Electrocardiographic and Electrophysiological Characteristics of Idiopathic Ventricular Arrhythmias Ablated Through a Percutaneous Trans-pericardial Approach

Aims Idiopathic epicardial ventricular arrhythmias (VAs) are clustered in the areas of the summit and crux. This study was to report a group of idiopathic epicardial VAs remote from the summit and crux areas. Methods In total, 9 patients (6 males, mean age 32±13 years) were enrolled. The locations were identified by epicardial mapping and ablation. The electrocardiographic and electrophysiological characteristics were compared to those of 9 patients who had VAs ablated at the opposite endocardial site. Results VAs were identified at the epicardium, with 4 patients had VAs located at the inferior wall, one at the anterior wall, one at the apex and 3 patients had VAs at the lateral wall. A “QS” type at the location-related leads was the only identified surface electrocardiogram indication suggesting epicardial origin (compared to that of the controls, 100% vs 0%, p<0.001). Endocardial and epicardial mapping revealed pre-maturities of -11±4 ms and -25±8 ms, respectively (VS. -28±8 ms revealed by endocardial mapping in control patients, p<0.001 and p=0.389, respectively). All of the study cases demonstrated an “rS” pattern in the endocardial unipolar electrogram. Acute and long-term successful ablation (a median of 11 months of follow-up) was achieved in all patients without complications. Conclusion A distinct group of idiopathic VAs remote from the summit and crux areas warranting ablation by a subxiphoid approach were identified. Morphological ECG features of a “QS” type among the location-related grouped leads combined with the mapping findings helped in the identification of the epicardial site of origin.

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Cibenzoline for High-Frequency Ventricular Arrhythmias: A Short-Term Comparison With Quinidine and a Long-Term Follow-up

The Journal of Clinical Pharmacology ◽

10.1002/j.1552-4604.1987.tb03014.x ◽

1987 ◽

Vol 27 (4) ◽

pp. 283-287 ◽

Cited By ~ 6

Author(s):

Prasad R. Palakurthy ◽

Claudio Maldonado ◽

Gurbachan Sohi ◽

Nancy C. Flowers

Keyword(s):

High Frequency ◽

Ventricular Arrhythmias ◽

Short Term ◽

Long Term Follow Up

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External Reshaping of the Left Ventricle in Off-Pump Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/01.imi.0000220943.58491.df ◽

2006 ◽

Vol 1 (4) ◽

pp. 155-159

Author(s):

Sotirios N. Prapas ◽

Demetrios A. Protogeros ◽

Vassilios N. Kotsis ◽

Ioannis A. Panagiotopoulos ◽

Ioannis P. Raptis ◽

...

Keyword(s):

Coronary Artery ◽

Ejection Fraction ◽

Heart Surgery ◽

Bypass Graft ◽

Lateral Wall ◽

Left Ventricular ◽

Inferior Wall ◽

Off Pump ◽

Anterolateral Wall

Background Dyskinetic areas of the lateral and inferior left ventricular (LV) wall are frequently encountered in patients with coronary artery disease. In clinical practice, all of the techniques described for the restoration of shape and function of the LV require cardiopulmonary bypass. A new technique of LV external reshaping that aims to obtain a near-normal ventricular conical shape is described. This technique is performed during an off-pump coronary artery bypass graft (CABG) operation. It is used mainly on the inferior and lateral walls of the ventricle, but also on the anterolateral wall when warranted. This technique can be considered an alternative to classic aneurysmectomy in high-risk cases. Methods All patients underwent total arterial revascularization without aortic manipulation. Intraoperative transesophageal echocardiography was used in all cases to define the dilated akinetic/dyskinetic area. This area was effectively plicated using interrupted mattress sutures reinforced with Teflon felt or pericardial strips. This technique allows near normalization of the geometry of the ventricle and LV end-diastolic volume reduction. In cases of preexisting mitral regurgitation (MR), a reduction of the MR was observed after lateral wall restoration. From September 2002 to April 2005, the external reshaping technique was applied on 56 cases among 949 off-pump CABG cases (5.9%). A detailed transthoracic echocardiogram was obtained preoperatively. The mean ejection fraction of all enrolled patients was 31.2 ± 7%. The location of the plication was: lateral wall in 22, inferior wall in 16, and anterolateral wall in 18. The average number of coronary anastomoses was 2.6. Twelve patients were found to have 2–3 + MR. All patients were followed up during a period of 35 months. Results One patient died due to severe right ventricular dysfunction. Seven patients developed atrial fibrillation, and one had ventricular tachycardia. During the follow-up period, we observed a reduction of left ventricular end-diastolic diameter and a parallel augmentation of ejection fraction (mean 42.2 ± 4%). The ventricular cavity's architecture was normalized. Among the 12 patients with MR, an improvement of regurgitation was noted in 10 (from 2–3+ to 1–2+). One patient died during the follow-up period, and 1 patient required reoperation due to persistent severe MR. Conclusions The external reshaping of the LV during beating heart surgery is technically feasible, has promising results, and can be performed without major complications.

