scholarly journals Mapping and Surgical Ablation of Focal Epicardial Left Ventricular Tachycardia

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Arif Elvan ◽  
Hauw T. Sie ◽  
Anand R. Ramdat Misier ◽  
Andre C. Linnenbank ◽  
Peter Paul H. M. Delnoy ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Minimal Invasive ◽  
Left Ventricular ◽  
Lv Function ◽  
Ventricular Ectopy ◽  
Rf Ablation ◽  
Epicardial Mapping ◽  
Epicardial Ablation ◽  
Surgical Ablation ◽  
Technical Challenge

We describe a technical challenge in a 17-year-old patient with incessant epicardial focal ventricular arrhythmia and diminished LV function. Failure of ablation at the earliest activated endocardial site during ectopy suggested an epicardial origin, which was supported by specific electrocardiographic criteria. Epicardial ablation was not possible due to the localization of the origin of the ventricular tachycardia adjacent to the phrenic nerve. Minimal invasive surgical multielectrode high-density epicardial mapping was performed to localize the arrhythmia focus. Epicardial surgical RF ablation resulted in the termination of ventricular ectopy. After 2 years, the patient is still free from arrhythmias.

Ventricular tachycardia ablation in nonischemic cardiomyopathy

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
D Nascimento Matos ◽  
D Cavaco ◽  
P Carmo ◽  
MS Carvalho ◽  
G Rodrigues ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Left Ventricular ◽  
Scientific Development ◽  
Left Ventricular Ejection ◽  
Drug Resistant ◽  
Nonischemic Cardiomyopathy ◽  
Epicardial Ablation ◽  
Ventricular Ejection Fraction ◽  
Ventricular Tachycardia Ablation

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.

Abstract 16215: Ventricular Dyssynchrony is Associated With Arrhythmic Mitral Prolapse Prior to Chamber Remodeling

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Dimosthenis Pandis ◽  
Marc Miller ◽  
Ahmed El-Eshmawi ◽  
Ioulia A Grapsa ◽  
Percy Boateng ◽  
...  
Keyword(s):  
At Risk ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Function ◽  
Study Cohort ◽  
Ventricular Ectopy ◽  
Myocardial Mechanics ◽  
Ventricular Dyssynchrony ◽  
Mechanical Dispersion ◽  
The Mean

Introduction: Asymptomatic patients on active surveillance for degenerative mitral regurgitation are at risk of ventricular arrhythmia and sudden death. Hypothesis: Abnormal myocardial mechanics may precede ventricular remodeling and may help identify at-risk patients. Methods: Multi-directional myocardial mechanics and LV dyssynchrony were assessed in 204 consecutive patients awaiting surgical mitral repair for severe degenerative MR in a quaternary mitral reference center. Results: The mean age was 58 ±12.5 years and 40% were females. The mean EF was 63% ± 6% and 92% had compensated LV function (EF>60% and LVESD<4cm) and only 24% had elevated LV filling pressures (E/e'≥13). Indexed LV wall stress-to-LVEDD, relative wall thickness and indexed LV mass-to-BSA were similar amongst males-females, although males had higher mean blood pressure (94 Vs. 90, P=0.02) . The peak global longitudinal strain (GLS) was -25.2% ± 3.3% and the mid-ventricular circumferential and radial strains were -33.5%±6.7% and 56%±25% respectively. Ventricular ectopy was present in 24.5% of patients and only 17% had atrial fibrillation (Afib) despite the significantly dilated left atria (mean LAVi 70±26.6 ml/m 2 ). The median LV mechanical dispersion was 40msec (IQR 30.7-56.5) but increased significantly with ventricular ectopy (65msec, P<0.01) and further influenced by concomitant Afib (p=0.001 for 2-factor interaction). Diastolic LV function did not correlate with dispersion (r=0.02 and 0.01 for E/A and E/e', P=NS) but was associated with the duration of LV diastolic filling (mean 502±140msec; r=0.2, P=0.004). Interpapillary radial strain delay was noted in the study cohort (mean delay 52.8msec, range 0-335msec) while intepapillary activation delay was manifested with concomitant ventricular ectopy (mean time-to-peak LS delay 57.5±48msec). Conclusions: Left ventricular dyssynchrony manifested by increased mechanical dispersion and imbalanced interpapillary mechanics are observed prior to overt chamber remodeling in significant degenerative MR and is associated with ventricular ectopy. Further studies are needed to assess the related clinical implications and potential impact on risk stratification in this patient group.

