%) and congestive heart failure (CHF) (12.9%) were the most common etiologies. Among the readmissions, patients readmitted for CHF had the highest rate of readmission mortality (9.2%). Of the patients readmitted within 30 days of the procedure, 278 patients (6.8%) were readmitted for recurrent VT. Via multivariable analysis, CHF (OR: 1.97; 95% CI: 1.12-3.47; P = 0.02) and non-elective index admissions (OR: 1.63; 95% CI: 1.04-2.55; P = 0.03) were identified as the independent predictors predictive of 30-day readmissions for recurrent VT. CONCLUSIONS Recurrent VT was the most common cause of readmission after the VT ablation procedure, and CHF and non-elective index admissions were the significant predictors of these early readmissions. Readmission due to CHF had the highest mortality rate during readmission.
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Affiliation(s)
- Min Choon Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
- Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, NJ, USA
| | - Qi Xuan Ang
- Department of Internal Medicine, Sparrow Health System and Michigan State University, East Lansing, MI, USA
| | - Yong Hao Yeo
- Department of Internal Medicine/Pediatrics, Beaumont Health, Royal Oak, MI, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Luis R Scott
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Ayman A Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Jakub Sroubek
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Pasquale Santangeli
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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24
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Lenarczyk R, Zeppenfeld K, Tfelt-Hansen J, Heinzel FR, Deneke T, Ene E, Meyer C, Wilde A, Arbelo E, Jędrzejczyk-Patej E, Sabbag A, Stühlinger M, di Biase L, Vaseghi M, Ziv O, Bautista-Vargas WF, Kumar S, Namboodiri N, Henz BD, Montero-Cabezas J, Dagres N. Management of patients with an electrical storm or clustered ventricular arrhythmias: a clinical consensus statement of the European Heart Rhythm Association of the ESC-endorsed by the Asia-Pacific Heart Rhythm Society, Heart Rhythm Society, and Latin-American Heart Rhythm Society. Europace 2024; 26:euae049. [PMID: 38584423 PMCID: PMC10999775 DOI: 10.1093/europace/euae049] [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: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 04/09/2024] Open
Abstract
Electrical storm (ES) is a state of electrical instability, manifesting as recurrent ventricular arrhythmias (VAs) over a short period of time (three or more episodes of sustained VA within 24 h, separated by at least 5 min, requiring termination by an intervention). The clinical presentation can vary, but ES is usually a cardiac emergency. Electrical storm mainly affects patients with structural or primary electrical heart disease, often with an implantable cardioverter-defibrillator (ICD). Management of ES requires a multi-faceted approach and the involvement of multi-disciplinary teams, but despite advanced treatment and often invasive procedures, it is associated with high morbidity and mortality. With an ageing population, longer survival of heart failure patients, and an increasing number of patients with ICD, the incidence of ES is expected to increase. This European Heart Rhythm Association clinical consensus statement focuses on pathophysiology, clinical presentation, diagnostic evaluation, and acute and long-term management of patients presenting with ES or clustered VA.
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Affiliation(s)
- Radosław Lenarczyk
- Medical University of Silesia, Division of Medical Sciences, Department of Cardiology and Electrotherapy, Silesian Center for Heart Diseases, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- The Department of Forensic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frank R Heinzel
- Cardiology, Angiology, Intensive Care, Städtisches Klinikum Dresden Campus Friedrichstadt, Dresden, Germany
| | - Thomas Deneke
- Clinic for Interventional Electrophysiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
- Clinic for Electrophysiology, Klinikum Nuernberg, University Hospital of the Paracelsus Medical University, Nuernberg, Germany
| | - Elena Ene
- Clinic for Interventional Electrophysiology, Heart Center RHÖN-KLINIKUM Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Christian Meyer
- Division of Cardiology/Angiology/Intensive Care, EVK Düsseldorf, Teaching Hospital University of Düsseldorf, Düsseldorf, Germany
| | - Arthur Wilde
- Department of Cardiology, Amsterdam UMC University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Tel Hashomer, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Markus Stühlinger
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Luigi di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA
| | - Marmar Vaseghi
- UCLA Cardiac Arrythmia Center, Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Ohad Ziv
- Case Western Reserve University, Cleveland, OH, USA
- The MetroHealth System Campus, Cleveland, OH, USA
| | | | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | | | - Benhur Davi Henz
- Instituto Brasilia de Arritmias-Hospital do Coração do Brasil-Rede Dor São Luiz, Brasilia, Brazil
| | - Jose Montero-Cabezas
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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25
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Verma A, Essebag V, Neuzil P, Dyrda K, Balt J, Dinov B, Darma A, Arya A, Sacher F, Reddy VY, Boersma L, Grigorov I, De Potter T. Cryocure-VT: the safety and effectiveness of ultra-low-temperature cryoablation of monomorphic ventricular tachycardia in patients with ischaemic and non-ischaemic cardiomyopathies. Europace 2024; 26:euae076. [PMID: 38582974 PMCID: PMC10998960 DOI: 10.1093/europace/euae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/18/2024] [Indexed: 04/08/2024] Open
Abstract
AIMS The ultra-low-temperature cryoablation (ULTC) ablation system using -196°C N2 cryogen has been reported to create lesions with freeze duration-dependent depth titratable to over 10 mm with minimum attenuation by scar. Cryocure-VT (NCT04893317) was a first-in-human clinical trial evaluating the safety and efficacy of a novel, purpose-built ULTC catheter in endocardial ablation of scar-dependent ventricular tachycardias (VTs). METHODS AND RESULTS This prospective, multi-centre study enrolled patients referred for de novo or second ablations of recurrent monomorphic VT of both ischaemic and non-ischaemic aetiologies. Primary safety and efficacy endpoints of the study were freedom from device- or procedure-related major adverse events (MAEs) up to 30 days post-ablation, acute non-inducibility of clinical VTs at the end of the procedure, and freedom from sustained VT or implantable defibrillator intervention at 6 months. Ultra-low-temperature cryoablation was performed in 64 patients (age 67 ± 11 years, 78% ischaemic, ejection fraction = 35 ± 10%) at 9 centres. The primary acute effectiveness endpoint was achieved in 94% (51/54) of patients in whom post-ablation induction was attempted. There were no protocol-defined MAEs; four procedure-related serious adverse events resolved without clinical sequelae. At 6-month follow-up, 38 patients (60.3%) remained VT-free, and freedom from defibrillator shock was 81.0%, with no significant difference between ischaemic and non-ischaemic cohorts. In 47 patients with defibrillator for at least 6 months prior to the ablation, the VT burden was reduced from median of 4, inter-quartile range (IQR, 1-9) to 0, IQR (0-2). CONCLUSION In this first-in-human multi-centre experience, endocardial ULTC ablation of monomorphic VT appears safe and effective in patients with both ischaemic-cardiomyopathy and non-ischaemic-cardiomyopathy. CLINICAL TRIAL REGISTRATION NCT04893317.
