673Bipolar radiofrequency ablation supported by non-ionic catheter irrigation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P R Futyma ◽  
P Kulakowski
Keyword(s):  
Catheter Ablation ◽  
Antiarrhythmic Drugs ◽  
Left Ventricular ◽  
Ablation Catheter ◽  
Safe Distance ◽  
Lesion Formation ◽  
Bipolar Radiofrequency ◽  
Antiarrhythmic Treatment ◽  
Catheter Irrigation

Abstract Introduction Bipolar radiofrequency catheter ablation (Bi-RFCA) or irrigation of ablation catheter (AC) using non-ionic coolant, such as dextrose-5 in water (D5W), are novel ways to improve lesion formation in case of arrhythmia refractoriness. Combination of these two methods has not yet been described. Puprose To determine feasibility and effectiveness of Bi-RFCA additionally supported by non-ionic catheter irrigation for treatment of refractory premature ventricular complexes (PVC) or ventricular tachycardia (VT). Methods Consecutive patients after failed extensive Bi-RFCA or D5W-irrigated ablation for symptomatic PVCs or non-sustained VT (nsVT) underwent Bi-RFCA supported with D5W coolant. Results We ultimately enrolled 2 patients (2 males, age 64 ± 12 years) after failed extensive ablations for the left ventricular summit PVCs and nsVT to undergo Bi-RFCA supported with D5W irrigation of both AC and intracardiac return electrode (IRE). Previous pharmacological antiarrhythmic treatment consisting of at least one drug and catheter ablation failed in both patients. Bi-RFCA was delivered between earliest activation sites located in the left/right aortic commissure and the left pulmonic cusp (Figure). Efforts were made to achieve safe distance from coronary arteries, AC, and IRE.  Bipolar RFCA (35 ± 7W power, 8 ± 4 applications, 199 ± 166s RF time)  led to acute elimination of PVCs in both patients. Baseline impedance oscillated around 250Ω and initial 50-70Ω impedance drop was observed during first 20s of bipolar applications, followed by impedance rise up to 350-450Ω. No steam pop occurred and  there were no complications during procedures. All antiarrhythmic drugs were discontinued. Follow-up lasted 8 ± 2 months, there was no nsVT recurrence and 90,4% PVC burden reduction was achieved: from 30000 to 3100 PVC/day in patient #1 and from 39000 to 3500 PVC/day in patient #2. Both patients remained symptom-free. Conclusion Bi-RFCA can be additionally supported using non-ionic D5W coolant. Such approach is feasible and can be safe and effective. More data on impedance imbalance during D5W-supported bipolar RF applications is warranted. Abstract Figure. Fluoroscopic view and 12-lead ECG

scholarly journals Symptomatic Premature Ventricular Contractions in Vasovagal Syncope Patients: Autonomic Modulation and Catheter Ablation

2021 ◽  
Vol 12 ◽  
Author(s):  
Lihui Zheng ◽  
Wei Sun ◽  
Yu Qiao ◽  
Bingbo Hou ◽  
Jinrui Guo ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Antiarrhythmic Drugs ◽  
Vasovagal Syncope ◽  
Ventricular Outflow Tract ◽  
Vagal Activity ◽  
Autonomic Modulation ◽  
Premature Ventricular Contractions ◽  
Before And After ◽  
The Impact

IntroductionThere has been limited reports about the comorbid premature ventricular contractions (PVCs) and vasovagal syncope (VVS). Deceleration capacity (DC) was demonstrated to be a quantitative evaluation to assess the cardiac vagal activity. This study sought to report the impact of autonomic modulation on symptomatic PVCs in VVS patients.Methods and ResultsTwenty-six VVS patients with symptomatic idiopathic PVCs were consecutively enrolled. Identification and catheter ablation of left atrial ganglionated plexi (GP) and PVCs were performed in 26 and 20 patients, respectively. Holter 24 h-electrocardiograms were performed before and after the procedure to evaluate DC and PVCs occurrence. Eighteen patients were subtyped as DC-dependent PVCs (D-PVCs) and eight as DC-independent PVCs groups (I-PVCs). In D-PVCs group, circadian rhythm of hourly PVCs was positively correlated with hourly DC (P < 0.05) while there was no correlation in I-PVCs group (P > 0.05). Fifty-three GPs with positive vagal response were successfully elicited (2.0 ± 0.8 per patient). PVCs failed to occur spontaneously nor to be induced in six patients. In the remaining 20 patients, PVCs foci identified were all located in the ventricular outflow tract region. Post-ablation DC decreased significantly from baseline (P < 0.05). During mean follow-up of 10.64 ± 6.84 months, syncope recurred in one patient and PVCs recurred in another. PVCs burden of the six patients in whom neither catheter ablation nor antiarrhythmic drugs were applied demonstrated a significant decrease during follow-up (P = 0.037).ConclusionAutonomic activities were involved in the occurrence of symptomatic idiopathic PVCs in some VVS patients. D-PVCs might be facilitated by increased vagal activities. Catheter ablation of GP and PVCs foci may be an effective, safe treatment in patients with concomitant VVS and idiopathic PVCs.

