Abstract 12974: Successful VT Ablation Utilising Intracoronary Gelatin Sponge Injection

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Eugene M Gan ◽  
Paul C Lim ◽  
Kelvin C Chua ◽  
Eric T Lim ◽  
Daniel T Chong ◽  
...  
Keyword(s):  
Coronary Intervention ◽  
Left Ventricular ◽  
Gelatin Sponge ◽  
Far Field ◽  
Exit Site ◽  
Circumflex Artery ◽  
Ventricular Assist ◽  
Left Circumflex Artery ◽  
Vt Ablation ◽  
Epicardial Access

Introduction: We report two cases of recurrent ventricular tachycardia (VT) successfully treated by intra-coronary Gelatin sponge embolization where initial endocardial ablation was unsuccessful and epicardial approaches were unfavourable. Case Histories: (1) A 75-year-old male with Inferior STEMI who underwent PCI to oRPDA developed VT storm that required DCCV 11 times. The VT was hemodynamically unstable, hence only substrate modification was performed. He still had recurrent episodes of VT and a second ablation attempt localised VT circuit breakout to the infero-apical septum, but ablation was unsuccessful due to a deep intramural circuit. Epicardial ablation was not attempted due to a 1cm pericardial effusion after the first procedure. Unipolar signals from selective wiring of the distal rPDA with a percutaneous coronary intervention guidewire and microcatheter showed early local electrograms. 5ml of Gelatin sponge injection was injected after a 5x2mm coil failed to occlude the distal rPDA. Post occlusion, VT was not inducible with double ventricular extra-stimuli. He has been VT free for 5 months (2) A 41-year-old female with dilated cardiomyopathy, previous left ventricular assist device and revision was admitted for VT storm. The VT map identified earliest activation with far-field pre-systolic potentials at the baso-lateral LV segment. Pre-systolic far field ventricular EGMs were also seen in the adjacent coronary sinus, consistent with a likely epicardial exit site of the VT. Endocardial ablation failed, and epicardial access was not feasible due to adhesions. Coronary angiography revealed a small calibre non dominant left circumflex artery supplying the VT exit site. Cold saline injection down the mLCX terminated the VT and the vessel was occluded with 5 ml of Gelatin sponge. VT was subsequently not inducible. Discussion & Conclusion: Critical portions of VT circuits may course epicardially or intramurally 3 , limiting successful endocardial catheter ablation. Epicardial access was risky. Coronary vessel embolization using coils 4 and ethanol 5 have been performed. Use of absorbable Gelatin sponge has been described in managing coronary perforation 6 , but to the best of our knowledge these are the first cases of its use in VT ablation.

Prevalence and Localization of Hibernating Myocardium Among Patients with Left Ventricular Dysfunction

2019 ◽  
Vol 15 (9) ◽  
pp. 884-889
Author(s):  
Emine Acar ◽  
Ayşegül Aksu ◽  
Gökmen Akkaya ◽  
Gamze Çapa Kaya
Keyword(s):  
Scar Tissue ◽  
Left Ventricular ◽  
Hibernating Myocardium ◽  
Circumflex Artery ◽  
Irrigation Area ◽  
Left Circumflex Artery ◽  
Pet Ct ◽  
Perfusion Defects ◽  
The Right ◽  
Fdg Pet Ct

Objective: This study evaluated how much of the myocardium was hibernating in patients with left ventricle dysfunction and/or comorbidities who planned to undergo either surgical or interventional revascularization. Furthermore, this study also identified which irrigation areas of the coronary arteries presented more scar and hibernating tissue. Methods: At rest, Tc-99m MIBI SPECT and cardiac F-18 FDG PET/CT images collected between March 2009 and September 2016 from 65 patients (55 men, 10 women, mean age 64±12) were retrospectively analyzed in order to evaluate myocardial viability. The areas with perfusion defects that were considered metabolic were accepted as hibernating myocardium, whereas areas with perfusion defects that were considered non-metabolic were accepted as scar tissue. Results: Perfusion defects were observed in 26% of myocardium, on average 48% were associated with hibernation whereas other 52% were scar tissue. In the remaining Tc-99m MIBI images, perfusion defects were observed in the following areas in the left anterior descending artery (LAD; 31%), in the right coronary artery (RCA; 23%) and in the Left Circumflex Artery (LCx; 19%) irrigation areas. Hibernation areas were localized within the LAD (46%), LCx (54%), and RCA (64%) irrigation areas. Scar tissue was also localized within the LAD (54%), LCx (46%), and RCA (36%) irrigation areas. Conclusion: Perfusion defects are thought to be the result of half hibernating tissue and half scar tissue. The majority of perfusion defects was observed in the LAD irrigation area, whereas hibernation was most often observed in the RCA irrigation area. The scar tissue development was more common in the LAD irrigation zone.

