Post-Ventricular Tachycardia Ablation Follow-Up Management

2009 ◽  
pp. 219-226
Author(s):  
Jeremy N. Ruskin ◽  
Atul Verma ◽  
Martin Borggrefe ◽  
Martin J. Schalij ◽  
Robert A. Schweikert
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Tachycardia Ablation

P1457Does high density mapping increase the efficacy of ischemic ventricular tachycardia ablation?

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Nunes Ferreira ◽  
G Silva ◽  
N Cortez-Dias ◽  
P Silverio-Antonio ◽  
T Rodrigues ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
High Density ◽  
Electrical Storm ◽  
High Morbidity ◽  
Amiodarone Therapy ◽  
Ventricular Tachycardia Ablation ◽  
Density Mapping ◽  
Vt Ablation

Abstract Introduction  The treatment of ventricular tachycardia (VT) in patients (pts) with ischemic heart disease (IHD) represents a challenge because of its high morbidity and mortality rates and low long-term success rates. In the VANISH clinical trial, 51% of pts undergoing the conventional ablation technique developed within 2 years the combined outcome of mortality or electrical storm (ES) or appropriate CDI shock. The use of high-density substrate maps can lead to greater precision in substrate evaluation and ideally to improved ablation success. Objectives  To assess the efficacy of substrate-guided ischemic VT ablation using high-density mapping. Methods  Single-center prospective study of consecutive IHD pts submitted to endocardial ablation of substrate-guided VT using multipolar catheters (PentaRayTM or HDGridTM) and three-dimensional mapping systems with automatic annotation software. The maps were evaluated in order to identify the intra-cicatricial channels (areas of bipolar voltage <1.5mV) in which sequential propagation of local abnormal ventricular activities (LAVAs) were observed, during or after QRS. The ablation strategy aimed at the abolition of all intra-cicatricial LAVAs, directing the radiofrequency applications primarily to the entrances of the channels. The success of ablation was assessed by the primary outcome (death by any cause or ES or appropriate CDI shock) at 2 years and compared to the population of the VANISH study undergoing conventional ablation, using Cox regression and Kaplan- Meier survival analysis. Results  We included 40 patients, 95% males, 70 ± 8 years, mean ejection fraction 34 ± 10%. 82% on previous amiodarone therapy and 72% were ICD carriers. 32% underwent ablation during hospitalization for ES and 20% had previously undergone VT ablation. The median duration of substrate mapping was 74 minutes, with a mean of 2290 collected points. Major complications were seen in 1 patient (aortic dissection). During a mean follow-up time of 17.3 ± 12.9 months, the long-term success rate of VT ablation was 75%. Additionally, there was a reduction in the proportion of patients receiving amiodarone before vs after ablation (82% vs. 45% respectively). The rate of events observed during follow-up was lower than expected, namely by comparison with the population of the VANISH study undergoing conventional ablation (25% vs 51% at 24 months, HR 0.42 CI 95% 0.2-0.88, p = 0.022), reflecting a relative risk reduction of 58%. Conclusions  High density mapping allows a detailed characterization of the dysrhythmic substrate in patients with VT in an IHD context. Our results suggest that these technological innovations may be improving the clinical success of VT ablation. Abstract Figure.

Outcome of cardiac tamponades in interventional electrophysiology

EP Europace ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. 1240-1251 ◽  
Author(s):  
Thomas Fink ◽  
Vanessa Sciacca ◽  
Sebastian Feickert ◽  
Andreas Metzner ◽  
Tina Lin ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Structural Heart Disease ◽  
High Volume ◽  
Ventricular Tachycardia Ablation ◽  
Atrial Ablation ◽  
Electrophysiological Studies ◽  
Electrophysiological Procedures ◽  
Independent Risk Factors ◽  
Related Mortality

