scholarly journals 3D transvenous radiofrequency ablation of manifest epicardial posterior-septal accessory pathways in children: Can technology innovations improve the outcome?

2021 ◽  
pp. 1-6
Author(s):  
Fabrizio Drago ◽  
Pietro Paolo Tamborrino ◽  
Vincenzo Pazzano ◽  
Corrado Di Mambro ◽  
Massimo Stefano Silvetti
Keyword(s):  
Success Rate ◽  
Coronary Sinus ◽  
Young Patients ◽  
Recent Experience ◽  
Image Integration ◽  
Accessory Pathways ◽  
Technology Innovations ◽  
Acute Success ◽  
Transvenous Approach ◽  
Increase Success Rate

Abstract Introduction: The aim of the study was to revise our more recent experience about epicardial posterior-septal accessory pathways radiofrequency transcatheter ablation in children and young patients using a transvenous approach through the coronary sinus, to understand if new mapping and ablation technologies can increase success rate and safety. Methods and results: Twenty children (mean age 13 ± 3 years) with epicardial posterior-septal accessory pathways (14 in coronary sinus and 6 in the middle cardiac vein) underwent radiofrequency transcatheter ablation with CARTO-3® system with help of the CARTO-Univu® module. Acute success rate was 73%. No patient was lost to follow-up (mean time 11.4 ± 9 months). The recurrence rate was 19%. Two patients underwent a successful redo-procedure; the overall long-term success rate was 65%. Navistar® catheter presented the highest acute success rate in the coronary sinus. Navistar SmartTouch® was the only catheter that did not present recurrences after the acute success, and it was successfully used in two patients previously unsuccessfully treated with a Navistar ThermoCool®. Acute success rate was 79% without image integration with angio-CT, while it was 63% after the introduction of CARTO-Merge®. Conclusion: Epicardial posterior-septal accessory pathways can be definitively eliminated by transvenous radiofrequency transcatheter ablation in more than half of the cases in children. Acute success rate does not seem to depend on catheters used, but contact-force catheter seems to be useful in cases with recurrences. Image integration with cardiac-CT does not increase success rate, but it is useful to detect coronary sinus alterations to better guide ablation strategy.

scholarly journals 707 Transvenous radiofrequency ablation of epicardial posterior-septal accessory pathways in children with WPW syndrome: can technology and imaging innovations improve the outcome?

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Vincenzo Pazzano ◽  
Pietro Paolo Tamborrino ◽  
Corrado Di Mambro ◽  
Massimo Stefano Silvetti ◽  
Fabrizio Drago
Keyword(s):  
Radiofrequency Ablation ◽  
Success Rate ◽  
Coronary Sinus ◽  
Young Patients ◽  
Ct Reconstruction ◽  
Accessory Pathways ◽  
Acute Success ◽  
Angio Ct ◽  
Septal Localization ◽  
Lost To Follow Up

Abstract Aims The aim of the study was to analyse our recent single-centre experience about epicardial posterior-septal accessory pathways transcatheter ablation in children and young patients using radiofrequency through the coronary sinus, in order to understand which mapping and ablation strategy is associated with higher success rate and safety. Methods and results We reviewed all the cases of ablation of overt accessory pathways (in Wolff–Parkinson–White syndrome) with epicardial posterior-septal localization performed in children or young patients at our institution in the last 5 years. Twenty-two paediatric patients (mean age: 13 ± 3 years) with epicardial posterior-septal accessory pathways (15 in coronary sinus and 7 in the Middle Cardiac Vein) underwent radiofrequency transcatheter ablation with CARTO 3TM. Acute success rate was 77%. No patient was lost to follow-up (mean time 14.4 ± 9 months). The recurrence rate was 18%. Two patients underwent a successful redo-procedure; the overall long-term success rate was 68%. NAVISTAR® catheter presented the highest acute success rate in the coronary sinus. NAVISTAR SMARTTOUCH® was the only catheter that did not present recurrences after the acute success and it was successfully used in two patients previously unsuccessfully treated with a NAVISTAR THERMOCOOL®. Integration with angio-CT of coronary sinus branches obtained with CARTOMERGE was associated with higher success rate in patients with a previous failed ablation attempt. Conclusions Epicardial posterior-septal accessory pathways can be successfully treated with transvenous radiofrequency ablation in more than half of the cases in children/young patients. Acute success rate does not seem to depend on catheters used but contact-force catheter seems to be useful in cases with recurrences. Image integration with cardiac-CT reconstruction of coronary sinus branches anatomy can be useful to better guide ablation in case of previously failed attempts.

