scholarly journals Substrate Characterization and Outcomes of Ventricular Tachycardia Ablation in Titin Cardiomyopathy: A Multicenter Study

2021 ◽  
Author(s):  
Andres Enriquez ◽  
Jackson Liang ◽  
Jeffrey Smietana ◽  
Daniele Muser ◽  
Pablo Salazar ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Electrical Storm ◽  
Circulatory Support ◽  
Long Term Outcomes ◽  
Bundle Branch Block ◽  
Ventricular Tachycardia Ablation ◽  
Increased Risk ◽  
Arrhythmogenic Substrate ◽  
Vt Ablation

Background - Truncating variants of the titin gene (TTNtv) are a leading cause of dilated cardiomyopathy (DCM) and have been associated with an increased risk of ventricular arrhythmias. This study evaluated the substrate distribution and the acute and long-term outcomes of patients with TTN-related cardiomyopathy undergoing ventricular tachycardia (VT) ablation. Methods - This multicenter registry included 15 patients with DCM (age 59±11 years, 93% male, ejection fraction 30±12%) and genotypically confirmed TTNtvs who underwent VT ablation between July 2014 and July 2020. Results - All patients presented with sustained monomorphic VT, including electrical storm in 4 of them. A median of 2 VTs per patient were induced during the procedure (cycle-length 318±68 ms) and the predominant morphologies were left bundle branch block with inferior axis (39%) and right bundle branch block with inferior axis (29%). A complete map of the left ventricle (LV) was created in 12 patients and showed voltage abnormalities mainly at the periaortic (92%) and basal septal region (58%). A preprocedural cardiac magnetic resonance imaging was available in 13 patients and in 11 there was evidence of LV delayed gadolinium enhancement, with predominantly midmyocardial distribution. Sequential ablation from both sides of the septum was required in 47% of patients to target septal intramural substrate and epicardial ablation was performed in 20%. At the end of the procedure, the clinical VT was noninducible in all patients, while in 3 cases a non-clinical VT was still inducible. After a follow-up of 26.5±23.0 months, 53% of patients experienced VT recurrence, 20% received transplant or mechanical circulatory support and 7% died. Conclusion - The arrhythmogenic substrate in TTN-related cardiomyopathy involves the basal septal and perivalvular regions. Long-term outcomes of catheter ablation are modest, with high recurrence rate, likely related to an intramural location of VT circuits.

P1457Does high density mapping increase the efficacy of ischemic ventricular tachycardia ablation?

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Nunes Ferreira ◽  
G Silva ◽  
N Cortez-Dias ◽  
P Silverio-Antonio ◽  
T Rodrigues ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
High Density ◽  
Electrical Storm ◽  
High Morbidity ◽  
Amiodarone Therapy ◽  
Ventricular Tachycardia Ablation ◽  
Density Mapping ◽  
Vt Ablation

Abstract Introduction  The treatment of ventricular tachycardia (VT) in patients (pts) with ischemic heart disease (IHD) represents a challenge because of its high morbidity and mortality rates and low long-term success rates. In the VANISH clinical trial, 51% of pts undergoing the conventional ablation technique developed within 2 years the combined outcome of mortality or electrical storm (ES) or appropriate CDI shock. The use of high-density substrate maps can lead to greater precision in substrate evaluation and ideally to improved ablation success. Objectives  To assess the efficacy of substrate-guided ischemic VT ablation using high-density mapping. Methods  Single-center prospective study of consecutive IHD pts submitted to endocardial ablation of substrate-guided VT using multipolar catheters (PentaRayTM or HDGridTM) and three-dimensional mapping systems with automatic annotation software. The maps were evaluated in order to identify the intra-cicatricial channels (areas of bipolar voltage <1.5mV) in which sequential propagation of local abnormal ventricular activities (LAVAs) were observed, during or after QRS. The ablation strategy aimed at the abolition of all intra-cicatricial LAVAs, directing the radiofrequency applications primarily to the entrances of the channels. The success of ablation was assessed by the primary outcome (death by any cause or ES or appropriate CDI shock) at 2 years and compared to the population of the VANISH study undergoing conventional ablation, using Cox regression and Kaplan- Meier survival analysis. Results  We included 40 patients, 95% males, 70 ± 8 years, mean ejection fraction 34 ± 10%. 82% on previous amiodarone therapy and 72% were ICD carriers. 32% underwent ablation during hospitalization for ES and 20% had previously undergone VT ablation. The median duration of substrate mapping was 74 minutes, with a mean of 2290 collected points. Major complications were seen in 1 patient (aortic dissection). During a mean follow-up time of 17.3 ± 12.9 months, the long-term success rate of VT ablation was 75%. Additionally, there was a reduction in the proportion of patients receiving amiodarone before vs after ablation (82% vs. 45% respectively). The rate of events observed during follow-up was lower than expected, namely by comparison with the population of the VANISH study undergoing conventional ablation (25% vs 51% at 24 months, HR 0.42 CI 95% 0.2-0.88, p = 0.022), reflecting a relative risk reduction of 58%. Conclusions  High density mapping allows a detailed characterization of the dysrhythmic substrate in patients with VT in an IHD context. Our results suggest that these technological innovations may be improving the clinical success of VT ablation. Abstract Figure.

