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Europace : European Pacing,... Dec 2023The aim of this study was to investigate the outcomes of catheter ablation (CA) in preventing arrhythmic events among patients with symptomatic Brugada syndrome (BrS)...
AIMS
The aim of this study was to investigate the outcomes of catheter ablation (CA) in preventing arrhythmic events among patients with symptomatic Brugada syndrome (BrS) who declined implantable cardioverter defibrillator (ICD) implantation.
METHODS AND RESULTS
A total of 40 patients with symptomatic BrS were included in the study, of which 18 refused ICD implantation and underwent CA, while 22 patients received ICD implantation. The study employed substrate modification (including endocardial and epicardial approaches) and ventricular fibrillation (VF)-triggering pre-mature ventricular contraction (PVC) ablation strategies. The primary outcomes were a composite endpoint consisting of episodes of VF and sudden cardiac death during the follow-up period. The study population had a mean age of 43.8 ± 9.6 years, with 36 (90.0%) of them being male. All patients exhibited the typical Type 1 BrS electrocardiogram pattern, and 16 (40.0%) were carriers of an SCN5A mutation. The Shanghai risk scores were comparable between the CA and the ICD groups (7.05 ± 0.80 vs. 6.71 ± 0.86, P = 0.351). Ventricular fibrillation-triggering PVCs were ablated in 3 patients (16.7%), while VF substrates were ablated in 15 patients (83.3%). Epicardial ablation was performed in 12 patients (66.7%). During a median follow-up of 46.2 (17.5-73.7) months, the primary outcomes occurred more frequently in the ICD group than in the CA group (5.6 vs. 54.5%, Log-rank P = 0.012).
CONCLUSION
Catheter ablation is an effective alternative therapy for improving arrhythmic outcomes in patients with symptomatic BrS who decline ICD implantation. Our findings support the consideration of CA as an alternative treatment option in this population.
Topics: Humans; Male; Adult; Middle Aged; Female; Brugada Syndrome; Ventricular Fibrillation; Defibrillators, Implantable; China; Electrocardiography; Catheter Ablation
PubMed: 37889958
DOI: 10.1093/europace/euad318 -
Journal of Clinical Medicine Jun 2023Implantation of a permanent pacemaker and atrioventricular (AV) node ablation (pace-and-ablate) is an established approach for rate and symptom control in elderly...
BACKGROUND
Implantation of a permanent pacemaker and atrioventricular (AV) node ablation (pace-and-ablate) is an established approach for rate and symptom control in elderly patients with symptomatic atrial fibrillation (AF). Left bundle branch area pacing (LBBAP) is a physiological pacing strategy that might overcome right ventricular pacing-induced dyssynchrony. In this study, the feasibility and safety of performing LBBAP and AV node ablation in a single procedure in the elderly was investigated.
METHODS
Consecutive patients with symptomatic AF referred for pace-and-ablate underwent the treatment in a single procedure. Data on procedure-related complications and lead stability were collected at regular follow-up at one day, ten days and six weeks after the procedure and continued every six months thereafter.
RESULTS
25 patients (mean age 79.2 ± 4.2 years) were included and underwent successful LBBAP. In 22 (88%) patients, AV node ablation and LBBAP were performed in the same procedure. AV node ablation was postponed in two patients due to lead-stability concerns and in one patient on their own request. No complications related to the single-procedure approach were observed with no lead-stability issues at follow-up.
CONCLUSIONS
LBBAP combined with AV node ablation in a single procedure is feasible and safe in elderly patients with symptomatic AF.
PubMed: 37373721
DOI: 10.3390/jcm12124028 -
Journal of Arrhythmia Dec 2021Exposure to radiation during catheter ablation procedures poses a risk to the heath of both the patient and electrophysiology laboratory staff. Recently, the feasibility...
BACKGROUND
Exposure to radiation during catheter ablation procedures poses a risk to the heath of both the patient and electrophysiology laboratory staff. Recently, the feasibility and effectiveness of zero-fluoroscopy ablation have been reported. However, studies on the outcomes of zero-fluoroscopy ablation in Japan remain limited. This study investigated the outcomes of zero-fluoroscopy ablation for cardiac arrhythmias at a Japanese institute.
METHODS AND RESULTS
We present a retrospective analysis of the safety, efficacy, and feasibility data from 221 consecutive patients who underwent zero-fluoroscopy ablation. Of these patients, 181 had atrial fibrillation, 17 had paroxysmal supraventricular tachycardia, 13 had atrial tachycardia, 6 had ventricular tachycardia, and 4 had ventricular premature contractions. We performed zero-fluoroscopy ablation using three-dimensional electro-anatomical mapping systems and intracardiac echocardiography imaging. Ultrasound-guided sheath insertion was performed on all cases. Our experience includes exclusively endocardial cardiac ablations. The mean follow-up was 24 months. The recurrence rates were 25.4% for atrial fibrillation, 5.9% for paroxysmal supraventricular tachycardia, 15.4% for atrial tachycardia, 33.3% for ventricular tachycardia, and 25% for ventricular premature contraction. Complications occurred in two patients (0.9%), and there was no occurrence of death. A fluoroscopic guide was used in three cases for the confirmation of vascular access (one case) and for complications (two cases).