scholarly journals Catheter ablation of difficult accessory pathways guided by three-dimensional electroanatomic mapping: first experience

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
N Vecchio ◽  
A Bochoeyer ◽  
JC Lopez Diez ◽  
N Schnetzer ◽  
J Dorado ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Success Rate ◽  
Three Dimensional ◽  
Electroanatomic Mapping ◽  
Av Block ◽  
Accessory Pathways ◽  
Primary Success ◽  
Acute Success ◽  
One Year

Abstract Funding Acknowledgements Type of funding sources: None. Background Catheter ablation of paraseptal accessory pathways (PAP)  is associated with longer fluoroscopy and procedure times, more radiofrequency lesions, as well as a higher rate of recurrence and complications. In anteroseptal or midseptal PAP, recurrence and risk of AV block is even higher. Guided ablations with a three-dimensional  electroanatomic mapping system  (3D) report greater efficacy and safety. Purpose To assess the acute success rate and complications of PAP 3D catheter ablation. Report the recurrence rate at one year of follow-up. Methods Descriptive analysis that included patients with difficult PAP 3D catheter ablation between 2017 and 2019. Acute success was defined as the disappearance of ventricular pre-excitation 15 seconds after starting the application and the absence of retrograde conduction (Figure). In all cases, a one-year follow-up was performed with ECG and 24-hour Holter. Results 25 patients were included during the mentioned period. The average age was 23 years, 60% (15 p) were men and 56% (14 p) were symptomatic due to palpitations. 1 patient had previous heart disease (ebstein"s anomaly). 36% (9 p) had a previous procedure: 5 patients with previous failed radiofrequency ablation, 1 patient with failed anteroseptal cryoablation and 3 patients with suspended ablation due to risk of AV block. The most frequent location was the posteroseptal. (Table) The primary success rate was 92% (23 of 25 p). Ablation was unsuccessful in two patients, one with Ebstein"s disease and the other with a left posteroseptal PAP. None of the patients presented complications associated with the procedure. During the one-year follow-up, one patient was registered with asymptomatic recurrence (1 of 23; 4.35%: right posteroseptal location), demonstrated by manifest preexcitation on the control ECG. Conclusion In our first experience, catheter ablation of difficult accessory pathways guided by three-dimensional electroanatomic mapping showed a high primary success rate without associated complications. Recurrence during follow-up was similar to that reported in the literature. Accessory Pathway locationPatientsRight Posteroseptal11 (44%)Left Posteroseptal5 (20%)Anteroseptal5 (20%)Midseptal4 (16%)Abstract Figure

scholarly journals Ablation in patients with Ebstein Anomaly and Wolff Parkinson White Syndrome

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Cueva-Parra ◽  
G Bustillos-Garcia ◽  
JA Fernandez-Domenech ◽  
J Gomez-Flores ◽  
MF Marquez ◽  
...  
Keyword(s):  
Success Rate ◽  
Electroanatomical Mapping ◽  
Ebstein Anomaly ◽  
White Syndrome ◽  
Wpw Syndrome ◽  
Accessory Pathways ◽  
Acute Success ◽  
The Mean ◽  
The Right ◽  
Wolff Parkinson White Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background - Introduction: Ablation in patients with Ebstein Anomaly (EA) and Wolff Parkinson White syndrome (WPW) is challenging due to the complex anatomy and the presence of multiple accessory pathways (AP). Objectives Report the results of our recent experience of ablation in patients with EA and WPW syndrome. Methods We conducted a retrospective review of the cases of EA and WPW syndrome, which were taken to ablation in our center between 2015 and 2020. Results We found that in the indicated period 30 electrophysiological studies and ablations had been performed in 26 patients, 53.8% were males and the mean age at the time of the study was 20.6 ± 9.1 years, the mean tricuspid septal valve attachment was 44.5 ± 17.7%. Regarding the procedures, 15 were conventional studies (50%) and 15 (50%) were performed with electroanatomical mapping. We used intracardiac echocardiogram (ICE) in 10 cases (33.3%). The acute success rate was 85.7% and in the follow-up 3 patients (10%) presented recurrence. Only one patient presented a major complication, which was a complete AV block. There was a tendency to improve the acute success with the use of electroanatomical mapping in comparation with conventional studies (93.3% vs 66.6%, p = 0.068), and with the use of ICE acute success was significantly improved (100% vs 70%, p = 0.04). Seven patients presented multiple accessory pathways (26.9%). The most frequent location was the right posterolateral with 61.53%, followed by the right posteroseptal with 26.9% and the right lateral with 19.2%. Conclusions The ablation in patients with EA and WPW syndrome constitutes a challenge, we found that the use of electroanatomical mapping and the use of ICE could improve the acute success rate. New studies are needed to demonstrate the usefulness of these techniques to improve the acute success rate and to reduce the recurrence rate. ProceduresProcedures (N = 30)N%Conventional procedures1550.0Electroanatomical mapping1550.0Intracardiac echocardiogram1033.3Acute success2485.7Recurrence310.0Major complication13.3Descriptive table of our experience in ablation of patients with ED and WPW syndrome.Abstract Figure. Location of the accessory pathways

