Feasibility of the transseptal approach for fast and unstable left ventricular tachycardia mapping and ablation with a non-contact mapping system

2006 ◽  
Vol 16 (2) ◽  
pp. 111-116 ◽  
Author(s):  
Claudio Pratola ◽  
Elisa Baldo ◽  
Pasquale Notarstefano ◽  
Toselli Tiziano ◽  
Roberto Ferrari
Keyword(s):  
Ventricular Tachycardia ◽  
Left Ventricular ◽  
Contact Mapping ◽  
Mapping System ◽  
Transseptal Approach

68 EFFECTS OF PACING SITE ON LEFT VENTRICULAR ACTIVATION SEQUENCES USING A NON-CONTACT MAPPING SYSTEM: IMPLICATIONS FOR HEART FAILURE PACING.

2004 ◽  
Vol 52 (Suppl 2) ◽  
pp. S357.3-S357
Author(s):  
D. Xing ◽  
F. G. Devecchi ◽  
T. R. Staley ◽  
D. S. Glassman ◽  
J. B. Martins
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
Contact Mapping ◽  
Mapping System ◽  
Ventricular Activation

scholarly journals Mapping of reentrant spontaneous polymorphic ventricular tachycardia in a Scn5a+/− mouse model

2011 ◽  
Vol 300 (5) ◽  
pp. H1853-H1862 ◽  
Author(s):  
Claire A. Martin ◽  
Laila Guzadhur ◽  
Andrew A. Grace ◽  
Ming Lei ◽  
Christopher L.-H. Huang
Keyword(s):  
Ventricular Tachycardia ◽  
Conduction Block ◽  
Polymorphic Ventricular Tachycardia ◽  
Wild Type ◽  
Contact Mapping ◽  
Epicardial Surface ◽  
Mapping System ◽  
Activation Times ◽  
First Time ◽  
Multielectrode Recording

Two major mechanisms have been postulated for the arrhythmogenic tendency observed in Brugada Syndrome (BrS): delays in conduction or increased heterogeneities in repolarization. We use a contact mapping system to directly investigate the interacting roles of these two mechanisms in arrhythmogenesis using a genetic murine model for BrS for the first time. Electrograms were obtained from a multielectrode recording array placed against the left ventricle and right ventricle (RV) of spontaneously beating Langendorff-perfused wild type (WT) and Scn5a+/− mouse hearts. Scn5a+/− hearts showed activation waves arriving at the epicardial surface consistent with slowed conduction, which was exacerbated in the presence of flecainide. Lines of conduction block across the RV resulting from premature ventricular beats led to the formation of reentrant circuits and polymorphic ventricular tachycardia. WT hearts showed an inverse relationship between activation times and activation recovery intervals measured at the epicardial surface, which resulted in synchronicity of repolarization times. In contrast, Scn5a+/− hearts, despite having smaller mean activation recovery intervals, demonstrated a greater heterogeneity compared with WT. Isochronal maps showed that their normal activation recovery interval gradients at the epicardial surface were disrupted, leading to heterogeneity in repolarization times. We thus directly demonstrate the initiation of arrhythmia in the RV of Scn5a+/− hearts. This occurs as a result of the combination of repolarization heterogeneities leading to lines of conduction block and unidirectional conduction, with conduction slowing allowing the formation of reentrant circuits. The repolarization heterogeneities may also be responsible for the changing pattern of block, leading to the polymorphic character of the resulting ventricular tachycardia.

Optimized Transseptal Approach for Left Ventricular Tachycardia Ablation in a Patient With a Mechanical Prosthetic Aortic Valve

2005 ◽  
Vol 58 (6) ◽  
pp. 756-758 ◽  
Author(s):  
Rodrigo Isa Param ◽  
Nicasio Pérez-Castellano ◽  
Julián Villacastín ◽  
Javier Moreno ◽  
Eduardo Ruiz ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Aortic Valve ◽  
Left Ventricular ◽  
Ventricular Tachycardia Ablation ◽  
Prosthetic Aortic Valve ◽  
Transseptal Approach

scholarly journals Mapping and ablation of ventricular tachycardia with the aid of a non-contact mapping system

Heart ◽  
1999 ◽  
Vol 81 (6) ◽  
pp. 570-575 ◽  
Author(s):  
R J Schilling ◽  
N S Peters ◽  
D W Davies
Keyword(s):  
Ventricular Tachycardia ◽  
Contact Mapping ◽  
Mapping System

