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Circulation. Arrhythmia and... Jun 2024Endocardial catheter-based pulsed field ablation (PFA) of the ventricular myocardium is promising. However, little is known about PFA's ability to target intracavitary...
BACKGROUND
Endocardial catheter-based pulsed field ablation (PFA) of the ventricular myocardium is promising. However, little is known about PFA's ability to target intracavitary structures, epicardium, and ways to achieve transmural lesions across thick ventricular tissue.
METHODS
A lattice-tip catheter was used to deliver biphasic monopolar PFA to swine ventricles under general anesthesia, with electroanatomical mapping, fluoroscopy and intracardiac echocardiography guidance. We conducted experiments to assess the feasibility and safety of repetitive monopolar PFA applications to ablate (1) intracavitary papillary muscles and moderator bands, (2) epicardial targets, and (3) bipolar PFA for midmyocardial targets in the interventricular septum and left ventricular free wall.
RESULTS
(1) Papillary muscles (n=13) were successfully ablated and then evaluated at 2, 7, and 21 days. Nine lesions with stable contact measured 18.3±2.4 mm long, 15.3±1.5 mm wide, and 5.8±1.0 mm deep at 2 days. Chronic lesions demonstrated preserved chordae without mitral regurgitation. Two targeted moderator bands were transmurally ablated without structural disruption. (2) Transatrial saline/carbon dioxide assisted epicardial access was obtained successfully and epicardial monopolar lesions had a mean length, width, and depth of 30.4±4.2, 23.5±4.1, and 9.1±1.9 mm, respectively. (3) Bipolar PFA lesions were delivered across the septum (n=11) and the left ventricular free wall (n=7). Twelve completed bipolar lesions had a mean length, width, and depth of 29.6±5.5, 21.0±7.3, and 14.3±4.7 mm, respectively. Chronically, these lesions demonstrated uniform fibrotic changes without tissue disruption. Bipolar lesions were significantly deeper than the monopolar epicardial lesions.
CONCLUSIONS
This in vivo evaluation demonstrates that PFA can successfully ablate intracavitary structures and create deep epicardial lesions and transmural left ventricular lesions.
Topics: Animals; Ventricular Septum; Catheter Ablation; Swine; Heart Ventricles; Feasibility Studies; Papillary Muscles; Time Factors; Pericardium; Cardiac Catheters; Ultrasonography, Interventional; Electrophysiologic Techniques, Cardiac; Equipment Design; Female
PubMed: 38753535
DOI: 10.1161/CIRCEP.124.012734 -
European Heart Journal. Case Reports May 2024Ablation failures are common in case of intramural location of the arrhythmogenic substrate.
BACKGROUND
Ablation failures are common in case of intramural location of the arrhythmogenic substrate.
CASE SUMMARY
We report the case of a patient with cardiomyopathy contributed by frequent monomorphic ventricular arrhythmias (VAs) from intramural basal interventricular septum treated with double-balloon venous ethanol ablation (VEA) after a previous failed endocardial radiofrequency (RF) ablation.
DISCUSSION
Double-balloon VEA represents a safe and effective therapeutic option in case of intramural VAs also in the absence of venous collaterals joining selectively an intramural arrhythmic substrate.
PubMed: 38751903
DOI: 10.1093/ehjcr/ytae216 -
Europace : European Pacing,... May 2024Imaging using cardiac computed tomography (CT) or magnetic resonance (MR) imaging has become an important option for anatomic and substrate delineation in complex atrial... (Review)
Review
Pre- and post-procedural cardiac imaging (computed tomography and magnetic resonance imaging) in electrophysiology: a clinical consensus statement of the European Heart Rhythm Association and European Association of Cardiovascular Imaging of the European Society of Cardiology.
Imaging using cardiac computed tomography (CT) or magnetic resonance (MR) imaging has become an important option for anatomic and substrate delineation in complex atrial fibrillation (AF) and ventricular tachycardia (VT) ablation procedures. Computed tomography more common than MR has been used to detect procedure-associated complications such as oesophageal, cerebral, and vascular injury. This clinical consensus statement summarizes the current knowledge of CT and MR to facilitate electrophysiological procedures, the current value of real-time integration of imaging-derived anatomy, and substrate information during the procedure and the current role of CT and MR in diagnosing relevant procedure-related complications. Practical advice on potential advantages of one imaging modality over the other is discussed for patients with implanted cardiac rhythm devices as well as for planning, intraprocedural integration, and post-interventional management in AF and VT ablation patients. Establishing a team of electrophysiologists and cardiac imaging specialists working on specific details of imaging for complex ablation procedures is key. Cardiac magnetic resonance (CMR) can safely be performed in most patients with implanted active cardiac devices. Standard procedures for pre- and post-scanning management of the device and potential CMR-associated device malfunctions need to be in place. In VT patients, imaging-specifically MR-may help to determine scar location and mural distribution in patients with ischaemic and non-ischaemic cardiomyopathy beyond evaluating the underlying structural heart disease. Future directions in imaging may include the ability to register multiple imaging modalities and novel high-resolution modalities, but also refinements of imaging-guided ablation strategies are expected.
