Catheter Ablation for Ventricular Tachycardia after failed Endocardial Ablation - Epicardial Substrate or Inappropriate Endocardial Ablation?
Summary of "Catheter Ablation for Ventricular Tachycardia after failed Endocardial Ablation - Epicardial Substrate or Inappropriate Endocardial Ablation?"
BACKGROUND :: The substrate of myocardial VT may involve the subepicardial myocardium.
: We aimed to assess the incidence of epicardial substrates in patients with a previously failed endocardial ablation attempt for ventricular tachycardia (VT) as well as safety and effectiveness of epicardial ablation.
: Using an electroanatomical mapping system, endo- and epicardial maps were acquired. Irrigated radiofrequency current ablations of all inducible VTs were performed.
: Between 2005 and 2009 fifty-nine patients with or without structural heart disease underwent epicardial VT ablation. Pericardial access failed in 3 of these patients (5%). Of the remaining 56 patients, an epicardial substrate was found in 41 (73%). Overall, acute success was achieved in 46/59 patients (78%) with complete VT abolition in 27 (46%) and partial abolition in 19 (32%). Successful outcomes were the result of endocardial ablation only in 14 patients (24%), epicardial ablation in 21 patients (36%) and endo-/epicardial in 11 patients (19%). Ablation failed to prevent reinduction in 8 patients (13%) and VTs were non-inducible prior to ablation in 5 (8%). Two peri-procedural deaths occurred, one after right ventricular perforation and one due to electromechanical dissociation. In two patients, hepatic bleeding was observed. Recurrence of any VT occurred in 27/57 surviving patients (47%) during a median follow-up of 362 days (q1-q3; 180-468 days). Repeat epicardial mapping was not feasible due to adhesions in 3/12 (25%) patients.
: In patients with a previously failed endocardial VT ablation, epicardial mapping reveals a VT substrate in nearly (3/4) of all patients, and epicardial ablation is required for successful VT abolition in more than half of the patients. However, life-threatening complications may occur. Repeat epicardial access was not possible in 25% due to local pericardial adhesions.
Asklepios Klinik St. Georg, Dept. of Cardiology, Hamburg, Germany.
This article was published in the following journal.
Name: Heart rhythm : the official journal of the Heart Rhythm Society
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20709191
- DOI: http://dx.doi.org/10.1016/j.hrthm.2010.08.010
-Cardiac sarcoid-related ventricular tachycardia (VT) is a rare disorder; the underlying substrate and response to ablation are poorly understood. We sought to examine the ventricular substrate and ou...
Ventricular tachycardia (VT) ablation for ventricular arrhythmias is a validated approach, typically performed endocardially, or combined with an epicardial approach if endocardial ablation failed or ...
Although uncommon, supraventricular tachycardia is difficult to manage during pregnancy. Catheter ablation traditionally has been deferred owing to radiation exposure risks. Three-dimensional mapping ...
Radiofrequency Catheter Ablation of Idiopathic Ventricular Arrhythmias Originating from Intramural Foci in the Left Ventricular Outflow Tract; Efficacy of Sequential vs. Simultaneous Unipolar Catheter Ablation.
-Idiopathic ventricular arrhythmias (VAs) originating from the left ventricular outflow tract (LVOT) sometimes require catheter ablation from the endocardial and epicardial sides for their elimination...
There is a paucity of data regarding the complications and in-hospital mortality after catheter ablation for ventricular tachycardia (VT) in patients with ischemic heart disease.
The purpose of the study is to assess the effectiveness and safety of a new device called an Intramural Needle Ablation Catheter (INA catheter). The INA catheter is used for locating and ...
To demonstrate that scar-based ventricular tachycardia (VT) ablation using the FlexAbility™ ablation catheter system results in a superior clinical outcome compared to routine drug thera...
The primary objective is to provide additional corroborative safety and efficacy data for the Navistar ThermoCool catheter for the treatment of subjects with ischemic Ventricular Tachycard...
This study aims to assess whether a combined technique of substrate ablation and ablation of the clinically presenting VT at the site of early activation is superior to ablation of the cli...
This trial evaluates the safety and effectiveness of catheter ablation for PAF. The investigational catheter being studied is the NAVISTAR® THERMOCOOL® irrigated-tip catheter. It is cur...
Medical and Biotech [MESH] Definitions
Removal of tissue by vaporization, abrasion, or destruction. Methods used include heating tissue by hot liquids or microwave thermal heating, freezing (CRYOABLATION), chemical ablation, and photoablation with LASERS.
Removal of tissue with electrical current delivered via electrodes positioned at the distal end of a catheter. Energy sources are commonly direct current (DC-shock) or alternating current at radiofrequencies (usually 750 kHz). The technique is used most often to ablate the AV junction and/or accessory pathways in order to interrupt AV conduction and produce AV block in the treatment of various tachyarrhythmias.
Implantable devices which continuously monitor the electrical activity of the heart and automatically detect and terminate ventricular tachycardia (TACHYCARDIA, VENTRICULAR) and VENTRICULAR FIBRILLATION. They consist of an impulse generator, batteries, and electrodes.
An abnormally rapid ventricular rhythm usually in excess of 150 beats per minute. It is generated within the ventricle below the BUNDLE OF HIS, either as autonomic impulse formation or reentrant impulse conduction. Depending on the etiology, onset of ventricular tachycardia can be paroxysmal (sudden) or nonparoxysmal, its wide QRS complexes can be uniform or polymorphic, and the ventricular beating may be independent of the atrial beating (AV dissociation).
A malignant form of polymorphic ventricular tachycardia that is characterized by HEART RATE between 200 and 250 beats per minute, and QRS complexes with changing amplitude and twisting of the points. The term also describes the syndrome of tachycardia with prolonged ventricular repolarization, long QT intervals exceeding 500 milliseconds or BRADYCARDIA. Torsades de pointes may be self-limited or may progress to VENTRICULAR FIBRILLATION.