Voltage Disturbances During Pregnancy

2017 ◽  
Author(s):  
Heather C. Nixon
Keyword(s):  
Ventricular Tachycardia ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Well Being ◽  
Left Ventricular ◽  
Ventricular Ectopy ◽  
Conversion Therapy ◽  
St Segment ◽  
Assessment And Treatment ◽  
The Impact

This chapter covers the incidence, etiology, and treatment of the most common electrocardiogram and rhythm disturbances encountered during pregnancy. Baseline electrocardiogram changes associated with pregnancy include left ventricular hypertrophy and ST segment depressions secondary to anatomic and metabolic changes of pregnancy. The most common arrhythmias include atrial and ventricular ectopy, which are usually benign in nature. Supraventricular and ventricular tachycardia are also discussed in detail, along with the impact of antiarrhythmic and electrical conversion therapy on fetal and maternal well-being. An understanding of the pathophysiology, assessment, and treatment of these rhythm disturbances is requisite knowledge for all anesthesiologists to provide optimal and timely care to parturients.

P960Non-inducible ventricular arrhythmia soon after ventricular tachycardia ablation predicts long-term recurrence in patients with reduced ejection fraction

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M K Kiyokuni ◽  
M N Narikawa ◽  
T K Kino ◽  
Y T Taguchi ◽  
S M Miyagawa ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ejection Fraction ◽  
Ventricular Arrhythmia ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Risk Factors ◽  
Rf Ablation ◽  
Vt Ablation ◽  
First Time

Abstract Introduction Radiofrequency (RF) ablation for ventricular arrhythmia in patients with reduced left ventricular ejection fraction (LVEF) is recognized to be one of the important strategies for suppressing the fatal arrhythmia events. Although, RF ablation for those patients has been performed for decades, the optimal endpoint remains unclear. Hypothesis We assessed the hypothesis that non-inducibility of any ventricular tachycardia (VT) or ventricular fibrillation (VF) immediately after VT ablation predicts long-term recurrence free rate of ventricular arrhythmia in patients who were diagnosed sustained VT with reduced LVEF.  Methods From January 2014 to August 2019, we conducted a single center retrospective analysis for 127 consecutive patients with right or left ventricular arrhythmia who performed the first time RF ablation. Exclusion criteria were LVEF &gt;50% and RF ablations for premature ventricular contraction or for non-sustained VT. Then 26 patients (age 69 ± 7, male 92%) were enrolled. All of the ablation procedures were performed using irrigated RF catheters and 3D mapping systems. We defined non-inducible group as the patients without monomorphic VT (clinical monomorphic VT or non-clinical monomorphic VT with any cycle length), polymorphic VT and VF by electrophysiological study (EPS) immediately after the ablation. The primary endpoint of this study was a recurrence of any sustained VT and VF during the follow up period. Results All of 26 patients were followed for a mean of 30.9 ± 22.3months.Of those patients, 7 patients were non-inducible group and 19 patients were inducible group. Age, sex, body mass index, coronary risk factors, LVEF (non-inducible:42 ± 5% vs inducible:35 ± 10%, p = 0.12), renal function and the etiology of LV dysfunction did not differ between patients with non-inducible group and inducible group (all non-significant). Catheter ablation procedural characteristics including activation mapping (non-inducible:29% vs inducible:36%, p = 1.00), entrainment mapping (14% vs 42%, p = 0.19), substrate mapping (86% vs 95%, p = 0.47), pace-mapping (86% vs 68%, p = 0.63), RF time (21 ± 13vs 18 ± 21min, p = 0.70), number of RF applications (27 ± 13vs 27 ± 32, p = 0.89), fluoroscopy time (77 ± 50vs 87 ± 42min, p = 0.59) and procedure time (309 ± 87vs 282 ± 61min, p = 0.37) did not differ between two groups. Medications before and after the VT ablation did not differ between two groups. The recurrence of any sustained VT and VF significantly lower in patients with non-inducible group than those with inducible group (Figure). Conclusion This study demonstrated that, in patients with reduced LVEF presenting sustained VT who performed RF ablation, non-inducibility of any VT and VF immediately after RF ablation predicts long-term decreased risk of recurrence of any sustained VT and VF. Not only clinical but also non-clinical VT and VF may be targeted as well at the first time VT ablation for those patients. Abstract Figure