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Affiliation(s)
- Atul Verma
- Division of Cardiology, McGill University Health Centre, D13.173, 1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada
| | - Vidal Essebag
- Division of Cardiology, McGill University Health Centre, D13.173, 1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada
| | - Petr Neuzil
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Montreal, QC, Canada
| | - Jippe Balt
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Borislav Dinov
- Department of Electrophysiology, Leipzig Heart Center, Leipzig, Germany
| | - Angeliki Darma
- Department of Electrophysiology, Leipzig Heart Center, Leipzig, Germany
| | - Arash Arya
- Department for Internal Medicine, University Hospital Halle, Halle, Germany
| | - Frederic Sacher
- Bordeaux University Hospital, IHU LIRYC, University of Bordeaux, Bordeaux, France
| | - Vivek Y Reddy
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
- Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, New York, NY, USA
| | - Lucas Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Heart Failure and Arrhythmias,Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Tom De Potter
- Cardiovascular Center, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium
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26
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Lambiase PD, Maclean E. Review of the National Institute for Health and Care Excellence guidelines on the management of atrial and ventricular arrhythmias. Heart 2024; 110:313-322. [PMID: 37487695 DOI: 10.1136/heartjnl-2022-322122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/03/2023] [Indexed: 07/26/2023] Open
Abstract
The National Institute for Health and Care Excellence (NICE) guidelines present a synopsis of extensive internal evidence and technology reviews, with a particular focus on clinical efficacy and cost-effectiveness within the NHS in England. This approach has delivered a novel perspective on arrhythmia management, with important distinctions from other policymakers' recommendations. For example, when compared with the European Society of Cardiology (ESC) and the American Heart Association (AHA)/Heart Rhythm Society (HRS)/American College of Cardiology (ACC) guidelines on atrial fibrillation (AF), NICE advocates unique strategies regarding arrhythmia detection, stroke and bleeding risk stratification, and rhythm control (NICE CG 196). Likewise, for patients at risk of sudden cardiac death, NICE TA314 not only recommends device therapy based on New York Heart Association class and ECG findings, but also incorporates quality-adjusted life year data from analysis of key randomised controlled trials.This review examines the NICE guidelines, together with those from the AHA/HRS/ACC and ESC, on the management of AF and ventricular arrhythmias and highlights the key common features and discrepancies between these important documents.
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Affiliation(s)
- Pier D Lambiase
- Cardiac Electrophysiology, St Bartholomew's Hospital, London, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Edd Maclean
- Cardiac Electrophysiology, St Bartholomew's Hospital, London, UK
- Queen Mary University of London, William Harvey Research Institute, London, UK
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27
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Ahmad A, Doshi RN. Ventricular arrhythmias: It is the substrate that counts. Heart Rhythm 2024; 21:172-173. [PMID: 38000654 DOI: 10.1016/j.hrthm.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 11/26/2023]
Affiliation(s)
- Amier Ahmad
- Department of Clinical Cardiac Electrophysiology, HonorHealth, Scottsdale, Arizona
| | - Rahul N Doshi
- Department of Clinical Cardiac Electrophysiology, HonorHealth, Scottsdale, Arizona.
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28
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Könemann H, Güler-Eren S, Ellermann C, Frommeyer G, Eckardt L. Antiarrhythmic Treatment in Heart Failure. Curr Heart Fail Rep 2024; 21:22-32. [PMID: 38224446 PMCID: PMC10828006 DOI: 10.1007/s11897-023-00642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE OF REVIEW Arrhythmias are common in patients with heart failure (HF) and are associated with a significant risk of mortality and morbidity. Optimal antiarrhythmic treatment is therefore essential. Here, we review current approaches to antiarrhythmic treatment in patients with HF. RECENT FINDINGS In atrial fibrillation, rhythm control and ventricular rate control are accepted therapeutic strategies. In recent years, clinical trials have demonstrated a prognostic benefit of early rhythm control strategies and AF catheter ablation, especially in patients with HF with reduced ejection fraction. Prevention of sudden cardiac death with ICD therapy is essential, but optimal risk stratification is challenging. For ventricular tachycardias, recent data support early consideration of catheter ablation. Antiarrhythmic drug therapy is an adjunctive therapy in symptomatic patients but has no prognostic benefit and well-recognized (proarrhythmic) adverse effects. Antiarrhythmic therapy in HF requires a systematic, multimodal approach, starting with guideline-directed medical therapy for HF and integrating pharmacological, device, and interventional therapy.
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Affiliation(s)
- Hilke Könemann
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany.
| | - Sati Güler-Eren
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Christian Ellermann
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
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Stanciulescu LA, Vatasescu R. Ventricular Tachycardia Catheter Ablation: Retrospective Analysis and Prospective Outlooks-A Comprehensive Review. Biomedicines 2024; 12:266. [PMID: 38397868 PMCID: PMC10886924 DOI: 10.3390/biomedicines12020266] [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: 12/30/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
Ventricular tachycardia is a potentially life-threatening arrhythmia associated with an overall high morbi-mortality, particularly in patients with structural heart disease. Despite their pivotal role in preventing sudden cardiac death, implantable cardioverter-defibrillators, although a guideline-based class I recommendation, are unable to prevent arrhythmic episodes and significantly alter the quality of life by delivering recurrent therapies. From open-heart surgical ablation to the currently widely used percutaneous approach, catheter ablation is a safe and effective procedure able to target the responsible re-entry myocardial circuit from both the endocardium and the epicardium. There are four main mapping strategies, activation, entrainment, pace, and substrate mapping, each of them with their own advantages and limitations. The contemporary guideline-based recommendations for VT ablation primarily apply to patients experiencing antiarrhythmic drug ineffectiveness or those intolerant to the pharmacological treatment. Although highly effective in most cases of scar-related VTs, the traditional approach may sometimes be insufficient, especially in patients with nonischemic cardiomyopathies, where circuits may be unmappable using the classic techniques. Alternative methods have been proposed, such as stereotactic arrhythmia radioablation or radiotherapy ablation, surgical ablation, needle ablation, transarterial coronary ethanol ablation, and retrograde coronary venous ethanol ablation, with promising results. Further studies are needed in order to prove the overall efficacy of these methods in comparison to standard radiofrequency delivery. Nevertheless, as the field of cardiac electrophysiology continues to evolve, it is important to acknowledge the role of artificial intelligence in both the pre-procedural planning and the intervention itself.
