COMPLICATION RATES OF EPICARDIAL VENTRICULAR TACHYCARDIA ABLATION: A POOLED ANALYSIS

Abstract Fascicular left ventricular tachycardia (VT) is the second most frequent idiopathic left VT in the setting of a structurally normal heart. Catheter ablation is curative in most patients with low complication rates. We report a case of ostial left anterior descending coronary artery (LAD) occlusion during fascicular ventricular tachycardia ablation. Dissection was the most likely cause of LAD obstruction. To the authors’ best knowledge, this is the first case reporting selective LAD dissection during electrophysiology study with no left main coronary artery (LMCA) affection.

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Complication rates following ventricular tachycardia ablation in ischaemic and non-ischaemic cardiomyopathies: a systematic review

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-021-00948-6 ◽

2021 ◽

Author(s):

Wern Yew Ding ◽

Charles M. Pearman ◽

Laura Bonnett ◽

Ahmed Adlan ◽

Shui Hao Chin ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Vascular Complications ◽

Major Complication ◽

Complication Rates ◽

Ventricular Tachycardia Ablation ◽

Ischaemic Cardiomyopathy ◽

Cerebrovascular Events ◽

Acute Complications ◽

Vt Ablation

Abstract Background Catheter ablation of ventricular tachycardia (VT) is associated with potential major complications, including mortality. The risk of acute complications in patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM) has not been systematically evaluated. Methods PubMed was searched for studies of catheter ablation of VT published between September 2009 and September 2019. Pre-specified primary outcomes were (1) rate of major acute complications, including death, and (2) mortality rate. Results A total of 7395 references were evaluated for relevance. From this, 50 studies with a total of 3833 patients undergoing 4319 VT ablation procedures fulfilled the inclusion criteria (mean age 59 years; male 82%; 2363 [62%] ICM; 1470 [38%] NICM). The overall major complication rate in ICM cohorts was 9.4% (95% CI, 8.1–10.7) and NICM cohorts was 7.1% (95% CI, 6.0–8.3). Reported complication rates were highly variable between studies (ICM I2 = 90%; NICM I2 = 89%). Vascular complications (ICM 2.5% [95% CI, 1.9–3.1]; NICM 1.2% [95% CI, 0.7–1.7]) and cerebrovascular events (ICM 0.5% [95% CI, 0.2–0.7]; NICM, 0.1% [95% CI, 0–0.2]) were significantly higher in ICM cohorts. Acute mortality rates in the ICM and NICM cohorts were low (ICM 0.9% [95% CI, 0.5–1.3]; NICM 0.6% [95% CI, 0.3–1.0]) with the majority of overall deaths (ICM 75%; NICM 80%) due to either recurrent VT or cardiogenic shock. Conclusion Overall acute complication rates of VT ablation are comparable between ICM and NICM patients. However, the pattern and predictors of complications vary depending on the underlying cardiomyopathy.

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Complication rates of ventricular tachycardia ablation: Comparison of safety outcomes derived from administrative databases and clinical trials

International Journal of Cardiology ◽

10.1016/j.ijcard.2015.08.116 ◽

2015 ◽

Vol 201 ◽

pp. 529-531 ◽

Cited By ~ 13

Author(s):

Naga Venkata Pothineni ◽

Abhishek Deshmukh ◽

Deepak Padmanabhan ◽

Swathi Kovelamudi ◽

Nileshkumar J. Patel ◽

...

Keyword(s):

Clinical Trials ◽

Ventricular Tachycardia ◽

Administrative Databases ◽

Complication Rates ◽

Ventricular Tachycardia Ablation ◽

Safety Outcomes

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Feasibility and Safety of Laparoscopic‐Guided Epicardial Access for Ventricular Tachycardia Ablation

Journal of the American Heart Association ◽

10.1161/jaha.120.016654 ◽

2020 ◽

Vol 9 (15) ◽

Author(s):

Andre A. L. Carmo ◽

Silvia Zenobio ◽

Bruno C. Santos ◽

Manoel O. C. Rocha ◽

Antonio L. P. Ribeiro

Keyword(s):

