Intracardiac Echocardiography to Guide Catheter Ablation of Ventricular Arrhythmias in Ischemic Cardiomyopathy

2021 ◽  
Author(s):  
Pierre C. Qian ◽  
Usha B. Tedrow
Keyword(s):  
Catheter Ablation ◽  
Ventricular Arrhythmias ◽  
Ischemic Cardiomyopathy ◽  
Intracardiac Echocardiography ◽  
Guide Catheter

How to use intracardiac echocardiography to guide catheter ablation of outflow tract ventricular arrhythmias

Heart Rhythm ◽  
2020 ◽  
Vol 17 (8) ◽  
pp. 1405-1410
Author(s):  
Ashkan Ehdaie ◽  
Fangzhou Liu ◽  
Eugenio Cingolani ◽  
Xunzhang Wang ◽  
Sumeet S. Chugh ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ventricular Arrhythmias ◽  
Intracardiac Echocardiography ◽  
Outflow Tract ◽  
Guide Catheter

scholarly journals A new mapping method to estimate exit sites of ventricular arrhythmias using intracardiac echocardiography and M-mode for catheter ablation

2017 ◽  
Vol 33 (5) ◽  
pp. 440-446
Author(s):  
Osamu Inaba ◽  
Junichi Nitta ◽  
Syunsuke Kuroda ◽  
Masahiro Sekigawa ◽  
Masahito Suzuki ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ventricular Arrhythmias ◽  
Intracardiac Echocardiography ◽  
Mapping Method

scholarly journals First-in-man experience with ultrasound renal denervation for treatment of recurrent ventricular arrhythmias

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D.N Millenaar ◽  
F Mahfoud ◽  
V Pavlicek ◽  
L Lauder ◽  
M Boehm ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Catheter Ablation ◽  
Ejection Fraction ◽  
Ventricular Arrhythmias ◽  
Ischemic Cardiomyopathy ◽  
Renal Denervation ◽  
Left Ventricular ◽  
Funding Source ◽  
Ultrasound Energy

Abstract Background/Introduction Ventricular arrhythmias (VA) are common in patients with chronic heart failure (CHF) and can be refractory to drugs and catheter ablation. Promising results of sympathomodulatory treatment have been reported in these patients. Purpose This first in man study aims at investigating catheter-based renal denervation (RDN) using ultrasound energy for treatment of refractory VA in patients with CHF. Methods Four patients (age 65±10 years, all male, left ventricular ejection fraction 36±7%, global longitudinal strain (GLS) −10±3%) with CHF (n=1 ischemic cardiomyopathy, n=3 non-ischemic cardiomyopathy) and refractory VA were treated with RDN using ultrasound energy. All patients had undergone endo- or epicardial catheter ablation for recurrent ventricular tachycardia (VT) or fibrillation (VF) in the past and were on at least 2 antiarrhythmic drugs. Computer tomography angiography was performed at baseline, duplex ultrasound of renal arteries, ambulatory blood pressure monitoring (ABPM) and ICD interrogations were performed before, 1 day and 3 months post RDN. Results Bilateral RDN using an ultrasound-based catheter were performed with at least 2 sonications in each main branch of the left and right renal artery. In this analysis, mean follow-up time was 113±12 days. All RDN procedures were performed without any complications. No renal artery stenoses during follow-up. Arrhythmic burden (measured as VT/VF episodes) within 3 months before RDN requiring ICD therapy was reduced from 3 [1.5–54.5] episodes of anti-tachycardia pacing (ATP) and 0.5 [0–1.25] adequate ICD shocks to 1 [0.75–1] episode of ATP. There were no adequate ICD shocks after 3 months. Mean 24-hour ABP before RDN was 94±8/65±9 mmHg with no change in BP following 3 months (SBP 92±1 mmHg, DBP 62±6 mmHg after 3 months). There was no change in left ventricular GLS (−10±3% before, −9±4% after RDN) or ejection fraction (36±7% before and after RDN). Conclusions RDN using ultrasound energy in patients with CHF and refractory VA was safely performed with no changes in blood pressure and reduced the arrhythmic burden after 3 months follow-up. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): ReCor Medical Inc.

