Relationship of Arrhythmogenic Substrate and Frequent Ventricular Extrasystoles in Patients with Nonischemic Cardiomyopathy

Here we report the case of a 31-year-old man admitted to our hospital with echocardiografic and Cardiac Magnetic Resonance signs of myocarditis complicated by ventricular tachycardia, initially resolved with direct current shock. After the recurrence of ventricular tachycardia the patient was submitted to electrophysiological study revealing a re-entrant circuit at the level of the medium segment of interventricular septum, successfully treated with transcatheter ablation. This case highlights how the presence of recurrent ventricular arrhythmias at the onset of acute myocarditis, suspected or proven, could be associated with a pre-existing arrhythmogenic substrate, therefore these patients should be submitted to electrophysiological study in order to rule out the presence of arrhythmogenic focuses that can be treated with transcatheter ablation.

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Ventricular Arrhythmias

10.2310/im.1075 ◽

2020 ◽

Author(s):

Roy M. John ◽

William G Stevenson

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Catheter Ablation ◽

Sudden Death ◽

Ventricular Arrhythmias ◽

Left Ventricular ◽

Polymorphic Ventricular Tachycardia ◽

Left Ventricular Ejection ◽

Premature Ventricular Contractions ◽

Increased Risk

Ventricular arrhythmias are common in all forms of heart disease and are an important cause of cardiac arrest and sudden death. Many ventricular arrhythmias are benign but may serve as a marker for underlying disease or its severity. Others are life threatening. The significance of an arrhythmia is determined by the specific characteristics of the arrhythmia and the associated heart disease, and these features guide evaluation and therapy. This review discusses various mechanisms and types of ventricular arrhythmias and management based on clinical presentation (including patients with symptomatic arrhythmia and increased risk of sudden death without arrhythmia symptoms). Genetic arrhythmia syndromes, such as abnormalities of repolarization and the QT interval, catecholaminergic polymorphic ventricular tachycardia (VT), and inherited cardiomyopathies, are discussed in depth. Under the rubric of management of ventricular arrhythmias, drug therapy for ventricular arrhythmias, implantable cardioverter-defibrillators (ICDs), and catheter ablation for VT are also covered. Tables chart out guideline recommendations for ICD therapy, drugs for the management of ventricular arrhythmias, and indications and contraindications for catheter ablation of ventricular arrhythmias. Electrocardiograms are provided, as well as management algorithms for ventricular arrhythmias based on patient presentation, and an algorithm for identifying patients with systolic heart failure and left ventricular ejection less than or equal to 35% who are candidates for consideration of an ICD for primary prevention of sudden cardiac death. This review contains 5 figures, 8 tables, and 61 references. Keywords: Ventricular arrhythmias, implanted cardioverter-defibrillator (ICD), Ventricular tachycardia (VT), Premature Ventricular Contractions (PVC), Myocardial Infarction (MI), Brugada syndrome, Arrhythmogenic right ventricular cardiomyopathy (ARVC), electrocardiographic (ECG)

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Ventricular Arrhythmias

10.2310/fm.1075 ◽

2020 ◽

Author(s):

Roy M. John ◽

William G Stevenson

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Catheter Ablation ◽

Sudden Death ◽

Ventricular Arrhythmias ◽

Left Ventricular ◽

Polymorphic Ventricular Tachycardia ◽

Left Ventricular Ejection ◽

Premature Ventricular Contractions ◽

Increased Risk

Ventricular arrhythmias are common in all forms of heart disease and are an important cause of cardiac arrest and sudden death. Many ventricular arrhythmias are benign but may serve as a marker for underlying disease or its severity. Others are life threatening. The significance of an arrhythmia is determined by the specific characteristics of the arrhythmia and the associated heart disease, and these features guide evaluation and therapy. This review discusses various mechanisms and types of ventricular arrhythmias and management based on clinical presentation (including patients with symptomatic arrhythmia and increased risk of sudden death without arrhythmia symptoms). Genetic arrhythmia syndromes, such as abnormalities of repolarization and the QT interval, catecholaminergic polymorphic ventricular tachycardia (VT), and inherited cardiomyopathies, are discussed in depth. Under the rubric of management of ventricular arrhythmias, drug therapy for ventricular arrhythmias, implantable cardioverter-defibrillators (ICDs), and catheter ablation for VT are also covered. Tables chart out guideline recommendations for ICD therapy, drugs for the management of ventricular arrhythmias, and indications and contraindications for catheter ablation of ventricular arrhythmias. Electrocardiograms are provided, as well as management algorithms for ventricular arrhythmias based on patient presentation, and an algorithm for identifying patients with systolic heart failure and left ventricular ejection less than or equal to 35% who are candidates for consideration of an ICD for primary prevention of sudden cardiac death. This review contains 5 figures, 8 tables, and 61 references. Keywords: Ventricular arrhythmias, implanted cardioverter-defibrillator (ICD), Ventricular tachycardia (VT), Premature Ventricular Contractions (PVC), Myocardial Infarction (MI), Brugada syndrome, Arrhythmogenic right ventricular cardiomyopathy (ARVC), electrocardiographic (ECG)