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Abstract 9860: Safety and Clinical Outcome of Catheter Ablation of Ventricular Arrhythmias Using Contact Force Sensing, Consecutive Case Series

Circulation ◽

10.1161/circ.132.suppl_3.9860 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Astrid A Hendriks ◽

Ferdi Akca ◽

Lara Dabiri Abkenari ◽

Muchtiar Khan ◽

Rohit E Bhagwandien ◽

...

Keyword(s):

Contact Force ◽

Ventricular Arrhythmias ◽

Case Series ◽

Long Term Outcome ◽

Major Complications ◽

Acute Success ◽

Vt Ablation ◽

Procedural Success

Introduction: Poor catheter-to-myocardial contact can lead to ineffective ablation lesions and suboptimal outcome. Contact force (CF) sensing catheters in ventricular tachycardia (VT) ablations has not been studied for their long term efficacy. Hypothesis: The hypothesis is that CF ablation is superior to manual ablation (MAN) and non-inferior to remote magnetic navigation (RMN) ablation for safety and efficacy in acute and long term outcome. Methods: A total of 249 consecutive patients underwent VT ablation, with the use of MAN, CF or RMN catheters were included in this single center cohort study from January 2007 until March 2014. The primary endpoints were procedural success, acute major complications and VT recurrences at follow-up. The average follow-up period was ± 20 months. Results: Acute success was achieved in 191 out of 249 procedures (75.9%). Acute success in manual ablation, CF ablation and RMN ablation was 70.1%, 72.3% and 85.2% respectively (P = 0.038). Major complications occurred in 3.2% and there was a trend towards less major complications (P = 0.055) in the RMN group. Thirty-six percent of the patients with an initially successful procedure had a recurrence during follow-up (CF 41.2% MAN 37.5% RMN 32.0% P = NS). Conclusions: The use of CF sensing catheters does not improve the procedural outcome or safety profile in comparison to non-CF sensing ablation in ventricular arrhythmias. RMN non-CF sensing ablation has the highest procedural success rate. Future studies are necessary to investigate the role of CF in VT ablation and to define the optimal force.

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Abstract 15692: Voltage Mapping in Atrial Fibrillation vs Sinus Rhythm: Results From the Mavs Study

Circulation ◽

10.1161/circ.142.suppl_3.15692 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Carola Gianni ◽

Jerri A Cunningham ◽

Sanghamitra Mohanty ◽

CHINTAN TRIVEDI ◽

Domenico G Della Rocca ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Low Voltage ◽