CONCLUSIONS
Zero-fluoroscopy ablation was routinely performed without compromising on safety and efficacy. This approach may eliminate the exposure to radiation for all individuals involved in this procedure.
PubMed: 34887953
DOI: 10.1002/joa3.12644 -
JACC. Clinical Electrophysiology Oct 2020This study sought to establish a mapping and ablation strategy to target intramural ventricular arrhythmias (VAs) by identifying the precise arrhythmia site of origin...
OBJECTIVES
This study sought to establish a mapping and ablation strategy to target intramural ventricular arrhythmias (VAs) by identifying the precise arrhythmia site of origin (SOO).
BACKGROUND
Radiofrequency ablation of intramural VAs is challenging because the arrhythmia origin is difficult to localize.
METHODS
In 83 consecutive patients with intramural VAs, a stepwise mapping approach was performed: ablation targeted directly the SOO when possible followed by the closest adjacent anatomical structure when necessary. If the SOO could not be identified, the earliest endocardial breakout sites were ablated. Safety and procedural outcomes between patients in whom the SOO could and could not be identified were compared.
RESULTS
The SOO was identified in 19 of 83 (23%) patients, and radiofrequency ablation was effective in eliminating VAs in all 19 (100%) patients by ablation at the SOO alone (n = 3), at the SOO and an anatomically adjacent area (n = 7), or at an anatomically adjacent area alone (n = 9). Breakout site mapping and ablation in the remaining 64 patients in whom the SOO was not identified was effective in 43 of 64 patients, which was significantly less than in patients in whom the SOO was identified (67% vs. 100%; p < 0.05).
CONCLUSIONS
Identification of the SOO was associated with a successful ablation procedure by either targeting the SOO directly or targeting an adjacent anatomical structure. Ablation at the breakout sites of intramural VAs has a lower efficacy than when the SOO can be directly targeted.
Topics: Arrhythmias, Cardiac; Catheter Ablation; Endocardium; Heart Ventricles; Humans; Tachycardia, Ventricular
PubMed: 33121661
DOI: 10.1016/j.jacep.2020.05.021 -
Revista Portuguesa de Cardiologia :... Jun 2024
Topics: Humans; Cardiomyopathies; Tachycardia, Ventricular; Catheter Ablation
PubMed: 38825368
DOI: 10.1016/j.repc.2024.05.006 -
JACC. Clinical Electrophysiology Mar 2023Predictors of effective ablation lesion delivery in the human left ventricle are not established, particularly in scar. Impedance drop and electrogram (EGM) attenuation...
BACKGROUND
Predictors of effective ablation lesion delivery in the human left ventricle are not established, particularly in scar. Impedance drop and electrogram (EGM) attenuation are potential surrogates to assess this.
OBJECTIVES
This study sought to establish the relationships between ablation index (AI) and force-time integral (FTI) with impedance drop and EGM attenuation in the human left ventricle.
METHODS
Patients undergoing ventricular tachycardia ablation were recruited. EGMs were collected preablation and postablation, with impedance, AI, and FTI measured during. Based on preablation bipolar voltage, myocardium was adjudged a low-voltage myocardium (LVM) (<0.50 mV), intermediate-voltage myocardium (IVM) (0.51-1.50 mV), and normal-voltage myocardium (NVM) (>1.50 mV). Relationships between these parameters were explored.
RESULTS
A total of 402 ablations were analyzed in 15 patients. The percent impedance drop correlated with AI and FTI (P < 0.0005; repeated-measures correlation coefficient: 0.54 and 0.44, respectively), a relationship that became weaker with increased myocardial fibrosis, (repeated-measures correlation coefficient for NVM, IVM, and LVM, AI: 0.67, 0.60, and 0.52, respectively; FTI: 0.59, 0.51, and 0.42, respectively). The curve between AI/FTI and impedance drop plateaued at 763 AI and 713 gram-seconds, an impedance drop of 7.5%. Shallower curves occurred progressively from NVM to LVM (P < 0.0005). Mixed models demonstrated that AI and FTI had a greater effect on impedance drop than myocardial fibrosis, drift, or orientation, (standardized β: 0.54 and 0.48, respectively). EGMs were attenuated with ablation (29.3%; IQR: 4.4%-53.3%; P < 0.0005), but attenuation did not correlate with AI or FTI.
CONCLUSIONS
On biophysical analysis, ablation beyond an AI of 763 and FTI of 713 gs offers minimal additional efficacy on average. Fibrosis blunts ablation efficacy. AI is a stronger correlate with impedance drop than FTI. EGM attenuation does not correlate with ablation parameters. (Late Potentials and Ablation Index in Ventricular Tachycardia Ablation; NCT03437408).