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Affiliation(s)
- Laura Adina Stanciulescu
- Cardio-Thoracic Department, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Cardiology Department, Clinical Emergency Hospital, 014461 Bucharest, Romania
| | - Radu Vatasescu
- Cardio-Thoracic Department, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Cardiology Department, Clinical Emergency Hospital, 014461 Bucharest, Romania
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30
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Waks JW, Maher TR, d'Avila A. Improving substrate mapping for ventricular tachycardia with a novel peak frequency annotation algorithm: Deconstructing the abnormal electrogram. Heart Rhythm 2024; 21:34-35. [PMID: 38178590 DOI: 10.1016/j.hrthm.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 10/25/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Jonathan W Waks
- Harvard Thorndike Arrhythmia Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
| | - Timothy R Maher
- Harvard Thorndike Arrhythmia Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Andre d'Avila
- Harvard Thorndike Arrhythmia Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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31
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Aryana A, D’Avila A. Emerging Tools and Techniques for Catheter Ablation of Cardiac Arrhythmias: A 2024 Update. J Innov Card Rhythm Manag 2024; 15:5718-5727. [PMID: 38304094 PMCID: PMC10829418 DOI: 10.19102/icrm.2024.15019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, CA, USA
| | - André D’Avila
- The Harvard Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
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32
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Aryana A, Hata C, de la Rama A, Nguyen K, Panescu D. A novel pulsed field ablation system using linear and spiral ablation catheters can create large and durable endocardial and epicardial ventricular lesions in vivo. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01714-6. [PMID: 38157151 DOI: 10.1007/s10840-023-01714-6] [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: 09/26/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND We investigated the preclinical safety and efficacy of ventricular pulsed field ablation (PFA) using a family of novel, 6-/8-Fr, linear, and spiral PFA/mapping catheters (CRC EP, Inc). METHODS QRS-gated, bipolar PFA (>2.0 kV) was performed in 10 healthy swine. Altogether, 20 endocardial and epicardial right and left ventricular applications were delivered. The catheters were inserted through an 8.5-Fr steerable introducer. The intensity of skeletal muscle activation was quantified using an accelerometer. Lesions were assessed by pre- versus post-PFA electrogram analysis, pacing threshold, 3D voltage mapping, necropsy, and histology. The swine rete mirabile, liver and kidneys were examined for embolic events. RESULTS All applications were single-shot (56 ± 18 s) without catheter repositioning. Minimal microbubbling was observed without significant skeletal muscle stimulation (mean acceleration 0.05 m/s2) or ventricular tachyarrhythmias. There was significant reduction in post- versus pre-PFA electrogram amplitude (0.5 ± 0.2 mV versus 3.2 ± 0.9 mV, P < 0.001) with a marked increase in pacing threshold (>20 mA versus 7.5 ± 2.9 mA, P < 0.001). All lesions were large and durable up to 28 days, measuring 32 ± 5 mm (length), 27 ± 8 mm (width), and 8 ± 3 mm (depth) using the spiral catheters and 43 ± 1 mm (length), 7 ± 1 mm (width), and 8 ± 1 mm (depth) using the linear catheters. Despite higher waveform voltages and prolonged applications, no thermal effects were detected at necropsy/histology. Moreover, gross and microscopic examinations revealed no evidence of thromboembolism, vascular or collateral injury. CONCLUSIONS A novel, QRS-gated PFA system using linear and spiral PFA catheters is capable of creating large and durable ventricular lesions in vivo without significant microbubbling, ventricular arrhythmias or thromboembolism.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA, 95819, USA.
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Eckardt L, Doldi F, Anwar O, Gessler N, Scherschel K, Kahle AK, von Falkenhausen AS, Thaler R, Wolfes J, Metzner A, Meyer C, Willems S, Köbe J, Lange PS, Frommeyer G, Kuck KH, Kääb S, Steinbeck G, Sinner MF. Major in-hospital complications after catheter ablation of cardiac arrhythmias: individual case analysis of 43 031 procedures. Europace 2023; 26:euad361. [PMID: 38102318 PMCID: PMC10754182 DOI: 10.1093/europace/euad361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
AIMS In-hospital complications of catheter ablation for atrial fibrillation (AF), atrial flutter (AFL), and ventricular tachycardia (VT) may be overestimated by analyses of administrative data. METHODS AND RESULTS We determined the incidences of in-hospital mortality, major bleeding, and stroke around AF, AFL, and VT ablations in four German tertiary centres between 2005 and 2020. All cases were coded by the G-DRG- and OPS-systems. Uniform code search terms were applied defining both the types of ablations for AF, AFL, and VT and the occurrence of major adverse events including femoral vascular complications, iatrogenic tamponade, stroke, and in-hospital death. Importantly, all complications were individually reviewed based on patient-level source records. Overall, 43 031 ablations were analysed (30 361 AF; 9364 AFL; 3306 VT). The number of ablations/year more than doubled from 2005 (n = 1569) to 2020 (n = 3317) with 3 times and 2.5 times more AF and VT ablations in 2020 (n = 2404 and n = 301, respectively) as compared to 2005 (n = 817 and n = 120, respectively), but a rather stable number of AFL ablations (n = 554 vs. n = 612). Major peri-procedural complications occurred in 594 (1.4%) patients. Complication rates were 1.1% (n = 325) for AF, 1.0% (n = 95) for AFL, and 5.3% (n = 175) for VT. With an increase in complex AF/VT procedures, the overall complication rate significantly increased (0.76% in 2005 vs. 1.81% in 2020; P = 0.004); but remained low over time. Following patient-adjudication, all in-hospital cardiac tamponades (0.7%) and strokes (0.2%) were related to ablation. Major femoral vascular complications requiring surgical intervention occurred in 0.4% of all patients. The in-hospital mortality rate adjudicated to be ablation-related was lower than the coded mortality rate: AF: 0.03% vs. 0.04%; AFL: 0.04% vs. 0.14%; VT: 0.42% vs. 1.48%. CONCLUSION Major adverse events are low and comparable after catheter ablation for AFL and AF (∼1.0%), whereas they are five times higher for VT ablations. In the presence of an increase in complex ablation procedures, a moderate but significant increase in overall complications from 2005-20 was observed. Individual case analysis demonstrated a lower than coded ablation-related in-hospital mortality. This highlights the importance of individual case adjudication when analysing administrative data.