Lateral Wall ◽

Posterior Wall ◽

Anterior Wall ◽

Inferior Wall ◽

Voltage Mapping ◽

First Time ◽

Mapping Catheter

Background: Left atrial (LA) scar can be identified with bipolar voltage mapping during sinus rhythm (SR). It is not clear whether the same voltage criteria can be applied during atrial fibrillation (AF). Objective: Aim of this study was to compare voltage maps performed in the same patient both in AF and SR. Methods: Voltage mapping was performed using a 10-pole circular mapping catheter in patients with non-paroxysmal AF undergoing first time RF ablation. For descriptive purposes, the LA was divided in 6 regions: septum, posterior wall (PW), inferior wall (IW), lateral wall, anterior wall, and roof. The threshold for low voltage was <0.5 mV (with a color range setting 0.2-0.5 mV). Mild “scar” was defined as an area low voltage 5-20%, moderate 20-35% and severe as >35%. Results: 16 patients (62% persistent AF, 38% longstanding persistent AF) were included in the study. The map density was comparable during AF and SR (mean points per map 551 vs 547, paired t test P = NS). 2 patients displayed normal voltage during both AF and SR. 14 patients showed areas of low voltage during AF, which were still present during SR in 8. All patients with mild “scarring” during AF (n = 4), showed normal voltage during SR. Of the 7 patients with moderate “scarring”, 2 patients showed normal voltage during SR, while in the remaining 5 “scarring” was only mild during SR. 3 patients showed extensive “scarring” during AF, which was only moderate during SR. During AF, areas of low voltage were more commonly observed in the PW (12/14) followed by the IW (6/14) and antero-septum (4/14); while in SR, in the antero-septum (4/8), PW (3/8) and IW (3/8). Interestingly, in all patients both the PW/IW and (less dramatically) the antero-septum showed more “scarring” during AF as compared to SR. Conclusion: Areas of low voltage are more severe and diffuse during AF when compared to SR. When areas of low voltage are detected during AF, they are more commonly seen in the PW, IW and antero-septal areas.

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Abstract 1891: Mortality After CRT: a Synergetic Effect Between Ventricular Remodeling and Reduced Frequency of Ventricular Arrhythmias. The InSync ICD Italian Registry

Circulation ◽

10.1161/circ.116.suppl_16.ii_406 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Luigi Di Biase ◽

Maurizio Gasparini ◽

Maurizio Lunati ◽

Massimo Santini ◽

S. Filippo Neri ◽

...

Keyword(s):

Ventricular Arrhythmias ◽

Ventricular Remodeling ◽

Synergetic Effect ◽

Cardiac Resynchronization ◽

Reverse Remodeling ◽

Term Survival ◽

Group 2 ◽

Group 1

Introduction: It is currently debated whether cardiac resynchronization therapy (CRT) has an effect on the burden of ventricular arrhythmias (VA). We investigated whether the reverse remodeling after CRT may reduce the occurrence of VA. Methods : The study included 398 patients enrolled in the InSync ICD Italian Registry, treated with CRT-D and with a follow-up of at least 12 months. Spontaneous VA detected by the device were reviewed and validated. Results: After 6 months of follow-up no VA episodes occurred in 319 patients (group 1), while VA episodes persisted in the remaining 79 (group 2). At baseline, clinical and echocardiographic characteristics of the two groups were comparable: NYHA class (2.9±0.6 vs. 3.0±0.7), QRS width (166±31ms vs. 163±34ms), ejection fraction (26±7% vs. 26±6%), LVEDV (251±98ml vs. 226±45ml), LVESV (182±84ml vs. 158±38ml) (All p=NS). At 6 month visit, ventricular remodeling was apparent only in group 2 pts: LVEDV (200±83ml, p=0.042 vs. Baseline), LVESV (133±65ml, p=0.002 vs. Baseline). No changes were evident in group 2 pts: LVEDV (216±69ml, p=0.769 vs. Baseline), LVESV (160±59ml, p=0.521 vs. Baseline). The long-term survival from all-cause death resulted higher in group 1 pts (Log-rank test: p=0.032). (Figure ) Conclusions: In patients treated with CRT, a reduction of ventricular arrhythmic events occurs during the initial 12 months following implant and is correlated with the degree of ventricular remodeling induced by the therapy. Patients demonstrating the remission of arrhythmic episodes will have better survival and more pronounced long term improvements.

