Use of a high-density mapping catheter for Purkinje-related ventricular tachycardia in a patient with a previous history of anterior myocardial infarction

Abstract Background Substrate mapping has highlighted the importance of targeting diastolic conduction channels and late potentials during ventricular tachycardia (VT) ablation. State-of-the-art multipolar mapping catheters have enhanced mapping capabilities. The purpose of this study was to investigate whether long-term outcomes were improved with the use of a HD Grid mapping catheter combining complementary mapping strategies in patients with structural heart disease VT. Methods Consecutive patients underwent VT ablation assigned to either HD Grid, Pentaray, Duodeca, or point-by-point (PbyP) RF mapping catheters. Clinical endpoints included recurrent anti-tachycardia pacing (ATP), appropriate shock, asymptomatic non-sustained VT, or all-cause death. Results Seventy-three procedures were performed (33 HD Grid, 22 Pentaray, 12 Duodeca, and 6 PbyP) with no significant difference in baseline characteristics. Substrate mapping was performed in 97% of cases. Activation maps were generated in 82% of HD Grid cases (Pentaray 64%; Duodeca 92%; PbyP 33% (p = 0.025)) with similar trends in entrainment and pace mapping. Elimination of all VTs occurred in 79% of HD Grid cases (Pentaray 55%; Duodeca 83%; PbyP 33% (p = 0.04)). With a mean follow-up of 372 ± 234 days, freedom from recurrent ATP and shock was 97% and 100% respectively in the HD Grid group (Pentaray 64%, 82%; Duodeca 58%, 83%; PbyP 33%, 33% (log rank p = 0.0042, p = 0.0002)). Conclusions This study highlights a step-wise improvement in survival free from ICD therapies as the density of mapping capability increases. By using a high-density mapping catheter and combining complementary mapping strategies in a strict procedural workflow, long-term clinical outcomes are improved.

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Cost Effectiveness Of Pentaray High Density Mapping Catheter In Treatment Of Ventricular Tachycardia In Turkey

Value in Health ◽

10.1016/j.jval.2017.08.1054 ◽

2017 ◽

Vol 20 (9) ◽

pp. A584

Author(s):

M Tatar ◽

E Tuna ◽

A Şentürk ◽

CG Turgut ◽

G Erdoğan ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Cost Effectiveness ◽

High Density ◽

Density Mapping ◽

Mapping Catheter

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Impact of high density mapping using a grid shaped catheter with orthogonal signal analysis on ventricular tachycardia ablation strategy

EP Europace ◽

10.1093/europace/euab116.353 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

I Roca ◽

F Lorgat ◽

H Haqqani ◽

J Lacotte ◽

F Roithinger ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Success Rate ◽

Low Voltage ◽

Left Ventricular ◽

High Density ◽

Electrode Configuration ◽

Density Mapping ◽

Slow Conduction ◽

Acute Success ◽

Mapping Catheter

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Abbott Background Ventricular tachycardia (VT) in patients with structural heart disease (SHD) is related to scar and slow conduction areas. Substrate-based ablation has become the gold standard treatment in patients with SHD-related refractory VT. A new high-density grid shaped catheter that allows simultaneous analysis of adjacent orthogonal bipolar signals can allow better understanding of these slow conduction areas with the potential to improve ablation results. Purpose This was a prospective, multicenter observational study to characterize the utility of electroanatomical mapping with a high density grid-style mapping catheter (HD Grid) in subjects undergoing catheter ablation for ventricular tachycardia (VT) in real-world clinical settings. Methods During the study period, patients who underwent VT ablation using the HD Grid catheter as the primary mapping catheter were included. Comparisons both during the procedure and retrospectively were performed between conventional electrode configuration maps and simultaneous orthogonal bipole electrode configuration maps. The influence of these different configurations on ablation strategy was analyzed. Results During study period (January 2019 – April 2020) 57 maps were performed in 34 VT subjects (average age: 64.3yr, male: 85.3%, ischemic cardiomyopathy: 70.6%). The left ventricle was mapped in 94.1% of subjects, including left ventricular outflow tract and papillary muscles in 20.6% and 8.8% respectively, reporting minimal or no ectopic beats in 97.1% of the subjects. The total number of mapping points collected was 14172.0 ± 15174.8 in 24.3 ± 17.9 min per map. Simultaneous orthogonal bipole mapping identified differences in 67.6% of maps compared to linear along-the-spline electrode configurations. The differences consisted mainly in the surface area (92%) and location of low voltage (40%). When compared during the procedure, simultaneous orthogonal bipole mapping was used to identify ablation strategy in 100% of cases. When compared to a standard along-the-spline configuration retrospectively, the ablation strategy identified with simultaneous orthogonal bipoles was different in 30.1% of cases. The ablation strategy used in these subjects was mainly substrate ablation (late potentials and low voltage areas in scar regions) with an acute success rate of 97.1%. Conclusions The use of the HD Grid catheter with the ability to analyze orthogonal signals is feasible and has the potential to change the ablation strategy in one third of VT patients with a high acute success rate.

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Prognostic significance and natural history of left ventricular thrombi in patients with acute anterior myocardial infarction: a two-dimensional echocardiographic study.

Circulation ◽

10.1161/01.cir.72.4.774 ◽

1985 ◽

Vol 72 (4) ◽

pp. 774-780 ◽

Cited By ~ 94

Author(s):

P Spirito ◽

P Bellotti ◽

F Chiarella ◽

S Domenicucci ◽

A Sementa ◽

...