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Affiliation(s)
- Lars Eckardt
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Florian Doldi
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Omar Anwar
- Asklepios Hospital St.Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Nele Gessler
- Asklepios Hospital St.Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Katharina Scherschel
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Ann-Kathrin Kahle
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Aenne S von Falkenhausen
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Raffael Thaler
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Julian Wolfes
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Andreas Metzner
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
- Klinik und Poliklinik für Kardiologie, Universitäres Herz- und Gefäßzentrum UKE Hamburg, Hamburg, Germany
| | - Christian Meyer
- Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium EVK, Düsseldorf, Germany
| | - Stephan Willems
- Asklepios Hospital St.Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Julia Köbe
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Philipp Sebastian Lange
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Gerrit Frommeyer
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer -Campus 1, 48149 Münster, Germany
| | - Karl-Heinz Kuck
- Asklepios Hospital St.Georg, Department of Cardiology and Internal Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Stefan Kääb
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Gerhard Steinbeck
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
| | - Moritz F Sinner
- Department of Cardiology, University Hospital, LMU Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), partner site: Munich Heart Alliance, Munich, Germany
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Gasperetti A, Peretto G, Muller SA, Hasegawa K, Compagnucci P, Casella M, Murray B, Tichnell C, Carrick RT, Cadrin-Tourigny J, Schiavone M, James C, Amin AS, Saguner AM, Dello Russo A, Tondo C, Stevenson W, Della Bella P, Calkins H, Tandri H. Catheter Ablation for Ventricular Tachycardia in Patients With Desmoplakin Cardiomyopathy. JACC Clin Electrophysiol 2023:S2405-500X(23)00897-6. [PMID: 38206263 DOI: 10.1016/j.jacep.2023.11.017] [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: 08/31/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Desmoplakin (DSP) pathogenic/likely pathogenic (P/LP) variants are associated with malignant phenotypes of arrhythmogenic cardiomyopathy (DSP-ACM). Reports of outcomes after ventricular tachycardia (VT) ablation in DSP-ACM are scarce. OBJECTIVES In this study, the authors sought to report on long-term outcomes of VT ablation in DSP-ACM. METHODS Patients with P/LP DSP variants at 9 institutions undergoing VT ablation were included. Demographic, clinical, and instrumental data as well as all ventricular arrhythmia (VA) events were collected. Sustained VAs after the index procedure were the primary outcome. A per-patient before and after ablation comparison of rates of VA episodes per year was performed as well. RESULTS Twenty-four DSP-ACM patients (39.3 ± 12.1 years of age, 62.5% male, median 6,116 [Q1-Q3: 3,362-7,760] premature ventricular complexes [PVCs] per 24 hours, median 4 [Q1-Q3: 2-11] previous VA episodes per patient at ablation) were included. Index procedure was most commonly endocardial/epicardial (19/24) The endocardium of the right ventricle (RV), the left ventricle (LV), or both ventricles were mapped in 8 (33.3%), 9 (37.5%), and 7 (29.2%) cases, respectively. Low voltage potentials were found in 10 of 15 patients in the RV and 11 of 16 in the LV. Endocardial ablation was performed in 18 patients (75.0%). Epicardial mapping in 19 patients (79.2%) identified low voltage potentials in 17, and 16 received epicardial ablation. Over the following 2.9 years (Q1-Q3: 1.8-5.5 years), 13 patients (54.2%) experienced VA recurrences. A significant reduction in per-patient event/year before and after ablation was observed (1.4 [Q1-Q3: 0.5-2.4] to 0.1 [Q1-Q3: 0.0-0.4]; P = 0.009). 2 patients needed heart transplantation, and 4 died (3 of heart failure and 1 noncardiac death). CONCLUSIONS VT ablation in DSP-ACM is effective in reducing the VA burden of the disease, but recurrences are common. Most VT circuits are epicardial, with both LV and RV low voltage abnormalities. Heart failure complicates clinical course and is an important cause of mortality.
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Affiliation(s)
- Alessio Gasperetti
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy; Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Giovanni Peretto
- Department of Cardiac Electrophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Steven A Muller
- Department of Cardiology, Division Heart and Lungs, Utrecht University Medical Centre, Utrecht, the Netherlands
| | - Kanae Hasegawa
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paolo Compagnucci
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy; Cardiology and Arrhythmology Clinic, University Hospital "Azienda Ospedaliero-Universitaria delle Marche," Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Azienda Ospedaliero-Universitaria delle Marche," Ancona, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Brittney Murray
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Crystal Tichnell
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Richard T Carrick
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center and Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Marco Schiavone
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Cardiology, Luigi Sacco University Hospital, Milan, Italy
| | - Cynthia James
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ahmad S Amin
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam, the Netherlands
| | - Ardan M Saguner
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland; Center for Translational and Experimental Cardiology, Department of Cardiology, Zurich University Hospital, University of Zurich, Schlieren, Switzerland
| | - Antonio Dello Russo
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy; Cardiology and Arrhythmology Clinic, University Hospital "Azienda Ospedaliero-Universitaria delle Marche," Ancona, Italy
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - William Stevenson
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paolo Della Bella
- Department of Cardiac Electrophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Hugh Calkins
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Harikrishna Tandri
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Lucas P, Sciacca V, Sommer P, Fink T. [Long-term results of catheter ablation of idiopathic and structural ventricular tachycardia]. Herzschrittmacherther Elektrophysiol 2023; 34:298-304. [PMID: 37855890 DOI: 10.1007/s00399-023-00964-1] [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: 07/19/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023]
Abstract
Catheter ablation of ventricular tachycardia (VTs) has emerged as an effective treatment modality. Ablation procedures for idiopathic VTs depends on the anatomical origin of the arrhythmias, is highly effective in certain cases, and has been implemented as a first-line therapy in recent European guidelines. In contrast, catheter ablation of VTs in patients with structural heart disease has a significant risk of arrhythmia recurrence. Interventional treatment for patients with ischemic cardiomyopathy was studied in multiple randomized multicenter trials and it was shown that catheter ablation was more effective in arrhythmia suppression compared to conservative treatment modalities. Catheter ablation of nonischemic cardiomyopathy suffers from far higher rates of arrhythmia recurrences as documented in several long-term studies and often needs complex procedures with or without epicardial mapping and ablation. There is still no clear proof of a mortality benefit from catheter ablation of VTs in patients with or without structural heart disease. Nevertheless, recent guidelines recommend catheter ablation as an alternative to implantation of cardioverter-defibrillators (ICD) in selected cases.