scholarly journals Long-term Outcomes of Ventricular Tachycardia Ablation in Different Types of Structural Heart Disease

2015 ◽  
Vol 4 (3) ◽  
pp. 177 ◽  
Author(s):  
Jackson J Liang ◽  
Pasquale Santangeli ◽  
David J Callans ◽  
◽  
◽  
...  
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Structural Heart Disease ◽  
Implantable Cardioverter Defibrillators ◽  
Mortality Benefit ◽  
Long Term Outcomes ◽  
Ventricular Tachycardia Ablation ◽  
Different Types ◽  
Vt Ablation

Ventricular tachycardia (VT) often occurs in the setting of structural heart disease and can affect patients with ischaemic or nonischaemic cardiomyopathies. Implantable cardioverter-defibrillators (ICDs) provide mortality benefit and are therefore indicated for secondary prevention in patients with sustained VT, but they do not reduce arrhythmia burden. ICD shocks are associated with increased morbidity and mortality, and antiarrhythmic medications are often used to prevent recurrent episodes. Catheter ablation is an effective treatment option for patients with VT in the setting of structural heart disease and, when successful, can reduce the number of ICD shocks. However, whether VT ablation results in a mortality benefit remains unclear. We aim to review the long-term outcomes in patients with different types of structural heart disease treated with VT ablation.

scholarly journals Pre-procedural image-guided versus non-image-guided ventricular tachycardia ablation—a review

2020 ◽  
Vol 28 (11) ◽  
pp. 573-583 ◽  
Author(s):  
A. A. Hendriks ◽  
Z. Kis ◽  
M. Glisic ◽  
W. M. Bramer ◽  
T. Szili-Torok
Keyword(s):  
Overall Survival ◽  
Ventricular Tachycardia ◽  
Meta Analysis ◽  
Bibliographic Databases ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Ventricular Tachycardia Ablation ◽  
Image Guided ◽  
Vt Ablation

Abstract Background Magnetic resonance imaging and computed tomography in patients with ventricular tachycardia (VT) after myocardial infarction (MI) helps to delineate scar from healthy tissue. Image-guided VT ablation has not yet been studied on a large scale. Objective The aim of the meta-analysis was to compare the long-term outcome of image-guided VT ablation with a conventional approach for VT after MI. Methods Eight electronic bibliographic databases were searched to identify all relevant studies from 2012 until 2018. The search for scientific literature was performed for studies that described the outcome of VT ablation in patients with an ischaemic substrate. The outcome of image-guided ablation was compared with the outcome of conventional ablations. Results Of the 2990 citations reviewed for eligibility, 38 articles—enrolling a total of 7748 patients—were included into the meta-analysis. Five articles included patients with image-guided ablation. VT-free survival was 82% [74–90] in the image-guided VT ablation versus 59% [54–64] in the conventional ablation group (p < 0.001) during a mean follow-up of 35 months. Overall survival was 94% [90–98] in the image-guided versus 82% [76–88] in the conventional VT ablation group (p < 0.001). Conclusions Image-guided VT ablation in ischaemic VT was associated with a significant benefit in VT-free and overall survival as compared with conventional VT ablation. Visualising myocardial scar facilitates substrate-guided ablation procedures, pre-procedurally and by integrating imaging during the procedure, and may consequently improve long-term outcome.