Abstract 646: Epicardial Ablation Of Ventricular Tachycardia - A Single Centre Experience

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Boris Schmidt ◽  
KR Julian Chun ◽  
Buelent Koektuerk ◽  
Feifan Ouyang ◽  
Karl-Heinz Kuck
Keyword(s):  
Ventricular Tachycardia ◽  
Success Rate ◽  
Single Centre ◽  
Epicardial Ablation ◽  
Single Centre Experience ◽  
Radiofrequency Current ◽  
Acute Success ◽  
Procedural Success ◽  
Lv Aneurysm

Background: Radiofrequency current ablation (RFA) of ventricular tachycardia (VT) focuses on endocardial (endo) substrates. However, if endo RFA fails, an epi approach is a potential treatment option. We report a single centre experience of epi VT ablation. Patients and Methods: Between 06/2005 and 02/2008 42 pts (14 female, mean age 49 ± 18 years) underwent electroanatomical endo and epi mapping and ablation for intractable VT, syncope or VT storm with multiple ICD discharges. Pts with normal heart (n=7), ischemic cardiomyopathy (ICM; n=8), NICM (n=11), ARVD (n=8), LV-aneurysm (n=7) or sarcoidosis (n=1) were studied. Mean LV ejection fraction was 45±12%. 20/42 had had at least 1 previous ablation attempt for VT (range 1– 4 ablations). Acute success was defined as non-inducibility of the previously inducible VT. Chronic success was defined as recurrence of any VT. Results: Acute procedural success rate was 79% (30/38). In 4 pts VTs were not inducible during EPS. In 28/42 pts endo mapping revealed no pathologic potentials. In 23/38 pts and 7/38 the succesful RFC ablation site was epi and endo, respectively. In 9/38 pts endo ablation failed and VT could only be ablated from epi. Further 7/38 pts needed both endo and epi ablation. In In 4/8 failed ablations epi RFC ablation was impossible due to failed access to target site (adhesions; n=2), close vicinity of a coronary artery (n=1) or the phrenic nerve (n=1). Procedure duration was 263±97 min. Unfortunately, 1 pt died due to perforation of RV and 1 pt had severe hepatic bleeding after epi puncture. One pt died in cardiogenic shock 1 d after the procedure. In 2 pts a sterile pericarditis occurred which resolved without any further intervention. After a median follow-up of 293 days (1–929 days) 53% of pts were alive and free from any VT. Conclusion: In pts with failed endo RFC ablation for VT due to different etiologies epi RFC ablation was acutely successful in 61% of pts with a moderate chronic success rate. However, major complications occured in approximately 5% of pts. Epi mapping should be considered if endo pathologic potentials are absent or if endo ablation failed.