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Abstract 16480: Characteristics and Outcomes of Patients With Papillary Muscle Ventricular Arrhythmias

Circulation ◽

10.1161/circ.132.suppl_3.16480 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Carola Gianni ◽

Luigi Di Biase ◽

Sanghamitra Mohanty ◽

Chintan Trivedi ◽

Yalçin Gökoglan ◽

...

Keyword(s):

Pericardial Effusion ◽

Ventricular Arrhythmias ◽

Rf Ablation ◽

Crista Terminalis ◽

Remote Magnetic Navigation ◽

Standard Procedures ◽

Acute Success ◽

The One

Introduction: We sought to investigate the characteristics and outcomes of patients who underwent RF ablation of PM ventricular arrhythmias (VA) in our center. Results: 26 patients were included, median age was 66 years (16 to 85), 46% female, all with normal LVEF. PM VAs were PVCs in 68% patients, and PVC + VT in 32%. Site of origin was the LV infero-septal PM in 73%, LV antero-lateral PM in 15% and right ventricular RV septal PM in 12%. 46% of patients showed other VAs in addition to the one originating from the PMs; in 33% of these patients, additional VAs were 2 or more. These VAs were mostly PVCs (92%), localized in the LVOT (64% - 56 % in the basal LV and 44% in the aortic cusps) and the septal RVOT (36%). The only additional VT was fascicular. All the PMs and mappable additional VAs were ablated with RF energy through an irrigated catheter and the aid of ICE; a remote magnetic navigation system (RMS) was used in half of the procedures. In one case, PVC suppression required additional epicardial ablation. Major complications occurred in 2 patients (8%): 1 pericardial effusion (the patient underwent ablation of a crista terminalis premature atrial complex in the same procedure) and 1 pseudoaneurysm. Acute success (PM VA suppression/non-inducibility) was achieved in 96% of patients (the patient with pericardial effusion could be anticoagulated further and the procedure was stopped). After a median follow-up period of 8 (4-14) months, long-term success (no PM VT recurrence or PVC burden reduced by 80% off antiarrhythmic drugs) was 92% after a single procedure, 96% after repeat procedures. When considering additional VAs, the only recurrence was a parahisian RVOT PVC. No difference in acute or overall long-term success was observed when comparing RMS-guided vs standard procedures (respectively 92% vs 100 % and 100% vs 92%; P = NS). Conclusion: PM VAs are most commonly PVCs originating from the LV infero-septal PM and are frequently (48%) associated with an additional ventricular focus (LVOT > RVOT >> fascicular VT). RF ablation is safe and effective in eliminating or significantly reduce the burden of PM VAs, as well the extra-PM foci that are commonly encountered in this population. RMS guided ablation is not inferior to standard ablation in this subset of patients.

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Impact of ventricular arrhythmias on survival in patients after myocardial infarction

International Journal of Diagnostic Imaging ◽

10.5430/ijdi.v1n1p21 ◽

2014 ◽

Vol 1 (1) ◽

pp. 21 ◽

Cited By ~ 1

Author(s):

Katarzyna Anna Mitręga ◽

Agnieszka Kolczyńska ◽

Joanna Hanzel ◽

Sylwia Cebula ◽

Stanisław Morawski ◽

...

Keyword(s):

