scholarly journals Epicardial and Endocardial Ablation Based on Channel Mapping in Patients With Ventricular Tachycardia and Chronic Chagasic Cardiomyopathy: Importance of Late Potential Mapping During Sinus Rhythm to Recognize the Critical Substrate

2021 ◽  
Author(s):  
Cristiano de Oliveira Dietrich ◽  
Lucas de Oliveira Hollanda ◽  
Claudio Cirenza ◽  
Angelo Amato Vincenzo de Paola
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Circumflex Artery ◽  
End Point ◽  
Potential Mapping ◽  
Late Potential ◽  
Chagasic Cardiomyopathy ◽  
Considerable Morbidity ◽  
Activation Mapping

Background Ventricular tachycardia (VT) in patients with chronic chagasic cardiomyopathy (CCC) is associated with considerable morbidity and mortality. Catheter ablation of VT in patients with CCC is very complex and challenging. The main goal of this work was to assess the efficacy of VT catheter ablation guided by late potentials (LPs) in patients with CCC. Methods and Results Seventeen consecutive patients with refractory VT and CCC were prospectively included in the study. Combined endo‐epicardial voltage and late activation mapping were obtained during baseline rhythm to define scarred and LP areas, respectively. The end point of the ablation procedure was the elimination of all identified LPs. Epicardial and endocardial dense scars (<0.5 mV) were detected in 17/17 and 15/17 patients, respectively. LPs were detected in the epicardial scars of 16/17 patients and in the endocardial scars of 14/15 patients. A total of 63 VTs were induced in 17 patients; 22/63 (33%) were stable and entrained, presenting LPs recorded in the isthmus sites. The end point of ablation was achieved in 15 of 17 patients. Ablation was not completed in 2 patients because of cardiac tamponade or vicinity of the phrenic nerve and circumflex artery. Three patients (2 with unsuccessful ablation) had VT recurrence during follow‐up (39 months). Conclusions Endo‐epicardial LP mapping allows us to identify the putative isthmuses of different VTs and effectively perform catheter ablation in patients with CCC and drug‐refractory VTs.

scholarly journals Causes of recurrences after stereotactic radio-ablation for refractory ventricular tachycardia

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Herrera Siklody ◽  
R Jumeau ◽  
M Ozsahin ◽  
R Moeckli ◽  
M Le Bloa ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Antiarrhythmic Drugs ◽  
Interventricular Septum ◽  
Mean Value ◽  
Funding Source ◽  
Circumflex Artery ◽  
Ablation Volume ◽  
A Site

Abstract Introduction Stereotactic radio-ablation (STAR) has been recently introduced for the management of ventricular tachycardia (VT) refractory to antiarrhythmic drugs (AADs) and catheter ablation (CA). The incidence and mechanisms of VT recurrences after STAR remain unknown. We report causes of recurrence in patients (pts) after STAR. Methods From 09.2017 to 01.2020, 12pts suffering from refractory VT were enrolled. The underlying cardiopathy was ischemic in 3, inflammatory in 3 and idiopathic in 6 pts. Before STAR, an invasive electro-anatomical mapping (Carto3) of the VT substrate (VT-sub) was performed. A mean dose of 22±2Gy was delivered to the VT-sub using the Cyberknife® system. Results The ablation volume was 24±7cc and involved the interventricular septum (IVS) in 10. After a median follow-up of 9±7 months, VT burden decreased by 78% (mean value, from 89 to 20 VT/semester). Out of the 12 pts, 9 (75%) presented some form of VT recurrence (table): 1) that spontaneously resolved in 2 pts; 2) remote from the VT-sub in 2 cases; 3) managed with AADs that had failed before STAR in 2 cases; 4) within the treated VT-sub in 3 cases. In the latter 3 cases, one recurrence came from a site adjacent to the circumflex artery (mean dosis 14.4 Gy), and two were located within the treated IVS (one displaying marked fibrosis, and one with sarcoidosis). Only 4/12 (33%) pts required additional CA. Conclusion STAR led in our patients to a strong VT burden reduction. Recurrences occurred at sites remote from the irradiated volume, within the IVS or in under-dosed sites adjacent to critical structures. Funding Acknowledgement Type of funding source: None

