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Medicine Feb 2021Hemodynamically-instable ventricular arrhythmias (VAs) are rare in patients with pulmonary hypertension (PH). To the best of our knowledge, only 1 case has been reported...
INTRODUCTION
Hemodynamically-instable ventricular arrhythmias (VAs) are rare in patients with pulmonary hypertension (PH). To the best of our knowledge, only 1 case has been reported so far. Moreover, the pathogenesis of this kind of arrhythmia remains obscured and its treatment is challenging. Here we report another case and presented the substrate for VAs initiation and therapeutic effect of radiofrequency ablation.
PATIENT CONCERNS
This is a 57-year-old man who presented paroxysmal palpitation associated with presyncope at rest. Surface electrocardiogram (ECG) revealed frequent ventricular premature contractions and non-sustained ventricular tachycardia when symptoms occurred. He also had a history of severe PH which was secondary to atrial septal defect and partial anomalous pulmonary venous drainage and suffered from obvious dyspnea when climbing stairs World Health Organization Class III (WHO Class III).
DIAGNOSIS
Hemodynamically-instable VAs associated with severe PH.
INTERVENTION
Echocardiography revealed enlargement of right ventricle (right ventricle [RV]: 43 mm). Electrophysiological examination showed the origin of VAs is next to a small low-voltage zone of RV. Radiofrequency delivery at the origin successfully terminated VAs without occurrence of complication.
OUTCOME
The patient was free from arrhythmias and got an improvement of exercise tolerance, just with mild dyspnea when climbing stairs World Health Organization Class II (WHO class II), during six-month follow up.
LESSONS
This case suggests the low-voltage zone of remodeled RV, which may be secondary to increased pulmonary artery pressure, serves as the substrate for VAs initiation in patient with PH. Radiofrequency ablation can successfully terminate VAs and the termination of VAs can significantly improve the patient's impaired exercise tolerance.
Topics: Echocardiography; Electrophysiologic Techniques, Cardiac; Heart Ventricles; Humans; Hypertension, Pulmonary; Male; Middle Aged; Radiofrequency Ablation; Ventricular Premature Complexes; Ventricular Remodeling
PubMed: 33663121
DOI: 10.1097/MD.0000000000024896 -
Circulation. Arrhythmia and... Sep 2021[Figure: see text].
[Figure: see text].
Topics: Body Surface Potential Mapping; Catheter Ablation; Connectin; DNA; DNA Mutational Analysis; Female; Follow-Up Studies; Heart Ventricles; Humans; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Mutation; Retrospective Studies; Tachycardia, Ventricular
PubMed: 34315225
DOI: 10.1161/CIRCEP.121.010006 -
Archivos de Cardiologia de Mexico 2022A young female patient with normal ejection fraction. History of premature ventricular complex (PVC) radiofrequency ablation located in left ventricular outflow tract....
A young female patient with normal ejection fraction. History of premature ventricular complex (PVC) radiofrequency ablation located in left ventricular outflow tract. Two years later frequent PVC is observed in a different location (> 47000 in 24 h Holter). Anti-arrhythmic drugs were used unsuccessfully. PVCs were located in left ventricular summit. Radiofrequency ablation through coronary sinus and anterior interventricular vein was performed. During follow up no recurrence was observed. A young female patient with normal ejection fraction. History of premature ventricular complex (PVC) radiofrequency ablation located in left ventricular outflow tract. Two years later frequent PVC is observed in a different location (> 47000 in 24 h Holter). Anti-arrhythmic drugs were used unsuccessfully. PVCs were located in left ventricular summit. Radiofrequency ablation through coronary sinus and anterior interventricular vein was performed. During follow up no recurrence was observed.
Topics: Catheter Ablation; Female; Heart Ventricles; Humans; Radiofrequency Ablation; Treatment Outcome; Ventricular Premature Complexes
PubMed: 34987237
DOI: 10.24875/ACM.20000356 -
JACC. Clinical Electrophysiology Jun 2019This study sought to determine the impact of repeat catheter ablation (CA) prior to hospital discharge based on inducibility of clinical ventricular tachycardia (VT)...
OBJECTIVES
This study sought to determine the impact of repeat catheter ablation (CA) prior to hospital discharge based on inducibility of clinical ventricular tachycardia (VT) during noninvasive programmed ventricular stimulation (NIPS).