Abstract 18117: Trends in the Utilization and Outcomes of Medicare Beneficiaries Undergoing Catheter Ablation for Ventricular Tachycardia

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Omair Yousuf ◽  
Robbert Zusterzeel ◽  
WIlliam Sanders ◽  
Carmen Dekmezian ◽  
Henry Silverman ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Circulatory Support ◽  
Complication Rates ◽  
Medicare Beneficiaries ◽  
Major Complications ◽  
Procedural Complications ◽  
Vt Ablation

Background: Sustained ventricular tachycardia (VT) is a significant cause of sudden death, progressive ventricular dysfunction, and heart failure hospitalizations. Radiofrequency catheter ablation is used to control incessant VT and prevent or reduce the frequency of VT episodes. However, data regarding mortality and complication rates with VT ablation are limited. Objective: To measure the incidence of procedural complications, repeat ablations, hospitalization for heart failure and ventricular tachycardia, and short and long term mortality in patients undergoing VT ablation. Methods: We conducted a population-based, retrospective cohort study of all fee-for-service Medicare beneficiaries who underwent catheter ablation for VT between 2000 and 2012. The main outcome measures were major complications within 30 days and 1-year rates of death, repeat ablation and heart failure and VT hospitalization. Results: There were 21,073 patients that received a VT ablation during the study period (mean age 70 years; 77% were men; 90% were white). The ablation frequency increased from 647 in 2000 to 2,760 in 2012. The 30-day incidence of pericardial complications was 2.3%, vascular complications 6.8%, stroke or transient ischemic attack 1.5%, need for mechanical circulatory support 2.3%, and death 4.2%. The 1-year incidence per 1,000 person-years for repeat ablation was 81, death 176, and hospitalization for heart failure and VT 156 and 272, respectively (Figure). Conclusions: Utilization of catheter ablation for VT has increased over the past 12 years. Major complications after VT ablation are relatively infrequent, but not trivial. These findings should inform discussion of potential procedural complications and long term prognosis and may have considerable implications when discussing treatment options for patients with VT.

scholarly journals Impact of a high-density grid catheter on long-term outcomes for structural heart disease ventricular tachycardia ablation

2021 ◽  
Author(s):  
Riccardo Proietti ◽  
Rory Dowd ◽  
Lim Ven Gee ◽  
Shamil Yusuf ◽  
Sandeep Panikker ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Structural Heart Disease ◽  
High Density ◽  
Long Term Outcomes ◽  
Density Mapping ◽  
Significant Difference ◽  
Vt Ablation ◽  
Mapping Catheter

Abstract Background Substrate mapping has highlighted the importance of targeting diastolic conduction channels and late potentials during ventricular tachycardia (VT) ablation. State-of-the-art multipolar mapping catheters have enhanced mapping capabilities. The purpose of this study was to investigate whether long-term outcomes were improved with the use of a HD Grid mapping catheter combining complementary mapping strategies in patients with structural heart disease VT. Methods Consecutive patients underwent VT ablation assigned to either HD Grid, Pentaray, Duodeca, or point-by-point (PbyP) RF mapping catheters. Clinical endpoints included recurrent anti-tachycardia pacing (ATP), appropriate shock, asymptomatic non-sustained VT, or all-cause death. Results Seventy-three procedures were performed (33 HD Grid, 22 Pentaray, 12 Duodeca, and 6 PbyP) with no significant difference in baseline characteristics. Substrate mapping was performed in 97% of cases. Activation maps were generated in 82% of HD Grid cases (Pentaray 64%; Duodeca 92%; PbyP 33% (p = 0.025)) with similar trends in entrainment and pace mapping. Elimination of all VTs occurred in 79% of HD Grid cases (Pentaray 55%; Duodeca 83%; PbyP 33% (p = 0.04)). With a mean follow-up of 372 ± 234 days, freedom from recurrent ATP and shock was 97% and 100% respectively in the HD Grid group (Pentaray 64%, 82%; Duodeca 58%, 83%; PbyP 33%, 33% (log rank p = 0.0042, p = 0.0002)). Conclusions This study highlights a step-wise improvement in survival free from ICD therapies as the density of mapping capability increases. By using a high-density mapping catheter and combining complementary mapping strategies in a strict procedural workflow, long-term clinical outcomes are improved.

