scholarly journals Predictors of VT recurrence in patients with VT inducibility at the end of radiofrequency ablation: Should we use VT non-inducibility as a routine endpoint?

2021 ◽  
Author(s):  
Kazutaka Nakasone ◽  
Koji Fukuzawa ◽  
Kunihiko Kiuchi ◽  
Mitsuru Takami ◽  
jun sakai ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Ventricular Tachycardia ◽  
Radiofrequency Ablation ◽  
Primary Endpoint ◽  
Rf Ablation ◽  
End Point ◽  
Vt Ablation

Introduction: It has been reported that ventricular tachycardia (VT) non-inducibility at the end of ablation is associated with less likely VT recurrence. However, it is not clear whether we should use VT non-inducibility as routine end point in VT ablation. The aim of this study was to evaluate VT recurrence in patients in whom VT non-inducibility could not be achieved at the end of the RF ablation and the factors attributing to the VT recurrence. METHODS and RESULTS: We analyzed 84 consecutive patients that underwent RF ablation, and 64 patients in whom VT non-inducibility could not be achieved were studied. The primary endpoint was recurrence of any sustained VT during the follow-up. During a median follow-up period of 1.4 years (IQR:0.3-2.0), 22 (34%) of the cases had VT recurrences. In the multivariate analysis showed that an LVEF≥35% (HR:0.21; 95% CI:0.07- 0.54; P<0.01) and successful identification and ablation of all clinical VT isthmuses (HR:0.21; 95% CI:0.03- 0.72; P=0.01) were independent predictors of fewer VT recurrences. RF ablation was associated with a 91.1% reduction in VT episodes. CONCLUSION: Even if VT non-inducibility could not be achieved, the patients with LVEF≥35% or in whom all clinical VT isthmuses could successfully be identify and ablated might be prevented from having VT recurrences. The validity of VT non-inducibility of any VT should be evaluated by each patient’s background and the results of the procedure.

P1018Evolution of atrioventricular conduction disorders after TAVI

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Irles ◽  
F Salerno ◽  
R Cassagneau ◽  
R Eschallier ◽  
C Maupain ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Primary Endpoint ◽  
Univariate Analysis ◽  
P Value ◽  
Conduction Disorders ◽  
Av Conduction ◽  
One Year ◽  
The One ◽  
Valve Implantation

Abstract Background The evolution of atrioventricular block (AVB) after Trans Aortic Valve Implantation (TAVI) is poorly understood, and indications of pacemaker (PM) implantation after TAVI not well defined. Modern PM algorithms can help studying the evolution of these AV conduction disorders after TAVI. SafeR® mode (Sorin® PM) allows to monitor precisely the AV conduction and to store AVB episodes in the PM memory as intracardiac electrograms, which can be re-read and validated afterwards. Methods From November 2015 and January 2017, all patients implanted in one of the 19 French enrolling centers with a Sorin® PM set in SafeR® mode after TAVI could be prospectively included in the study. All the PM interrogation files were centrally collected. The primary endpoint (PE) was the presence of at least one episode of high grade AVB (HG-AVB) beyond day 7 (D7) to one year after the TAVI. It could be validated either by the presence of a HG-AVB on EKG or telemetry, or by the confirmation of a HG-AVB in the PM memory files. Results 273 patients were included in the study, the PE was assessable in 197 patients. PE was validated in 74.6% patients. In univariate analysis, the use of an oversized prothesis or balloon, and all early episodes of HG-AVB (all those occurring up to D7) influence the validation of the PE. Other AV conduction disorders have no influence on the PE (Table). In multivariate analysis, only HG-AVB occurring between D2 and D7 has a significant influence on the PE. Factors influencing HG-AVB after TAVI Studied factor HG-AVB episode(s) during the one year follow up No HG-AVB episode during the one year follow up p value RBBB before TAVI (%) 41 34 0,346 Low implantation (>6mm) (%) 59 37 0,156 Use of Autoexpansive Valve (%) 62 62 0,990 Oversizing (%) 19 6 0,022 HG-AVB per TAVI (%) 56 30 0,001 HG-AVB D0-D1 (%) 53 24 0,001 HG-AVB D2-D7 (%) 68 34 0,001 New or wiser LBBB and improvement of PR interval after TAVI (%) 30 39 0,253 Influence of predefined factors on the Primary Endpoint. Conclusion The analysis of the SafeR® algorithm files in patients implanted with a PM after TAVI show a high incidence of HG-AVB during the one year follow up. In multivariate analysis, only HG-AVB occurring between D2 and D7 significantly influence the PE, confirming that AV conduction disorders occurring during the first 24 hours may spontaneously normalize. Acknowledgement/Funding Microport CRM

scholarly journals Idiopathic ventricular tachycardia in children: curative therapy with radiofrequency ablation