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.

scholarly journals Lessons learned from catheter ablation of ventricular arrhythmias in patients with a fully magnetically levitated left ventricular assist device

2021 ◽  
Author(s):  
Leonard Bergau ◽  
Philipp Sommer ◽  
Mustapha El Hamriti ◽  
Michel Morshuis ◽  
Denise Guckel ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Current Evidence ◽  
Electrical Storm ◽  
Ventricular Assist ◽  
Cannulation Site ◽  
Left Ventricular Assist

Abstract Introduction Data on catheter ablation of ventricular arrhythmias (VA) are scarce in patients with left ventricular assist devices (LVADs) and current evidence predominantly consists of case reports with outdated LVAD. This prospective observational study reports our experience in terms of catheter ablation of VAs in patients with novel 3rd generation LVADs. Methods and results Between 2018 and 2020, nine consecutive patients undergoing a total number of ten ablation procedures for VAs were analyzed. The mean duration between LVAD implantation and catheter ablation was 23 ± 16 months. Acute procedural success was achieved in all patients. VA substrates were not related to the LVAD scarring (cannula) site in the majority of patients. All procedures were conducted without any relevant procedure-related complications. In terms of follow-up, only one patient presented with a repeat episode of electrical storm requiring ICD-shocks 16 months after the initial ablation procedure. Four patients suffered of singular VA effectively treated with antitachycardia pacing via their ICD. The remainder were free of any VA relapse (n = 4). Two non-procedure-related deaths occurred during follow-up. Conclusions Catheter ablation of VAs in patients with 3rd generation LVAD is feasible and leads to satisfying clinical results in terms of freedom from VA recurrence and quality of life. The majority of arrhythmia substrates in these patients are not directly related to the LVAD cannulation site and may represent a progress of heart failure. Graphic abstract

scholarly journals Early arrhythmia recurrence after catheter ablation for persistent atrial fibrillation: is it predictive for late recurrence?

2021 ◽  
Author(s):  
Miruna A. Popa ◽  
Marc Kottmaier ◽  
Elena Risse ◽  
Marta Telishevska ◽  
Sarah Lengauer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Antiarrhythmic Drugs ◽  
De Novo ◽  
Persistent Atrial Fibrillation ◽  
Late Recurrence ◽  
Early Recurrence ◽  
Transient Phenomenon ◽  
Future Studies

Abstract Background Early recurrence of atrial tachyarrhythmia (ERAT) is common after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF), but its clinical significance in patients with persistent AF remains unclear. We sought to determine the predictive value of ERAT for rhythm outcome after RFCA for persistent AF. Methods The study included 207 consecutive patients (mean age 66.4 ± 10.7 years, male 66.2%) with persistent and long-standing persistent AF undergoing de novo pulmonary vein isolation (± atrial substrate ablation). All patients remained off antiarrhythmic drugs. ERAT was defined as any atrial arrhythmia ≥ 30 s occurring within the first 30 days. Late recurrence (LR) was determined during follow-up visits scheduled 1, 3, 6 and 12 months post-ablation using 7-day Holter ECGs. Results ERAT occurred in 143/207 (69.1%) patients as AF (60%) or atrial tachycardia (40%) and was persistent in 82% of cases. During a median follow-up of 22.2 months, LR occurred significantly more often in patients with ERAT than in patients without ERAT (92.3 vs. 43.8%, P < 0.001). The only independent predictors for LR were ERAT (OR 16.8, 95% CI 6.184–45.797, P < 0.001) and intraprocedural termination to sinus rhythm (OR 0.052, 95% CI 0.003–0.851, P = 0.038). Extending the blanking period from 30 to 90 days did not impact LR rates. Conclusion ERAT following ablation of persistent AF is strongly associated with late arrhythmia recurrence, which challenges the assumption that ERAT represents merely a transient phenomenon. While limiting the blanking period to 30 days seems justified, the benefit of early re-ablations remains to be addressed in future studies. Graphic abstract

5209Stereotactic radioablation of ventricular tachycardia guided by direct integration of 3D electroanatomic mapping: development and validation of a new method

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Sramko ◽  
J Cvek ◽  
P Peichl ◽  
L Knybel ◽  
J Kautzner
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Left Ventricular ◽  
Radiotherapy Planning ◽  
Electroanatomic Mapping ◽  
Left Ventricular Ejection ◽  
Drug Resistant ◽  
Direct Integration ◽  
Work Station