BACKGROUND
Inducibility of clinical VT during NIPS performed several days after CA identifies patients at high risk of recurrence. The impact of NIPS-guided repeat CA has not been reported.
METHODS
Consecutive patients with structural heart disease undergoing CA of VT followed by NIPS were studied. Clinical VT was defined by comparison with 12-lead electrocardiograms and stored implantable cardioverter-defibrillator electrograms from spontaneous VT episodes. Among those with inducible clinical VT at NIPS, VT-free survival was compared between those in whom ablation was repeated (group 1) versus those in whom ablation was not repeated (group 2) prior to hospital discharge.
RESULTS
Among 469 patients (64 ± 12 years of age; 85% males; 60% ischemic), 216 patients (46%) underwent NIPS 3 days (interquartile range: 2 to 4 days) after CA. Clinical VT was induced in 45 patients (21%). Among those 45, CA was repeated in 11 patients (24%). There were no significant differences in baseline clinical or index CA characteristics between groups 1 and 2. Over a median 36-month follow-up, only 1 patient (9%) in group 1 experienced VT recurrence compared to 24 patients (71%) in group 2 (p < 0.01). In univariate Cox regression, repeat CA guided by NIPS (hazard ratio: 0.07; 95% confidence interval: 0.01 to 0.58; p = 0.01) was the only predictor of VT-free survival.
CONCLUSIONS
In patients with inducible clinical VT during post-ablation NIPS, repeat CA was associated with significantly lower risk of subsequent recurrence.
Topics: Aged; Catheter Ablation; Defibrillators, Implantable; Disease-Free Survival; Electric Stimulation; Epicardial Mapping; Female; Heart Ventricles; Humans; Male; Middle Aged; Proportional Hazards Models; Recurrence; Reoperation; Tachycardia, Ventricular
PubMed: 31221360
DOI: 10.1016/j.jacep.2019.03.007 -
Journal of the American College of... Mar 1996The current study reviews the safety and efficacy of radiofrequency catheter ablation for the treatment of right ventricular outflow tachycardia in children and... (Clinical Trial)
Clinical Trial
OBJECTIVES
The current study reviews the safety and efficacy of radiofrequency catheter ablation for the treatment of right ventricular outflow tachycardia in children and adolescents and describes a modified method for mapping the tachycardia focus.
BACKGROUND
Although radiofrequency catheter ablation has proved highly effective for the treatment of supraventricular tachycardia during childhood and adolescence, its application in children with idiopathic right ventricular outflow tachycardia has been limited.
METHODS
Six children (mean [+/- SD] age 10.6 +/- 2.4 years, range 6 to 16) with right ventricular outflow tachycardia underwent seven radiofrequency catheter ablation procedures. The mean tachycardia cycle length was 323 +/- 24 ms (range 300 to 360). Two multipolar catheters were positioned in the right ventricular outflow tract to map the tachycardia focus.
RESULTS
Radiofrequency catheter ablation was successful in five (83%) of the six children (95% confidence interval 36% to 99%). At successful ablation sites, local endocardial activation time preceded the surface QRS onset by 46 +/- 5 ms (range 37 to 57), and there was concordance of the 12-lead pace map and the electrocardiogram (ECG) in 11 (one patient) to 12 ECG leads (four patients). One patient developed complete right bundle branch block during radiofrequency catheter ablation. There were no additional complications and no clinical recurrences over a mean follow-up period of 12.7 +/- 3.8 months (range 9 to 22).
CONCLUSIONS
These results suggest that radiofrequency catheter ablation is a safe and effective treatment for right ventricular outflow tachycardia during childhood and adolescence. In addition, tachycardia mapping may be enhanced by use of a multipolar right ventricular outflow catheter technique.
Topics: Adolescent; Catheter Ablation; Child; Electrocardiography; Electrophysiology; Female; Follow-Up Studies; Heart Ventricles; Humans; Male; Tachycardia, Ventricular
PubMed: 8613616
DOI: 10.1016/0735-1097(95)00539-0 -
Heart Rhythm Aug 2008Epicardial catheter ablation via subxiphoid percutaneous access currently is used upon failure of endocardial catheter ablation. The safety, efficacy, and applicability...