Topics: Humans; Consensus; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Catheter Ablation; Electrophysiologic Techniques, Cardiac; Tachycardia, Ventricular; Atrial Fibrillation; Predictive Value of Tests; Europe; Treatment Outcome
PubMed: 38743765
DOI: 10.1093/europace/euae108 -
Frontiers in Cardiovascular Medicine 2024We present a case of a 32-year-old male with a history of palpitations and preexcitation on ECG who underwent altogether four failed catheter ablations using different...
We present a case of a 32-year-old male with a history of palpitations and preexcitation on ECG who underwent altogether four failed catheter ablations using different approaches in the two other electrophysiology centers within two years. ECG showed overt preexcitation with a positive delta wave in lead I and negative in leads V1-V3, suggesting a right free wall accessory pathway. During the electrophysiological study, the accessory pathway was localized on the free lateral wall. However, the electrograms and mapping during atrial and ventricular pacing suggested the presence of true epicardial accessory pathway. Repeated radiofrequency energy delivery with the support of the steerable sheath and excellent contact (as assessed by intracardiac echocardiography) at the earliest ventricular activation was not successful. Therefore, the Farawave catheter (Boston Scientific, Inc) was used, and a flower configuration with the intention to cover the entire atrial attachment of the pathway during ventricular pacing was selected. Application of pulsed field resulted in interruption of accessory pathway conduction. An electrophysiological study one year later confirmed the persistent effect of ablation. This case illustrates the potential utility of pulsed field energy for the ablation of atrial insertion of the accessory pathway with an epicardial course. Such an approach can avoid epicardial mapping and access and may improve the safety of the procedure.
PubMed: 38737710
DOI: 10.3389/fcvm.2024.1392264 -
Journal of Clinical Medicine Apr 2024Premature ventricular complexes (PVCs) are commonly encountered problems in clinical settings. The range of symptoms can be from asymptomatic to palpitations, fatigue,... (Review)
Review
Premature ventricular complexes (PVCs) are commonly encountered problems in clinical settings. The range of symptoms can be from asymptomatic to palpitations, fatigue, or heart failure symptoms. A higher burden of PVCs is a risk factor for development of PVC-induced cardiomyopathy (PIC). Rhythm evaluation by 12-lead ECG and an ambulatory monitoring device are essential. Currently, several imaging modalities, such as echocardiography and cardiac magnetic resonance imaging, are utilized to evaluate the underlying structure that may be related to PIC. Beta blockers and antiarrhythmic drugs are typically part of the initial management strategy. If these fail, catheter ablation of PVCs is typically the next step. The purpose of this article is to summarize the current evidence/knowledge about PIC.
PubMed: 38731164
DOI: 10.3390/jcm13092635 -
Indian Pacing and Electrophysiology... May 2024Premature ventricular contraction (PVC) is usually eliminated in the earliest activation site based on the conventional electrode of ablation catheter. However, the...
Premature ventricular contraction (PVC) is usually eliminated in the earliest activation site based on the conventional electrode of ablation catheter. However, the large size electrode may contain far-field potential. The QDOT MICRO ablation catheter has three micro electrodes with 0.33 mm electrode length, in addition to the conventional electrode with 3.5 mm electrode length. The micro electrodes can reflect only near-field potential. A 78-year-old with symptomatic frequent PVCs underwent catheter ablation. PVC-1 showed good pace-mapping in distal great cardiac vein (GCV). The local bipolar electrograms in the conventional electrode of ablation catheter preceded the PVC-QRS onset by 32 ms in distal GCV and 13 ms in left coronary cusp (LCC), but those in the micro electrodes preceded only by 13 ms both in distal GCV and LCC. PVC-1 was eliminated by radiofrequency (RF) application, not in distal GCV, but in LCC. PVC-2 showed good pace-mapping in LCC. The local bipolar electrograms in both the conventional electrode and the micro electrodes of ablation catheter preceded the PVC-QRS onset by 32 ms in LCC. PVC-2 was eliminated by RF application in LCC. Comparing the local electrograms of micro electrodes and the conventional electrodes may be important for identifying depth of the origin of PVCs.