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Affiliation(s)
- Philipp Lucas
- Klinik für Elektrophysiologie und Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland
| | - Vanessa Sciacca
- Klinik für Elektrophysiologie und Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie und Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland.
| | - Thomas Fink
- Klinik für Elektrophysiologie und Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland
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36
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Cherbi M, Voglimacci-Stephanopoli Q, Delasnerie H, Mandel F, Domain G, Foltran D, Mondoly P, Beneyto M, Rollin A, Maury P. Systematic use of half normal saline during ablation of ventricular tachycardia in structural heart disease. Pacing Clin Electrophysiol 2023; 46:1546-1552. [PMID: 37885373 DOI: 10.1111/pace.14845] [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: 06/15/2023] [Revised: 09/12/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Efficiency and safety of ablation using half normal saline (HNS) has been shown in refractory ventricular tachycardia (VT), but no evaluation in unselected larger populations has been made. OBJECTIVE To evaluate the efficiency and safety of systematic HNS ablation in VT ablation. METHODS All successive VT ablations in patients with structural heart disease from 2018 to 2021 used HNS in our center and were retrospectively included. RESULTS One hundred seventy-seven successive VT ablation procedures using HNS have been performed in 148 patients (91% males, mean 64 ± 12 years, ischemic cardiomyopathy 64%, left ventricular ejection fraction 38 ± 13%). A mean of 19 ± 7.5 min of RF was delivered, with a mean power of 44 ± 7 W. Relevant complications happened in 9% (strokes 2%, tamponades 3%, atrioventricular block during septal ablations 5%). Over a mean follow-up of 15 ± 9 months, VT recurred in 46%. Final recurrence rate after one or several procedures was 36% (18 months follow-up). Number of VT episodes decreased from 14 ± 35 before to 2.5 ± 10 after ablation (p < .0001) and number of ICD shocks decreased from 4.8 ± 6.8 to 1.5 ± 0.8 (p = .027). CONCLUSION Systematic use of HNS during VT ablations in patients with structural heart disease leads to long-term recurrences rates and complications in the range of what is reported using normal saline. Although controlled studies are needed for demonstrating the superiority of such attitude, the use of HNS in every scar-related VT ablation seems safe for standard cases and may be furthermore useful in case of refractory arrhythmias due to difficult-to-ablate substrates.
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Affiliation(s)
- Miloud Cherbi
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | | | - Hubert Delasnerie
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Franck Mandel
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Guillaume Domain
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Deborah Foltran
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Pierre Mondoly
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Maxime Beneyto
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
- Unité INSERM U 1048, Toulouse, France
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
- Unité INSERM U 1048, Toulouse, France
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Chung WH, Hayase J, Davies MJ, Do DH, Sorg JM, Ajijola OA, Buch EF, Boyle NG, Shivkumar K, Bradfield JS. Cryothermal energy demonstrates shorter ablation time and lower complication rates compared with radiofrequency in surgical hybrid ablation for recurrent ventricular tachycardia. Heart Rhythm 2023; 20:1708-1717. [PMID: 37659454 DOI: 10.1016/j.hrthm.2023.08.036] [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: 07/02/2023] [Revised: 08/08/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Recurrent ventricular tachycardia (VT) after prior endocardial catheter ablation(s) presents challenges in the setting of prior cardiac surgery where percutaneous epicardial access may not be feasible. OBJECTIVE The purpose of this study was to compare the outcomes of cryothermal vs radiofrequency ablation in direct surgical epicardial access procedures. METHODS We performed a retrospective study of consecutive surgical epicardial VT ablation cases. Surgical cases using cryothermal vs radiofrequency ablation were analyzed and outcomes were compared. RESULTS Between 2009 and 2022, 43 patients underwent either a cryothermal (n = 17) or a radiofrequency (n = 26) hybrid epicardial ablation procedure with direct surgical access. Both groups were similarly matched for age, sex, etiology of VT, and comorbidities with a high burden of refractory VT despite previous endocardial and/or percutaneous epicardial ablation procedures. The surgical access site was lateral thoracotomy (76.5%) in the cryothermal ablation group compared with lateral thoracotomy (42.3%) and subxiphoid approach (38.5%) in the radiofrequency group, with the remainder in both groups performed via median sternotomy. The ablation time was significantly shorter in those undergoing cryothermal ablation vs radiofrequency ablation (11.54 ± 15.5 minutes vs 48.48 ± 23.6 minutes; P < .001). There were no complications in the cryothermal ablation group compared with 6 patients with complications in the radiofrequency group. Recurrent VT episodes and all-cause mortality were similar in both groups. CONCLUSION Hybrid surgical VT ablation with cryothermal or radiofrequency energy demonstrated similar efficacy outcomes. Cryothermal ablation was more efficient and safer than radiofrequency in a surgical setting and should be considered when surgical access is required.
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Affiliation(s)
- Wei-Hsin Chung
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California; Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Justin Hayase
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California; Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Mark J Davies
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California; Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Duc H Do
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Julie M Sorg
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Eric F Buch
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California.
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Suna G, Mellor GJ. Explaining the Unexplained: A Practical Approach to Investigating the Cardiac Arrest Survivor. Arrhythm Electrophysiol Rev 2023; 12:e27. [PMID: 38124802 PMCID: PMC10731537 DOI: 10.15420/aer.2023.06] [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: 03/11/2023] [Accepted: 10/12/2023] [Indexed: 12/23/2023] Open
Abstract
Sudden cardiac arrest (SCA) is a common cause of death. The majority of SCA is caused by ventricular arrhythmia due to underlying CHD. Aborted SCA with no apparent diagnosis after initial assessment with ECG, echocardiography and coronary assessment is referred to as unexplained cardiac arrest (UCA). Systematic evaluation of such patients may reveal a specific diagnosis in up to half of patients before a diagnosis of idiopathic VF is assigned. Specific diagnoses include inherited cardiac conditions, such as latent cardiomyopathies or inherited primary electrical disease. Identifying the cause of UCA is therefore not only critical for appropriate management of the SCA survivors to prevent recurrence, but also for their family members who may be at risk of the same condition. This review provides a tiered, systematic approach for the investigation of UCA.