Medicina ◽  
2007 ◽  
Vol 43 (10) ◽  
pp. 803 ◽  
Author(s):  
Dalia Bakšienė ◽  
Rima Šileikienė ◽  
Vytautas Šileikis ◽  
Tomas Kazakevičius ◽  
Vytautas Zabiela ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Radiofrequency Ablation ◽  
Therapeutic Option ◽  
Age At Onset ◽  
Rare Condition ◽  
Ablation Therapy ◽  
Curative Therapy ◽  
Idiopathic Ventricular Tachycardia ◽  
Mapping Technology

Idiopathic ventricular tachycardia is a rare condition, and there is a lack of clear guidelines for the necessity and indications for prophylactic antiarrhythmic or curative treatment. The aim of this study was to review the clinical picture of idiopathic ventricular tachycardia and evaluate the efficacy and safety of radiofrequency ablation therapy in children. Material and methods. The subjects of this study were 16 children with idiopathic ventricular tachycardia. The mean age at onset of idiopathic ventricular tachycardia was 12 years. All patients underwent electrophysiological examination. Nonfluoroscopic mapping technology (CartoTM) was used in one case. Radiofrequency ablation was performed in all children (mean duration of follow-up was 46 months). Results. Six children with idiopathic ventricular tachycardia were free of symptoms. Palpitation was the only complain in four patients, and six patients presented with symptoms of circulatory disorder (the tendency of the higher rate of ventricular tachycardia and more premature contractions and episodes of ventricular tachycardia in one day were noticed in five of them). All children after radiofrequency ablation were alive, and only one complication (complete right bundle branch block) occurred. Success at last follow-up included five children with left and six with right idiopathic ventricular tachycardia. Conclusions. Catheter ablation seems a promising therapeutic option with the outlook possible of the idiopathic ventricular tachycardia in children. It is safe enough and should be considered as the therapy of choice even in children without of symptoms if they wish to live active social and physical life.

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 &lt;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.

Endoscopic ultrasound-guided radiofrequency ablation for pancreatic neuroendocrine tumors and pancreatic cystic neoplasms: a prospective multicenter study

Endoscopy ◽  
2019 ◽  
Vol 51 (09) ◽  
pp. 836-842 ◽  
Author(s):  
Marc Barthet ◽  
Marc Giovannini ◽  
Nathalie Lesavre ◽  
Christian Boustiere ◽  
Bertrand Napoleon ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Neuroendocrine Tumors ◽  
Endoscopic Ultrasound ◽  
Multicenter Study ◽  
Cystic Neoplasm ◽  
Pancreatic Neuroendocrine Tumors ◽  
Prospective Multicenter Study ◽  
End Point ◽  
Mean Size

Abstract Background Pancreatic neuroendocrine tumors (NETs) and intraductal pancreatic mucinous neoplasia (IPMN) with worrisome features are surgically managed. Endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) has recently been developed. The safety of EUS-RFA was the primary end point of this study, its efficacy the secondary end point. Methods This was a prospective multicenter study that was planned to include 30 patients with a 1-year follow-up with either a NET < 2 cm or a pancreatic cystic neoplasm (PCN), either a branch duct IPMN with worrisome features or a mucinous cystadenoma (MCA). EUS-RFA was performed with an 18G RFA cooling needle. Results 12 patients had 14 NETs (mean size 13.1 mm, range 10 – 20 mm); 17 patients had cystic tumors (16 IPMNs, 1 MCA; mean size 28 mm, range 9 – 60 mm). Overall three adverse events occurred (10 %), two of these in the first two patients (one pancreatitis, one small-bowel perforation). After these initial patients, modifications in the protocol resulted in a decrease in complications (3.5 %), with one patient having a pancreatic ductal stenosis. Among the 14 NETs, at 1-year follow-up 12 had completely disappeared (86 % tumor resolution), with three patients having a delayed response. Among the 17 PCNs, at 12 months, there were 11 complete disappearances and one diameter that decreased by > 50 % (significant response rate 71 %). All 12 mural nodules showed complete resolution. Conclusions EUS-RFA of pancreatic NETs or PCNs is safe with a 10 % complication rate, which can be decreased by improved prophylaxis for the procedure.

