scholarly journals Hybrid Catheter-Based and Surgical Techniques for Ablation of Ventricular Arrhythmias

2020 ◽  
Vol 9 (2) ◽  
pp. 97-103
Author(s):  
Fouad Khalil ◽  
Konstantinos Siontis ◽  
Gabor Bagameri ◽  
Ammar M Killu ◽  
◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ventricular Arrhythmia ◽  
Ventricular Arrhythmias ◽  
Surgical Techniques ◽  
Hybrid Technique ◽  
Surgical Ablation ◽  
Safety And Efficacy ◽  
Energy Delivery ◽  
Novel Approach ◽  
Growing Body

Catheter ablation is a rapidly expanding and evolving field. The advent of interventional techniques and advances in technology have allowed catheter ablation to supplant antiarrhythmic surgery for ventricular arrhythmia treatment. However, issues related to access and energy delivery limit the use of catheter ablation in some cases. Hybrid catheter-based and surgical techniques represent a novel approach to overcome these limitations. The hybrid technique combines the strengths and minimises the limitations of either catheter or surgical ablation alone. There is a growing body of evidence in the literature supporting the safety and efficacy of the hybrid surgical technique. This review aims to provide an overview of hybrid surgical-catheter ablation for ventricular arrhythmia.

scholarly journals The Role of the Electrophysiologist in Convergent Ablation

2020 ◽  
Vol 9 (1) ◽  
pp. 8-14
Author(s):  
Nadeev Wijesuriya ◽  
Nikos Papageorgiou ◽  
Edd Maclean ◽  
Bunny Saberwal ◽  
Syed Ahsan
Keyword(s):  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Radiofrequency Catheter Ablation ◽  
Hybrid Technique ◽  
Surgical Ablation ◽  
Safety And Efficacy ◽  
Hybrid Ablation ◽  
Established Treatment ◽  
The Coordinator

Catheter ablation is a well-established treatment for patients with AF in whom sinus rhythm is desired. Both radiofrequency catheter ablation and cryoablation are widely performed, rapidly developing techniques. Convergent ablation is a novel hybrid technique combining an endocardial radiofrequency ablation with a minimally invasive epicardial surgical ablation. Some suggest that hybrid ablation may be more effective than lone endocardial ablation in achieving the elusive goal of maintaining sinus rhythm in patients with non-paroxysmal AF. In this article, the authors examine the safety and efficacy of catheter ablation and convergent ablation for long-standing, persistent AF. We also outline the crucial role that electrophysiologists play, not only as a procedure operator, but also as the coordinator and developer of this multidisciplinary service.

Fluoroless catheter ablation of supraventricular and ventricular arrhythmias in pregnancy: validation of a standard approach in a large multicenter registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Stec ◽  
K Styczkiewicz ◽  
J Sledz ◽  
A Sledz ◽  
M Chrabaszcz ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ventricular Arrhythmia ◽  
Pregnant Women ◽  
Ventricular Arrhythmias ◽  
Study Group ◽  
Heart Team ◽  
Femoral Access ◽  
Electroanatomic Mapping System ◽  
Multicenter Registry ◽  
In Pregnancy

Abstract Background An increasing experience in zero- (ZF) or near-zero fluoroscopy catheter ablation (CA) supports the implementation of early, fluoroless approach for recurrent, symptomatic arrhythmias in pregnancy. Purpose The aim of the study was to evaluate the feasibility, efficacy, and safety of CA with a standardized ZF approach during pregnancy. Methods Data were derived from a large prospective multicenter registry (ELEKTRO-RARE-A-CAREgistry). Between 2012 and 2019, more than 2655 CA procedures were performed in women in intention-to-treat using a ZF fluoroscopy approach. The procedures were performer using: 1) femoral access, 2) double-catheter technique, without intracardiac echocardiography, 3) electroanatomic mapping system (Ensite, Abbott, USA) for mapping and navigation, 4) conscious, light sedation. Shared decision making approach was applied, including a pregnancy heart team consultations. Results The study group consisted of 18 pregnant women (mean age: 30.3±5.0 years; range: 19–38 years; mean gestational age during CA: 21.4±9.2 weeks; range: 7–36 weeks). All pregnant women had no overt structural heart disease. Among women in reproductive age, pregnant women referred for ZF-CA approach accounted for approximately 2% of procedures. In the study group, the major indications for CA included: AVNRT (n=10); OAVRT/WPW (n=2); focal idiopathic ventricular arrhythmia (n=4), AT (n=1) and AF (n=1). Five women had double substrate for CA. In AF case general anesthesia and transesophageal echocardiography were used to monitor ZF-transseptal puncture and right-sided pulmonary vein isolation. All procedures were successfully completed without fluoroscopy, and without serious maternal or fetal complications. The procedure and ablation application times were 55.0±30.0 min and 394±338 s, respectively. In one patient second procedure for idiopathic ventricular arrhythmia was postponed after delivery. Conclusion Implementation of pregnancy heart team and a standard fluoroless protocol for CA in daily electrophysiological practice allowed an early, safe, and effective CA of maternal supraventricular tachycardia and idiopathic ventricular arrhythmias in pregnancy. Funding Acknowledgement Type of funding source: None

scholarly journals Kamrai tachycardiák katéterablatiós kezelése

2015 ◽  
Vol 156 (25) ◽  
pp. 995-1002
Author(s):  
Attila Mihálcz ◽  
Tamás Szili-Török ◽  
Kálmán Tóth
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Diagnostic Tests ◽  
Ventricular Arrhythmias ◽  
Structural Heart Disease ◽  
Technical Aspects ◽  
Safety And Efficacy ◽  
Ventricular Tachycardia Ablation ◽  
The Past ◽  
Ventricular Tachycardias