Abstract 16668: Long-term Outcomes After Endo-epicardial Catheter Ablation of Ventricular Tachycardia in Nonischemic Cardiomyopathy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Erica S Zado ◽  
Pasquale Santangeli ◽  
Francis E Marchlinski
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Substantial Improvement ◽  
Nonischemic Cardiomyopathy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Linear Ablation ◽  
Long Term Follow Up

Introduction: Endo-epicardial catheter ablation of ventricular tachycardia (VT) in patients (pts) with nonischemic cardiomyopathy (NICM) has been reported to have satisfactory results at the short- and mid-term follow-up. We sought to determine the outcomes at the long-term follow-up of endo-epicardial ablation of VT in NICM. Hypothesis: Catheter ablation provides satisfactory long term outcome Methods: We prospectively enrolled 128 pts (age 59±13 years, 116 [91%] males) with NICM who underwent endo-epicardial radiofrequency catheter ablation at our Institution. After substrate mapping, all critical sites for the clinical or induced VT(s), identified with activation, entrainment or pace-mapping, together with late, split and fractionated potentials were targeted with focal and/or linear ablation. The procedural endpoint was noninducibility of sustained monomorphic VT. Pts were followed with ICD interrogation. Results: A total of 108 (73%) pts had idiopathic dilated NICM. The remaining 20 (14%) pts had hypertrophic CM (n=11), suspected inflammatory CM (n=6), or valvular CM (n=3). The mean LV ejection fraction was 33±15%. After a mean follow-up of 19 months (max 97 months), a total of 36 (28%) pts died and 17 (13%) underwent heart transplant. Cumulative survival free from any recurrent VT was 53% (68/128 patients) (Figure A). In the remaining 60 (47%) patients with VT recurrences, catheter ablation still resulted in a significant beneficial clinical impact on VT burden, with 25/60 (42%) having only isolated (1-2) VT episodes over follow-up, and a striking reduction of VT storm in the remaining pts (Figure B). Conclusions: In patients with NICM and VT, endo-epicardial substrate-based ablation is effective in achieving long-term freedom from any VT in 53% of patients, with a substantial improvement in VT burden in many of the remaining patients.

5209Stereotactic radioablation of ventricular tachycardia guided by direct integration of 3D electroanatomic mapping: development and validation of a new method

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Sramko ◽  
J Cvek ◽  
P Peichl ◽  
L Knybel ◽  
J Kautzner
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Left Ventricular ◽  
Radiotherapy Planning ◽  
Electroanatomic Mapping ◽  
Left Ventricular Ejection ◽  
Drug Resistant ◽  
Direct Integration ◽  
Work Station

Abstract Background Stereotactic body radiotherapy (SBRT) has emerged as a promising bailout therapy for recurrent ventricular tachycardia (VT) in patients with failed radiofrequency catheter ablation. However, SBRT can function only if the ablation target is precisely identified. Purpose We sought to develop a novel method for direct integration of electroanatomic mapping (EAM) data to an SBRT work station for radioablation of VT. Methods Candidates for SBRT were patients with recurrent, drug-resistant VT who underwent ≥2 previous radiofrequency catheter ablations (CARTO 3, Biosense-Webster, Diamond Barr, CA) and continued to have inducible clinical VT or clinical recurrences of VT. At the end of the last catheter ablation, the operators performed additional EAM to obtain landmarks for image registration: aorta with the ostium of the left main coronary artery or left atrium with ostia of pulmonary veins. Correct position of the catheter at the landmark was verified by intra-cardiac echocardiography. VT substrate–defined by a combination of voltage mapping, pace mapping, and detection of local abnormal ventricular activity and/or late potentials was marked by custom tags as a target for SBRT. The CARTO maps were exported and converted to 3D shells with encoded EAM properties (VTK format). On the following day, the patients underwent contrast-enhanced computer tomography (CT) of the heart. Using 3D Slicer software 4.10 (slicer.org), the EAM-derived anatomical structures with the marked ablation target were projected onto CT images by landmark registration with manual correction. The CT study with the projected contours of the EAM-detected ablation target was imported as a DICOM-RT format into a stereotactic radiotherapy planning work station (Multiplan 3.5, Accuray, Sunnyvale, CA). SBRT was performed using a contemporary radiosurgery system with real-time motion tracking of the ablation target (CyberKnife 8.5, Accuray). The prescribed (X-ray) dose was 25 Gy during a single session. Results The proposed work-flow was verified in four patients with structural heart disease and drug-resistant VT who had 2–3 unsuccessful radiofrequency catheter ablations (all males; age: 68–78 years; left ventricular ejection fraction: 20–25%; ischemic/non-ischemic cardiomyopathy: 2/2). Integration of EAM data with CT was achieved in all patients. None of them experienced acute radiotoxicity after SBRT. At a follow-up checkup at one month, three of the patients remained arrhythmia-free. One patient experienced VT recurrence one day after SBRT, but no VTs recurred during the following month of follow-up. Figure 1 Conclusions This is the first report demonstrating the feasibility of SBRT of VT guided by direct integration of EAM. The proposed method is best suited as a bailout procedure for patients with previously failed catheter ablation. Acknowledgement/Funding M.S. was supported by ESC Research Fellowship 2018

