Catheter ablation of Idiopathic Ventricular Arrhythmias in Nepal-5 Years Single Centre Experience

Background and Aims: Idiopathic ventricular arrhythmia (IVAs) is defined as premature ventricular complexes (PVCs), nonsustained ventricular tachycardia or sustained ventricular tachycardia (VT) in the absence of obvious structural heart disease. Catheter ablation has become an established treatment strategy for wide varieties of idiopathic ventricular arrhythmias. The aim of this study is to report the efficacy and safety of catheter ablation of idiopathic ventricular arrhythmias, for the first time in Nepal. Methods: This is a retrospective observational descriptive study of all patients who underwent electrophysiological study and radiofrequency catheter ablation for IVAs from March, 2015 to February 2020 at Shahid Gangalal National Heart center (SGNHC). Results: Altogether 101 patients underwent an EP study with intent to ablations for idiopathic ventricular arrhythmias. In 13 patients, ventricular arrhythmias were not present on the procedure day and also could not be induced in the lab, therefore ablation was performed in 88 patients only. RVOT was the most common site of these arrhythmias comprising 51% of all cases, followed by fascicular VT (34%) and basal left ventricular IVAs (15%). Out of 88 patients, the acute success of 7 patients could not be assessed because of very infrequent PVCs. Out of remaining 81 patients, acute success achieved in 77 patients (95%). Recurrence occurred in 9 patients (10.7%) and 4 patients underwent repeat ablation giving rise to over clinical success during follow up in 78 patients (88.7%). There were two major complications, one pulmonary embolism and another cardiac tamponade both managed successfully. Conclusion: This single-center single operator study demonstrates that catheter ablation of idiopathic ventricular arrhythmias has a high success and low complication rate

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Minimising radiation exposure in catheter ablation of ventricular arrhythmias

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02120-4 ◽

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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Outcomes of pre-emptive and rescue use of percutaneous left ventricular assist device in patients with structural heart disease undergoing catheter ablation of ventricular tachycardia

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-016-0168-8 ◽

2016 ◽

Vol 48 (1) ◽

pp. 27-34 ◽

Cited By ~ 38

Author(s):

Nilesh Mathuria ◽

Geru Wu ◽

Francia Rojas-Delgado ◽

Mossaab Shuraih ◽

Mehdi Razavi ◽

...

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Catheter Ablation ◽

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Structural Heart Disease ◽

Left Ventricular ◽

Assist Device ◽

Ventricular Assist ◽

Left Ventricular Assist

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Brugada syndrome: A brand new case

Vojnosanitetski pregled ◽

10.2298/vsp0908667j ◽

2009 ◽

Vol 66 (8) ◽

pp. 667-670

Author(s):

Ruzica Jurcevic ◽

Lazar Angelkov ◽

Dejan Vukajlovic ◽

Velibor Ristic ◽

Milosav Tomovic ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Ventricular Fibrillation ◽

Brugada Syndrome ◽

Electrophysiological Study ◽

Structural Heart Disease ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Type I ◽

Ventricular Ejection Fraction ◽

St Segment Elevation

Background: Brugada syndrome (BS) is a disorder characterized by syncope or sudden death associated with one of several electrocardiographic (ECG) patterns characterized by incomplete right bundle branch block and ST elevation in the anterior precordial leads. Patients with BS are prone to develop ventricular tachyarrhythmias that may lead to syncope, cardiac arrest, or sudden cardiac death. Case report. A 58-year-old woman is the first described case of Brugada syndrome in Serbia with intermittent typical changes in basic electrocardiography (ECG): ST segment elevation in the precordial chest leads like dome or coved - major form or type I. For the last 27 years the patient had suffered of palpitations and dizziness, without syncopal events. Her sister had died suddenly during the night in sleep. During 24-hour Holter monitoring the patient had ventricular premature beats during the night with R/T phenomenon and during the recovery phase of exercise testing had rare premature ventricular beats as the consequence of parasympatethic stimulation. Late potentials were positive. Echocardiography revealed left ventricular ejection fraction of 60%. We performed coronary angiography and epicardial coronary arteries were without significant stenosis and structural heart disease was excluded. In the bigining of the electrophysiological study ECG was normal, and after administration of Propaphenon i.v. Brugada syndrome unmasked with appearance of type I ECG pattern. A programed ventricular stimulation induced non sustained ventricular tachycardia. One-chamber implantable cardioverter defibrillator was implanted and the patient was treated with a combination od amiodarone and metoprolol per os. After one-year follow-up, there were no episodes of ventricular tachycardia and ventricular fibrillation. Conclusion. Brugada syndrome is a myocardial disorder which prognosis and therapy are related to presence of ventricular fibrillation or ventricular tachycardia. Electrophysiologicaly induced malignant ventricular disorders class I are indication for implantation of cardioverter defibrilator, as also occurred in presented patient.

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Kamrai tachycardiák katéterablatiós kezelése

Orvosi Hetilap ◽

10.1556/650.2015.30167 ◽

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.

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Role of Electrophysiological Study and Catheter Ablation for Recurrent Ventricular Tachycardia Complicating Myocarditis

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2015.63 ◽

2012 ◽

Vol 55 (2) ◽

pp. 96-99

Author(s):

Emanuele Cecchi ◽

Serena Fatucchi ◽

Elena Crudeli ◽

Cristina Giglioli

Keyword(s):

Ventricular Tachycardia ◽

Cardiac Magnetic Resonance ◽

Catheter Ablation ◽

Ventricular Arrhythmias ◽

Acute Myocarditis ◽

Electrophysiological Study ◽

Interventricular Septum ◽

Arrhythmogenic Substrate ◽

Rule Out

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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Catheter Ablation for Ventricular Arrhythmias

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2013.2.1.45 ◽

2013 ◽

Vol 2 (1) ◽

pp. 45 ◽

Cited By ~ 2

Author(s):

Eyal Nof ◽

William G Stevenson ◽

Roy M John ◽

◽

...