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Affiliation(s)
- Gonca Suna
- Cardiology Department, Royal Papworth Hospital NHS Foundation Trust Cambridge, UK
| | - Greg J Mellor
- Cardiology Department, Royal Papworth Hospital NHS Foundation Trust Cambridge, UK
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Reddy RK, Howard JP, Ahmad Y, Shun-Shin MJ, Simader FA, Miyazawa AA, Saleh K, Naraen A, Samways JW, Katritsis G, Mohal JS, Kaza N, Porter B, Keene D, Linton NWF, Francis DP, Whinnett ZI, Luther V, Kanagaratnam P, Arnold AD. Catheter Ablation for Ventricular Tachycardia After MI: A Reconstructed Individual Patient Data Meta-analysis of Randomised Controlled Trials. Arrhythm Electrophysiol Rev 2023; 12:e26. [PMID: 38124803 PMCID: PMC10731517 DOI: 10.15420/aer.2023.07] [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: 03/16/2023] [Accepted: 06/24/2023] [Indexed: 12/23/2023] Open
Abstract
Background The prognostic impact of ventricular tachycardia (VT) catheter ablation is an important outstanding research question. We undertook a reconstructed individual patient data meta-analysis of randomised controlled trials comparing ablation to medical therapy in patients developing VT after MI. Methods We systematically identified all trials comparing catheter ablation to medical therapy in patients with VT and prior MI. The prespecified primary endpoint was reconstructed individual patient assessment of all-cause mortality. Prespecified secondary endpoints included trial-level assessment of all-cause mortality, VT recurrence or defibrillator shocks and all-cause hospitalisations. Prespecified subgroup analysis was performed for ablation approaches involving only substrate modification without VT activation mapping. Sensitivity analyses were performed depending on the proportion of patients with prior MI included. Results Eight trials, recruiting a total of 874 patients, were included. Of these 874 patients, 430 were randomised to catheter ablation and 444 were randomised to medical therapy. Catheter ablation reduced all-cause mortality compared with medical therapy when synthesising individual patient data (HR 0.63; 95% CI [0.41-0.96]; p=0.03), but not in trial-level analysis (RR 0.91; 95% CI [0.67-1.23]; p=0.53; I2=0%). Catheter ablation significantly reduced VT recurrence, defibrillator shocks and hospitalisations compared with medical therapy. Sensitivity analyses were consistent with the primary analyses. Conclusion In patients with postinfarct VT, catheter ablation reduces mortality.
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Affiliation(s)
- Rohin K Reddy
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - James P Howard
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - Yousif Ahmad
- Section of Cardiovascular Medicine, Yale UniversityNew Haven, CT, US
| | | | | | | | - Keenan Saleh
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - Akriti Naraen
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - Jack W Samways
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - George Katritsis
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - Jagdeep S Mohal
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - Nandita Kaza
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - Bradley Porter
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | - Daniel Keene
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | | | - Darrel P Francis
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | | | - Vishal Luther
- National Heart and Lung Institute, Imperial College LondonLondon, UK
| | | | - Ahran D Arnold
- National Heart and Lung Institute, Imperial College LondonLondon, UK
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40
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Mirwais M, Markman TM. Catheter ablation as first-line therapy for ventricular tachycardia: is it time for a paradigm shift? J Interv Card Electrophysiol 2023; 66:1547-1548. [PMID: 36795271 DOI: 10.1007/s10840-023-01502-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Maiwand Mirwais
- University of Pennsylvania, 1 Convention Ave, Philadelphia, PA, 19104, USA
| | - Timothy M Markman
- University of Pennsylvania, 1 Convention Ave, Philadelphia, PA, 19104, USA.
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41
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Kotake Y, Huang K, Bennett R, De Silva K, Bhaskaran A, Kanawati J, Turnbull S, Zhou J, Campbell T, Kumar S. Efficacy and safety of catheter ablation as first-line therapy for the management of ventricular tachycardia. J Interv Card Electrophysiol 2023; 66:1701-1711. [PMID: 36754908 PMCID: PMC10547804 DOI: 10.1007/s10840-023-01483-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Ventricular tachycardia (VT) is associated with significantly increased morbidity and mortality. Catheter ablation (CA) in line with an implantable cardioverter-defibrillator (ICD) is highly effective in VT management; however, it is unknown if CA should be considered as first-line therapy. The aim of this study is to verify the efficacy and safety of CA as first-line therapy for the first VT presentation (as adjunctive to ICD insertion), compared to initial ICD insertion and anti-arrhythmic drug (AAD) therapy. METHODS Data from patients with the first presentation for VT from January 2017 to January 2021 was reviewed. Patients were classified as "ablation first" vs "ICD first" groups and compared the clinical outcomes between groups. RESULTS One hundred and eighty-four consecutive patients presented with VT; 34 underwent CA as first-line therapy prior to ICD insertion, and 150 had ICD insertion/AAD therapy as first-line. During the median follow-up of 625 days, patients who underwent CA as first-line therapy had significantly higher ventricular arrhythmia (VA)-free survival (91% vs 59%, log-rank P = 0.002) and composite of VA recurrence, cardiovascular hospitalization, transplant, and death (84% vs 54%, log-rank P = 0.01) compared to those who did not undergo CA. Multivariate analysis revealed that first-line CA was the only protective predictor of VA recurrence (hazard ratio (HR) 0.20, P = 0.003). There were 3 (9%) peri-procedural complications with no peri-procedural deaths. CONCLUSION Real-world data supports the efficacy and safety of CA as first-line therapy at the time of the first VT hospitalization, compared to the initial ICD implant and AAD therapy.
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Affiliation(s)
- Yasuhito Kotake
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Kaimin Huang
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Richard Bennett
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Kasun De Silva
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Ashwin Bhaskaran
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Juliana Kanawati
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Julia Zhou
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.
- Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia.
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42
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Messori A, Fadda V, Romeo MR, Veneziano S, Trippoli S. A Comparison of Statistical Analysis Between "Real" Patients Reported in Kaplan-Meier Curves and "Reconstructed" Patients Estimated Through the IPDfromKM Method: Analysis of Eight Trials Evaluating Catheter Ablation of Ventricular Tachycardia. Cureus 2023; 15:e47891. [PMID: 37905162 PMCID: PMC10613324 DOI: 10.7759/cureus.47891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 11/02/2023] Open
Abstract
Time-to-event endpoints are most widely used in oncology and, to a lesser extent, in cardiology. Typical statistical parameters employed in this context include overall survival, progression-free survival, and recurrence-free survival. The graphical presentation of the results is based on the Kaplan-Meier plot. When Kaplan-Meier curves are included in a meta-analysis, the typical methodological approach is a simplified one because the results of each trial (as well as those of the meta-analysis itself) are expressed through a 2x2 contingency; the methodological simplification is that the follow-up is left out from the analysis and, consequently, the Kaplan-Meier curves are omitted as well. The IPDfromKM method, developed in 2021, is an artificial intelligence algorithm designed to be used in these situations. According to this method, to keep the Kaplan-Meier curves in the meta-analysis, each curve is converted into a database of individual patients (which are denoted as "reconstructed" individual patients). In this way, for the purposes of the meta-analysis, the statistical methods are based on individual patients (like those of clinical trials) so that the Kaplan-Meier curves must not be excluded, and the effect of the follow-up can, therefore, be investigated. This technical report describes the IPDfromKM method in all of its operational details. To present the method, a meta-analysis investigating the effects of catheter ablation to prevent ventricular tachyarrhythmia (VT) has been taken as an example. The original meta-analysis, which included nine controlled trials, was published in February 2023 and adopted the simplified approach based on 2x2 contingency tables. We have reanalyzed these trials by using the IPDfromKM method. Overall, both the standard binary meta-analysis and the IPDfromKM method showed that ablation significantly reduces VT recurrence (hazard ratio, 0.820 for binary meta-analysis vs 0.728 for the IPDfromKM method). By contrast, while no heterogeneity was found by the binary method, the IPDfromKM found significant heterogeneity, which was confirmed by visual inspection of the Kaplan-Meier curves. This suggests that the results of the IPDfromKM method are more accurate because they include the effect of the follow-up on patients' outcomes. In conclusion, our reanalysis confirms the significant benefit determined by ablation, but a more pronounced degree of between-trial heterogeneity has been found. Finally, it should be stressed that, outside the field of meta-analysis, the IPDfromKM method is also applicable to carry out an indirect comparison between treatments that have never been compared in real clinical trials. In this case, reconstructed patients are analyzed by conducting a simulated comparative trial.