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Catheter Ablation of Ventricular Tachycardia in LMNA Cardiomyopathy: Out of Sight but not Out of Mind

10.22541/au.162605915.53218041/v1 ◽

2021 ◽

Author(s):

Ahmad Halawa ◽

Paul Zei ◽

Neal Lakdawala ◽

William Sauer ◽

Usha Tedrow ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Success Rate ◽

Ventricular Arrhythmias ◽

Cycle Length ◽

Electrical Storm ◽

Arrhythmogenic Substrate ◽

Ablation Success ◽

Endocardial Mapping ◽

Activation Mapping

Lamin Cardiomyopathy (LC) is associated with refractory ventricular arrhythmias. Catheter ablation success rate is low due to presence of multiple circuits and intramural substrate. We present a LC case presented with electrical storm. During catheter ablation, arrhythmia was easily inducible but activation mapping, including full epicardial and endocardial mapping, failed to demonstrate the full tachycardia cycle length (70% only) suggesting intramural activation. Critical isthmus was not identified even with successful concealed entrainment on both Endo/epicardial surfaces. This case shows that even combined endocardial and epicardial catheter approach can be ineffective in identifying the full arrhythmogenic substrate in LC.

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Catheter Ablation of Life-Threatening Ventricular Arrhythmias in Athletes

Medicina ◽

10.3390/medicina57030205 ◽

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.

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Point ablation for macro-reentrant ventricular tachycardia associated with Ebstein’s anomaly and pulmonary atresia: a case report

Cardiology in the Young ◽

10.1017/s1047951120003820 ◽

2020 ◽

pp. 1-3

Author(s):

Keiko Toyohara ◽

Yasuko Tomizawa ◽

Morio Shoda

Keyword(s):

Ventricular Tachycardia ◽

Case Report ◽

Catheter Ablation ◽

Right Ventricle ◽

Low Voltage ◽

Pulmonary Atresia ◽

Ebstein’S Anomaly ◽

Ebstein's Anomaly ◽

Slow Conduction ◽

Hypoplastic Right Ventricle

Abstract We report a case with Ebstein’s anomaly and pulmonary atresia with sustained monomorphic ventricular tachycardia in a patient without a ventriculotomy history. In the low voltage area between the atrialised right ventricle and hypoplastic right ventricle, there was a ventricular tachycardia substrate and slow conduction. The tachycardia circuit was eliminated by a point catheter ablation at the area with diastolic fractionated potentials.

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Ventricular tachycardia ablation in nonischemic cardiomyopathy

EP Europace ◽

10.1093/europace/euab116.362 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

D Nascimento Matos ◽

D Cavaco ◽

P Carmo ◽

MS Carvalho ◽

G Rodrigues ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Left Ventricular ◽

Scientific Development ◽

Left Ventricular Ejection ◽

Drug Resistant ◽

Nonischemic Cardiomyopathy ◽

Epicardial Ablation ◽

Ventricular Ejection Fraction ◽

Ventricular Tachycardia Ablation

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Catheter ablation outcomes for drug-resistant ventricular tachycardia (VT) in nonischemic cardiomyopathy (NICM) are suboptimal when compared to ischemic cardiomyopathy. We aimed to analyse the long-term efficacy and safety of percutaneous catheter ablation in this subset of patients. METHODS Single-center observational retrospective registry including consecutive NICM patients who underwent catheter ablation for drug-resistant VT during a 10-year period. The efficacy endpoint was defined as VT-free survival after catheter ablation, while safety outcomes were defined by 30-days mortality and procedure-related complications. Independent predictors of VT recurrence were assessed by Cox regression. RESULTS In a population of 68 patients, most were male (85%), mean left ventricular ejection fraction (LVEF) was 34 ± 12%, and mean age was 58 ± 15 years. All patients had an implantable cardioverter-defibrillator. Twenty-six (38%) patients underwent epicardial ablation (table 1). Over a median follow-up of 3 years (IQR 1-8), 41% (n = 31) patients had VT recurrence and 28% died (n = 19). Multivariate survival analysis identified LVEF (HR= 0.98; 95%CI 0.92-0.99, p = 0.046) and VT storm at presentation (HR = 2.38; 95%CI 1.04-5.46, p = 0.041) as independent predictors of VT recurrence. The yearly rates of VT recurrence and overall mortality were 21%/year and 10%/year, respectively. No patients died at 30-days post-procedure, and mean hospital length of stay was 5 ± 6 days. The complication rate was 7% (n = 5, table 1), mostly in patients undergoing epicardial ablation (4 vs 1 in endocardial ablation, P = 0.046). CONCLUSION LVEF and VT storm at presentation were independent predictors of VT recurrence in NICM patients after catheter ablation. While clinical outcomes can be improved with further technical and scientific development, a tailored endocardial/epicardial approach was safe, with low overall number of complications and no 30-days mortality. Abstract Figure.

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

Circulation ◽

10.1161/circ.132.suppl_3.16668 ◽

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.

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