scholarly journals Prospective use of ablation index for the ablation of right ventricle outflow tract premature ventricular contractions: a proof of concept study

EP Europace ◽  
2020 ◽  
Author(s):  
Alessio Gasperetti ◽  
Rita Sicuso ◽  
Antonio Dello Russo ◽  
Giulio Zucchelli ◽  
Ardan Muammer Saguner ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ejection Fraction ◽  
Right Ventricle ◽  
Radiofrequency Catheter Ablation ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Left Ventricular Ejection ◽  
Free Wall ◽  
Premature Ventricular Contractions ◽  
Ablation Index

Abstract Aims Radiofrequency catheter ablation (RFCA) represents an effective option for idiopathic premature ventricular contractions (PVCs) treatment. Ablation Index (AI) is a novel ablation marker incorporating RF power, contact force, and time of delivery into a single weighted formula. Data regarding AI-guided PVCs RFCA are currently lacking. Aim of the study was to compare AI-guided and standard RFCA outcomes in patients with PVCs originating from the right ventricle outflow tract (RVOT). Methods and results Consecutive patients undergoing AI-guided RFCA of RVOT idiopathic PVCs were prospectively enrolled. Radiofrequency catheter ablation was performed following per-protocol target cut-offs of AI, depending on targeted area (RVOT free wall AI cut-off: 590; RVOT septum AI cut-off: 610). A multi-centre cohort of propensity-matched (age, sex, ejection fraction, and PVC site) patients undergoing standard PVCs RFCA was used as a comparator. Sixty AI-guided patients (44.2 ± 18.0 years old, 58% male, left ventricular ejection fraction 56.2 ± 3.8%) were enrolled; 34 (57%) were ablated in RVOT septum and 26 (43%) patients in the RVOT free wall area. Propensity match with 60 non-AI-guided patients was performed. Acute outcomes and complications resulted comparable. At 6 months, arrhythmic recurrence was more common in non-AI-guided patients whether in general (28% vs. 7% P = 0.003) or by ablated area (RVOT free wall: 27% vs. 4%, P = 0.06; RVOT septum 29% vs. 9% P = 0.05). Ablation Index guidance was associated with improved survival from arrhythmic recurrence [overall odds ratio 6.61 (1.95–22.35), P = 0.001; RVOT septum 5.99 (1.21–29.65), P = 0.028; RVOT free wall 11.86 (1.12–124.78), P = 0.039]. Conclusion Ablation Index-guidance in idiopathic PVCs ablation was associated with better arrhythmic outcomes at 6 months of follow-up.

scholarly journals Catheter ablation for ventricular arrhythmias using remote magnetic navigation in patients with reduced ejection fraction

2021 ◽  
Vol 27 (3) ◽  
pp. 99-102
Author(s):  
Mohamed Dardari ◽  
Alexandrina Nastasa ◽  
Corneliu Iorgulescu ◽  
Stefan Bogdan ◽  
Vlad Bataila ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ejection Fraction ◽  
Complication Rate ◽  
Ventricular Arrhythmias ◽  
Radiofrequency Catheter Ablation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Complete Elimination ◽  
Premature Ventricular Contractions ◽  
Ventricular Ejection Fraction

Objective. Radiofrequency catheter ablation is an effective treatment option for cardiac arrhythmias including complex and ventricular arrhythmias. Remote magnetic catheter navigation (RMN) has been developed as a novel way of approach aiming to improve outcome and reduce complication rate, and reduce radiation exposure for both operator and patient. Our aim was to compare success and complication rate in patients with or without severely reduced left ventricular ejection fraction (LVEF). Methods. We retrospectively analyzed all the patients (n = 98) which have undergone RMN in our center between 2015-2021. No selection criteria for RMN procedure have been applied. All clinical and paraclinical, as well as procedural data were collected. Patients were divided into two groups, with or without severely reduced LVEF ≤ 35%. CARTO system was used for 3D electroanatomic mapping. RMN was done using Niobe ES system and an open-irrigated magnetic ablation catheter. Success rate was defi ned by complete elimination of clinical arrhythmia. Non-inducibility following ablation was assessed in all patients presenting with any type of ventricular arrhythmia other than premature ventricular contractions. Testing for inducibility was done by ventricular programmed pacing with up to four extra-stimuli. The statistical analysis was performed using SPSS software. P-value < 0.05 was considered signifi cant. Results. Successful ablation with complete elimination of the clinical arrhythmia was achieved in 92.3% of the patients with severely reduced LVEF and in 88.1% of patients with LVEF > 35% (p = 0.73). Overall minor complication rate was 2.04% with spontaneous resolution. No major complications were reported. Non-inducibility was achieved in 56.4% of the patients with LVEF ≤ 35% and in 79.2% of the patients with LVEF >35% (p = 0.023). Conclusion. Radiofrequency catheter ablation using RMN is effective and safe regardless of the presence or not of a severely reduced LVEF.

scholarly journals Predictors of Left Ventricular Ejection Fraction Improvement after Radiofrequency Catheter Ablation in Patients With PVC-Induced Cardiomyopathy: A Systematic Review

2019 ◽  
Vol 15 ◽  
Author(s):  
Farbod Zahedi Tajrishi ◽  
Mohammad Hossein Asgardoon ◽  
Amirhossein Seyed Hosseinpour ◽  
Alipasha Meysamie ◽  
Ali Vasheghani-Farahani
Keyword(s):  
Systematic Review ◽  
Catheter Ablation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Predictive Factors ◽  
Radiofrequency Catheter Ablation ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