Abstract Background Stereotactic body radiotherapy (SBRT) has emerged as a promising bailout therapy for recurrent ventricular tachycardia (VT) in patients with failed radiofrequency catheter ablation. However, SBRT can function only if the ablation target is precisely identified. Purpose We sought to develop a novel method for direct integration of electroanatomic mapping (EAM) data to an SBRT work station for radioablation of VT. Methods Candidates for SBRT were patients with recurrent, drug-resistant VT who underwent ≥2 previous radiofrequency catheter ablations (CARTO 3, Biosense-Webster, Diamond Barr, CA) and continued to have inducible clinical VT or clinical recurrences of VT. At the end of the last catheter ablation, the operators performed additional EAM to obtain landmarks for image registration: aorta with the ostium of the left main coronary artery or left atrium with ostia of pulmonary veins. Correct position of the catheter at the landmark was verified by intra-cardiac echocardiography. VT substrate–defined by a combination of voltage mapping, pace mapping, and detection of local abnormal ventricular activity and/or late potentials was marked by custom tags as a target for SBRT. The CARTO maps were exported and converted to 3D shells with encoded EAM properties (VTK format). On the following day, the patients underwent contrast-enhanced computer tomography (CT) of the heart. Using 3D Slicer software 4.10 (slicer.org), the EAM-derived anatomical structures with the marked ablation target were projected onto CT images by landmark registration with manual correction. The CT study with the projected contours of the EAM-detected ablation target was imported as a DICOM-RT format into a stereotactic radiotherapy planning work station (Multiplan 3.5, Accuray, Sunnyvale, CA). SBRT was performed using a contemporary radiosurgery system with real-time motion tracking of the ablation target (CyberKnife 8.5, Accuray). The prescribed (X-ray) dose was 25 Gy during a single session. Results The proposed work-flow was verified in four patients with structural heart disease and drug-resistant VT who had 2–3 unsuccessful radiofrequency catheter ablations (all males; age: 68–78 years; left ventricular ejection fraction: 20–25%; ischemic/non-ischemic cardiomyopathy: 2/2). Integration of EAM data with CT was achieved in all patients. None of them experienced acute radiotoxicity after SBRT. At a follow-up checkup at one month, three of the patients remained arrhythmia-free. One patient experienced VT recurrence one day after SBRT, but no VTs recurred during the following month of follow-up. Figure 1 Conclusions This is the first report demonstrating the feasibility of SBRT of VT guided by direct integration of EAM. The proposed method is best suited as a bailout procedure for patients with previously failed catheter ablation. Acknowledgement/Funding M.S. was supported by ESC Research Fellowship 2018

Abstract 17223: Castle of Stone or Straw, Radiofrequency Ablation of Atrial Fibrillation in Heart Failure?

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Brian D McCauley ◽  
Esseim Sharma ◽  
John Dudley ◽  
Antony Chu
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Prospective Trials

Introduction: Based on the data from CASTLE-AF trial, in patient with Atrial Fibrillation (AF) and heart failure (HF) catheter ablation may offer a significant reduction in both death, and hospitalization, while promoting maintenance of sinus rhythm as well as improvement in left ventricular ejection fraction (LVEF). This multi-center randomized trial is hailed as a paradigm shifting study in catheter ablation, however it is not without fault. One of the critiques of the CASTLE-AF trial was the high frequency of crossover between the treatment arms. To help sort out this potential source of confounding, we performed a systematic meta-analysis of prospective trials for catheter ablation in AF in patients with Class II through IV heart failure. Hypothesis: The reduction in death, and hospitalization, as well as the maintenance in sinus rhythm and improvement in LVEF seen CASTLE-AF trial are support by other similarly designed AF ablation trials. Methods: Using the inclusion/exclusion criteria from the CASTLE-AF trial, we performed a systematic meta-analysis of 28 published studies. Randomized and non-randomized observational studies comparing the impact of catheter ablation of AF in HF. Studies were identified using the Cochrane Library, EMBASE, and PubMed. Results: A total of 29 studies were identified (n =2,339). Mean follow-up was 25 (95% confidence interval, 18-40) months. Efficacy in maintaining sinus rhythm at follow-up end was 60% (43%-76%). Left ventricular ejection fraction improved significantly during follow-up by 15% (P<0.001). Conclusions: Following our meta-analysis, we found data to support the findings of improved LVEF and maintenance of sinus rhythm reported in the CASTLE-AF trial. However, due to differences in study design, we were unable to further validate the reduction in both hospitalization and death seen in CASTLE-AF. We recommend future prospective trials be conducted without cross over to further explore this topic.

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