BACKGROUND
Epicardial catheter ablation via subxiphoid percutaneous access currently is used upon failure of endocardial catheter ablation. The safety, efficacy, and applicability of epicardial catheter ablation likely will improve with direct visualization of the pericardial space.
OBJECTIVE
The purpose of this study was to assess the feasibility of percutaneous endoscopic guidance for identification of epicardial anatomic landmarks and epicardial catheter ablation.
METHODS
Dual subxiphoid epicardial access and femoral venous and arterial access were obtained in six healthy swine. The endoscope and electrophysiology catheter were advanced to the pericardial space. Anatomic landmarks were identified via endoscopy and confirmed by multiview fluoroscopic assessment of proximity to endocardial catheters in the area of interest. Radiofrequency ablation of selected anatomic targets was performed under endoscopic guidance. Targeting of lesions was assessed by pathologic examination of the target and surrounding structures.
RESULTS
Dual large-bore subxiphoid epicardial access was obtained without complications in all animals. The coronary sinus, left anterior descending coronary artery, left atrial appendage, and pulmonary veins were easily visualized in all animals. Catheter ablation of anatomic targets, including the right ventricular outflow tract, left atrial appendage, and pulmonary veins, was performed successfully under direct endoscopic observation. Endoscopic guidance of point and linear lesions near coronary vessels also was assessed. Pathology revealed successful targeting of lesions.
CONCLUSION
Endoscopic guidance of percutaneous epicardial electrophysiologic procedures is feasible. Direct visualization of epicardial structures, catheters, and lesions may improve the safety and efficacy of epicardial catheter ablation and reduce staff and patient radiation exposure.
Topics: Animals; Atrial Fibrillation; Catheter Ablation; Echocardiography; Feasibility Studies; Heart Atria; Heart Ventricles; Pericardium; Swine; Thoracoscopy
PubMed: 18675221
DOI: 10.1016/j.hrthm.2008.05.004 -
International Heart Journal Nov 2022High-intensity focused ultrasound (HIFU) can cause necrotic damage in deep tissues through thermal ablation and cavitation, without significant damage to the surrounding...
High-intensity focused ultrasound (HIFU) can cause necrotic damage in deep tissues through thermal ablation and cavitation, without significant damage to the surrounding tissues. High blood perfusion of heart affects the energy deposition. This study aimed to evaluate the effect of cooling of coronary blood flow for HIFU ablation.Continuous and pulsed HIFU (2000 J) at duty cycles of 100% and 25% were examined for their capacity to ablate the perfused porcine heart tissue in vitro. After ablation, grayscale changes and pathological features were observed or measured, and the area and volume of tissue necrosis were calculated.The cardiomyocytes in the lesions underwent necrosis with a clear boundary. The endocardial surface was intact without necrosis. The three-dimensional morphology of the lesions appeared approximately as ellipsoids. With the increase in perfusion speed, the necrotic volume in the target area was gradually reduced.HIFU has the potential to become a new minimally invasive surgery for ventricular septal myocardial ablation. Reduction of coronary blood flow can improve the ablation effect.
Topics: Swine; Animals; High-Intensity Focused Ultrasound Ablation; Heart Ventricles; Necrosis; Myocytes, Cardiac
PubMed: 36372408
DOI: 10.1536/ihj.22-162 -
JACC. Clinical Electrophysiology Jun 2022
Topics: Catheter Ablation; Heart Ventricles; Humans; Pulmonary Veins
PubMed: 35738849
DOI: 10.1016/j.jacep.2022.05.004 -
Polish Archives of Internal Medicine Jun 2019Radiofrequency ablation (RFA) of outflow tract ventricular arrhythmia (VA) that originates from the aortic cusps can be challenging. Data on long‑ term efficacy and... (Comparative Study)
Comparative Study
INTRODUCTION
Radiofrequency ablation (RFA) of outflow tract ventricular arrhythmia (VA) that originates from the aortic cusps can be challenging. Data on long‑ term efficacy and safety as well as optimal technique after aortic cusp ablation have not previously been reported.
OBJECTIVES
This aim of the study was to determine the short- and long‑ term outcomes after RFA of aortic cusp VA, and to evaluate aortic valve injuries according to echocardiographic screening.