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Affiliation(s)
- Andrea Messori
- Health Technology Assessment (HTA) Unit, Tuscany Regional Health Care System, Firenze, ITA
| | - Valeria Fadda
- Pharmacology and Therapeutics, Ente di Supporto Tecnico Amministrativo Regionale (ESTAR), Firenze, ITA
| | - Maria R Romeo
- Health Policy, Fondazione Toscana Gabriele Monasterio, Massa, ITA
| | | | - Sabrina Trippoli
- Health Technology Assessment (HTA) Unit, Tuscany Regional Health Care System, Firenze, ITA
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43
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Natale A, Zeppenfeld K, Della Bella P, Liu X, Sabbag A, Santangeli P, Sommer P, Sticherling C, Zhang X, Di Biase L. Twenty-five years of catheter ablation of ventricular tachycardia: a look back and a look forward. Europace 2023; 25:euad225. [PMID: 37622589 PMCID: PMC10451002 DOI: 10.1093/europace/euad225] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 08/26/2023] Open
Abstract
This article will discuss the past, present, and future of ventricular tachycardia ablation and the continuing contribution of the Europace journal as the platform for publication of milestone research papers in this field of ventricular tachycardia ablation.
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Affiliation(s)
- Andrea Natale
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, 3000 N. I-35, Suite 720, Austin, TX 78705, USA
| | - Katja Zeppenfeld
- Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands
| | - Paolo Della Bella
- Department of Cardiac Electrophysiology and Arrhythmology, San Raffaele University Hospital, Milan, Italy
| | - Xu Liu
- Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Avi Sabbag
- Sheba Medical Center, Tel HaShomer, Israel and the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Philipp Sommer
- Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | - Xiaodong Zhang
- Montefiore Health System, Einstein Medical School, New York, USA
| | - Luigi Di Biase
- Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, 3000 N. I-35, Suite 720, Austin, TX 78705, USA
- Montefiore Health System, Einstein Medical School, New York, USA
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44
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Vázquez-Calvo S, Roca-Luque I, Althoff TF. Management of Ventricular Arrhythmias in Heart Failure. Curr Heart Fail Rep 2023; 20:237-253. [PMID: 37227669 DOI: 10.1007/s11897-023-00608-y] [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] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE OF REVIEW Despite substantial progress in medical and device-based heart failure (HF) therapy, ventricular arrhythmias (VA) and sudden cardiac death (SCD) remain a major challenge. Here we review contemporary management of VA in the context of HF with one particular focus on recent advances in imaging and catheter ablation. RECENT FINDINGS Besides limited efficacy of antiarrhythmic drugs (AADs), their potentially life-threatening side effects are increasingly acknowledged. On the other hand, with tremendous advances in catheter technology, electroanatomical mapping, imaging, and understanding of arrhythmia mechanisms, catheter ablation has evolved into a safe, efficacious therapy. In fact, recent randomized trials support early catheter ablation, demonstrating superiority over AAD. Importantly, CMR imaging with gadolinium contrast has emerged as a central tool for the management of VA complicating HF: CMR is not only essential for an accurate diagnosis of the underlying entity and subsequent treatment decisions, but also improves risk stratification for SCD prevention and patient selection for ICD therapy. Finally, 3-dimensional characterization of arrhythmogenic substrate by CMR and imaging-guided ablation approaches substantially enhance procedural safety and efficacy. VA management in HF patients is highly complex and should be addressed in a multidisciplinary approach, preferably at specialized centers. While recent evidence supports early catheter ablation of VA, an impact on mortality remains to be demonstrated. Moreover, risk stratification for ICD therapy may have to be reconsidered, taking into account imaging, genetic testing, and other parameters beyond left ventricular function.
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Affiliation(s)
- Sara Vázquez-Calvo
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC Barcelona University Hospital, C/Villarroel N° 170, 08036, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Ivo Roca-Luque
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC Barcelona University Hospital, C/Villarroel N° 170, 08036, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Till F Althoff
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC Barcelona University Hospital, C/Villarroel N° 170, 08036, Barcelona, Catalonia, Spain.
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
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45
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Bhaskaran A, De Silva K, Kumar S. Contemporary updates on ventricular arrhythmias: from mechanisms to management. Intern Med J 2023; 53:892-906. [PMID: 36369893 PMCID: PMC10947276 DOI: 10.1111/imj.15976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/09/2022] [Indexed: 03/20/2024]
Abstract
Ventricular arrhythmias (VAs) are a group of heart rhythm disorders that can be life-threatening and cause significant morbidity. VA in the presence of structural heart disease (SHD) has distinct prognostic implications and requires a comprehensive and multifaceted approach for investigation and management. Early specialist referral should be considered for all patients with VA. Particular urgency is recommended in patients with syncope, nonsustained/sustained VA on Holter monitor and SHD on cardiac imaging because of the heightened risk of sudden cardiac death. Comprehensive phenotyping is recommended for most patients with VA, encompassing noninvasive cardiac functional testing, multimodality imaging and genetic testing in select circumstances. Management of idiopathic VA is guided heavily by symptom burden and the presence of ventricular systolic impairment. In SHD, guideline-directed heart failure therapy and device implantation are critical considerations. Whilst commonly used and well-established, antiarrhythmic drugs can be hampered by toxicity and failure of adequate arrhythmia control. Catheter ablation is increasingly being considered a feasible first-line alternative to medical therapy, where outcomes are influenced by disease aetiology and scar burden in SHD. Catheter ablation is associated with reduced arrhythmia recurrence and burden and improved quality of life at follow-up.