Abstract Aims The aim of this study was to analyse tamponades following electrophysiological procedures regarding frequency and mortality in a high-volume centre and to identify independent predictors for severe tamponades. Methods and results We performed a retrospective study on 34 982 consecutive patients undergoing diagnostic electrophysiological studies or catheter ablation of cardiac arrhythmias. The combined endpoint was defined as severe tamponade. Criteria for severe tamponade included surgical repair, repeat pericardiocentesis, cardiopulmonary resuscitation, intrahospital death or death during follow-up, and thrombo-embolic events or complications due to therapeutic management. Multivariate analysis was performed to identify independent predictors for severe tamponade. A total of 226 tamponades were identified. Overall frequency of tamponades was 0.6%. Procedures requiring epicardial approach had the highest rate of tamponades (9.4%). Twenty-nine patients with tamponade underwent surgery (12.8% of all tamponades and 21.4% of tamponades during epicardial procedures). Overall tamponade-related mortality was 0.03% (9 deaths). Fifty-six patients (24.8%) experienced severe tamponade. Independent risk factors for severe tamponades were endocardial ablation of ventricular tachycardia, epicardial approach, balloon device ablation, high aspiration volume during pericardiocentesis and structural heart disease. Conclusion The frequency of tamponades is strongly dependent on the type of procedure performed. Overall tamponade-related mortality was low but significantly higher in patients undergoing epicardial procedures. Surgical backup should be considered for patients undergoing complex ventricular tachycardia ablation and left atrial ablation procedures.

Abstract 16071: Electroanatomical Voltage and Morphology Characteristics in Post-infarction Patients Undergoing Ventricular Tachycardia Ablation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Dimitris Tsiachris ◽  
John Silberbauer ◽  
Teresa Oloriz ◽  
Hiroya Mizuno ◽  
Francesca Baratto ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Cardiac Death ◽  
Prognostic Value ◽  
Low Voltage ◽  
Ventricular Tachycardia Ablation ◽  
Vt Ablation ◽  
Endocardial Surface ◽  
Morphology Characteristics ◽  
Primary Strategy

Introduction: We analyzed the endo-epicardial electroanatomical mapping (EAM) characteristics, their association with clinical data and their prognostic value in a large cohort of post-myocardial infarction (MI) patients. Methods: We performed analysis of voltage (bipolar dense scar-DS and low voltage-LV areas, unipolar LV and penumbra areas) and morphology characteristics (presence of abnormal late-LPs and early potentials-EPs) in 100 post-MI patients undergoing EAM-based ventricular tachycardia (VT) ablation (26 endo-epicardial procedures). We defined as unipolar LV areas those with voltage <8 mV and unipolar penumbra area the unipolar LV area beyond the bipolar LV area. The ratio of bipolar DS to LV area reflected the fibrosis density within the infarct region. Results: Mean endocardial surface area was 236.1 cm2. Of that, 10.2% was bipolar DS, 21.8% was bipolar LV and 46.7% was unipolar LV. Endocardial penumbra was present in all but one patients and mean area was 51.6 cm2 (24.9%). There was no endocardial bipolar DS in 18% of the patients. Endocardial bipolar DS area >22.5 cm2 (sensitivity 61.1% and specificity 87.5%) best predicted scar transmurality. Endocardial LPs were recorded in 66% of the patients and epicardially in 17/26 (65.4%). Endocardial bipolar DS area >7 cm2 (sensitivity 88.2% and specificity 66.7%) and endocardial bipolar scar density >0.35 (sensitivity 52.9% and specificity 100%) predicted epicardial LPs. Abolition of endocardial LPs was achieved in 51/66 (77.3%) and of epicardial LPs in 10/17 (58.8%) patients. As a primary strategy, LPs and VT-mapping ablation occurred in 48%, only VT-mapping ablation in 27%, only LPs ablation in 17% and EPs ablation (in the absence of LPs) in 6%. After a median follow-up time of 628 days, endocardial LP abolition was associated (HR 0.274, p=0.01) with reduced VT recurrence (32%). Endocardial LP presence (HR 0.177, p=0.041) acted as a prophylactic predictor while increased endocardial penumbra area (HR=1.028, p=0.044) as an adverse predictor of cardiac death (7%). Conclusions: Endocardial scar extension and density predicted scar transmurality and endo-epicardial presence of LPs, although DS is not always identified in post-MI patients. LPs were abolished in 51% resulting in improved outcome.