Keyword(s):

Myocardial Infarction ◽

Natural History ◽

Prognostic Significance ◽

Left Ventricular ◽

Two Dimensional ◽

Anterior Myocardial Infarction ◽

Echocardiographic Study ◽

History Of ◽

Left Ventricular Thrombi

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Ventricular tachycardia storm management in a COVID-19 patient: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa217 ◽

2020 ◽

Vol 4 (FI1) ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Gianfranco Mitacchione ◽

Marco Schiavone ◽

Alessio Gasperetti ◽

Giovanni B Forleo

Keyword(s):

Ventricular Tachycardia ◽

Ventricular Arrhythmias ◽

Cardiac Involvement ◽

Previous History ◽

Left Ventricular ◽

Electrical Storm ◽

Increased Risk ◽

History Of ◽

Myocardial Involvement ◽

Artery Disease

Abstract Background Coronavirus disease 2019 (COVID-19) has been associated with myocardial involvement. Among cardiovascular manifestations, cardiac arrhythmias seem to be fairly common, although no specifics are reported in the literature. An increased risk of malignant ventricular arrhythmias and electrical storm (ES) has to be considered. Case summary We describe a 68-year-old patient with a previous history of coronary artery disease and severe left ventricular systolic disfunction, who presented to our emergency department describing cough, dizziness, fever, and shortness of breath. She was diagnosed with COVID-19 pneumonia, confirmed after three nasopharyngeal swabs. Ventricular tachycardia (VT) storm with multiple implantable cardioverter defibrillator (ICD) shocks was the presenting manifestation of cardiac involvement during the COVID-19 clinical course. A substrate-based VT catheter ablation procedure was successfully accomplished using a remote navigation system. The patient recovered from COVID-19 and did not experience further ICD interventions. Discussion To date, COVID-19 pneumonia associated with a VT storm as the main manifestation of cardiac involvement has never been reported. This case highlights the role of COVID-19 in precipitating ventricular arrhythmias in patients with ischaemic cardiomyopathy who were previously stable.

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Impact of the COVID-19 pandemic in patients with a previous history of premature myocardial infarction

American Journal of Preventive Cardiology ◽

10.1016/j.ajpc.2020.100128 ◽

2020 ◽

Vol 4 ◽

pp. 100128

Author(s):

Meral Kayikcioglu ◽

Ozlem Kuman Tuncel ◽

Lale Tokgozoglu

Keyword(s):

Myocardial Infarction ◽

Previous History ◽

History Of ◽

Premature Myocardial Infarction

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P1515Female sex is an independent predictor of mortality in patients with STEMI in Spain: a study in 325,017 episodes over 11 years (2005–2015)

European Heart Journal ◽

10.1093/eurheartj/ehz748.0277 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Anguita ◽

A Sambola Ayala ◽

J Elola ◽

J L Bernal ◽

C Fernandez ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Hospital Mortality ◽

Independent Predictor ◽

National Health System ◽

Anterior Myocardial Infarction ◽

Female Sex ◽

Spanish National Health System ◽

History Of ◽

The Impact

Abstract Background Recent studies reported a decrease in the mortality of ST-elevation myocardial infarction (STEMI) patients. This favorable evolution could not extend to women. The interaction between gender and mortality in STEMI remains controversial. Purpose To assess the impact of female sex on mortality of patients with STEMI through of period of 11 years. Methods We conducted a retrospective longitudinal study using information provided by the minimal database system of the Spanish National Health System to identify all hospitalizations in patients aged 35–94 years with the principal diagnosis of STEMI from 2005–2015. Results A total of 325,017 STEMI were identified. Of them, 273,182 were included, and 106,277 (38.8%) were women. Women were older than men and had more comorbidities. Through the study period 53% men vs 37.2% underwent PTCA; women presented more frequently heart failure, shock and stroke than men (p<0.001, respectively). The mean crude in-hospital mortality rate for the whole study period was higher in women (OR: 2.18; 95% CI: 2.12.-2.23, p<0.0001). Female sex was independently associated with higher in-hospital mortality (adjusted OR: 1.18; 95% CI: 1.14–1.22, p<0.001) (Table 1). The risk was maintained through the whole study period (lower OR: 1.14 in 2014; higher OR: 1.28 in 2006). Table 1. Variables independently associated with in-hospital mortality adjusted by risk in a multilevel logistic regression model, 2005–2015 STEMI In-hospital mortality Odds Ratio P 95% CI Woman 1.18 <0.001 1.14 1.22 Age 1.06 <0.001 1.06 1.06 History of PTCA 1.58 <0.001 1.40 1.77 Congestive heart failure 1.26 <0.001 1.22 1.30 Acute Myocardial Infarction 1.84 <0.001 1.54 2.20 Anterior myocardial infarction 1.47 <0.001 1.23 1.76 Cardio-respiratory failure or shock 15.25 <0.001 14.78 15.75 Hypertension 0.81 <0.001 0.79 0.84 Stroke 5.76 <0.001 5.18 6.42 Cerebrovascular disease 0.86 <0.001 0.79 0.93 Renal failure 1.95 <0.001 1.88 2.02 Vascular disease and complications 7.03 <0.001 5.72 8.63 CI, Confidence Interval. Conclusions Female sex is an independent predictor of mortality in patients with STEMI in Spain, maintaining through a period of the 11 years.

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