Percutaneous radiofrequency ablation of inoperable pulmonary metastases from colorectal cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 3502-3502
Author(s):  
T. D. Yan ◽  
J. King ◽  
D. Glenn ◽  
K. Steinke ◽  
D. L. Morris
Keyword(s):  
Colorectal Cancer ◽  
Multivariate Analysis ◽  
Radiofrequency Ablation ◽  
Lung Metastasis ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Univariate Analysis ◽  
Prognostic Parameters ◽  
Percutaneous Radiofrequency Ablation

3502 Background: This current study was an open, prospective and nonrandomized phase II study, which critically evaluated the prognostic parameters for local disease-free survival (DFS) and overall survival (OS) in patients who underwent percutaneous radiofrequency ablation (RFA) for inoperable colorectal pulmonary metastases (CRPM). Methods: The inclusion criteria were patients who had inoperable CRPM, due to number, distribution, poor performance status or patients’ refusal to accept surgery. The exclusion criteria were lesions > 6 per hemithorax; diameter of metastases > 5 cm; bleeding diathesis; and/or significantly compromised lung function. All patients underwent percutaneous RFA with a radiological clear margin of at least 2 cm. The end-points of this study were local DFS and OS, determined from the time of RFA intervention. Ten clinical and six treatment-related prognostic parameters were assessed in univariate and multivariate analyses. All patients were reviewed at one week, one month and every three months thereafter with chest CT. Fifty-five patients entered into the study. The follow-up was complete and the median follow-up was 24 months (6 to 40). Results: The median local DFS was not reached and 2-year local DFS was 57%. Univariate analysis demonstrated that largest size of lung metastasis, location of lung metastases, post-RFA CEA at 1 month and 3 months were significant for local DFS. In multivariate analysis, largest size of lung metastasis of ≤ 3 cm and post-RFA CEA of ≤ 5 ng/ml at 1 month were independently associated with an improved local DFS. The median OS was 33 months (4 to 40), with 1-, 2-, and 3-year survival of 85%, 64% and 46%, respectively. Univariate analysis demonstrated that interval between the diagnoses of colorectal cancer and pulmonary metastasis; largest size of lung metastasis and location of lung metastases were significant for OS. In multivariate analysis, only size of lung metastasis of ≤ 3 cm was independently associated with an improved OS. Conclusions: Percutaneous RFA of inoperable CRPM may have a useful role in patients with a lesion of ≤ 3 cm. No significant financial relationships to disclose.

P960Non-inducible ventricular arrhythmia soon after ventricular tachycardia ablation predicts long-term recurrence in patients with reduced ejection fraction

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M K Kiyokuni ◽  
M N Narikawa ◽  
T K Kino ◽  
Y T Taguchi ◽  
S M Miyagawa ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ejection Fraction ◽  
Ventricular Arrhythmia ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Risk Factors ◽  
Rf Ablation ◽  
Vt Ablation ◽  
First Time