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Catheter Ablation ◽

Ventricular Arrhythmias ◽

Structural Heart Disease ◽

Success Rates ◽

Effective Treatment Option ◽

Cardioverter Defibrillator ◽

Mapping Techniques ◽

Catheter Technology

Catheter ablation has emerged as an important and effective treatment option for many recurrent ventricular arrhythmias. The approach to ablation and the risks and outcomes are largely determined by the nature of the severity and type of underlying heart disease. In patients with structural heart disease, catheter ablation can effectively reduce ventricular tachycardia (VT) episodes and implantable cardioverter defibrillator (ICD) shocks. For VT and symptomatic premature ventricular beats that occur in the absence of structural heart disease, catheter ablation is often effective as the sole therapy. Advances in catheter technology, imaging and mapping techniques have improved success rates for ablation. This review discusses current approaches to mapping and ablation for ventricular arrhythmias.

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Association of age with clinical features and ablation outcomes of paroxysmal supraventricular tachycardias

Heart ◽

10.1136/heartjnl-2021-319685 ◽

2021 ◽

pp. heartjnl-2021-319685

Author(s):

Pablo Ávila ◽

David Calvo ◽

María Tamargo ◽

Aitor Uribarri ◽

Tomas Datino ◽

...

Keyword(s):

Catheter Ablation ◽

Clinical Features ◽

Electrophysiological Study ◽

Structural Heart Disease ◽

Continuous Variable ◽

Recurrence Rates ◽

Age Related ◽

Acute Success ◽

Supraventricular Tachycardias ◽

Relationship Of

ObjectiveThe role of age in clinical characteristics and catheter ablation outcomes of atrioventricular nodal re-entrant tachycardia (AVNRT) or orthodromic atrioventricular re-entrant tachycardia (AVRT) has been assessed in retrospective studies categorising age by arbitrary cut-offs, but contemporary analyses of age-related trends are lacking. We aimed to study the relationship of age with epidemiological, clinical features and catheter ablation outcomes of AVNRT and AVRT.MethodsWe recruited 600 patients (median age 56 years, 60% female) with a confirmed diagnosis of AVNRT (n=455) or AVRT (n=145) by means of an electrophysiological study. They were interrogated for arrhythmia-related symptoms with a structured questionnaire and followed up to 1 year. We analysed age as a continuous variable using regression models and adjusting for relevant covariables.ResultsBoth typical and atypical forms of AVNRT upraised with age while AVRT decreased (p<0.001 by regression). Female sex predominance in AVNRT was not observed in older patients. Overall, these tachycardias became more symptomatic with ageing despite a longer tachycardia cycle length (p<0.001) and regardless of the presence of structural heart disease, with a higher proportion of dizziness, syncope, chest pain or dyspnoea (p<0.005 for all) and a lower presence of palpitations or neck pounding (p<0.001 for both). Age was not associated with catheter ablation acute success, periprocedural complications or 1-year recurrence rates (p>0.05 for all).ConclusionsAge, evaluated as a continuous variable, had a significant association with the clinical profile of patients with AVNRT and AVRT. Nevertheless, catheter ablation outcomes and complications were not significantly related to patients’ age.

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A 52-year-old woman with ventricular tachycardia

Heart ◽

10.1136/heartjnl-2018-313347 ◽

2018 ◽

Vol 104 (24) ◽

pp. 2025-2043 ◽

Cited By ~ 1

Author(s):

Ana Fidalgo ◽

Leticia Fernandez-Friera ◽

Jorge Solis

Keyword(s):

Heart Disease ◽

Ventricular Tachycardia ◽

Pulse Sequence ◽

Electrophysiological Study ◽

Structural Heart Disease ◽

Left Ventricular ◽

Left Ventricular Cavity ◽

List Type ◽

Oblique View ◽

Cardiovascular Mr

Clinical introductionA 52-year-old woman with shortness of breath and palpitations was referred to a cardiologist. A 24-hour Holter demonstrated high density (37%) of ventricular premature beats (VPBs) and long runs of non-sustained (eventually sustained) monomorphic ventricular tachycardia (VT) with the same morphology as several VPBs detected in a 12-lead ECG (figure 1A). A transthoracic echocardiogram was performed, and the patient’s evaluation was completed with a functional and gadolinium-enhanced cardiovascular MR (CMR) study (figure 1B,C) to assess structural heart disease. In a follow-up visit, an electrophysiological study (EPS) was performed to identify the origin of VPBs and VT (figure 1D).Figure 1(A) A 12-lead ECG. (B) Cine CMR-SSFP (steady-state-free-precession) sequence on a three-chamber view. (C) Inversion-recovery gradient echo CMR pulse sequence for delayed enhancement assessment. (D) Three-dimensional electroanatomic voltage mapping of the left ventricular cavity (cranial left anterior oblique view). CMR, cardiovascular MR.QuestionWhat is the most likely cause of VPBs and VT?Idiopathic VT in the absence of structural heart disease.Bileaflet mitral valve prolapse (MVP).Dilated cardiomyopathy.Left ventricular non-compaction cardiomyopathy.Ischaemic cardiomyopathy.

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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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