Topics: Humans; Heart Ventricles; Myocardium; Catheter Ablation; Tachycardia, Ventricular; Fibrosis
PubMed: 36371330
DOI: 10.1016/j.jacep.2022.10.001 -
JACC. Clinical Electrophysiology Jul 2020
Topics: Heart Ventricles; Humans; Myocardial Infarction; Tachycardia, Ventricular
PubMed: 32703563
DOI: 10.1016/j.jacep.2020.04.013 -
Europace : European Pacing,... Mar 2020Pulsed field ablation (PFA) is a novel, non-thermal modality that selectively ablates myocardium with ultra-short electrical impulses while sparing collateral tissues....
AIMS
Pulsed field ablation (PFA) is a novel, non-thermal modality that selectively ablates myocardium with ultra-short electrical impulses while sparing collateral tissues. In a proof-of-concept study, the safety and feasibility of ventricular PFA were assessed using a prototype steerable, endocardial catheter.
METHODS AND RESULTS
Under general anaesthesia, the left and right ventricles of four healthy swine were ablated using the 12-Fr deflectable PFA catheter and a deflectable sheath guided by electroanatomic mapping. Using the study catheter, electrograms were recorded for each site and pre-ablation and post-ablation pacing thresholds (at 2.0 ms pulse width) were recorded in two of four animals. After euthanasia at 35.5 days, the hearts were submitted for histology. The PFA applications (n = 39) resulted in significant electrogram reduction without ventricular arrhythmias. In ablation sites where it was measured, the pacing thresholds increased by >16.8 mA in the right ventricle (3 sites) and >16.1 mA in the left ventricle (7 sites), with non-capture at maximum amplitude (20 mA) observable in 8 of 10 sites. Gross measurements, available for 28 of 30 ablation sites, revealed average lesion dimensions to be 6.5 ± 1.7 mm deep by 22.6 ± 4.1 mm wide, with a maximum depth and width of 9.4 mm and 28.6 mm, respectively. In the PFA lesions, fibrous tissue homogeneously replaced myocytes with a narrow zone of surrounding myocytolysis and no overlying thrombus. When present, nerve fascicles and vasculature were preserved within surrounding fibrosis.
CONCLUSION
We demonstrate that endocardial PFA can be focally delivered using this prototype catheter to create homogeneous, myocardium-specific lesions.
Topics: Animals; Arrhythmias, Cardiac; Catheter Ablation; Endocardium; Heart Ventricles; Myocardium; Swine; Tachycardia, Ventricular
PubMed: 31876913
DOI: 10.1093/europace/euz341 -
The Journal of Innovations in Cardiac... Mar 2023Coronary venous mapping and ablation can be an effective strategy in targeting ventricular arrhythmias that arise from intramural or epicardial sites of origin. We...
Coronary venous mapping and ablation can be an effective strategy in targeting ventricular arrhythmias that arise from intramural or epicardial sites of origin. We discuss the case of a patient with ischemic cardiomyopathy referred to our center for index ventricular tachycardia ablation after receiving multiple shocks from his implantable cardioverter-defibrillator who underwent coronary venous mapping and ablation as an adjunct to endocardial ventricular tachycardia ablation.
PubMed: 36998421
DOI: 10.19102/icrm.2023.14035 -
JACC. Clinical Electrophysiology Feb 2020This study sought to examine clinical characteristics of procedural and long-term outcomes in patients undergoing catheter ablation (CA) of outflow tract ventricular...
OBJECTIVES
This study sought to examine clinical characteristics of procedural and long-term outcomes in patients undergoing catheter ablation (CA) of outflow tract ventricular arrhythmias (OT-VAs) over 16 years.
BACKGROUND
CA is an effective treatment strategy for OT-VAs.
METHODS
Patients undergoing CA for OT-VAs from 1999 to 2015 were divided into 3 periods: 1999 to 2004 (early), 2005 to 2010 (middle), and 2011 to 2015 (recent). Successful ablation site (right ventricular OT, aortic cusps/left ventricular OT, or coronary venous system/epicardium), VA morphology (right bundle branch block or left bundle branch block), and acute and clinical success rates were assessed.
RESULTS
Six hundred eighty-two patients (336 female) were included (early: n = 97; middle: n = 204; recent: n = 381). Over time there was increase in use of irrigated ablation catheters and electroanatomic mapping, and more VAs were ablated from the aortic cusp/left ventricular OT or coronary venous system/epicardium (14% vs. 45% vs. 56%; p < 0.0001). Acute procedural success was achieved in 585 patients (86%) and was similar between groups (82% vs. 84% vs. 88%; p = 0.27). Clinical success was also similar between groups (86% vs. 87% vs. 88%; p = 0.94), but more patients in earlier periods required repeat ablation (18% vs. 17% vs. 9%; p = 0.02). Overall complication rate was 2% (similar between groups).
CONCLUSIONS
Over a 16-year period there was an increase in patients undergoing CA for OT-VTs, with more ablations performed at non-right ventricular outflow tract locations using electroanatomic mapping and irrigated-tip catheters. Over time, single procedure success has improved and complications have remained limited.
Topics: Adult; Arrhythmias, Cardiac; Bundle-Branch Block; Catheter Ablation; Female; Heart Ventricles; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 32081227
DOI: 10.1016/j.jacep.2019.10.004