Catheter ablation of ventricular tachycardias emerged significantly as standard therapy in the past 20 years. In this review recent advances in catheter ablation of ventricular tachycardias are discussed. The authors first present in details the technical aspects of ablation strategies, main indications and contraindications of ventricular tachycardia ablation and the necessary pre- and postinterventional diagnostic tests. Outcome is also discussed in different forms of ventricular tachycardias in detail. The authors summarize the safety and efficacy of catheter ablation of ventricular arrhythmias. They recommend that ablation of ventricular tachycardias should be considered earlier in patients with and without structural heart disease. Orv. Hetil., 2015, 156(25), 995–1002.

scholarly journals Radiofrequency Ablation Strategies for Intramural Ventricular Arrhythmias

2021 ◽  
pp. 08-12
Keyword(s):  
Radiofrequency Ablation ◽  
Catheter Ablation ◽  
Ventricular Arrhythmias ◽  
Radiofrequency Energy ◽  
Success Rates ◽  
The Past ◽  
Energy Delivery ◽  
Radiofrequency Energy Delivery ◽  
Mapping Techniques ◽  
Established Treatment

Catheter ablation is an established treatment strategy for ventricular arrhythmias. However, the presence of intramural substrate poses challenges with mapping and delivery of radiofrequency energy, limiting overall success of catheter ablation. Advances over the past decade have improved our understanding of intramural substrate and paved the way for innovative treatment approaches. Modifications in catheter ablation techniques and development of novel ablation technologies have led to improved clinical outcomes for patients with ventricular arrhythmias. In this review, we explore mapping techniques to identify intramural substrate and describe available radiofrequency energy delivery techniques that can improve overall success rates of catheter ablation.

Safety and efficacy of catheter ablation of ventricular arrhythmias with para-Hisian origin via a systematic direct approach from the aortic sinus cusp

Heart Rhythm ◽  
2018 ◽  
Vol 15 (11) ◽  
pp. 1626-1633 ◽  
Author(s):  
Hui-Qiang Wei ◽  
Xiao-Gang Guo ◽  
Xu Liu ◽  
Gong-Bu Zhou ◽  
Qi Sun ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ventricular Arrhythmias ◽  
Direct Approach ◽  
Aortic Sinus ◽  
Safety And Efficacy

scholarly journals Catheter Ablation of Life-Threatening Ventricular Arrhythmias in Athletes

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 205
Author(s):  
Nicola Tarantino ◽  
Domenico G. Della Rocca ◽  
Nicole S. De Leon De La Cruz ◽  
Eric D. Manheimer ◽  
Michele Magnocavallo ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ventricular Arrhythmias ◽  
Individual Factors ◽  
Substantial Part ◽  
Arrhythmogenic Substrate ◽  
Life Threatening ◽  
History Of ◽  
Anatomic Distribution ◽  
Artery Disease ◽  
Surveillance Analysis

A recent surveillance analysis indicates that cardiac arrest/death occurs in ≈1:50,000 professional or semi-professional athletes, and the most common cause is attributable to life-threatening ventricular arrhythmias (VAs). It is critically important to diagnose any inherited/acquired cardiac disease, including coronary artery disease, since it frequently represents the arrhythmogenic substrate in a substantial part of the athletes presenting with major VAs. New insights indicate that athletes develop a specific electro-anatomical remodeling, with peculiar anatomic distribution and VAs patterns. However, because of the scarcity of clinical data concerning the natural history of VAs in sports performers, there are no dedicated recommendations for VA ablation. The treatment remains at the mercy of several individual factors, including the type of VA, the athlete’s age, and the operator’s expertise. With the present review, we aimed to illustrate the prevalence, electrocardiographic (ECG) features, and imaging correlations of the most common VAs in athletes, focusing on etiology, outcomes, and sports eligibility after catheter ablation.

scholarly journals Minimising radiation exposure in catheter ablation of ventricular arrhythmias

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matevž Jan ◽  
David Žižek ◽  
Tine Prolič Kalinšek ◽  
Dimitrij Kuhelj ◽  
Primož Trunk ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiation Exposure ◽  
Ventricular Arrhythmias ◽  
Major Complication ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Complex Nature ◽  
Group 2 ◽  
Procedural Outcomes ◽  
Group 1

Abstract Background Conventional fluoroscopy guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD). Methods Fifty-two (age 53.4 ± 17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional electro-anatomical mapping system and intra-cardiac echocardiography. Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed. Results Sixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9 ± 71.7 vs 123.6 ± 42.2 min; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p = 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p = 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complication rate was 5%. Conclusions Fluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.

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