Surgical Ablation Supplemented by Ethanol Injection for Ventricular Tachycardia Refractory to Percutaneous ablation

Background: Combination of endocardial and epicardial approach has improved the overall success rate of ventricular tachycardia (VT) ablation in patients with cardiomyopathy. However, the origins of some VTs are truly intramural or close to coronary arteries, which make this combined strategy either prone to failure or too risky. Objectives: This observational study aimed to explore the feasibility and efficacy of direct epicardial ablation combined with intramural ethanol injection via surgical approach for such VTs. Methods: Six consecutive patients with recurrent sustained VT refractory to combined endocardial and epicardial radiofrequency ablation were included. Direct epicardial access was achieved through limited left thoracotomy in 3 patients and median sternotomy in other 3 patients. Ablation was performed using irrigation catheter guided by electroanatomic mapping. Ethanol was injected in all patients to reinforce transmural lesions. The primary outcome was freedom of sustained VT determined by device interrogation and periodical 24h-holter recordings subsequently. Results: Over a median follow-up of 22 months (range, 6~65), all patients remained free of sustained VT. One patient died of pulmonary infection one year after the procedure. Conclusions: A hybrid strategy of surgical ablation combined with intramural ethanol injection is feasible and effective in patients with multiple failed percutaneous ablation attempts.

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Surgical Ablation Supplemented by Ethanol Injection for Ventricular Tachycardia Refractory to Percutaneous ablation

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.15162 ◽

2021 ◽

Author(s):

Gang Yang ◽

Yongfeng Shao ◽

Weidong Gu ◽

Buqing Ni ◽

Bing Yang ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Percutaneous Ablation ◽

Surgical Ablation ◽

Ethanol Injection

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P3196 Predictors of successful percutaneous ablation of atrial fibrillation at six months and one year follow-up

European Heart Journal ◽

10.1016/s0195-668x(03)95826-x ◽

2003 ◽

Vol 24 (5) ◽

pp. 598

Author(s):

P ADRAGAO

Keyword(s):

Atrial Fibrillation ◽

Percutaneous Ablation ◽

One Year

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Surgical ablation of ventricular tachycardia with sequential map-guided subendocardial resection: electrophysiologic assessment and long-term follow-up.

Circulation ◽

10.1161/01.cir.77.1.131 ◽

1988 ◽

Vol 77 (1) ◽

pp. 131-141 ◽

Cited By ~ 52

Author(s):

D E Haines ◽

B B Lerman ◽

I L Kron ◽

J P DiMarco

Keyword(s):

Ventricular Tachycardia ◽

Surgical Ablation ◽

Long Term Follow Up

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A25-5 Predictors of successful percutaneous ablation of atrial fibrillation at six months and one year follow-up

EP Europace ◽

10.1016/s1099-5129(03)91649-7 ◽

2003 ◽

Vol 4 ◽

pp. B38

Author(s):

P ADRAGAO

Keyword(s):

Atrial Fibrillation ◽

Percutaneous Ablation ◽

One Year

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

Circulation ◽

10.1161/circ.132.suppl_3.16647 ◽

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.

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Catheter ablation for ventricular tachycardia in Chagas disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.0759 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Kulchetscki ◽

A.P Ferraz ◽

F.C Gouvea ◽

F.K.B Alexandre ◽

M.P Mayrink ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Chagas Disease ◽

Clinical Status ◽

Functional Class ◽

Recurrence Rates ◽

Kaplan Meier ◽

All Cause Mortality ◽

One Year

Abstract Background Chagas disease (ChD) is a major cause of non-ischemic cardiomyopathy (NICM) in Latin America and is becoming more frequent in other parts of the world, especially due to immigration movements. Ventricular Tachycardia (VT) is more common in this type of NICM than others, and finding an effective treatment strategy still is a challenge. Catheter ablation is an option, but there is poor data regarding its efficacy and safety. Purpose Evaluate the outcomes after VT catheter ablation in ChD patients. Methods Data were collected by VT studies reports and patient record analysis, including comorbidities and clinical status at baseline and on follow-up. We analyzed all-cause mortality, one-year VT recurrence rate and procedure related major complications. Results Between January 2013 and December 2018, 157 catheter ablation procedures in 121 ChD patients were performed in our institution. The mean follow-up time was 22.6±22.1 (mean ± SD) months. Overall post procedure mortality was 33.1%, and mean survival time was 51.2 months (95% CI: 44.8–58. NYHA functional class (p=0.022), ejection fraction (p=0.020) and immediate ablation result (p 0.002) were predictors of all-cause mortality in the follow-up. Clinical VT inducibility after ablation was a predictor of VT recurrence at one year (p=0.04). An epicardial approach was performed in 125 (79%) procedures, and accidental right ventricle (RV) puncture occurred in 23 (18.4%), in which open-chest surgery for bleeding hemostasis was necessary in 4 procedures (3.2%). Conclusion Mortality and recurrence rates in ChD patients after VT ablation were high, and correlated with heart failure severity. Epicardial approach is often necessary in this subset of patients. There was a correlation between immediate ablation results and recurrence. Kaplan-Meier of cumulative survival Funding Acknowledgement Type of funding source: None