PATIENTS AND METHODS
This was a prospective multicenter registry (AVATAR, Aortic Cusp Ventricular Arrhythmias: Long Term Safety and Outcome from a Multicenter Prospective Ablation Registry) study. A total of 103 patients at a mean age of 56 years (34-64) from the "Electra" Registry (2005-2017) undergoing RFA of aortic cusps VA were enrolled. The following 3 ablation techniques were used: zero‑fluoroscopy (ZF; electroanatomical mapping [EAM] without fluoroscopy), EAM with fluoroscopy, and conventional fluoroscopy‑ based RFA. Data on clinical history, complications after RFA, echocardiography, and 24‑ hour Holter monitoring were collected. The follow up was 12 months or longer.
RESULTS
There were no major acute cardiac complications after RFA. In one case, a vascular access complication required surgery. The median (interquartile range [IQR]) procedure time was 75 minutes (IQR, 58-95), median follow‑ up, 32 months (IQR, 12-70). Acute and long term procedural success rates were 93% and 86%, respectively. The long‑ term RFA outcomes were observed in ZF technique (88%), EAM with fluoroscopy (86%), and conventional RFA (82%), without differences. During long‑ term follow‑up, no abnormalities were found within the aortic root.
CONCLUSIONS
Ablation of VA within the aortic cusps is safe and effective in long‑ term follow up. The ZF approach is feasible, although it requires greater expertise and more imaging modalities.
Topics: Adult; Aged; Arrhythmias, Cardiac; Catheter Ablation; Female; Fluoroscopy; Follow-Up Studies; Heart Ventricles; Humans; Male; Middle Aged; Practice Guidelines as Topic; Prospective Studies; Radiofrequency Ablation; Registries; Treatment Outcome
PubMed: 31169259
DOI: 10.20452/pamw.14861 -
Journal of Interventional Cardiac... Mar 2023Reduced biventricular pacing (BiVP) is a common phenomenon in cardiac resynchronization therapy (CRT) with impact on CRT-response and patients' prognosis. Data on... (Clinical Trial)
Clinical Trial
BACKGROUND
Reduced biventricular pacing (BiVP) is a common phenomenon in cardiac resynchronization therapy (CRT) with impact on CRT-response and patients' prognosis. Data on treatment strategies for patients with ventricular arrhythmia and BiVP reduction is sparse. We sought to assess the effects of ventricular arrhythmia treatment on BiVP.
METHODS
In this retrospective analysis, the data of CRT patients with a reduced BiVP ≤ 97% due to ventricular arrhythmia were analyzed. Catheter ablation or intensified medical therapy was performed to optimize BiVP.
RESULTS
We included 64 consecutive patients (73 ± 10 years, 89% male, LVEF 30 ± 7%). Of those, 22/64 patients (34%) underwent ablation of premature ventricular contractions (PVC) and 15/64 patients (23%) underwent ventricular tachycardia (VT) ablation while 27/64 patients (42%) received intensified medical treatment. Baseline BiVP was 88.1% ± 10.9%. An overall increase in BiVP percentage points of 8.8% (range - 5 to + 47.6%) at 6-month follow-up was achieved. No changes in left ventricular function were observed but improvement in BiVP led to an improvement in NYHA class in 24/64 patients (38%). PVC ablation led to a significantly better improvement in BiVP [9.9% (range 4 to 22%) vs. 3.2% (range - 5 to + 10.7%); p = < 0.001] and NYHA class (12/22 patients vs. 4/27 patients; p = 0.003) than intensified medical therapy. All patients with VT and reduced BiVP underwent VT ablation with an increase of BiVP of 16.3 ± 13.4%.
CONCLUSION
In this evaluation of ventricular arrhythmia treatment aiming for CRT optimization, both medical therapy and catheter ablation were shown to be effective. Compared to medical therapy, a higher increase in BiVP was observed after PVC ablation, and more patients improved in NYHA class.
CLINICAL TRIAL REGISTRATION
The study was registered at clinical trials.org in August 2019: NCT04065893.
Topics: Female; Humans; Male; Arrhythmias, Cardiac; Cardiac Resynchronization Therapy; Heart Failure; Heart Ventricles; Retrospective Studies; Treatment Outcome; Ventricular Function, Left
PubMed: 35697890
DOI: 10.1007/s10840-022-01259-0