Abstract 4090: Substrate Modification Using Electroanatomically-guided Linear Ablation During Sinus Rhythm To Treat Post-infarction Ventricular Tachycardia

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Thomas Deneke ◽  
Bernd Lemke ◽  
Leif-Ilja Boesche ◽  
Bernd Calcum ◽  
Andreas Muegge ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Ventricular Arrhythmia ◽  
Sinus Rhythm ◽  
Border Zone ◽  
Ablation Procedure ◽  
Substrate Modification ◽  
Linear Ablation ◽  
Partial Success

Catheter ablation of ventricular tachycardia (VT) in the setting of ischemic cardiomyopathy can be performed to modify the underlying substrate. We evaluated the efficacy of a linear VT ablation procedure based on sinus rhythm (SR) substrate maps to treat ischemic VT in consecutive patients. Methods: In 110 consecutive patients with ischemic VT (56% not tolerated) catheter ablation was attempted. During SR left ventricular scar mapping was performed identifying scar tissue (bipolar voltages 1.5mV). Regionalization of VT-exit regions was performed based on pace-mapping within the scar border zone. Ablation was directed towards the identified exit region performing linear ablation along the scar border. ICD-holter interrogation was performed during follow-up. Results: A mean of 2.7±1.6 different VTs were inducible per patient (total 286). In 97% (107) of all patients (74% of all inducible VTs ablated: 213/286) the clinical VT was successfully ablated. In 68 patients (62%) no sustained monomorphic VT (complete success) was inducible at the end of the ablation procedure whereas in 39 patients (35%) VTs (partial success) were still inducible. Over a median follow-up of 12 months (6 –39) 88 (80%) patients were free from any ventricular arrhythmia. 19 successfully ablated patients had recurrences in between 6 to 36 months post intervention but the number of episodes treated by the ICD was significantly reduced (16±4 within 3 months (3±2) (p=0.02). No difference in patients with tolerated compared to non-tolerated VTs were detected (recurrences in 7/48 (15%) tolerated and 15/62 (24%) non-tolerated; p=0.13). There was a significant difference in freedom from any VT in patients with complete (88%) versus partial success (72%) (p=0.04). Conclusions: Substrate modification targeting only the scar-border zone including the VT exit site based on SR-maps is highly effective in suppressing the occurrence of a clinical VT in patients with remote myocardial infarction (97%). Based on the electro-anatomical findings complete freedom from any ventricular arrhythmia over a median of 1 year can be achieved in 80% of all patients. No difference in regard to freedom from any ventricular arrhythmia can be documented in patients with tolerated and non-tolerated VTs.

scholarly journals Catheter ablation of ventricular tachycardia in 136 patients with coronary artery disease: Results and long-term follow-up

1994 ◽  
Vol 24 (6) ◽  
pp. 1506-1514 ◽  
Author(s):  
Bernd-Dieter Gonska ◽  
Kejiang Cao ◽  
Anselm Schaumann ◽  
Axel Dorszewski ◽  
Friederike von zur Mühlen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Ventricular Tachycardia ◽  
Coronary Artery ◽  
Catheter Ablation ◽  
Long Term Follow Up ◽  
Artery Disease

Long-Term Follow-Up After Radiofrequency Catheter Ablation of Ventricular Tachycardia: A Successful Approach?

2002 ◽  
Vol 13 (5) ◽  
pp. 417-423 ◽  
Author(s):  
ALIDA E. BORGER BURG ◽  
NATASJA M.S. GROOT ◽  
LIESELOT ERVEN ◽  
MARIANNE BOOTSMA ◽  
ERNST E. WALL ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Long Term Follow Up ◽  
Successful Approach
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