Abstract 15824: Safety and Efficacy of Periprocedural Direct Oral Anticoagulant versus Aspirin Use for Reduction of the Risk of Cerebrovascular Events in Patients Undergoing Ventricular Tachycardia Radiofrequency Catheter Ablation (STROKE-VT)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Dhanunjaya Lakkireddy ◽  
Jayaprakash Shenthar ◽  
Deepak Padmanabhan ◽  
Bharath Banavalikar ◽  
Ghulam Murtaza ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Controlled Trial ◽  
Brain Mri ◽  
Study Drug ◽  
Left Ventricular ◽  
Moderate Sedation ◽  
Cerebrovascular Events ◽  
Multicenter Randomized Controlled Trial ◽  
Transseptal Approach

Background: The STROKE-VT is an ongoing, multicenter, randomized controlled trial that studies the differences in cerebrovascular events between DOAC vs ASA use post procedurally in ischemic and non-ischemic cardiomyopathy patients undergoing left ventricular tachycardia radiofrequency ablation (VT RFA). Methods: 52 Eligible patients scheduled for VT RFA were randomized 1:1 post procedurally to a DOAC (n=26; Dabigatran-11/Rivaroxaban-12 & Apixaban-3) or ASA (n=26, 81mg) for 30 days. VT ablation was performed under moderate sedation or general anesthesia either through retrograde aortic (n=28) or transseptal (n=24) approach. All patients were given IV heparin for ACT>300msec. Study drug was administered 3 hours after hemostasis. A brain MRI was done within 6-12 hours post VTRFA and at 30 days. NIH stroke scale was used to assess for neurological changes before, after and at 30 day follow up. Results: 52 patients (M:F- 4.2:1) with 55% ICM were enrolled. DOAC group was slightly older (65±8 vs 60±6 yrs, p=0.04)), had longer procedural (186±76 vs 150±51, p<0.001) and RF time (45 ± 23 vs 24±23, p=0.01) and greater use of transseptal approach (58 vs 42%, p=0.03) compared to the ASA group. One patient in the ASA group had a TIA in the immediate postop period. 31% (16/52) had acute asymptomatic cerebral embolizations (ACE) (25% vs 5% with Retrograde aortic approach). DOAC group had a significantly lower incidence of ACE at 1 month f/u MRI (8 vs 38%, p<0.001). On multivariate analysis predictors of acute post VTRFA ACE were retrograde aortic approach, prolonged procedure and RFA time, while delayed ACE was ASA therapy. Two patients died of progressive heart failure with one in each group. 1 patient had a TIA during f/u in the ASA group. Conclusions: DOAC decrease the incidence of delayed ACE after VTRFA. However, retrograde aortic approach and prolonged procedural and RFA time can increase the risk of acute ACE.

Dispersion-based reentry: mechanism of initiation of ventricular tachycardia in isolated rabbit hearts

1999 ◽  
Vol 276 (2) ◽  
pp. H413-H423 ◽  
Author(s):  
Emmanuelle Robert ◽  
A. Guy M. Aya ◽  
Jean E. de la Coussaye ◽  
Pascale Péray ◽  
Jean-Marie Juan ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Potassium Channel ◽  
Conduction Block ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Potassium Channel Openers ◽  
Mapping System ◽  
Conduction Velocities ◽  
High Concentrations ◽  
Ventricular Conduction

The aim of the study was to determine whether facilitation of reentry by potassium-channel openers is related to dispersion of refractoriness and/or modification of anisotropic properties of ventricular myocardium. The dispersion of ventricular effective refractory period (VERP), longitudinal and transverse ventricular conduction velocities (θL and θT, respectively), and wavelength [λ = VERP × θ(L or T)] were studied in Langendorff-perfused left ventricular epicardium in 20 rabbits during infusion of incremental doses of levcromakalim or nicorandil. Dispersion of refractoriness was assessed using standard deviation of VERP mean (SD-VERP), dispersion index (DI; SD-VERP/mean VERP), and maximum dispersion (Dmax = VERPmax − VERPmin). Ventricular conduction velocities and anisotropic ratio were not modified, whatever the dose used. VERP and λ were significantly shortened at high concentrations of levcromakalim and nicorandil. At these doses, SD-VERP, DI, and Dmax were increased significantly. Analysis of ventricular tachycardia induction, performed using a high-resolution ventricular mapping system, confirmed that heterogeneity and shortening of VERP were factors inducing functional conduction block. Our data suggest that, in rabbit left ventricular epicardium, functional conduction block facilitating the occurrence of reentry could be initiated by shortening and, especially, by dispersion of refractoriness during infusion of potassium-channel openers.

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