Ventricular Tachycardia ◽

Organ Injury ◽

Complication Rates ◽

Abdominal Organ ◽

Nerve Paralysis ◽

Phrenic Nerve Paralysis ◽

Ventricular Tachycardia Ablation ◽

Chagas Cardiomyopathy ◽

Surgical Access ◽

Epicardial Access

Background The usual approach to epicardial access in patients with Chagas cardiomyopathy and megacolon is surgical access to avoid bowel injury. However, there are concerns regarding its safety in cases of Chagas cardiomyopathy with reports of prolonged mechanical ventilation and high mortality in this clinical setting. The aim of this study was to examine feasibility and complication rates for ventricular tachycardia ablation performed with laparoscopic‐guided epicardial access. Methods and Results This single center study examined complication rates of the first 11 cases of ventricular tachycardia ablation in patients with Chagas cardiomyopathy, using laparoscopic guidance to access epicardial space. All 11 patients underwent epicardial VT ablation using laparoscopic‐guided epicardial access, and the complication rates were compared with historical medical reports. The main demographic features of our population were age, 63±13 years; men, 82%; and median ejection fraction, 31% (Q1=30% and Q3=46%). All patients were sent for ventricular tachycardia ablation because of medical therapy failure. The reason for laparoscopy was megacolon in 10 patients and massive liver enlargement in 1 patient. Epicardial access was achieved in all patients. Complications included 1 severe cardiogenic shock and 1 phrenic nerve paralysis. No intra‐abdominal organ injury occurred; only 1 death, which was caused by progressive heart failure, was reported more than 1 month after the procedure. Conclusions Laparoscopic‐guided epicardial access in the setting of ventricular tachycardia ablation and enlarged intra‐abdominal organ is a simple alternative to more complex surgical access and can be performed with low complication rates.

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Faculty Opinions recommendation of Long-term Outcomes of Ventricular Tachycardia Ablation in Different Types of Structural Heart Disease.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726122471.793533528 ◽

2017 ◽

Author(s):

Brian Olshansky

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Structural Heart Disease ◽

Long Term Outcomes ◽

Ventricular Tachycardia Ablation ◽

Different Types

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Faculty Opinions recommendation of Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726334804.793533539 ◽

2017 ◽

Author(s):

Rakesh Gopinathannair

Keyword(s):

Ventricular Tachycardia ◽

Antiarrhythmic Drugs ◽

Ventricular Tachycardia Ablation

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Impact of augmented-reality improvement in ablation catheter navigation as assessed by virtual-heart simulations of ventricular tachycardia ablation

Computers in Biology and Medicine ◽

10.1016/j.compbiomed.2021.104366 ◽

2021 ◽

Vol 133 ◽

pp. 104366

Author(s):

Adityo Prakosa ◽

Michael K. Southworth ◽

Jennifer N. Avari Silva ◽

Jonathan R. Silva ◽

Natalia A. Trayanova

Keyword(s):

Ventricular Tachycardia ◽

Augmented Reality ◽

Ablation Catheter ◽

Ventricular Tachycardia Ablation ◽

Catheter Navigation

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Ventricular scar channel entrances identified by new wideband cardiac magnetic resonance sequence to guide ventricular tachycardia ablation in patients with cardiac defibrillators

EP Europace ◽

10.1093/europace/euaa021 ◽

2020 ◽

Vol 22 (4) ◽

pp. 598-606

Author(s):

Ivo Roca-Luque ◽

Ana Van Breukelen ◽

Francisco Alarcon ◽

Paz Garre ◽

Jose M Tolosana ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Standard Procedure ◽

False Negative ◽

False Negative Rate ◽

Historical Cohort ◽

Ventricular Tachycardia Ablation ◽

Vt Ablation ◽

Lge Cmr

Abstract Aims Ventricular tachycardia (VT) substrate-based ablation has become a standard procedure. Electroanatomical mapping (EAM) detects scar tissue heterogeneity and define conduction channels (CCs) that are the ablation target. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is able to depict CCs and increase ablation success. Most patients undergoing VT ablation have an implantable cardioverter-defibrillator (ICD) that can cause image artefacts in LGE-CMR. Recently wideband (WB) LGE-CMR sequence has demonstrated to decrease these artefacts. The aim of this study is to analyse accuracy of WB-LGE-CMR in identifying the CC entrances. Methods and results Thirteen consecutive ICD-patients who underwent VT ablation after WB-LGE-CMR were included. Number and location of CC entrances in three-dimensional EAM and in WB-LGE-CMR reconstruction were compared. Concordance was compared with a historical cohort matched by cardiomyopathy, scar location, and age (26 patients) with LGE-CMR prior to ICD and VT ablation. In WB-CMR group, 101 and 93 CC entrances were identified in EAM and WB-LGE-CMR, respectively. In historical cohort, 179 CC entrances were identified in both EAM and LGE-CMR. The EAM/CMR concordance was 85.1% and 92.2% in the WB and historical group, respectively (P = 0.66). There were no differences in false-positive rate (CC entrances detected in CMR and absent in EAM: 7.5% vs 7.8% in WB vs. conventional CMR, P = 0.92) nor in false-negative rate (CC entrances present in EAM not detected in CMR: 14.9% vs.7.8% in WB vs. conventional CMR, P = 0.23). Epicardial CCs was predictor of poor CMR/EAM concordance (OR 2.15, P = 0.031). Conclusion Use of WB-LGE-CMR sequence in ICD-patients allows adequate VT substrate characterization to guide VT ablation with similar accuracy than conventional LGE-CMR in patients without an ICD.

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