Abstract 16647: Surgical Cryoablation of Ventricular Tachycardia at the Time of LVAD Implantation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Erica S Zado ◽  
Pasquale Santangeli ◽  
Gregory Supple ◽  
Brian Betensky ◽  
Michael Riley ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Left Ventricular ◽  
Assist Device ◽  
Surgical Ablation ◽  
Ventricular Assist ◽  
Antiarrhythmic Drug Therapy ◽  
Left Ventricular Assist ◽  
History Of ◽  
The Mean

Introduction: Patients (pts) with advanced heart failure (HF) undergoing implantation of a left ventricular assist device (LVAD) are at high risk of recurrent ventricular tachycardia (VT). We report the outcome of surgical VT cryoablation (VT CA) at the time of LVAD insertion in pts with advanced HF and drug-refractory VT. Hypothesis: Outcome will be enhanced with pre-operative mapping. Methods: We included consecutive patients with advanced HF and recurrent VT refractory to antiarrhythmic drug therapy and/or conventional catheter ablation, who underwent LVAD implantation and concomitant surgical VT CA. Results: The cohort included 6 pts (5 [83%] male, age 62±10 years) with ischemic (4, 67%) or nonischemic (2, 33%) cardiomyopathy. The mean LVEF prior to surgery was 19±7% (10-27%). All patients had history of recurrent VT, with 4 (67%) pts presenting in VT storm. All were on amiodarone, 1 on oral and the others on IV amiodarone along with IV lidocaine prior to surgery. Four pts (67%) had preoperative detailed electroanatomic mapping (EAM) of the VT substrate, which was used to guide surgical ablation. Cryo lesions were deployed endocardially using the LV apical core as access and/or epicardially to areas identified as scar visually complemented by preop EAM when available (figure). There were no complications related to the CA. Over a follow-up 10.3±12.7 months (range 2-35 months), 4 pts (67%) had no VT, 1 pt had 2 ATP-terminated episodes at 2 months and 1 pt had significant reduction of VT burden (from 11 shocks before surgery to 1 shock at follow-up). The 2 pts with recurrences did not have pre-operative mapping prior to surgical ablation. One patient died of non-cardiac causes at 7 months and 2 patients underwent heart transplant at 10 and 35 months. Conclusions: In pts with advanced HF and refractory VT, surgical ablation can be safely and effectively accomplished at the time of LVAD implantation. When ablation is guided by pre-operative EAM, the outcome may be enhanced.

scholarly journals Epicardial Radiofrequency Ablation: Who, When, and How?

2021 ◽  
Author(s):  
Chin-Yu Lin
Keyword(s):  
Ventricular Tachycardia ◽  
Radiofrequency Ablation ◽  
Ischemic Cardiomyopathy ◽  
Imaging Modalities ◽  
Disease Entity ◽  
Potential Complication ◽  
Epicardial Mapping ◽  
Epicardial Ablation ◽  
The Past ◽  
Epicardial Access

In the past decades, it has been known that reentry circuits for ventricular tachycardia or focal triggers of premature ventricular complexes are not limited to the subendocardial myocardium. Rather, intramural or subepicardial substrates may also give rise to ventricular tachycardia, particularly in those with non-ischemic cardiomyopathy. Besides, some of the idiopathic ventricular tachycardia might be originated from epicardial foci. Percutaneous epicardial mapping and ablation have been successfully introduced to treat this sub-epicardiac ventricular tachycardia. Herein, this chapter reviews the indications for epicardial ablation and the identification of epicardial ventricular tachycardia by disease entity, electrocardiography and imaging modalities. This chapter also described the optimal technique for epicardial access and the potential complication.

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