BACKGROUND: Frequent premature ventricular contractions (PVC) can result in PVC-induced cardiomyopathy (PVC-iCMP), leading to reduced Left ventricular ejection fraction (LVEF) that can be improved by radiofrequency catheter ablation (RFCA). We performed a systematic review to determine the variables predicting LVEF improvement after RFCA in PVC-iCMP. METHODS: We developed a “population, intervention, outcome and predictive factors” framework and searched MEDLINE, Embase, Cochrane Library, Cochrane Collaboration and Cochrane Database of Systematic Reviews (CDSR) for full-text, peer-reviewed publications addressing predictive factors of LVEF improvement≥5% only if deemed significant by the respective study, ≥10% or to ≥ 50% after RFCA ablation in patients with PVC-iCMP with no type/date/language limitation until the end of 2017. RESULTS: Our initial search yielded 2226 titles, 1519 of which remained after removing the duplicates. Finally, 11 articles- 2 cohorts, 7 quasi-experimental studies, 1 case-control and 1 meta-analysis- were included. Sustained successful ablation, higher baseline PVC burden, LVEF, QRS duration, post-PVC systolic blood pressure rise and post-PVC pulse pressure change, the absence of an underlying cardiomyopathy, younger age, and variability of the frequency of PVCs during the day and lower left ventricular end diastolic diameter (LVEDD) are suggested predictive factors for LVEF improvement in patients with PVC-iCMP. CONCLUSIONS: The mentioned factors may all be useful to identify PVC-iCMP patients who would benefit from RFCA, although the evidence is not yet strong enough.

144 The influence of radiofrequency catheter ablation of right ventricle outflow tract on heart rate variability

EP Europace ◽  
2005 ◽  
Vol 7 (Supplement_1) ◽  
pp. 22-22
Author(s):  
B. Sredniawa ◽  
A. Musialik-Lydka ◽  
P. Pruszkowska-Skrzep ◽  
R. Lenarczyk ◽  
O. Kowalski ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Catheter Ablation ◽  
Right Ventricle ◽  
Radiofrequency Catheter Ablation ◽  
Outflow Tract

scholarly journals 1186 Three-dimensional analysis of right ventricle strain in transplanted hearts and rejection: an ongoing prospective study

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
RCPLD Costa ◽  
A C T Rodrigues ◽  
C H Fischer ◽  
E B Lira-Filho ◽  
C G Monaco ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricle ◽  
Heart Transplantation ◽  
Three Dimensional ◽  
Posterior Wall ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Free Wall ◽  
Humoral Rejection ◽  
Cellular Rejection

Abstract Background The main obstacle for success after heart transplantation is graft rejection, since is mainly asymptomatic and diagnosed by endomyocardial biopsy (EMB). New echocardiographic technologies could bring benefits to that population if subtle changes in heart mechanics were related to an incipient state of rejection. Purpose To quantify echocardiographic parameters of right ventricle strain and volumes by a semi-automated offline software and to identify the presence of any relation between those findings and the histopathologic diagnose of rejection. Methods a prospective cohort of 35 postoperative heart transplant patients who were submitted to echocardiographic evaluation up to six hours after EMB, including two-dimensional chamber quantification of left ventricular (LV) volumes and ejection fraction; conventional and tissue Doppler measurements were used for flow and functional analysis. Offline assessment of the right ventricle (RV) was made by TOMTEC software, with the acquisition of RV volumes (EDV, ESV, SV) and ejection fraction, TAPSE, FAC and three-dimensional(3D) RV free wall and septal strain using speckle tracking. EMB results were classified as positive for cellular rejection if graded as 2R (two or more interstitial infiltrate spots and myocyte damage) and positive for humoral rejection if they show any response by immunofluorescence assay. Results We studied 35 patients, aged 50 ±11, 21 male (67%), totaling 58 examinations, and then we made two analysis of EMB: one in two groups regarding cellular rejection (53 negative and 5 positive) and other regarding humoral rejection (50 negative and 8 positive). RVEDV was higher in the cellular rejection group (112,5 ± 29,6 ml) compared to those with negative biopsy (86,8 ± 24,7 mL; p = 0,01). RV stroke volume showed a similar behavior (53,5 ± 22,3 mL vs. 34,5 ± 11,3 mL; p &lt; 0,01). Regarding humoral rejection by immunofluorescence, patients who tested positive showed lower RVEDV (79,5 ± 10,5 mL vs. 90,57 ± 27,31 mL; p = 0,02) and RVESV (45,53 ± 6,33 mL vs. 53,87 ± 19,87 mL; p = 0,01). RV free wall strain was lower in the group with positive immunofluorescence (-18,35 ± 2,79% vs. -15,34 ± 5,35%; p = 0,01). Regarding 2D measurements , interventricular septal (11,5 ± 1,06 mm vs. 10,56 ± 1,38 mm; p = 0,02) and left ventricular posterior wall (10,75 ± 1,03 mm vs. 10,04 ± 1,1 mm; p = 0,05) were also thicker in the group with positive immunofluorescence for rejection. Conclusion Both cellular and humoral rejection after heart transplantation are associated to increased 3D RV volumes whereas a decrease in RV free wall strain is only observed in humoral rejection; in patients with positive immunofluorescence results a significant increase is seen for septal and posterior wall thickness.

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