Obesity and Left Ventricular Assist Device Driveline Exit Site Infection

ASAIO Journal ◽  
2010 ◽  
Vol 56 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Ashley L. Raymond ◽  
Abdallah G. Kfoury ◽  
Corey J. Bishop ◽  
Erin S. Davis ◽  
Kimberly M. Goebel ◽  
...  
Keyword(s):  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Site Infection ◽  
Exit Site ◽  
Assist Device ◽  
Ventricular Assist ◽  
Exit Site Infection ◽  
Left Ventricular Assist

scholarly journals Left ventricular summit -- concept, anatomical description and clinical significance

2021 ◽  
Author(s):  
Marcin Kuniewicz ◽  
Artur Baszko ◽  
Mateusz Holda ◽  
Dyjhana Ali ◽  
Grzegorz Karkowski ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Cardiac Computed Tomography ◽  
Nerve Fibers ◽  
Left Ventricular ◽  
Autonomic Nerve ◽  
Radiofrequency Energy ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Electrophysiological Procedures ◽  
Septal Perforator

The left ventricular summit (LVS) is a triangular area located at the most superior portion of the left epicardial ventricular region, surrounded by the two branches of the left coronary artery: the left anterior interventricular artery and the left circumflex artery. The triangle is bounded by the apex, septal and mitral margins and base. This review aims to provide a systematic and comprehensive anatomical description and proper terminology in the LVS region that may facilitate exchanging information among anatomists and electrophysiologists, increasing knowledge of this cardiac region. We postulate that the most dominant septal perforator (not the first septal perforator) should characterize the LVS definition. Abundant epicardial adipose tissue overlying the LVS myocardium may affect arrhythmogenic processes and electrophysiological procedures within the LVS region. The LVS is divided into two clinically significant regions: accessible and inaccessible areas. Rich arterial and venous coronary vasculature and a relatively dense network of cardiac autonomic nerve fibers are present within the LVS boundaries. Although the approach to the LVS may be challenging, it can be executed indirectly using the surrounding structures. Delivery of the proper radiofrequency energy to the arrhythmia source, avoiding coronary artery damage at the same time, may be a challenge. Therefore, coronary angiography or cardiac computed tomography imaging is strongly recommended before any procedure within the LVS region. Further research on LVS morphology and physiology should increase the safety and effectiveness of invasive electrophysiological procedures performed within this region of the human heart. Published in Diagnostics: https://doi.org/10.3390/diagnostics11081423

scholarly journals A Rare Case of Left Ventricular Non-Compaction with Coronary Artery Anomaly Complicated by ST-Elevation Myocardial Infarction and Subcutaneous Defibrillator Implantation

2022 ◽  
Vol 19 (2) ◽  
pp. 791
Author(s):  
Francesca Romana Prandi ◽  
Federica Illuminato ◽  
Chiara Galluccio ◽  
Marialucia Milite ◽  
Massimiliano Macrini ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Family History ◽  
Lateral Wall ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Congenital Defects ◽  
Circumflex Artery ◽  
First Case ◽  
The Right

Left ventricular non-compaction (LVNC) is a rare congenital cardiomyopathy caused by arrest of normal endomyocardial embryogenesis and characterized by the persistence of ventricular hypertrabeculation, isolated or associated to other congenital defects. A 33-year-old male, with family history of sudden cardiac death (SCD), presented to our ER with typical chest pain and was diagnosed with anterior STEMI. Coronary angiography showed an anomalous origin of the circumflex artery from the right coronary artery and a critical stenosis on the proximal left anterior descending artery, treated with primary percutaneous coronary intervention. The echocardiogram documented left ventricular severe dysfunction with lateral wall hypertrabeculation, strongly suggestive for non-compaction, confirmed by cardiac MRI. At 3 months follow up, for the persistence of the severely depressed EF (30%) and the family history for SCD, the patient underwent subcutaneous ICD (sICD) implantation for primary prevention. To the best of our knowledge, this is the first case of LVNC associated with anomalous coronary artery origin and STEMI reported in the literature. Arrhythmias are common in LVNC due to endocardial hypoperfusion and fibrosis. sICD overcomes the risks of transvenous ICD, and it is a valuable option when there is no need for pacing therapy for bradycardia, cardiac resynchronization therapy and anti-tachycardia pacing.

scholarly journals Dual coronary embolization associated with atrial fibrillation: a case report