Abstract Introduction Radiofrequency (RF) ablation for ventricular arrhythmia in patients with reduced left ventricular ejection fraction (LVEF) is recognized to be one of the important strategies for suppressing the fatal arrhythmia events. Although, RF ablation for those patients has been performed for decades, the optimal endpoint remains unclear. Hypothesis We assessed the hypothesis that non-inducibility of any ventricular tachycardia (VT) or ventricular fibrillation (VF) immediately after VT ablation predicts long-term recurrence free rate of ventricular arrhythmia in patients who were diagnosed sustained VT with reduced LVEF.  Methods From January 2014 to August 2019, we conducted a single center retrospective analysis for 127 consecutive patients with right or left ventricular arrhythmia who performed the first time RF ablation. Exclusion criteria were LVEF &gt;50% and RF ablations for premature ventricular contraction or for non-sustained VT. Then 26 patients (age 69 ± 7, male 92%) were enrolled. All of the ablation procedures were performed using irrigated RF catheters and 3D mapping systems. We defined non-inducible group as the patients without monomorphic VT (clinical monomorphic VT or non-clinical monomorphic VT with any cycle length), polymorphic VT and VF by electrophysiological study (EPS) immediately after the ablation. The primary endpoint of this study was a recurrence of any sustained VT and VF during the follow up period. Results All of 26 patients were followed for a mean of 30.9 ± 22.3months.Of those patients, 7 patients were non-inducible group and 19 patients were inducible group. Age, sex, body mass index, coronary risk factors, LVEF (non-inducible:42 ± 5% vs inducible:35 ± 10%, p = 0.12), renal function and the etiology of LV dysfunction did not differ between patients with non-inducible group and inducible group (all non-significant). Catheter ablation procedural characteristics including activation mapping (non-inducible:29% vs inducible:36%, p = 1.00), entrainment mapping (14% vs 42%, p = 0.19), substrate mapping (86% vs 95%, p = 0.47), pace-mapping (86% vs 68%, p = 0.63), RF time (21 ± 13vs 18 ± 21min, p = 0.70), number of RF applications (27 ± 13vs 27 ± 32, p = 0.89), fluoroscopy time (77 ± 50vs 87 ± 42min, p = 0.59) and procedure time (309 ± 87vs 282 ± 61min, p = 0.37) did not differ between two groups. Medications before and after the VT ablation did not differ between two groups. The recurrence of any sustained VT and VF significantly lower in patients with non-inducible group than those with inducible group (Figure). Conclusion This study demonstrated that, in patients with reduced LVEF presenting sustained VT who performed RF ablation, non-inducibility of any VT and VF immediately after RF ablation predicts long-term decreased risk of recurrence of any sustained VT and VF. Not only clinical but also non-clinical VT and VF may be targeted as well at the first time VT ablation for those patients. Abstract Figure

Premature ventricular contraction-induced cardiomyopathy in children

2015 ◽  
Vol 26 (4) ◽  
pp. 711-717 ◽  
Author(s):  
Zebulon Z. Spector ◽  
Stephen P. Seslar
Keyword(s):  
Ventricular Tachycardia ◽  
Radiofrequency Ablation ◽  
Premature Ventricular Contraction ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Ventricular Contraction ◽  
Premature Ventricular Contractions ◽  
Multi Centre Study ◽  
History Of

AbstractBackgroundAdults with high premature ventricular contraction burden can develop left ventricular dilation, dysfunction, and strain, consistent with a cardiomyopathy, which is reversible with radiofrequency ablation of the premature ventricular contractions. Evidence in children with similar ectopy burden is limited. We performed a single-centre retrospective review to examine the prevalence of premature ventricular contraction-induced cardiomyopathy, natural history of ventricular ectopy, and progression to ventricular tachycardia in children with frequent premature ventricular contractions.MethodsChildren aged between 6 months and 18 years, with premature ventricular contractions comprising at least 20% of rhythm on 24-hour Holter monitor, were included in our study. Those with significant structural heart disease, ventricular tachycardia greater than 1% of rhythm at the time of premature ventricular contraction diagnosis, or family history of cardiomyopathy – except tachycardia-induced – were excluded. Cardiomyopathy was defined by echocardiographic assessment.ResultsA total of 36 children met the study criteria; seven patients (19.4%, 95% CI 6.2–32.6%) met the criteria for cardiomyopathy, mostly at initial presentation. Ectopy decreased to <10% of beats without intervention in 16.7% (95% CI 4.3–29.1%) of the patients. No patient progressed to having ventricular tachycardia as more than 1% of beats on follow-up Holter. Radiofrequency ablation was performed in three patients without cardiomyopathy.ConclusionsOur study demonstrates a higher prevalence of cardiomyopathy among children with high premature ventricular contraction burden than that previously shown. Ectopy tended to persist throughout follow-up. These trends suggest the need for a multi-centre study on frequent premature ventricular contractions in children. In the interim, regular follow-up with imaging to evaluate for cardiomyopathy is warranted.