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Wide Anterior Maxillary Reconstruction with Equine Bone Xenograft: A Case Report of 24-Month Follow-Up

Case Reports in Surgery ◽

10.1155/2020/8890935 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Davide De Cicco ◽

Giuseppe Colella ◽

Gianpaolo Tartaro ◽

Nicola Zerbinati ◽

Romolo Fragola ◽

...

Keyword(s):

Surgical Ablation ◽

Case Presentation ◽

Primary Surgery ◽

Implant Placement ◽

Real Process ◽

Safety And Reliability ◽

Dental Rehabilitation ◽

Prosthesis Removal ◽

One Year

Introduction. Orofacial reconstruction plays an important role in the treatment of patients affected by oral and maxillofacial cancers. Improvements in technologies and studies of biomaterials have widely expanded surgical possibilities to achieve good functional and aesthetic outcomes. By the way, xenografting procedures gained great consensus in the last decades, because of their documented reliability and efficacy. We present a case of anterior maxillary chondrosarcoma (CHS) that has undergone surgical ablation followed by reconstruction with an equine-derived bone xenograft. Case Presentation. A 68-year-old woman affected by CHS of the premaxilla underwent surgical ablation involving the four incisors followed by reconstruction using an equine-derived bone substitute. Bony reconstruction was planned to achieve implant and dental prosthetic rehabilitation at a second surgical time. Primary surgery was carried out without complications. Good integration of the graft was confirmed by radiological examination. At 12-month follow-up, the patient refused the implant placement and spontaneously adopted a mobile prosthesis. One year later, plates and screws were removed, because of the exposure of a titanium plate. The graft was finally rejected within 3 weeks. Discussion. Nonantigenic equine-derived biomaterials have shown reliability and a good safety profile. In the presented case, implant insertion should have been performed 12 months after the primary surgery. During the follow-up, until dental mobile prosthesis was applied, clinical and instrumental examinations demonstrated a good integration of the graft. We suppose that a chronic inflammation of the mucosa led to the exposure of the plate, perhaps due to pressure, minimal movements, or imperfect fitting of the mobile prosthesis. Removal of fixation means was performed to prevent grafting failure, without success. On the other hand, missing load could induce the graft to act just like a prosthesis, without a real process of integration. Safety and reliability of equine-derived bone xenografts cannot be currently confirmed if not followed by implant insertion and dental rehabilitation.

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A25-5 Predictors of successful percutaneous ablation of atrial fibrillation at six months and one year follow-up

EP Europace ◽

10.1016/eupace/4.supplement_2.b38-b ◽

2003 ◽

Vol 4 (Supplement_2) ◽

pp. B38-B38

Author(s):

P. Adragao ◽

D. Cavaco ◽

K. Reis-Santos ◽

C. Aguiar ◽

F. Morgado ◽

...

Keyword(s):

Atrial Fibrillation ◽

Percutaneous Ablation ◽

One Year

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Recurrent Blandin-Nuhn mucocele and intralesional ethanol injection

Praxis of Otorhinolaryngology ◽

10.5606/kbbu.2021.92053 ◽

2021 ◽

Vol 9 (3) ◽

pp. 111-113

Author(s):

İdiris Çıldır

Keyword(s):

Physical Examination ◽

Female Patient ◽

Cystic Lesion ◽

Treatment Method ◽

Ethanol Injection ◽

One Year ◽

The One

A 21-year-old female patient presented with a swelling under the tongue that lasted about a month. A 2¥1 cm cystic lesion was found on the left side of the tongue ventral face in the physical examination, and the patient was operated. However, a partial recurrence was detected after the surgery; thereby, intralesional ethanol was administered. The lesion disappeared after the administration of ethanol, and there was no recurrence during the one-year follow-up. We presented this case to demonstrate the efficacy of this treatment method.

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