Clinical Application of PET/CT Fusion Imaging for Three-Dimensional Myocardial Scar and Left Ventricular Anatomy during Ventricular Tachycardia Ablation

2009 ◽  
Vol 20 (6) ◽  
pp. 597-604 ◽  
Author(s):  
JING TIAN ◽  
MARK F. SMITH ◽  
PONRAJ CHINNADURAI ◽  
VASKEN DILSIZIAN ◽  
Aharon TURGEMAN ◽  
...  
2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Jone ◽  
M Runciman ◽  
K K Collins

Abstract Introduction Eleven-year-old male presented with nonsustained ventricular tachycardia presented for ablation of ventricular tachycardia located on the left lateral wall that is likely associated with anterolateral papillary muscle. Although he was asymptomatic, his atria have become dilated over time thus he was scheduled for a catheter ablation. Echocardiographic-fluoroscopic fusion imaging has shown transseptal puncture using this technology is safe and required less time in crossing the atrial septum; however, fusion imaging with 3D echocardiography overlay of left ventricular papillary muscle onto fluoroscopy has not been used in ventricular tachycardia ablations. Purpose The purpose of this clinical case was to evaluate the application of this new technology of echocardiography-fluoroscopy fusion imaging to guide left ventricular tachycardia ablation. Methods Echocardiographic-fluoroscopic fusion imaging was used for transseptal puncture and a 3D echocardiographic image of the left ventricle with anterolateral papillary muscle was overlaid onto fluoroscopy (Figure 1). The radiofrequency catheter was used to ablate the left anterolateral papillary muscle. With fused imaging, the ablation catheter was seen at the left anterolateral papillary muscle, and care was taken to prevent perforation of the lateral wall of the left ventricle. Results With fusion imaging of the left anterolateral papillary muscle overlaid onto fluoroscopy, the lateral wall of the left ventricular was also delineated. The catheter was easily visualized with fusion imaging to prevent perforation of the left ventricle while radiofrequency ablation was performed (Figure 1). Discussion 3D echocardiography provides excellent soft tissue definition of the lateral wall of the left ventricle and papillary muscle while fluoroscopy provides clear visualization of the ablation catheter. The ability of fusion imaging to overlay the 3D echocardiographic images onto fluoroscopy allowed for easy visualization of the anterolateral papillary muscle while the radiofrequency ablation was performed to avoid lateral wall perforation of the left ventricle. Future studies of echocardiographic-fluoroscopic fusion imaging should evaluate the potential to reduce procedure time and improve patient outcomes. Abstract P635 Figure.


2018 ◽  
Vol 56 (1) ◽  
pp. 63-66
Author(s):  
Kresimir Kordic ◽  
Sime Manola ◽  
Ivan Zeljkovic ◽  
Ivica Benko ◽  
Nikola Pavlovic

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.


Heart Rhythm ◽  
2008 ◽  
Vol 5 (2) ◽  
pp. 326-327
Author(s):  
Miguel A. Arias ◽  
Eduardo Castellanos ◽  
Alberto Puchol ◽  
Belén Santos

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
D Nascimento Matos ◽  
D Cavaco ◽  
P Carmo ◽  
MS Carvalho ◽  
G Rodrigues ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Catheter ablation outcomes for drug-resistant ventricular tachycardia (VT) in nonischemic cardiomyopathy (NICM) are suboptimal when compared to ischemic cardiomyopathy. We aimed to analyse the long-term efficacy and safety of percutaneous catheter ablation in this subset of patients. METHODS Single-center observational retrospective registry including consecutive NICM patients who underwent catheter ablation for drug-resistant VT during a 10-year period. The efficacy endpoint was defined as VT-free survival after catheter ablation, while safety outcomes were defined by 30-days mortality and procedure-related complications. Independent predictors of VT recurrence were assessed by Cox regression. RESULTS In a population of 68 patients, most were male (85%), mean left ventricular ejection fraction (LVEF) was 34 ± 12%, and mean age was 58 ± 15 years. All patients had an implantable cardioverter-defibrillator. Twenty-six (38%) patients underwent epicardial ablation (table 1). Over a median follow-up of 3 years (IQR 1-8), 41% (n = 31) patients had VT recurrence and 28% died (n = 19). Multivariate survival analysis identified LVEF (HR= 0.98; 95%CI 0.92-0.99, p = 0.046) and VT storm at presentation (HR = 2.38; 95%CI 1.04-5.46, p = 0.041) as independent predictors of VT recurrence. The yearly rates of VT recurrence and overall mortality were 21%/year and 10%/year, respectively. No patients died at 30-days post-procedure, and mean hospital length of stay was 5 ± 6 days. The complication rate was 7% (n = 5, table 1), mostly in patients undergoing epicardial ablation (4 vs 1 in endocardial ablation, P = 0.046). CONCLUSION LVEF and VT storm at presentation were independent predictors of VT recurrence in NICM patients after catheter ablation. While clinical outcomes can be improved with further technical and scientific development, a tailored endocardial/epicardial approach was safe, with low overall number of complications and no 30-days mortality. Abstract Figure.


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