PubMed: 38729242
DOI: 10.1016/j.ipej.2024.05.001 -
Circulation Jun 2024The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of...
2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.
AIM
The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy.
METHODS
A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate.
STRUCTURE
Hypertrophic cardiomyopathy remains a common genetic heart disease reported in populations globally. Recommendations from the "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy" have been updated with new evidence to guide clinicians.
Topics: Humans; American Heart Association; Cardiology; Cardiomyopathy, Hypertrophic; Disease Management; United States
PubMed: 38718139
DOI: 10.1161/CIR.0000000000001250 -
The Egyptian Heart Journal : (EHJ) :... May 2024Brugada syndrome (BrS) is an inherited arrhythmogenic syndrome characterized by cove-shaped ST-segment elevation in leads V1-V3 and incomplete or complete right bundle... (Review)
Review
BACKGROUND
Brugada syndrome (BrS) is an inherited arrhythmogenic syndrome characterized by cove-shaped ST-segment elevation in leads V1-V3 and incomplete or complete right bundle branch block. BrS exhibits autosomal dominant inheritance with incomplete penetrance and a male predominance. It carries a significant risk of sudden cardiac death due to ventricular fibrillation (VF).
MAIN BODY
Recent studies have highlighted the presence of epicardial fibrosis as a proarrhythmic substrate in BrS, revolutionizing our understanding of the disease's pathophysiology. Catheter ablation has emerged as a crucial intervention for symptomatic BrS patients experiencing recurrent episodes of ventricular tachycardia (VT) or VF. By potentially obviating the need for implantable cardioverter-defibrillator (ICD) implantation, epicardial ablation offers a promising therapeutic approach.
CONCLUSION
This review emphasizes the significance of current evidence and ongoing research in shaping the role of epicardial ablation as a curative strategy in BrS management, highlighting its potential benefits and the necessity for further investigation.
PubMed: 38713300
DOI: 10.1186/s43044-024-00485-3 -
Frontiers in Cardiovascular Medicine 2024Currently, the bipolar radiofrequency ablation forceps manufactured by are the main instrument for surgical ablation in patients with rheumatic heart disease (RHD)...
BACKGROUND
Currently, the bipolar radiofrequency ablation forceps manufactured by are the main instrument for surgical ablation in patients with rheumatic heart disease (RHD) concomitant with atrial fibrillation (AF). The bipolar radiofrequency ablation forceps by has a greater advantage in price compared with . However, few studies have been reported on the comparison of their clinical efficacy. The aim of this study is to compare the short-term clinical efficacy of the two ablation forceps for RHD concomitant with AF.
METHODS
Clinical data of 167 patients with RHD concomitant with AF admitted to the Department of Cardiac Major Vascular Surgery, Affiliated Hospital of North Sichuan Medical College, were retrospectively analyzed, and the restoration efficacy of sinus rhythm (SR) and cardiac function after surgery were compared with two ablation forceps.
RESULTS
The end-systolic diameter of the right atrium and the end-systolic diameter of the left atrium in the patients of both groups at each postoperative time point decreased compared with that of the preoperative period ( < 0.05), and the left ventricular ejection fraction started to improve significantly at 6 months after surgery compared with that of the preoperative period (< 0.05). There was no difference between the two groups of patients in the comparison of the aforementioned indicators at different points in time ( > 0.05). At 12 months postoperatively, the SR maintenance rate in using the ablation forceps by (73.3%) was lower than that for (86.4%) and the cumulative recurrence rate of AF in using the ablation forceps was greater than that for .
CONCLUSIONS
The two bipolar radiofrequency ablation forceps compared in the study are safe and effective in treating patients of RHD concomitant with AF, and the ablation forceps by may be more effective in restoring SR in the short term.
PubMed: 38711794
DOI: 10.3389/fcvm.2024.1335407 -
Journal of General and Family Medicine May 2024We present a 23-year-old woman with depression and long COVID in whom a diagnosis of idiopathic ventricular tachycardia (VT) was made. Although the relationship between...
We present a 23-year-old woman with depression and long COVID in whom a diagnosis of idiopathic ventricular tachycardia (VT) was made. Although the relationship between idiopathic VT and long COVID remains unknown, this is the first report of idiopathic VT detected in a patient with long COVID.
PubMed: 38707697
DOI: 10.1002/jgf2.687