Abstract 16778: Ventricular Tachycardia Ablation Outcomes Based on Scar Location in Patients With Ischemic Cardiomyopathy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Himanayani Mamillapalli ◽  
Viorel G Florea ◽  
Sravya Veligandla ◽  
Smitha Murthy ◽  
Jian-Ming Li ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ischemic Cardiomyopathy ◽  
Pulseless Electrical Activity ◽  
Anterior Wall ◽  
Inferior Wall ◽  
Ventricular Tachycardia Ablation ◽  
Significant Difference ◽  
Vt Ablation ◽  
Lost To Follow Up

Introduction: Catheter ablation of ventricular tachycardia (VT) reduces implantable cardioverter defibrillator (ICD) therapies, improves hospitalization, and improves survival in patients with ischemic cardiomyopathy (ICM). Hypothesis: The goal of this study is to evaluate outcomes of patients with VT ablation by scar location in patients with ICM. Methods: Consecutive retrospective review of patients with ICM who underwent VT ablation at Minneapolis Veterans Affairs Health Care system between July 2008 and September 2019 were assessed for clinical outcomes. Results: Seventy-five patients with ICM underwent VT ablation during the study period. Average age was 67.6 ± 7 years old and 100% Male. Three patients were lost to follow up. Overall mortality was 53.3% and was highest in the inferior wall scar (IWS) group (Figure 1A, Table). Mean survival after ablation was 2.2 years. Most common cause of death was cardiac which included congestive heart failure, myocardial ischemia, and cardiac arrest (VT and pulseless electrical activity) (Figure 1B). On post-ablation echocardiogram, patients with anterior wall scar (AWS) had a lower mean ejection fraction (23%) compared to IWS group (30%) and this was statistically significant (p < 0.03, two-tailed t-test). The average number of ablations for recurrent VT was 1.4 with no significant difference between the groups. Fifty-five percent of patients were on anti-arrhythmics post ablation. Conclusions: VT ablation patients with IWS mediated VT have a trend towards higher mortality compared to those with AWS. This may be due to neuroregulatory pathway of VTs based on cardiac innervation.

Abstract 16621: Clinical Results of Scar Related Ventricular Tachycardia Ablation Performed in a South America School Hospital

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Cristiano Pisani ◽  
Carina Hardy ◽  
Sissy Lara ◽  
Muhieddine Chokr ◽  
Hugo Bellotti ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
South America ◽  
Median Time ◽  
Chagas Disease ◽  
Clinical Results ◽  
Artery Dissection ◽  
Ventricular Tachycardia Ablation ◽  
Refractory Hypotension ◽  
Vt Ablation

Introduction: Ventricular Tachycardia (VT) ablation is indicated in patients with recurrent episodes of VT or ICD shocks despite the use of AAD. Hypothesis: to evaluate the clinical characteristics and follow-up of patients that underwent scar related VT ablation in a school hospital in south america. Methods: We collected and analyzed data of all VT ablation performed in our institution between 2013 and 2014. Results: During the 2-year period we performed 107 scar related VT ablation procedures in 86 patients with an age of 56.7±14 years-old, most were male (70,9%). Sixty (56%) presented Chagas disease, 17 (16%) ischemic, 13 (12%) dilated, 12 (11%) RVAD and 5 (5%) other cardiomyopathies and the mean LV EF was 36.9±12.4%. The ablation was performed with CARTO in 60 (56,1%), Ensite 3 (2,8%) and EP only mapping in 44 (41,1%) procedures. Epicardial mapping was performed in 65 procedures (60,7%), most frequent in Chagas patients (81,7%;P<0.001). There was complications in 6 (5,6%) procedures: one hemopericardium that open-chest surgery was necessary; two iliac artery dissection, both with conservative treatment; one complete AV block; one patient with refractory hypotension with the need of IABP and procedure interruption and one patient with late cardiac tamponade with the need of surgical drainage. In a median follow-up of 261 (Q1: 93 Q3: 479) days, 42 (40%) procedures presented recurrence in a median time of 40 (Q1: 7.5 Q3: 125) days. After the VT recurrence the ablation was repeated, and one patient underwent 4 ablation, 2 three ablations and 13 underwent two ablations. Following the last ablation, 61 (72.6%) patients remained free of VT recurrence (figure). Sixteen (19%) patients died in a median time of 34 (Q1: 14.75 Q3: 93) days following last ablation. Conclusion: Chagas disease was the most common cardiopathy in this population, where epicardial approach was frequently performed. After the last procedure, the majority of patients remained free of VT recurrence

Long term follow‐up after ventricular tachycardia ablation in patients with congenital heart disease

2019 ◽  
Vol 30 (9) ◽  
pp. 1560-1568 ◽  
Author(s):  
Jiandu Yang ◽  
Michael Brunnquell ◽  
Jackson J. Liang ◽  
David J. Callans ◽  
Fermin C. Garcia ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Congenital Heart ◽  
Ventricular Tachycardia Ablation ◽  
Long Term Follow Up
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