Myocardial Infarction ◽

Risk Factor ◽

Ventricular Arrhythmias ◽

Independent Risk Factor ◽

Premature Ventricular Beats ◽

Large Numbers ◽

Ventricular Extrasystoles ◽

Long Term Follow Up

Introduction: Despite the continuous development of new methods of pharmacological and invasive treatment for patients with acute myocardial infarction (MI) the prognosis of long-term survival is still uncertain. Therefore, there is still need to look for new noninvasive predictors of death in patients after MI. Aim: To analyze the prognostic value of ventricular arrhythmias in predicting mortality following MI in long-term follow-up. Methods: We analyzed 390 consecutive patients (114 females and 276 males, aged 63.9 ± 11.15 years, mean EF: 43.8 ± 7.9%) with MI treated invasively. On the 5th day after MI 24-hour digital Holter recording was performed to assess the number of premature ventricular beats (VPB) and their sustained forms such as: salvos and nonsustained ventricular tachycardia (nsVT < 30 s). The large numbers of ventricular extrasystoles: ≥ 10 VPB / hour were considered as abnormal. In echocardiography the size of heart cavities and cardiac contractile function were evaluated. Within 30.1 ± 15.1 months of follow-up 38 patients died. Results: In the group of patients with MI the mean value of ventricular ectopy during the day was: 318.8 ± 1447.6. Large numbers of ventricular extrasystoles were observed in 75% patients, while nsVT in 6% patients. Significant differences in the incidence of death after MI were observed in patients with nsVT and ventricular salvos. In the group of patients who died in comparison to the group of patients who survived in long-term follow-up, a significantly less ventricular ectopic incidence was noted (9.83% vs 90.17%, p < 0.01). In patients who died after MI more premature ventricular beats (≥ 10 VPB / h) and a greater nsVT incidence were observed; however not significant. Moreover, in patients with MI the systolic and diastolic LV dimension, decreased values of hemoglobin, salvos and nsVT incidence are the independent risk factors of death. The strongest independent risk factor of death after MI is salvos (HR: 1.32, P < 0.01). Conclusions: In long term follow-up the largest differences in death were observed in patients with ventricular salvos and nsVT. Furthermore, ventricular salvos are the strongest independent risk factor of death in patients with AMI.

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P337Natural history, reversibility and arrhythmias associated with truncating titin variants in dilated cardiomyopathy

European Heart Journal ◽

10.1093/eurheartj/ehz747.0171 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C R Vissing ◽

T B Rasmussen ◽

M S Olesen ◽

L N Pedersen ◽

A Dybro ◽

...

Keyword(s):

Dilated Cardiomyopathy ◽

Medical Therapy ◽

Ventricular Arrhythmias ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Reverse Remodeling ◽

Absolute Increase ◽

The Mean

Abstract Background Truncating genetic variants in titin (TTNtv) are identified in 15–25% of patients with primary dilated cardiomyopathy (DCM). Previous genotype/phenotype studies have reported conflicting results regarding disease severity and pathologic features associated with TTNtv. Purpose To investigate the natural history, reversibility and burden of arrhythmias associated with TTNtv in a Danish cohort with long-term follow-up. Methods Patients with DCM, recruited from two Danish tertiary centers, were included based on the presence of a TTNtv in a cardiac expressed titin exon. Data on patients' medical history including symptoms, demography, family history, comorbidities, treatment, ECG features, and echocardiograms were registered. Outcome data including all-cause mortality, need of heart transplantation (HTX) or left ventricular assist device (LVAD), and presence of ventricular and supraventricular arrhythmias were registered. Left ventricular reverse remodeling (LVRR) was defined as an absolute increase in left ventricular ejection fraction (LVEF) ≥10% points or normalization. Results A total of 104 patients (71 men, 69%; 72 probands) with definite TTNtv-DCM were included. The mean age at DCM diagnosis was (mean±SD) 45±13 years (43±13 for men; 49±14 for women, p<0.04) and median follow-up was 8.1 years. The mean LVEF was 28±13% at time of diagnosis (26±12% for men; 30±13% for women, p=0.173). During follow-up, 31 patients (30%; 24 men) died or needed HTX/LVAD. Medical therapy was associated with LVRR in 79% of patients 3.6 years after diagnosis. LVRR was maintained long-term in 64% of patients. Women had a better response to medical therapy compared to men (mean LVEF increase 19%; vs 15% in men, p<0.04). Atrial fibrillation/flutter was observed in 40% of patients and ventricular arrhythmias in 23% of patients. Men had an earlier occurrence of both supraventricular and ventricular arrhythmias (p=0.005) with half of the men having experienced an arrhythmia at the age of 54 years. Freedom from arrhythmias with age Conclusion TTNtv leads to a DCM phenotype associated with a marked gender-difference in age at DCM diagnosis and high burden of both supraventricular and ventricular arrhythmias. Importantly, the DCM-TTNtv phenotype was associated with a high degree of reversibility of systolic function following medical therapy.

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