scholarly journals P1578 The prognostic value of left ventricle longitudinal strain and cardiac biomarkers in asymptomatic patients with chronic severe aortic regurgitation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Verseckaite ◽  
D Vaiciuliene ◽  
J Laukaitiene ◽  
R Jonkaitiene ◽  
V Mizariene ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Left Ventricle ◽  
Aortic Regurgitation ◽  
Primary Endpoint ◽  
Longitudinal Strain ◽  
Cardiac Biomarkers ◽  
Optimal Timing ◽  
Severe Aortic Regurgitation ◽  
Asymptomatic Patients

Abstract Background Because of adaptive remodelling of the left ventricle (LV), patients with chronic severe aortic regurgitation (AR) can remain asymptomatic for prolonged periods. The main clinical challenge is to avoid irreversible damage to the myocardium and LV dysfunction, but the time of surgery should be such that the benefits of surgery outweigh the risks at that particular time. We aimed to evaluate the predictive value of global LV longitudinal strain (GLS) and natriuretic peptide in severe AR. Methods Comprehensive and 2D speckle tracking echocardiography was performed in 84 patients with severe AR. Patients were divided into the asymptomatic group (n = 56; 41 men; mean age 46.1 ± 15.4 years) and the group with indications for AV surgery (n = 28; 27 men; mean age 49.0 ± 14.3 years). Asymptomatic patients were followed for about 4.4 ± 2.4 years. The primary endpoint was to detect the development of HF symptoms, deterioration in the LVEF(≤50%) and/or severe LV dilatation (EDD &gt; 70mm or ESS &gt; 50mm). Results Patients with the need of AV surgery showed a significantly larger impairment in GLS and higher increase in the values of NT-proBNP compared to asymptomatic patients (-17.2 ± 2.6 vs. -19.1 ± 2.4%, and 149.4 [86.6–500] vs. 112.5 [45.3–180.8]pg/mL, P &lt; 0.05, resp.). Of the 56 patients who were initially asymptomatic, 49 patients were prospectively monitored. The primary endpoint was reached in 16 (33%) patients with AR. Despite the preserved LVEF at baseline, patients in need of AV surgery had lower GLS compared to those who remained stable while being monitored (-17.1 ± 2.3 vs. -20.1 ± 1.8%, P &lt; 0.05). The baseline levels of NT-proBNP were higher among patients who progressed to needing AV surgery in comparison to that in no need of AV surgery at follow-up (194 [135-421.8] vs. 75.9 [34.1-136.7]pg/ml, P &lt; 0.05). In multivariate analysis, GLS and NT-proBNP were independent predictors of AV surgery. ROC analysis showed that the probability of primary endpoint occurrence was greater in patients with GLS &gt;-18.5% (AUC:0.85, P &lt; 0.05) and NT-proBNP &gt;130pg/ml (AUC:0.81, P &lt; 0.05). Conclusion GLS and NT-proBNP may be used as independent prognostic predictors of optimal timing of operation in asymptomatic severe AR during follow-up. Multivariate analysis Variables OR (95% CI) P Age 0.97 (0.89-1.06) 0.54 LV ESD 1.02 (0.78-1.34) 0.87 LV EF 1.07 (0.74-1.56) 0.71 GLS 3.36 (1.09-10.36) 0.035 NT-proBNP 1.02 (1.0-1.04) 0.049

129Magnetic resonance predictors of ventricular tachycardia recurrence after radiofrequency substrate ablation: septal and transmural channels

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Quinto ◽  
F Alarcon ◽  
P Sanchez ◽  
P Garre ◽  
F Zaraket ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Tissue Characterization ◽  
Interventricular Septum ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Border Zone ◽  
Left Ventricle Mass ◽  
Vt Ablation ◽  
Lge Cmr