P355Complete non-inducibility after radiofrequency ablation for electrical storm improves survival rates

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Nastasa ◽  
C Cojocaru ◽  
D A Radu ◽  
E Goanta ◽  
V Iliese ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Success Rate ◽  
Statistical Significance ◽  
Survival Rates ◽  
Electrical Storm ◽  
Programmed Ventricular Stimulation ◽  
Ventricular Stimulation ◽  
Threatening Condition ◽  
Acute Success

Abstract Background Electric storm is a life threatening condition, that can complicate multiple cardiac pathologies and is associated with high mortality.  Catheter ablation has been shown to reduce ventricular tachycardia (VT) burden in patients with electrical storm but the optimal procedural endpoint and the therapeutic particularities required by different etiologies are still under debate. Purpose Our objective was to determine if there are any periprocedural factors that influence midterm outcomes.  We also sought if there were any significant differences between the results for ischemic and nonischemic patients. Methods The study included 66 consecutive patients, mean age 60 years, 82% males, treated for electrical storm in our center with endocardial/endo-epicardial radiofrequncy catheter ablation (with or without remote magnetic navigation). Acute success was defined as elimination of the clinical tachycardia with complete non-inducibility (including ventricular fibrillation) or non-inducibility for monomorphic VT with programmed ventricular stimulation using up to 4 extrastimuli. Mean follow-up duration was 9.4 months and the type of recurrence was catalogued in 3 categories: initial VT (isolated), electric storm and other sustained VT. Results The overall acute success rate was 93%, complete non-inducibility was achieved in 64.5% and non-inducibility for monomorphic VT in 87.5% of the cases. Epicardial approach was used in 44% of the non-ischemic cases vs 10.5% of the ischemic ones (p = 0.005). There were no significant differences between complete noninducibility rates and recurrence/death rates of the ischemic vs nonischemic groups. Among the variables analysed for predicting noninducibility, only two reached statistical significance: mean QRS duration of the clinical tachycardia (160 ± 32 ms vs 240 ± 63.3ms, p = 0.02) and shortest RS complex (124 ± 14.7 ms vs 210 ± 12ms, p = 0.02). Recurrent ventricular arrhythmia occurred in 25% of the patients during follow up, from which: 27.2 % initial VT (isolated), 36.4% electric storm and 36.4% other sustained VT. Death rate was 10.6% (7 patients).  Kaplan Meier plot showed that the lot with complete noninducibility after programmed ventricular stimulation had better survival rates (p = 0.01). Conclusions Ablative therapy had a good acute success rate, without significant differences between ischemic and noninschemic patients in our study. Complete noninducibility after programmed ventricular stimulation  after ablation was associated with better survival rates. Unsuccessfull ablation is a predictor of inhospital death of these patients.

scholarly journals Catheter ablation of accessory pathways near the coronary sinus: Value of defining coronary arterial anatomy

Heart Rhythm ◽  
2015 ◽  
Vol 12 (3) ◽  
pp. 508-514 ◽  
Author(s):  
Jessica Mao ◽  
John M. Moriarty ◽  
Ravi Mandapati ◽  
Noel G. Boyle ◽  
Kalyanam Shivkumar ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Coronary Sinus ◽  
Accessory Pathways ◽  
Arterial Anatomy

scholarly journals Factors Associated with the Success Rate of Orthodontic Miniscrews Placed in the Upper and Lower Posterior Buccal Region

2008 ◽  
Vol 78 (1) ◽  
pp. 101-106 ◽  
Author(s):  
Cheol-Hyun Moon ◽  
Dong-Gun Lee ◽  
Hyun-Sun Lee ◽  
Jeong-Soo Im ◽  
Seung-Hak Baek
Keyword(s):  
Soft Tissue ◽  
Success Rate ◽  
Young Patients ◽  
Adult Patients ◽  
Soft Tissue Management ◽  
Chi Square ◽  
Second Molar ◽  
Attached Gingiva ◽  
Significant Difference ◽  
Maxilla And Mandible

Abstract Objective: To determine the success rate and the factors related to the success rate of orthodontic miniscrew implants (OMI) placed at the attached gingiva of the posterior buccal region. Materials and Methods: Four hundred eighty OMI placed in 209 orthodontic patients were examined retroactively. The sample was divided into young patients (range 10–18 years, N = 108) and adult patients (range 19–64 years, N = 109). The placement site was divided into three interdental areas from the first premolar to the second molar in the maxilla and mandible. According to soft tissue management, the samples were divided into incision and nonincision groups. Chi-square tests and multiple logistic regression analyses were used. Results: The overall success rate was 83.8%. Dislodgement of the OMI occurred most frequently in the first 1–2 months, and more than 90% of the failures occurred within the first 4 months. Sex, age, jaw, soft tissue management, and placement side did not show any difference in the success rate. Placement site, however, showed a significant difference in the mandible of adult patients. There was no difference in the success rate in the maxilla. Conclusions: Placement site is one of the important factors for success rate of OMI.

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