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Affiliation(s)
- Ashwin Bhaskaran
- Department of CardiologyWestmead HospitalSydneyNew South WalesAustralia
- Westmead Applied Research CentreUniversity of SydneySydneyNew South WalesAustralia
| | - Kasun De Silva
- Department of CardiologyWestmead HospitalSydneyNew South WalesAustralia
- Westmead Applied Research CentreUniversity of SydneySydneyNew South WalesAustralia
| | - Saurabh Kumar
- Department of CardiologyWestmead HospitalSydneyNew South WalesAustralia
- Westmead Applied Research CentreUniversity of SydneySydneyNew South WalesAustralia
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McCabe MD, Cervantes R, Kewcharoen J, Sran J, Garg J. Quelling the Storm: A Review of the Management of Electrical Storm. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00338-5. [PMID: 37296026 DOI: 10.1053/j.jvca.2023.05.029] [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: 04/12/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Abstract
Heightened sympathetic input to the myocardium potentiates cardiac electrical instability and may herald an electrical storm. An electrical storm is characterized by 3 or more episodes of ventricular tachycardia, ventricular fibrillation, or appropriate internal cardiac defibrillator shocks within 24 hours. Management of electrical storms is resource-intensive and inevitably requires careful coordination between multiple subspecialties. Anesthesiologists have an important role in acute, subacute, and long-term management. Identifying the phase of an electrical storm and understanding the characteristics of each morphology may help the anesthesiologist anticipate the management approach. In the acute phase, management of an electrical storm is aimed at providing advanced cardiac life support and identifying reversible causes. After initial stabilization, subacute management focuses on dampening the sympathetic surge with sedation, thoracic epidural, or stellate ganglion blockade. Definitive long-term management with surgical sympathectomy or catheter ablation also may be warranted. Our objective is to provide an overview of electrical storms and the anesthesiologist's role in management.
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Affiliation(s)
- Melissa D McCabe
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California.
| | - Richard Cervantes
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California
| | - Jakrin Kewcharoen
- Cardiac Arrhythmia Service, Loma Linda University School of Medicine, Loma Linda, California
| | - Jasmine Sran
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California
| | - Jalaj Garg
- Cardiac Arrhythmia Service, Loma Linda University School of Medicine, Loma Linda, California
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47
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Moustafa A, Elzanaty A, Karim S, Eltahawy E, Kahaly O, Elbatanony L, Khalil M, Maraey A, Chacko P. Outcomes of Ventricular Tachycardia Catheter Ablation in Patients Who Underwent Cardiac Defibrillator Implantation Nationwide Readmission Database Analysis. Am J Cardiol 2023:S0002-9149(23)00210-2. [PMID: 37188567 DOI: 10.1016/j.amjcard.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/22/2023] [Accepted: 04/09/2023] [Indexed: 05/17/2023]
Abstract
The timing of when to perform ventricular tachycardia (VT) ablation while receiving an implantable cardioverter defibrillator (ICD) during the same hospitalization has not been explored. This study aimed to investigate the use and outcomes of VT catheter ablation in patients with sustained VT receiving ICD in the same hospital stay. The Nationwide Readmission Database 2016 to 2019 was queried for all hospitalizations with a primary diagnosis of VT with subsequent ICD during the same admission. Hospitalizations were later stratified according to whether a VT ablation was performed. All catheter ablation of VT were performed before ICD implantation. The outcomes of interest were in-hospital mortality and 90-day readmission. A total of 29,385 VT hospitalizations were included. VT ablation was performed with subsequent ICD placement in 2,255 (7.6%), whereas 27,130 (92.3%) received an ICD only. No differences were found regarding in-hospital mortality (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.35 to 1.9, p = 0.67) and all-cause 90-day readmission rate (aOR 1.1, 95% CI 0.95 to 1.3, p = 0.16). An increase in readmission because of recurrent VT was noted in the VT ablation group (aOR 1.53, 8% vs 5% CI 1.2 to 1.9, p <0.01); the VT ablation group encompassed a higher number of patients with heart failure with reduced ejection fraction (p <0.01), cardiogenic shock (p <0.01), and mechanical circulatory support use (p <0.01). In conclusion, the use of VT ablation in patients admitted with sustained VT is low and reserved for higher risk patients with significant co-morbidities. Despite the higher risk profile of VT ablation cohort, no differences were found in the short-term mortality and readmission rate between the groups.
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Affiliation(s)
| | - Ahmed Elzanaty
- Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio
| | - Saima Karim
- Division of Cardiovascular Medicine, Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Ehab Eltahawy
- Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio
| | - Omar Kahaly
- Division of Cardiovascular Medicine, Promedica- Toledo Hospital, Toledo, Ohio
| | - Lamiaa Elbatanony
- Department of Cardiovascular Medicine, Tanta University, Tanta, Egypt
| | - Mahmoud Khalil
- Department of Internal Medicine, Lincoln Medical Center, Bronx, New York
| | - Ahmed Maraey
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, Illinois
| | - Paul Chacko
- Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio
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Hijazi W, Vandenberk B, Rennert-May E, Quinn A, Sumner G, Chew DS. Economic evaluation in cardiac electrophysiology: Determining the value of emerging technologies. Front Cardiovasc Med 2023; 10:1142429. [PMID: 37180811 PMCID: PMC10169721 DOI: 10.3389/fcvm.2023.1142429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Cardiac electrophysiology is a constantly evolving speciality that has benefited from technological innovation and refinements over the past several decades. Despite the potential of these technologies to reshape patient care, their upfront costs pose a challenge to health policymakers who are responsible for the assessment of the novel technology in the context of increasingly limited resources. In this context, it is critical for new therapies or technologies to demonstrate that the measured improvement in patients' outcomes for the cost of achieving that improvement is within conventional benchmarks for acceptable health care value. The field of Health Economics, specifically economic evaluation methods, facilitates this assessment of value in health care. In this review, we provide an overview of the basic principles of economic evaluation and provide historical applications within the field of cardiac electrophysiology. Specifically, the cost-effectiveness of catheter ablation for both atrial fibrillation (AF) and ventricular tachycardia, novel oral anticoagulants for stroke prevention in AF, left atrial appendage occlusion devices, implantable cardioverter defibrillators, and cardiac resynchronization therapy will be reviewed.
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Affiliation(s)
- Waseem Hijazi
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Elissa Rennert-May
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Amity Quinn
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Glen Sumner
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Derek S. Chew
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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Early Mortality After VT Ablation. JACC Clin Electrophysiol 2023. [DOI: 10.1016/j.jacep.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
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50
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Management of Ventricular Arrhythmias Worldwide. JACC Clin Electrophysiol 2023; 9:715-728. [DOI: 10.1016/j.jacep.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 02/24/2023]
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