Abstract   Ventricular tachycardia (VT) substrate-based ablation has become a gold standard in patients with structural heart disease. Success of VT ablation is related with mortality reduction. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is a powerful technique to assess substrate of VT. Myocardial fibrosis is electrically inert (Core) but it is surrounded by a ‘‘border-zone (BZ)’’ where normal cardiomyocytes intermingle with dense bundles of fibrosis. Slow impulse conduction in the BZ allows for the re-entry circuits leading to VT. Both the presence and extent of LGE have been associated with VT and SCD risk. LGE-CMR tissue characterization can be depicted as pixel signal intensity (PSI) maps and can guide VT ablation. The aim of this study was to analyze possible VT recurrence predictors in a long term follow-up of patients that underwent VT ablation (endo and/or epicardial) related with LGE-CMR PSI maps. We analyzed 234 consecutive patients (age: 63.2 ± 14 years, follow-up: 3.14 years ±1.8) undergoing VT ablation with scar-dechannelling technique at a single center from 2013 to 2018.  110 patients underwent a preprocedural LGE-CMR, and in 94 patients (85,5%) a CMR-aided ablation using the PSI maps was performed. All LGE-CMR images were semi-automatically processed using a dedicated software. PSI-based algorithm was applied to characterize the hyperenhanced area as core or BZ, using fixed threshold of the maximum intensity. A LV 3D shell was obtained and were imported into the navigation system. In the PSI maps, heterogenous tissue channels were defined as a continuous corridor of BZ surrounded by scar core or an anatomic barrier that connects 2 areas of healthy tissue. Results Overall recurrence of VT was 41.8 %. There was ICD shock reduction, from 43,6% to a 28,2% (ICD shocks before ablation 2,23 ± 7,32, after: 1,10 ± 2,92). Left ventricle mass predicted significantly VT recurrence (Mean 168,3 ± 53,3 vs 152,3 ± 46,4 g, HR 1,02 [1,01-1,02], p &lt; 0.001). LGE distribuition was predictive of VT recurrence when a more than 40% of the interventricular septum was involved (62,5% vs 37,8%; HR 1,6 [1,01-1,02]; p = 0,044). No differences in recurrence were found among the patterns of LGE distribution (transmural/epicardial/subendocardial or peculiar segments localizations). The amount of BZ and the total amont of Core + BZ was related with VT recurrence (BZ 26,6 ± 13,9 vs 19,56 ± 9,69 g, HR 1,03 [1,01-1,06], p = 0,012; total Core + BZ 37,1 ± 18,2 vs 29,0 ± 16,3 g, HR 1,02 [1,00-1,04], p = 0,033). Finally VT recurrence was higher in patients with channels with transmural path (66,7% vs 31,4%, HR 3,25 [1,70-6,23], p &lt; 0,001) or midmural channels (54,3% vs 27,6%, HR 2,49 [1,21–5,13], p = 0,013). CMR-aided scar dechanneling is a helpful and feasible technique which could identify patients with high risk of VT recurrence. High left ventricular mass, septal LGE distribution, transmural and midmural heterogeneous tissue channels were predictive factors of post ablation VT recurrence. Abstract Figure. VTchannel & heterogeoneus tissue channel

scholarly journals Estimation of efficiency of epicardial radiofrequency ablation of anatomic zone ganglionic plexi in patients with coronary heart disease and atrial fibrillation

2015 ◽  
Vol 18 (1) ◽  
pp. 14
Author(s):  
A. M. Chernyavskiy ◽  
S. S. Rakhmonov ◽  
Yu. Ye. Kareva ◽  
Ye. A. Pokushalov ◽  
I. A. Pak
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Radiofrequency Ablation ◽  
Rf Ablation ◽  
Ablation Procedure ◽  
The Mean ◽  
Artery Disease

The results of epicardial radiofrequency ablation of anatomic zone ganglionic plexi of the left atrium during CABG of patients with coronary heart disease and atrial fibrillation are analyzed. From 2009 to 2012 RF ablation procedure was performed in 92 patients with atrial fibrillation and coronary artery disease. Depending on the form of AF the patients were randomized into three groups. The mean follow-up was 14.49.6 months (from 3 до 36 months). Freedom from AF during 24 months after surgery was 78.6% for patients with paroxysmal AF, 42.5% for patients with persistent AF and 39% for patients with long-term persistent AF.

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