scholarly journals Multimodality Imaging to Guide Ventricular Tachycardia Ablation in Patients with Non-ischaemic Cardiomyopathy

2020 ◽  
Vol 8 (4) ◽  
pp. 255-264
Author(s):  
Ling Kuo ◽  
Jackson J Liang ◽  
Saman Nazarian ◽  
Francis E Marchlinski
Keyword(s):  
Ventricular Tachycardia ◽  
Multimodal Imaging ◽  
Current Knowledge ◽  
Multimodality Imaging ◽  
Effective Treatment Option ◽  
Ventricular Tachycardia Ablation ◽  
Ischaemic Cardiomyopathy ◽  
Vt Ablation ◽  
Procedural Planning

Catheter ablation is an effective treatment option for ventricular tachycardia (VT) in patients with non-ischaemic cardiomyopathy (NICM). The heterogeneous nature of NICM aetiologies and VT substrate in patients with NICM play a role in long-term ablation outcomes in this population. Over the past decades, more precise identification of NICM aetiologies and better characterisation of various substrates have been made. Application of multimodal imaging has greatly contributed to the accurate diagnosis of NICM subtypes and improved VT ablation strategies. This article summarises the current knowledge of multimodal imaging used in the characterisation of non-ischaemic NICM substrates, procedural planning and image integration for the optimisation of VT ablation.

Abstract 16797: Heart Failure Outcomes in Patients With Ischemic Cardiomyopathy After Ventricular Tachycardia Ablation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Himanayani Mamillapalli ◽  
Viorel G Florea ◽  
Mackenzie Mbai ◽  
Sravya Veligandla ◽  
Smitha Murthy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Tachycardia ◽  
Ischemic Cardiomyopathy ◽  
Anterior Wall ◽  
Veterans Affairs ◽  
First Year ◽  
Inferior Wall ◽  
Ventricular Tachycardia Ablation ◽  
Increased Risk ◽  
Vt Ablation

Introduction: Patients with congestive heart failure (CHF) are at an increased risk of developing ventricular tachycardia (VT). It is unclear how VT ablation affects CHF outcomes. Hypothesis: The goal of this study is to evaluate CHF exacerbations and echocardiogram findings based on location of myocardial scar in patients with Ischemic Cardiomyopathy (ICM) who have undergone VT ablation. Methods: This was a selected cohort of consecutive patients with ICM who underwent VT ablation at Minneapolis Veterans Affairs Health Care System between July 2008 and September 2019. CHF outcomes and echocardiogram variables were assessed. Results: Seventy-five patients with ICM underwent VT ablation, average age was 67.6 ± 7 years old and 100% male. Inferior wall scar (IWS) was the most prevalent (Figure, Table 1A). On pre-ablation echocardiogram, anterior wall scar (AWS) group overall had a lower mean ejection fraction (EF) of 26%, compared to IWS group of 32% (Table 1B). On post-ablation echocardiogram, patients with AWS had statistically significant (p < 0.03, two-tailed test) lower mean EF of 23% compared to IWS group of 30% (Table 1C). Twenty-five patients had admissions for CHF exacerbation post-ablation, 17 were in the first year after ablation (12 IWS and 5 AWS). Average time from ablation to CHF exacerbation was 2.1 years. Patients with IWS presented earlier with CHF exacerbation compared to AWS group (1.6 vs 1.8 years). Conclusions: Patients with ICM and AWS had a statistically significant mean lower EF post VT ablation compared to IWS group. However, patients with IWS had higher rates of admission for CHF exacerbation.

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