Intracardiac Echocardiography to Guide Catheter Ablation of Atrial Fibrillation

2021 ◽  
Author(s):  
Carola Gianni ◽  
Javier E. Sanchez ◽  
Domenico G. Della Rocca ◽  
Amin Al-Ahmad ◽  
Rodney P. Horton ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Intracardiac Echocardiography ◽  
Guide Catheter

128Non-invasive 3D mapping of earliest activation of premature ventricular complexes originating from intracardiac structures to guide catheter ablation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
Z Vali ◽  
A Mistry ◽  
S Velu ◽  
B Sidhu ◽  
X Li ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Real Time ◽  
Papillary Muscle ◽  
Ventricular Arrhythmias ◽  
3D Mapping ◽  
Non Invasive ◽  
Guide Catheter ◽  
Torso Model ◽  
Mapping System ◽  
Coronary Cusp

Abstract Funding Acknowledgements Research funding from Catheter Precision, Inc. Introduction Catheter ablation for ventricular arrhythmias such as premature ventricular complexes and ventricular tachycardia is an established management approach.  Non-invasive mapping to localise the earliest activation (site of origin) on the myocardium may help guide ablation.  Established ECGi methods using the inverse solution to reconstruct epicardial electrograms are unable to accurately locate arrhythmias from the endocardium or from intracardiac structures.  VIVO™ (Catheter Precision) is a novel vectorcardiography based 3D mapping system that may be able to localise arrhythmias from any part of the ventricle. Methods We reviewed our initial experience utilising this mapping system to guide catheter ablation of ventricular ectopics from the inter-ventricular septum, coronary cusp or papillary muscle.  A patient-specific 3D heart and torso model was created using semi-automated segmentation of MRI or CT scan images.  A 3D topographic image of the patient’s torso was taken to accurately position surface ECG electrode locations onto the 3D heart-torso model.  An ECG of the PVC was imported from LabSystemPro (Bard) into VIVO™ for analysis prior to ablation.  The result was then compared with the site of earliest activation identified using invasive electro-anatomical (EA) mapping. Results VIVO™ was used in 12 cases where the PVC was localised to an intracardiac structure – six papillary muscle, four to the septum and two from the coronary cusp.  VIVO™ was able to accurately localise the earliest activation site when compared to the invasive map in 5/6 papillary muscle cases, 3/4 septal cases and 2/2 coronary cusp cases.  Ablation was acutely successful in all cases.  One additional patient had a PVC localised non-invasively to the postero-medial papillary muscle, however an invasive 3D electro-anatomical map or ablation was not performed. In three cases we were able to merge the 3D geometry of the non-invasive map from VIVO™ into the Carto™ system to guide mapping and ablation in real time (see figure). Conclusion Our experience shows promising results for accurate non-invasive localisation of ventricular arrhythmias originating from intracardiac structures.  Non-invasive localisation is of particular value in cases where the arrhythmia is infrequent, difficult to induce or poorly tolerated haemodynamically.  The two cases where PVC localisation was inaccurate were performed using an older version of the software. With recent refinements, localisation is anticipated to be improved further. We also present the first experience of combining the VIVO™ geometry with the real-time invasive EA map.  This has potential to significantly speed up mapping time and reduce the need for expensive multi-polar catheters by allowing the operator to see their target in real time 3D.  Further work is ongoing to validate the accuracy of VIVO™ prospectively and quantitatively. Abstract Figure. VIVO map merged with Carto LV geometry

scholarly journals Intracardiac echocardiography to guide catheter ablation of an accessory pathway in Ebstein’s anomaly. A case report

2018 ◽  
Vol 20 (2) ◽  
pp. 250
Author(s):  
Gabriel Cismaru ◽  
Lucian Muresan ◽  
Radu Rosu ◽  
Mihai Puiu ◽  
Gabriel Gusetu ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Accessory Pathway ◽  
Intracardiac Echocardiography ◽  
Anterior Leaflet ◽  
Reentrant Tachycardia ◽  
Ebstein Anomaly ◽  
Guide Catheter ◽  
Reentrant Arrhythmia ◽  
The Right ◽  
Retrograde Conduction

We present the case of a 17-year-old girl with Ebstein anomaly and repeated episodes of reentrant tachycardia due to a right posterior accessory pathway. Catheter ablation was performed using intracardiac echocardiography. A ViewFlex Xtra probe was inserted and showed an anormal tricuspid valve with elongated anterior leaflet and low insertion of the septal leaflet towards the apex. The anatomical annulus was identified by the course of the right coronary artery. RF application on the posterior annulus stopped the reentrant arrhythmia. After ablation, programmed stimulation showed absence of both antegrade and retrograde conduction through the accessory pathway.

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