STEMedicine ◽  
2021 ◽  
Vol 2 (8) ◽  
pp. e99
Author(s):  
Yonggang Yuan ◽  
Zesheng Xu
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Blood Flow ◽  
Coronary Angiography ◽  
Coronary Intervention ◽  
Circumflex Artery ◽  
Effective Measure ◽  
St Segment Elevation ◽  
Left Circumflex Artery ◽  
Coronary Embolization

Background: Thrombotic occlusion of the coronary artery, which succeeds the atherosclerotic plaquerupture or erosion, gives rise to a major portion of acute myocardial infarction (AMI) incidences.Nevertheless, coronary embolism is gaining increasing recognition as another important factor contributingto AMI. Case presentation: A 72-year-old woman with atrial fibrillation (AF) and diabetes mellitus histories,presented with chest pain radiating to the left arm and shoulder that began 6 hours prior to admission.Electrocardiogram revealed AF plus ST-segment elevation in the anterior leads.Intervention: Patient was first treated with anti-platelet agents (aspirin plus ticagrelor) and atorvastatin.Emergency coronary angiography depicted multi-site coronary embolization of the left circumflex artery(LCX) and the left anterior descending artery (LAD). Blood flow was not restored after intracoronaryinjection of 600 ug tirofiban. 40 mg recombinant human prourokinase was then administered via aspirationthrombectomy catheter. Outcome: Two weeks later, coronary angiography showed no residual obstructive lesion in the LCX andLAD with TIMI (thrombolysis in myocardial infarction) 3 flow. Conclusion: Primary percutaneous coronary intervention is the most effective measure. In the case offailed blood flow restoration, thrombolytic treatment in both intravenous and intracoronary route should beconsidered.

scholarly journals A case of left circumflex artery stenosis involving ST segment depression in multiple leads with ST elevation in lead augmented vector right

2019 ◽  
Vol 6 (7) ◽  
pp. 2598
Author(s):  
C. P. Karunadas ◽  
Cibu Mathew
Keyword(s):  
Beta Blockers ◽  
Coronary Intervention ◽  
Drug Eluting Stent ◽  
Circumflex Artery ◽  
St Segment Elevation ◽  
Left Circumflex Artery ◽  
St Depression ◽  
St Segment ◽  
Lead Avr ◽  
St Elevation

Electrocardiography (ECG) patterns of ST-segment elevation in lead aVR with or without diffuse ST segment depression may predict either left main coronary artery or triple vessel stenosis. Here, we have presented the case of a 56-year-old female involving such an ECG pattern with ST-segment depression in more than eight leads and ST Segment elevation in lead aVR, however, showing stenosis of the mid-segment of the left circumflex artery (LCX). She was scheduled to undergo percutaneous coronary intervention with implantation of a drug-eluting stent with respect to mid LCX stenosis. The patient was asymptomatic post procedure and was discharged on beta blockers. To conclude, the ECG pattern of ST depression in multiple leads with ST-elevation in aVR lead can occur in LCX obstruction as well. 

Special Treatment and Wound Care of the Driveline Exit Site after Left Ventricular Assist Device Implantation

2015 ◽  
Vol 63 (08) ◽  
pp. 670-674 ◽  
Author(s):  
Jan Unterkofler ◽  
Rüdiger Autschbach ◽  
Ajay Moza ◽  
Andreas Goetzenich ◽  
Lachmandath Tewarie ◽  
...  
Keyword(s):  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Wound Care ◽  
Left Ventricular ◽  
Special Treatment ◽  
Exit Site ◽  
Assist Device ◽  
Ventricular Assist ◽  
Device Implantation ◽  
Left Ventricular Assist

scholarly journals Coronary Artery Hematoma Treated with Fenestration Using a Novel NSE Alpha® Scoring Balloon

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Naohiro Funayama ◽  
Takao Konishi ◽  
Tadashi Yamamoto ◽  
Daisuke Hotta
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Occlusion ◽  
Intramural Hematoma ◽  
Coronary Intervention ◽  
Optimal Management ◽  
True Lumen ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Scoring Balloon ◽  
Percutaneous Coronary

The optimal management of coronary intramural hematoma has not been defined. We described a case in which coronary occlusion developed due to an intramural hematoma after percutaneous coronary intervention for mid left circumflex artery (LCX). Intravascular ultrasound (IVUS) demonstrated the progression of the intramural hematoma and a totally compressed true lumen. Our approach was based on fenestration with a scoring balloon (NSE Alpha, Goodman, Japan), which allowed the deployment of an additional stent to be avoided. In conclusion, this management can be effectively and safely performed.

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